WHO Member States Hammering Out Details On Noncommunicable Diseases

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In a single voice, public health authorities spoke out about the need to take on the world’s heaviest disease burdens including cancer, diabetes, cardiovascular and chronic respiratory diseases. Now negotiations are narrowing in on the specifics of how to prevent and control these diseases, and achieving agreement on some commitments, including those related to medicine availability, could prove more challenging.

At the UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases (NCDs) in 2011, world leaders tasked the World Health Organization to develop a “comprehensive global monitoring framework” which includes voluntary global targets and indictors to measure progress on NCDs by the end of 2012.

The first target was set last May at the World Health Assembly when member states agreed to reduce premature mortality from noncommunicable diseases (NCDs) globally by 25 percent by 2025. The decision is available here [pdf].

Now public health officials have to agree on how to reach that goal. WHO member state officials will gather in a formal meeting from 5-7 November in Geneva to finalise the global monitoring framework, establishing a set of targets and indicators.

Additionally, the WHO Secretariat has released the “Zero Draft Global NCD Action Plan” which seeks to “consolidate the contours of an implementation and follow-up plan for the outcomes of the High-level Meeting, as well as an updated Action Plan for the Global Strategy for the Prevention and Control of NCDs covering the period 2013-2020 into one document.”

WHO members are scheduled to meet in informal consultations to discuss the draft on 1 November in Geneva.

Targets on NCD Medicines

While there is strong support for targets related to the four main NCD risk factors – tobacco use, excessive alcohol, poor diet, physical inactivity – there has been more debate on which additional targets to include in the framework.

Other targets mentioned, with varying degrees of support, in the 65th WHA NCD decision relate to salt/sodium intake, obesity, fat intake, cholesterol, and health system responses such as the availability of essential medicines for NCDs.

There are two targets related to medicines currently on the table as outlined in the most recently revised discussion paper on the global monitoring framework [pdf]: “50% of eligible people receive drug therapy to prevent heart attacks and strokes” and “80% availability of basic technologies and generic essential medicines required to treat major NCDs in both public and private facilities.”

As decided by the 65th WHA, WHO member governments have met in regional committees to review the discussion paper and submitted their meeting outcomes to the WHO. The WHO secretariat is in the process of preparing a summary report of the regional discussions, which should be available next week ahead of the formal member state meeting.

The European Regional Committee has published its key findings on monitoring NCDs, which measured country capacity to monitor the proposed targets and indicators via web-based consultations. A summary of the findings and the full report are available here.

Although national positions on the framework remain closely held, a delegate from Brazil confirmed that the country supports targets related to improving health systems.

“Of course Brazil supports access and availability to medicines, especially because we understand that the cost for treatments of these diseases is very high. But, you have to provide countries with the tools to achieve such targets. Otherwise, they will become a burden,” the official told Intellectual Property Watch.

The Brazilian delegate also mentioned discussing its national position with other South American countries at a technical level, but a political agreement has not yet been established.

Some non-governmental organisations (NGOs) also have submitted their position on the framework to the WHO for member state consideration. In a recently released position paper [pdf], the World Heart Federation emphasised the importance of including health systems targets: “To halt and reverse the NCD epidemic, it is paramount that the CVD [cardiovascular disease] burden be adequately addressed, which requires that those living with CVD and at highest risk of developing CVD have access to treatment and care.”

The paper also highlights division these targets has caused in the past and obstacles that could be encountered entering into these last phases of negotiations. “Although these targets [obesity, trans fat/fat intake, alcohol, and multidrug therapy to prevent and treat CVD] have been included in the most recent discussion paper, they have been identified as having limited support and need further advocacy to ensure their adoption.”

The NCD Alliance also calls for the inclusion of health system targets in its submission [pdf] to the WHO: “The NCD Alliance specifically requests Member States to support the health systems response targets on drug therapy and on the availability of essential NCD medicines/ technologies (80% availability already agreed as a target in the WHO Medium-Term Strategy to 2013). The international community is still falling short on providing treatment and care to millions of people with NCDs.”

Addressing NCDs Through 2020

The purpose of the “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020,” which was released as a ‘Zero Draft’ on 10 October, is multifold. Mandated by the 64th WHA and the 130th Executive Board (EB), the action plan is a continuation of the work set out in the current NCD action plan covering the period of 2008-2013.

Additionally, the 2013-2020 plan will build on the outcomes of the UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases, including the global monitoring framework, targets, and indictors.

Timothy Armstrong, coordinator of surveillance and population-based prevention in the WHO Department of Chronic Diseases and Health Promotion, told Intellectual Property Watch that the Global Action Plan is “quite a priority” in the prevention and control of NCDs.

“While the Global Monitoring Framework provides a high level view on progress, the Global Action Plan will provide the detailed policy and programmatic actions required to advance progress toward meeting a given set of targets, delving into the national and regional circumstances that need to be addressed,” said Armstrong.

Input to the zero draft includes informal consultations with member states and UN agencies held on 16-17 August as well as comments from web-based consultations, which included the participation of NGOs and some private sector participants.

In the zero draft, objective five covers issues related to the strengthening of health systems, the scaling-up of health coverage, improving access to medicines and promoting innovation. The actions recommended to improve access to essential medicines and technologies for the essential treatment of the big four NCDs are the following:

 “include essential NCD medicines and essential NCD technologies in national essential medicines and medical technologies lists, and improve efficiency in the procurement, supply management and access to these products;

 adopt strategies to improve affordability of medicines (separate prescribing and dispensing, control the wholesale and retail mark-ups through regressive mark-up schemes, exempt medicines required for essential NCD interventions from import tax and other forms of tax);

 promote procurement and use of generic medicines for prevention and control of NCDs by quality assurance of generic products, preferential registration procedures, generic substitution, financial incentives and education of prescribers and consumers.”

NCD related NGOs and selected private sector entities were invited to comment on the zero draft, which will be discussed during the second informal consultation on 1 November. Based on outcomes from this meeting, the WHO secretariat will develop a first draft for the Executive Board’s consideration in January.

ITU/WHO NCD Partnership

In terms of innovation, the zero draft of the NCD global action plan suggests the strengthening of “technological and innovation capacities of countries and remove obstacles to development and transfer of technology to low- and middle-income countries for the manufacture of medicines, vaccines, medical technologies and information and communication technologies such as m-Health for NCD prevention and control.”

As part of that strategy, the UN International Telecommunication Union (ITU) and the WHO launched the m-Health initiative during the ITU Telecom World 2012 conference on 17 October.

Vinayak Prasad, WHO project manager, told Intellectual Property Watch that “ITU brings the knowledge and wide scope of expertise that cover infrastructure deployment, policies, regulations, and standards development that can support the sustainable provision of m-Health interventions.”

“ITU is unique among UN agencies in having both public and private sector membership including ICT regulators, leading academic institutions and some 700 private companies. ITU is therefore well positioned to develop a holistic approach,” Prasad said.

According to a news release, mHealth will “initially run for a 4-year period and focus on prevention, treatment and enforcement to control noncommunicable diseases” and “work with partnerships at all levels.”

The initiative should build on existing projects and platforms and could help to strengthen health systems through more efficient data collection, improved health worker training, and enhanced patient counselling with pre-loaded health messages.

Related Articles:

http://www.ip-watch.org/2012/05/25/world-health-assembly-members-agree-on-ncd-resolution/

http://www.ip-watch.org/2012/05/24/world-health-assembly-draft-decision-on-ncds/

http://www.ip-watch.org/2011/09/15/ncds-pose-major-threat-to-public-health-who-reports/

Rachel Marusak Hermann may be reached at info@ip-watch.org.

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