In poor countries around the world, millions of people don’t have access to medicines against chronic diseases such as diabetes, heart disease and breast cancer. In some cases they can’t afford the medicine. More often, the nearest clinic is a long day’s walk from home or no doctor is available once they get there. And sometimes the nearest pharmacy doesn’t have the treatment in stock.
I saw this firsthand in 2000, when I began my career as a pharmaceutical sales representative in my home country, Kenya. An elderly woman came into the pharmacy where I was talking to the pharmacist about an antimalarial drug, the very prescription she was carrying. A malaria outbreak was raging in the area and the woman needed the drug for her grandson. When she left without filling the prescription, I followed her to ask why. She told me that she could not afford it. I paid for it myself but realized that while I could help one person, I couldn’t help everyone in need.
That sparked my passion to make medicines more affordable for people in my country and led me to join the Novartis Access program in Kenya, which, in partnership with Kenyan health providers, aims to make treatments for noncommunicable diseases (NCDs) such as cardiovascular diseases or respiratory illnesses available and affordable.
NCDs kill 38 million people each year — 3 out of 4 of them outside of the United States in LLMICs (low and lower middle income countries). Often, these countries do not have sufficient capacity to prevent, treat and care for patients suffering from these conditions.
The issue of access to medicine in the world’s poorest nations is too often clouded by ideological disputes over intellectual property and patent rights. Ninety-five percent of the drugs on the World Health Organization’s Essential Drugs List are not patented, yet many millions of patients have no way to get to them. A myriad of obstacles prevent patients in low-income countries from getting the medicines they need. This is why we rather should focus the debate on approaches that will best help patients get the treatments they desperately need.
An effective solution would be to encourage partnerships between pharmaceutical companies and governments or other healthcare providers to help make medicines, both patented and generics, available and affordable to patients in poor countries. Some of these partnerships are already showing promising results. In Kenya, at least four pharmaceutical companies are selling their treatments against chronic diseases at reduced prices as part of wide-ranging agreements with governments and healthcare providers. These partnerships work because guaranteed volumes and the promise of long-term collaboration can make this a sustainable model for many companies.
My company, for example, is working with governments and NGOs to deliver affordable treatments, including innovative medicines against chronic diseases, to the poorest people in the world — diseases that are overtaking infectious diseases as the main cause of death and disability. Launched in Kenya last year, Novartis Access offers a portfolio of 15 on- and off-patent medicines that we plan to make available to 20 million patients in low and lower middle income countries in the next four years. The treatments include medicines against cardiovascular diseases, type 2 diabetes, breast cancer and respiratory illnesses.
The portfolio costs governments and public-sector customers $1 per treatment per month. We’re committed to keeping the amount paid by patients at the lowest possible price. And we’re investing in education and training for workers in healthcare systems that have until recently been mostly focused on treating infectious diseases.
None of this will help solve the access problem unless we also improve the local availability of medicines in these countries. A recent WHO survey found that generic medicines, essential for the treatment of certain acute infectious diseases, were only available in just over half of the pharmacies and clinics in the 40 lower-income countries surveyed. For chronic diseases, only a third of the medicines were available. Lack of trained staff, poor infrastructure, poor data systems, and diversion of subsidized medicines from the public to the private sector are all factors contributing to this situation.
We don’t pretend to have the solution to improving access to medicines, but we think Novartis Access and programs like it offer compelling examples of how the pharmaceutical industry can work collaboratively to help overcome access issues in poor countries. Only by improving healthcare systems and access to high-quality treatment can we help people live better, longer and more productive lives while encouraging them to invest more in their own health.
I hope I will never again see a grandmother or any patient with a prescription in hand that goes unfilled.
Anthony Gitau manages the Novartis Access program in Kenya.
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