10 lessons we've learned from AIDS that we can apply to chronic diseases

An assistant at the Etoug-Ebe Baptist Hospital, a subsidiary of the Cameroon Baptist Convention Health Services, takes a blood sample of a patient participating in the Novartis Access program to fight non-communicable disease. Photo: Anne Mireille Nzouanekeu

This was originally published on the Huffington Post on October 30, 2017.

Communicable diseases like HIV/AIDS and malaria have taken a terrible toll on Kenya and other African countries over the last 20 years. In 2010, an estimated 51,000 Kenyans died from AIDS but that number has declined steadily, to 36,000 in 2016. Kenya is now considered an HIV success story. The same is true in many other countries.

Now there is a new epidemic of non-communicable diseases (NCDs) that is rising just as the world is starting to get a handle on communicable diseases, according to the Institute for Health Metrics and Evaluation. The Institute reports that the largest contributors to the loss of healthy life are now high blood pressure, smoking, high blood sugar and excess body weight.

But Dr. Samuel Mwenda, who knows a thing or two about both epidemics, believes there are lessons we have learned in the fight against communicable diseases that can now be applied to NCDs. Mwenda is general secretary and CEO of the Christian Health Association of Kenya (CHAK), a network of Protestant health facilities in Kenya. CHAK now supports 46,000 people living with HIV with antiretroviral therapy, representing about 9 percent of the total number of patients nationally.

In 2015, CHAK turned its attention to NCDs: With the support of Novartis Access, it began offering a portfolio of 15 products to treat cardiovascular disease, diabetes, respiratory illness and breast cancer at a price to governments, NGOs and other institutional customers not to exceed $1.00 per treatment per month. Since then, Novartis Access has also started working in Cameroon, Ethiopia, Pakistan, Rwanda and Uganda.

Initiatives to expand access to medicine on the rise, but need better evaluation

In Nairobi, Kenya, parents receive prescription medicines for their children as part of a free medical camp operated by Slums Information Development & Resources Centers. Photo: George Onyango, Courtesy of Photoshare

This was originally published on Global Health TV on August 31, 2018.

In the 1990s and 2000s, AIDS activists and other global health advocates started pressuring pharmaceutical companies to share their largesse with low- and middle-income countries (LMICs) by supplying critical medicines for free or at subsidized prices, especially for HIV/AIDS. The pressure was successful, and led to a series of access-to-medicine (AtM) initiatives.

The international community increasingly recognizes that the pharmaceutical industry must play a leading role in improving access to medicines. And apparently pharma companies themselves also acknowledge this responsibility, according to a study published in Health Affairs by a team of researchers at Boston University Department of Global Health. That study found that the number of these initiatives grew from 17 in 2000 to 102 in 2015. The researchers called this “clear evidence” that pharmaceutical companies had responded to calls to increase their commitment to improving access to medicines.

Most access-to-medicine initiatives are poorly evaluated but moves are afoot to change that

This was originally published on The Lancet Global Health Blog on August 11, 2017.

Two decades ago the World Health Organization and health activists were pressuring global pharmaceutical companies to launch more “access-to-medicine” (AtM) initiatives in low- and middle-income countries. The good news: That has started to happen. The bad news: Startlingly few of these initiatives have any idea what kind of impact they are making.

Those are some of the conclusions of a new study, published in Health Affairs in April. A team of researchers associated with the Boston University Department of Global Health discovered that the number of AtM initiatives from 21 companies had grown from 17 in 2000 to 102 in 2015 but they found published evaluations for only seven of them.

From those seven evaluations, the researchers found 47 articles that met their inclusion criteria for evidence, and all of them were published in peer-reviewed journals. They determined that 62 percent of these were low quality, 32 percent were very low quality and 6 percent were moderate quality. None of them were rated high quality.

The bottom line of the study: “Overall, our findings suggest that current efforts to evaluate the impact of industry-led access-to-medicines initiatives are inadequate.”

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

This was originally published on Humanosphere on November 25, 2016.

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.

“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.