Fulfilling a Millennium Healthcare Promise

Despite the advances made in healthcare there remains a startling amount of the world’s population that is unable to gain access to even the most basic services and treatments. This is an issue that has attracted considerable media coverage and represents a challenge for all those involved in healthcare to overcome (1). For example, data from the World Health Organization (WHO) show that the mortality rates for children under 5 years of age is 6 per 1,000 births in high-income countries, but stands at 159 per 1,000 births in the least developed countries surveyed (2 ).

Global action to drive change

In 2000, 189 world leaders made a commitment to achieve certain Millennium Development Goals by 2015. These goals aim to dramatically reduce poverty and ensure marked improvements in the health of the poor (2, 3 ). One of the issues highlighted as a particular threat to developing countries was the AIDS pandemic. The linkage of healthcare to poverty reduction and to long-term economic growth is considered an important feature of these efforts as it necessitates political resolve as well as the provision of funding.

Interestingly, these global improvements are aimed at both low and high-income countries. Despite the widespread publicity generated about these goals, WHO has warned that the challenges that stand in the way of achieving them should not be underestimated. In particular, it has stated that at present, no developing country is on course to meet child mortality targets (2, 3). There is however, encouraging news in the area of health intervention coverage. For example, measles immunization is rising in many countries and the efforts to combat malaria through the use of insecticide-treated bed nets have improved (2, 3 ).

In order to generate the momentum to achieve these targets, the first High-Level Forum (HLF) on the Millennium Development Goals took place in Geneva in January 2004 (4). It brought together representatives from agencies and governments in seventeen developing countries. A second HLF was held in Nigeria during early December 2004. Hosted by WHO in conjunction with the Nigerian government, the meeting involved a broader range of representatives from governments, aid agencies and charitable foundations (4 ).

Complex issues

The pharmaceutical industry has often found itself criticized for not doing more to improve access to essential medicines in developing countries (1, 5), but as the discussions at international meetings show, the healthcare situation in these countries is highly complex and is inseparable from politics. For example, the international Head of ActionAid's HIV/AIDS desk has attributed the Southern Africa region's failure to slow the spread of HIV/AIDS to a lack of political commitment (6). Although Southern Africa accounts for less then 2% of the world’s population, it is home to 30% of the world’s people living with HIV/AIDS (6 ).

In their defence, many governments in developing countries have pointed out that as financial aid is inconsistent from donor countries, it is inevitable that they must be overcautious in their plans. They highlight that it would be impossible to hire additional nurses and doctors, or spend more on AIDS treatments unless sufficient funding were available to ensure that these measures could be maintained in the long-term (3 ).

Any improvements require the effective cooperation of all parties and must be aimed at setting up reliable infrastructure as well as distribution for medical services (1). Furthermore, there will need to be adequate training of the healthcare personnel involved. A system that allows people access to affordable medicines is obviously desirable, particularly in medical emergencies, but it must be accompanied by improvement in other areas of the healthcare systems of these countries in order for long-term progress to be achieved (1). Furthermore, initiatives must be devised that encourage the pharmaceutical industry to tailor its R&D efforts to suit the healthcare requirements of the developing world (1). A range of these Public-Private Partnerships (PPP) initiatives, involving companies, governments and non-governmental organizations (NGOs) now exist (1, 5 ).

As more companies become involved in such not-for-profit initiatives others are likely to follow. One recent study identified 12 PPPs in existence between 1980 and 1990, but for the period 1990 to 2000 they found 71 such initiatives in operation (7). Therefore there has been a visible change in how the access to medicines issues is being addressed. The private sector has much to offer its public partners as it is accustomed to meeting drug productivity targets and so its active participation should be encouraged (1 ).

Outlook

The 2015 target for the Millennium Development Goals will be extremely difficult to achieve at a global level, but countries such as Peru, Mozambique and Vietnam have received public praise for their efforts to make technology and healthcare interventions available on an affordable basis (3 ).

Optimists have suggested that general global economic growth and increased trade will drive improvements in developing regions of the world, but this view fails to take into account the fact that the rising disease burden of these countries will place severe financial restrictions on them. In May 2004, the NGO ActionAid International stated that the Gross Domestic Product (GDP) for Southern African countries had dropped by 2.6% because of HIV/AIDS (6). WHO published information stating that in 2000, Africa’s GDP would have been an astonishing 32% higher if malaria had been eliminated 35 years earlier (8 ).

Perhaps a more encouraging thought is that the 2015 timescale should be sufficient for the PPPs to advance new drug therapies to the latter stages of clinical development and perhaps make them available to the populations that need them most. A number of compounds exhibiting promise for a range of diseases are already in early stage trials. Furthermore, some pharmaceutical companies have established dedicated programmes to develop compounds for diseases that predominantly affect the developing world (1). What will be important is to ensure that these R&D efforts account for the full range of diseases affecting the developing regions and do not solely target those that generate greatest media attention (1 ).

References

1. Kermani F. (2004). Neglected and Emerging Diseases: The Next R&D Challenge. Chiltern International. http://www.thepharmyard.com/shop/product.php?xProd=206&xSec=96

2. Millennium Development Goals (MDGs). World Health Organization. http://www.who.int/mdg/en/

3. Many countries challenged to attain the health-related Millennium Development Goals. Joint news release WHO/World Bank. 2 December 2004. http://www.who.int/mediacentre/news/releases/2004/pr88/en/

4. High-Level Forum on the Health MDGs. http://www.hlfhealthmdgs.org/

5. Kermani F. (2004). Is image everything? Inpharm. http://www.inpharm.com/External/InpH/1,2580,1-3-0-0-inp_intelligence_art-0-287636,00.html

6. Anon (2004). Southern Africa: GDP Drops By 2.6 Percent Because of HIV/Aids. UN Integrated Regional Information Networks. Johannesburg, South Africa. 20 May 2004. http://www.journ-aids.org/reports/20040520b.htm

7. Roscigno G (2003). Partnerships for Health: evolution and challenges. Foundation for Innovative New Diagnostics. European and Developing Countries Clinical Trials Partnership. EDCTP Rome 2004. http://www.edctp.org/

8. Anon (2000). Economic costs of malaria are many times higher than previously estimated. World Health Organization Press Release WHO/28. 25 April  2000. http://www.who.int/inf-pr-2000/en/pr2000-28.html