The challenge of equitable access to healthcare
The challenge of equitable access to healthcare, including medicines and vaccines, in Africa is one that has rightly captured the attention of many for decades. Access to quality healthcare has a direct correlation with economic growth and development as well as productivity rates, and the absence thereof, at best, undermines the development agenda and, at worst, leads to unnecessary deaths and creates significant socio-economic vulnerabilities – as witnessed during the COVID-19 pandemic.
And whilst most countries continue to grapple with communicable diseases such as HIV/AIDS and TB as well as maternal and child mortality, NCDs increasingly pose some of the greatest threats to health and development, particularly in lower to middle income countries (LMICs). In South Africa, NCDs are already the leading cause of death and disability, outpacing communicable diseases by more than 30%. Furthermore, the WHO estimates the burden of NCDs to be 2 to 3 times higher in sub Saharan Africa than in high income countries. The alarming rise of NCDs in Africa coincides with remarkable gains in the pace of innovation for the effective treatment of many NCDs, including cancers and rare diseases.
For example, despite increasing incidence of cancer, globally there is decreasing mortality thanks to advances in prevention, screening, diagnosis, and treatment. In three out of the four highest incidence tumour types (prostate, breast, colon) meaningful survival increase happened in the last decade. To further put this into context, 20 years ago, a lung cancer diagnosis was considered a death sentence. Since then, the five-year lung cancer survival rate has increased by 15-30% globally – largely due to immunotherapies. However, a third of all cervical cancer deaths globally still occur in sub-Saharan Africa, despite the region representing only 14% of the world’s female population and cancer incidence in sub-Saharan Africa is expected to double by 2040 to more than 1.6 million new cases per year. In addition to increases in vaccination, screening and early diagnosis, overall survival will rely on the timely availability of the most appropriate evidence-based treatments.
Unfortunately, when looking at access to many of these innovative medicines and vaccines, the picture is grim. According to PhRMA’s 2023 Global Access to New Medicines Report, which examines the launch and public reimbursement of new medicines across 72 different markets, amongst G20 countries, in South Africa, new medicines for cancer and rare diseases launched, on average, 5 years after first launch in the US with only 13% of all new medicines launched between 2012-2021 achieving some form of public reimbursement.
To achieve this, we believe that several principles must guide the debate and ideation around solutions for achieving equitable access and health security in Africa. The first is that innovation must be incentivised. Continued investment in R&D to address the most complex health issues of our time cannot be achieved without incentivising businesses through the protection of intellectual property rights.
The second is that sustainable solutions must be premised on shared value and win-win outcomes. Zero-sum games have never yielded sustainable and lasting outcomes. To address health inequities will require meaningful contributions and trade-offs from both the public sector and private players. The third is the importance of public-private partnerships. For too long, the issue of public health has involved governments and other public health actors to the exclusion of the private sector which is often engaged only as a supplier. The principle that underpins this is good governance, however, the most successful health systems have been characterised by private sector integration in the delivery of Universal Health Coverage. In Africa, there is an urgent need for all stakeholders to come together to co-create lasting solutions that will work best for all.
The fourth principle is a willingness to be led by need, and guided by pragmatic, workable solutions. To do this, we must consistently ask the question, “what are we solving for?” and if the answer is health equity and security there may be instances where local manufacturing is the answer but there will also be times when it is not. With ~30-60% of vaccines manufactured by some of the largest manufacturers destined for Africa, there is a case to be made for the local manufacture of vaccines, in the context of an enabling environment. However, when we consider the changing disease profile of the Continent with the rise of NCDs, and the latest technologies developed in this regard, enabling equitable access to these is unlikely to be achieved through local manufacturing and if the need is equitable access, different solutions will be required.
The fourth principle is a willingness to be led by need, and guided by pragmatic, workable solutions. To do this, we must consistently ask the question, “what are we solving for?” and if the answer is health equity and security there may be instances where local manufacturing is the answer but there will also be times when it is not. With ~30-60% of vaccines manufactured by some of the largest manufacturers destined for Africa, there is a case to be made for the local manufacture of vaccines, in the context of an enabling environment. However, when we consider the changing disease profile of the Continent with the rise of NCDs, and the latest technologies developed in this regard, enabling equitable access to these is unlikely to be achieved through local manufacturing and if the need is equitable access, different solutions will be required.
Finally, there must be a willingness to experiment and a commitment to seeing things through. Too many important issues in Africa remain in the realm of political discourse and deliberation, often due to unwillingness to make the necessary policy changes to enable the testing of different approaches. And when this happens, we not only fail to move issues beyond political discourse, but risk relegating them to mere political posturing, missing the unique opportunity this post-pandemic world has offered to Africa and the world.
– Innovation must be incentivised
– Sustainable solutions must be premised on shared value and win-win outcomes
– The importance of public-private partnerships
– The willingness to be led by need, and guided by pragmatic, workable solutions
– A willingness to experiment and a commitment to seeing things through
