Drug companies test out new strategies for improving access in poor countries

Cervical cancer, usually caused by vaccine-preventable human papillomavirus (HPV), is a leading killer of young women in Africa. WHO photo

By David J. Olson 

When Harald Nusser first walked into the waiting room of the hospital in Addis Ababa, Ethiopia and saw so many people suffering in the late stages of cancer, without even basic palliative care, he couldn’t believe his eyes.

“Some of them had so much pain, they were hitting their heads against the walls, to balance the pain they had inside with a different type of pain,” Nusser said.

A physician who works for one of the world’s biggest drug companies, he was especially affected by the women he saw suffering from breast cancer: “It was absolutely breath-taking to look at those women and realize that 99 percent of them would be dead in a year.”

For decades, the global health community has been focused mostly on communicable diseases like AIDS and malaria. Many like Nusser say the changing disease burdens of lower-income countries require more attention to noncommunicable diseases like cancer. Yet this isn’t happening, and most health systems in poor countries are not equipped to meet the need.

Harald Nusser

Harald Nusser

“When I saw this for the first time, I said to myself, you have to do something to change this,” Nusser said. That was in 2013 and, at Novartis, he is today doing something to try to change the situation.

About 61,000 people are diagnosed with cancer every year in Ethiopia, according to the World Health Organization, but few of them are treated. There are only eight oncologists in the entire country and the Black Lion Hospital, where Nusser had his epiphany, is Ethiopia’s only cancer-referral hospital. This dire situation is hardly unique, and the same horrible scenes play out every day in many other poor communities.

The cost of drugs is a barrier to the poor in the developing world, although it may not be the biggest access problem in countries like Ethiopia that lack much capacity to deliver medicines at any price. The drug industry, Big Pharma especially, has taken a lot of hits lately in the public arena for high drug prices, even in the rich world.

Novartis is among a number of drug firms that have come under criticism for attempts to extend drug patent protection in poor countries. The company lost a legal battle on this in India in 2013, as Humanosphere and other media reported at the time.

In 2015, Nusser helped launch Novartis Access, which is trying to find a commercial solution to the inherent tension between the need to get affordable medications to the poor and for drug companies to protect their bottom line, and intellectual property. It is also trying to address the need for training and health system strengthening.

Novartis today is actually ranked fairly high within the industry for its efforts to improve access to drugs. The new initiative Nusser launched is making 15 on- and off-patent medicines available to treat noncommunicable diseases (NCDs) in Kenya, at $1.00 per treatment per month was singled out for praise in this year’s Access To Medicines Index.

Almost three-quarters of NCD deaths occur in low- and middle-income countries like Kenya. In the developing world, four NCDs —cardiovascular disease, cancer, respiratory disease and diabetes — now account for 27 percent of deaths, according to the World Health Organization. Nusser described efforts to improve access to NCD drugs in the developing world in a talk he gave on the topic at a meeting of the American Society for Tropical Medicine and Hygiene in Atlanta recently.

Major progress has been made over the last 10-15 years in reducing deaths from some of the primary infectious disease killers. Partly as a result, fewer people are dying from AIDS or malaria and more, proportionately, are afflicted by noncommunicable diseases like cancer.  Many say health programs, therefore, must turn their attention to address the rising burden of noncommunicable diseases, without removing their focus on old pandemics like AIDS and malaria.

Yet advocates for this shift say donors are not allocating much money to support noncommunicable disease prevention.

Novartis Access is aimed at finding a social enterprise solution rather than simply seeking donations and charitable efforts. Novartis plans to expand it soon to Ethiopia, Rwanda and Senegal and hopes to be running in some 30 countries by 2020.

Novartis has an access strategy for reaching patients at different socio-economic levels: For high- and upper-middle income, they use a standard commercial-business approach. For most people living in low- and middle-low income countries, they use differential pricing, social business and Novartis Access and Novartis Malaria Initiative. For the poorest of the poor, they use philanthropy.

But the best of intentions do not always equate to measurable impact. To ensure that Novartis Access is measured and evaluated in an objective and transparent fashion, Novartis has asked Boston University (BU) to evaluate its impact on the availability and price of noncommunicable disease medicines at health facilities and households in Kenya.

Nusser hopes that one day he will visit the Black Lion Hospital and find a very different scene from the one he encountered on that first visit.

David J. Olson, a global development communications and social marketing consultant since 2011, is a freelance author who served as a Peace Corps volunteer in Togo, founded a grass-roots agricultural network in Mali for Lutheran World Relief and managed social marketing programs for PSI in Zambia, Bangladesh and Paraguay. After returning to the U.S. in 2002, he served as communications director for PSI and policy communications director for the Global Health Council.

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