WHO Negotiations On Global Monitoring Framework Seen As Success In Non-Communicable Disease Fight

World Health Organization members this week achieved consensus on a set of voluntary targets and indicators for the prevention and control of the world’s biggest killers, including cancer, diabetes, cardiovascular and chronic respiratory diseases. Two targets and several indicators relate to national health systems response.

WHO member states met in a formal meeting from 5-7 November in Geneva, ending in a night session. The meeting documents are available here and the advance, unedited meeting report is available here [pdf].

The call to develop the global monitoring framework for non-communicable diseases (NCDs) was made at the UN High-Level Meeting on the Prevention and Control of NCDs in September 2011. World leaders tasked the WHO to develop a “comprehensive global monitoring framework” which includes voluntary global targets and indicators to measure progress on NCDs by the end of 2012.

With nine targets and 25 indicators, meeting participants and observers are calling the framework a success, including Bjorn-Inge Larsen, secretary of health and care services in Norway, who chaired the meeting.

“I think that the targets and indicators that we set exceeded our expectations going into the meeting. We have never had targets that are so relevant in the area of NCDs. This framework sets us in the right direction,” Larsen told Intellectual Property Watch.

Targets on NCD Medicines

One of the global voluntary targets, the 25 per cent reduction in premature mortality from NCDs by 2012, was adopted by the World Health Assembly in May 2012 (IPW, WHO, 25 May 2012).

Discussions on the additional targets and indicators were based on a 31 October discussion paper [pdf] and included 11 targets. In the final report, targets on diabetes and obesity were combined. Both targets related to national systems response, expected to be areas of contention, were accepted with minor changes and were less controversial than other targets such as salt and alcohol, according to sources.

One national systems response target, related to essential medicines and technologies, reads: “80% availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities.”

This marks a slight change from the wording in the discussion paper, which specified the availability of “generic essential medicines.” According to a delegate from a middle-income country, the debate on this issue was “not very long, as we have agreed language here.”

The other national systems response target, related to drug therapy to prevent heart attack and stroke, reads: “At least 50% eligible people receive drug therapy and counseling (including glycemic control) to prevent heart attacks and strokes.”

HPV Vaccine: Cost-Prohibitive For Some Countries

One of the most debated issues related to national systems response was setting an indicator on the human papillomavirus (HPV) vaccine, which has been shown to protect against most cervical cancers in women.

Since November 2011, the HPV vaccine is available to 73 countries eligible to receive vaccines from the GAVI Alliance at a discounted price. According to a spokesperson from the organisation, the GAVI price is 63 per cent less expensive than the public price, which amounts to US$5 per dose. The vaccine is given in three doses.

According to sources, inclusion of an HPV indicator was a high priority for delegates from the AFRO region, while some middle-income countries that are not included on the GAVI list argued that the cost of the vaccine prohibits large-scale inoculation programmes.

In the final text, the indicator was included, but was described as “aspirational,” by the meeting chair to Intellectual Property Watch. It reads: “Availability, as appropriate, if cost-effective and affordable, of HPV vaccines, according to national programmes and policies.”

Nonetheless, its inclusion was seen as an important step for some non-governmental organisations (NGOs) including the Union for International Cancer Control (UICC), which was present as an observer of the three-day meeting.

“We were ecstatic that member states recognised the importance of cancer related infections by including targets such as the HPV vaccine,” Julie Torode, deputy CEO and director of Advocacy & Programmes at the UICC, told Intellectual Property Watch. “There was some concern among member states about the current cost of the HPV vaccine which did lead to agreement of the policy level indicator but as many member states from the AFRO region said that what is important at this stage is that it is being monitored.”

The NCD Alliance, also present during the formal WHO meeting, issued a media release in reaction to the global monitoring framework, which is available here [pdf].

The report on the NCD Global Monitoring Framework including indicators, and a set of voluntary global targets for the prevention and control of NCDs, will be submitted for the WHO Executive Board’s consideration in January.

See related Intellectual Property Watch article here.