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Sunday, November 23, 2014
- A tsunami is looming on the horizon and the world is unprepared for it. This one won’t be a massive wall of water but a tidal wave of disease – and experts say the international community needs to act fast to keep it from crashing.
“Non-communicable diseases (NCDs) – cancer, heart disease, diabetes and chronic respiratory diseases, among others – have become the leading cause of death worldwide,” Jeffrey Sturchio, senior partner at the U.S.-based consulting firm Rabin Martin, told a conference organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) on World Cancer Day in Geneva.
“Some 36 million people die from (NCDs) every year, 80 percent of them in low and middle income countries – a figure that will increase by 17 percent in the coming years and by 25 percent in Africa,” he added.
Tuberculosis and malaria, in comparison, kill one to two million people around the world every year.
“The disease burden is shifting to NCDs, but since developing countries still have to fight infectious diseases, they face a double burden,” Sturchio warned.
However, developing countries do not appear to be paying adequate attention to the impending crisis.
“In 2010 HIV/AIDS was responsible for 3.5 percent of deaths worldwide, malaria for 1.5 percent, cancer for 12.6 percent and heart diseases for 14 percent,” Cary Adams, chief executive officer of the Union for International Cancer Control, told IPS on the sidelines of the conference on Feb. 4.
These statistics alone should be sufficient for governments to put NCDs high on their list of national priorities. “But in sub-Saharan Africa, HIV/AIDS caused 13.3 percent of deaths, malaria 6.7 percent and cancer 4.5 percent”, he said, which explains why African health ministers keep putting cancer on the back burner.
“But the (reality) is, the problem will double in the next 15 years. There is a tsunami of NCDs approaching and we need to tackle it today,” Adams stressed.
To tackle this “tsunami”, four health federations – the International Diabetes Federation, the Union for International Cancer Control, the World Heart Federation and the Union against Lung Disease and Tuberculosis – came together to form the Non-communicable Diseases Alliance. With a network of over 2,000 non-governmental organisations based in over 170 countries, it seeks to amplify the voice of civil society in the global debate on NCDs.
The Alliance was also instrumental in pushing the United Nations General Assembly to organise, in September 2011, a high-level meeting that officially declared NCDs a “challenge of epidemic proportions”, which, if it is to be addressed, requires the cooperation of governments, civil society and the private sector.
“This is not an easy thing to do,” Adams, who chairs the NCD Alliance, conceded to IPS. “We have tried to work on a common agenda and find consensus, but some NGOs would not talk to us because we engage with the private sector. We try to embrace the private sector without compromising on integrity and independence and everything we do is based on science.”
Still, the mobilisation has borne some fruits. Five years ago, non-communicable diseases were barely on the agenda. The U.N.’s political declaration and a series of follow-up activities built tremendous momentum, resulting in a plan of action that stretches to 2025, with clear targets such as reducing NCD-related deaths by 25 percent in that time frame.But financial resources are stretched thin, and it is unlikely that the funds needed to launch a massive global campaign will be readily available.
“The reality is that in the last 20 years, tens of billions of dollars in official development assistance have gone to developing countries, mainly (to fight) HIV/AIDS, and it is unrealistic to think that the same will happen again,” Sturchio admitted.
It will therefore be necessary to capitalise on existing investments and reallocate some of the resources already in circulation, he said.
“Hundreds of HIV clinics were created across sub-Saharan Africa that can also be used for NCDs. When patients come to these clinics, they can also be tested for other infections or provided with vaccines,” he suggested.
For Margaret Kruk, a professor at Columbia University’s school of public health, primary care must be reconceptualised to tackle NCDs in low and middle-income countries.
“In theory, many NCD services can be provided in primary care, like primary prevention of hepatitis B, immunisation, smoking cessation, cholesterol and glucose testing, mammography and opportunistic screening for depression,” she said.
“But primary care in (developing) countries is not able to meet NCD challenges. The patient is not seen in a holistic way.”
She added that the challenge is most severe in sub-Saharan Africa, where, for the last half a century, national health plans have been oriented towards the “traditional killers” like infectious diseases, and have also focused heavily on maternal and child health.
This is partly due to the fact that the eight Millennium Development Goals (MDGs) laid out by the United Nations Millennium Summit in 2000 placed a great deal of emphasis on these “preventable causes of death”.
But as the 2015 deadline for achieving these targets draws closer, priorities will have to be re-examined.
Adams believes that one of the Alliance’s most important tasks over the next two years will be to make non-communicable diseases central in the post-2015 international development process.
Indeed, relatively simple public policy measures can go a long way in reducing NCDs – such as pushing people to consume less sugar and salt, eat less fatty foods, give up smoking and exercise more.
Already developing countries are becoming conscious that they don’t need additional funding for those measures. But when it comes to drugs, costs are much higher in developing countries than in the United States, for example.
From the manufacturer to the wholesale distributor, to the intermediaries and the clinics, monopolies, taxes, regulations and administrative hurdles push the price of medicines up to prohibitive rates in the global South.
The Southern African Development Community and the East African Community have undertaken initiatives to harmonise regulations at the regional level, but for Sturchio these are not enough: “Countries must be able to make sovereign decisions on the medicines they use, but today a lot of duplications make the supply chain inefficient.”
He does not believe intellectual property issues constitute an obstacle to stemming the wave of NCDs.
“Most of the medicines needed to treat NCDs are off patent,” he told IPS. “The challenge is to find ways to bring them to the people. Hundreds of medicines (to treat cancer) are very inexpensive and yet unavailable.”