Progress towards achieving the SDGS – including, ending the preventable deaths children under 5, and the epidemics of AIDS, tuberculosis, malaria, neglected tropical diseases, and hepatitis – can only be achieved with sustained political will, safe effective health tools, and sustainable financing.
For example, while there are new treatments called Direct Acting Antivirals (DAAs) that can actually cure hepatitis C patients and eliminate the disease globally, the challenge is immense. Fewer than 10% of those requiring life-saving treatment for hepatitis C are receiving it, with around 6 million treated out of the estimated 71 million affected. Tracing and treating those who inject drugs, a particularly vulnerable group is critical.
A real challenge is to build upon the effectiveness of existing tools to find and treat the millions of asymptomatic patients that contribute to a growing epidemic. DNDi launched its hepatitis C programme in 2016 at a time when DAAs cost tens of thousands of dollars per treatment course and represented a clear deterrent to actively searching for HCV-infected people. DAAs previously priced out of reach of most patients and health systems, are now available at certified quality for less than USD 100 per treatment course. However, affordable DAA prices are only available in countries with dynamic generic competition and public leadership.
Accessing DAAs at affordable prices is facilitated by using the full range of options available to governments, including competitive tendering and flexibilities available under the TRIPS Agreement, as Egypt, Malaysia, and Kazakhstan have shown. Reducing the burden placed on health systems by medicines prices allows for additional gains towards the SDGs, including ending catastrophic expenditures, reducing poverty, and increasing equality.
DNDi Intervention on Agenda Item 11.5: Preparation for the High-Level Meeting of the United Nations General Assembly on Universal Health Coverage.
The collective UHC agenda cannot be delivered without addressing the diagnostic and treatment technology gaps that hinder the effective treatment of patients, and are required to tackle the rising threat of drug resistance and for the sustainable elimination of infectious diseases, including hepatitis and Neglected Tropical Diseases (NTDs).
Developing new tools, that focus on public health priorities, based upon the principles of affordability, affordability, effectiveness, efficiency, and equity can significantly contribute to both individual health and the quality and resilience of health systems, reducing waste, inefficiency, and the burden of care.
Poor-quality care accounts for 60% of deaths from conditions amenable to health. The dearth of appropriate tools to assess, diagnose, and treat the most vulnerable is a significant driver of poor quality health services. A key measure of quality universal health coverage will be the extent to which it provides health care to the most vulnerable: the poor, children, those with neglected or stigmatized diseases, or otherwise at the periphery of health systems.
We welcome, as an important first step, the recommendation to member states in resolution EB144.R10 to support research and development of medicines and vaccines for communicable and non-communicable diseases, including NTDs.
We ask member states to also ensure that the UN High Level Meeting on Universal Health Coverage discuss indicators that measure the following elements, necessary to deliver quality UHC:
- The specific needs of all vulnerable and neglected populations, including children and adolescents
- The availability and accessibility of existing essential medicines and mechanisms to accelerate these
- The identification of priority products already in pipelines and the acceleration of their development
- Joint strategies between drug and diagnostics developers and delivery systems
- Building and support of public-health driven innovative R&D approaches to ensure evolving needs are continually met.
DNDi welcomes the implementation Roadmap. Our experience is aligned with its approach, to integrate considerations of access throughout the R&D process. We support further work on regulatory pathways.
Transparency on costs of R&D is a central element of DNDi’s policy. We put as much information into the public domain as possible, including all clinical trial data, our actual R&D costs and related financing flows, including the in-kind contributions from our partners where they provide them.
We consider transparency important to:
- Advance scientific knowledge – progress is based on openness and collaborative practices
- Demonstrate value for money of investments by our public and private funders
- Incentivize further funding for public and private investment in R&D and inform new public funding policies
Discussions around costing must of course be sophisticated, taking into account different business models, portfolios & technologies. Nevertheless, transparency remains for us a matter of public accountability for any institution seeking the benefit of public support and claiming to be engaged in supporting the SDGs.
Antimicrobial resistance is a major challenge to reaching the SDGs and implementing UHC. The Interagency Coordination Group on Antimicrobial Resistance warns that there is no time to wait to act against this global crisis. It calls on all actors to act now “to increase investment and innovation in quality-assured, new antimicrobials (particularly antibiotics), novel compounds, diagnostics, vaccines”.
For research and development to make a real contribution to global health, a bench to bedside approach is needed, focusing on public health priorities, which ensures new and existing antibiotics are affordable, available, and used wisely.
We need urgent collective action. We welcome the creation of an ADG and Department for AMR. We urge countries to approve Resolution EB 144.R11, including its recommendations to support innovative approaches to R&D and mobilization of the human and financial resources necessary. There is also an urgent need to move discussions about access and stewardship from principles to practice, where all stakeholders have a critical role to play, including the Tripartite Plus and funders.
For its part, the Global Antibiotic Research and Development Partnership, initiated by WHO and Drugs for Neglected Disease initiative (DNDi), as an important element to deliver the Global Action Plan, will redouble its efforts, currently focused on developing antibiotics to treat children, neonates with sepsis, and sexually transmitted infections, while integrating strategies for sustainable access. Later this year, GARDP will launch an ambitious new strategy with expanded priorities.
But actions cannot stop here. Continued political commitment at the highest level is necessary including at the UN High level Meeting on Universal Health Coverage and the UN General Assembly in September.