Improving Access to NCD Medicines and Products Will Help Build Future Pandemic Resilience
The international development community has long viewed noncommunicable diseases (NCDs) as a separate concern from infectious diseases. The COVID-19 pandemic, however, has bridged the gaps between the two types of conditions, challenging governments, health service providers, and the public health community to consider how infectious and chronic diseases intersect, and how to respond.
At a time when the world is putting billions of dollars into developing vaccines and medications as the ultimate solutions to SARS-CoV-2, we must recognize that the non-availability of existing treatments for NCDs has increased the vulnerability of billions of people worldwide to this virus. We have all seen the evidence that people living with an NCD are more likely to become seriously ill, be hospitalized, require ICU admission, and sadly, die from COVID-19. The pandemic is further worsening an already dire situation, with twenty percent of WHO-surveyed countries reporting that COVID-19 has negatively impacted the availability of essential NCD medicines.
We believe that if NCD medicines and products were widely available in all countries, there would be fewer deaths during the COVID-19 pandemic related to NCDs. Addressing this well-recognized and yet unmet need is one of many practical ways for the international community and national policymakers to collaborate to strengthen resilience to future pandemics.
Access to essential medicines and products for chronic disease in low- and middle-income countries (LMICs) was already woefully inadequate prior to COVID-19 in both the private and public sectors. A global analysis dating from 2008 showed mean availability of essential medicines in 36 LMICs was about 36% for NCDs versus 54% for acute diseases in the public sector, and 55% versus 66% in the private sector. For those medicines available in the private sector, they were at a much higher price. Recent localized studies suggest little to no improvement. The global landscape report titled Diabetes Supplies: Are They There When Needed?, an output of the No Empty Shelves project, reviewed 10 years of literature, interviewed stakeholders and extracted lessons learned from infectious disease to report on availability and affordability for hypertension and diabetes noting lack of availability of insulin and catastrophic costs associated with essential health products. Insulin availability in Kenya ranged from 3.7% to 53.3% in public health facilities and was concentrated at tertiary-level facilities.
This situation led a group of government agencies, private sector entities, nongovernmental organizations, philanthropic foundations, and academic institutions to launch the Coalition for Access to NCD Medicines and Products in 2017, with the aim of increasing access to and availability of medicines and products for people living with NCDs through advocacy, supply chain strengthening, finance and costing, and capacity building.
However, COVID-19 has brought into focus the renewed importance of addressing these problems. During infectious disease outbreaks, access to essential medicines decreases as supply chains are disrupted and health systems become over-burdened. Clinical care providers are diverted to the urgent needs of the pandemic, private and public sector pharmacies suffer from staff non-availability and lockdown restrictions; and patient access to these services drops radically due to absent transport networks, restrictions on movement, and loss of income for many households hit by unemployment. There is no global procurer for NCD medicines, like the role Gavi plays for vaccines or UNFPA and UNICEF play for reproductive health supplies. There is no well-oiled supply chain machinery working to reduce “unmet need” or achieve elimination targets as there is for many neglected tropical diseases. There is no safety net for NCDs.
As the pandemic is expected to continue into 2021, countries are attempting to adapt their NCD care in response. But they need support to identify and put in place feasible measures to mitigate the impact on people living with NCDs, and to avoid further damage to health systems that will worsen health and economic impacts. Implementation science can swiftly identify and test measures that may help, including: donor provision of NCD medication as emergency relief; capacity building at the primary health care level to manage NCDs, including referral pathways; rapid remote surveillance to identify the groups at greatest risk; protocols for safe, socially distanced distribution of medicines and supplies; and the availability of remote or socially distanced advice and support. Unfortunately, this approach is not yet a feature of the COVID-19 emergency response for many LMICs. We must work to change that.
Including NCDs in the global health security agenda
In the aftermath of COVID-19, governments and multi-lateral agencies will seek ways to prevent future infectious disease outbreaks. NCD control should be considered within the reinvigorated global health security (GHS) and pandemic preparedness agendas that will emerge, and those strategies must link more closely to population resilience.
GHS in its current form covers some key elements of better access to NCD medicines like surveillance, risk communications, and emergency response operations planning. And yet, global health security roadmaps and initiatives make no mention of NCDs. Addressing the NCD medicine and product gap can help create more resilient communities by reducing the number of people that are highly vulnerable to infectious diseases like COVID-19 and ensuring that they are protected from future pandemics.
‘Future-proofing’ populations against impacts during a pandemic requires plans and protocols to protect NCD medication supply and distribution. Stronger NCD surveillance capability within national disease recording systems, such as registries for people with diabetes or cardiovascular disease, will help identify people in need of essential medication, advice and support when their usual care is unreachable. Measures to improve the availability and affordability of NCD medication must get higher billing within national health strategies and the development aid provided to LMICs. Concerted efforts to put access plans for NCD medicines into action, including the Coalition’s current work to develop and test a demand forecast model for NCD medicines and products, will protect populations against the impacts of pandemic infectious disease. The Coalition is committed to working together through our activities and partnerships at the global, regional, and national levels, to build back better and improve the lives of people living with NCDs.
To learn more about the Coalition, to join us in this important work, or to tell us about the work that you are doing to improve global access to NCD medicines and products, click here. We also invite you to join us for a webinar on Wednesday, August 12th — “Conversations with Global Leaders: How improving access to NCD treatment and care is a critical element of building back better.” You can register for the webinar here.
About the Authors:
Angie Jackson-Morris is a Senior Global Health Specialist at RTI International. David J Heller is an Assistant Professor at Icahn School of Medicine at Mount Sinai & Arnhold Institute for Global Health and is a member of the Coalition’s Steering Committee. Rachel Nugent is VP of Global NCDs at RTI International and is the co-chair of the Coalition’s Steering Committee. Particular thanks to the Coalition’s Capacity Building and Finance & Costing Workstream members for their contributions to the shaping and authorship of this blog.
This blog is cross-posted at www.rti.org/globalncds
WHO. 1 June 2020. “COVID-19 significantly impacts health services for noncommunicable diseases, A rapid assessment.” Accessed on 27 June, 2020.
Rockers, P.C., Laing, R.O. and Wirtz, V.J., 2018. Equity in access to non-communicable disease medicines: a cross-sectional study in Kenya. BMJ global health, 3(3), p.e000828.
Nugent R, Jackson-Morris A.M. How Noncommunicable Disease Disease Interventions Can Mitigate COVID-19 and Build Resilience Against Future Pandemics. Blog Post. May 2020: https://www.rti.org/insights/non-communicable-disease-and-covid-19
National Academies of Sciences, Engineering, and Medicine. 2019. The convergence of infectious diseases and noncommunicable diseases: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25535. Accessed 27 June, 2020
World Health Organization. Roadmap for access 2019–2023 Comprehensive support for access to medicines and vaccines Zero draft v2. 2019. https://www.who.int/medicines/access_use/Roadmap_Englishv2.pdf?ua=1