Non-Communicable Diseases Issue Energises Public Health Policymakers

Concern over non-communicable diseases – traditionally a more developed-country set of problems like diabetes – is energising the international public health policy community. But representatives of the public interest are still grappling with their response.

A focal point of activity is a high-level meeting on prevention and control of noncommunicable diseases (NCDs), scheduled to be held on 19-20 September at the United Nations General Assembly at UN headquarters in New York.

“The NCD issue is a priority for the UN system at the moment, particularly in light of the September meeting, and that there is great interest in the issue from a large number of countries who are all affected by NCDs, no matter the socioeconomic bracket they are in,” WHO spokesperson Paul Garwood told Intellectual Property Watch.

“One can feel an incredible energy. NCD is certainly today the number one global health issue.” – Sanofi’s Martin Bernhardt

On 16 June, the United Nations held a meeting with civil society and announced that partnerships are needed to tackle these growing problems.

According to one non-governmental participant, many well-known public health advocacy organisations were not present or underrepresented.

NCDs also were a headliner at the last month’s World Health Assembly (IPW, WHO, 24 May 2011), the annual meeting of World Health Organization members.

At the May Health Assembly, countries unanimously endorsed a WHA resolution on the preparations for the September high-level meeting at the UN.

“Some 47 countries and 16 observers, including civil society, spoke on the resolution, which urges heads of state and government to attend the UN meeting in New York and call for action against the NCD challenge through an action-oriented outcome document,” said Garwood.

Today, the WHO announced release of a report on the “Global Tobacco Epidemic, 2011: Warning about the Dangers of Tobacco.” It includes global data including on which countries and populations have large warning labels on tobacco packaging.

“Of the world’s more than 1 billion tobacco smokers, more than 80 percent live in low- and middle-income countries and up to half will eventually die of a tobacco-related disease,” WHO said in a release. This year alone, the tobacco epidemic will kill nearly 6 million people, it said, including some 600,000 non-smokers.

“The prevention and control of NCDs is such a cross-cutting issue,” said Garwood. “The health and socioeconomic impacts are great and affect many areas of life, obviously including health but also development, costs for healthcare and economic bottom lines, including for developing countries.”

The response to NCDs is “multisectoral,” he added, and offers international actors from multiple fields “opportunities to take action through policy, whether it is around taxation, development support, education, agriculture and, clearly, health.”

Industry Opportunity

Northern industry, perhaps relieved to have a new focus from its defensive stance in international policy circles that are increasingly focussed on making their medical products affordable at the expense of patent profits, appears to be eagerly embracing the new topic.

The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) announced on 16 June that the research-based pharmaceutical industry had launched a Framework for Action on NonCommunicable Diseases.

The framework focuses “on the areas where the research-based pharmaceutical industry can make the most significant difference, such as innovation, access and affordability, but also prevention and health education,” according to a IFPMA press release [pdf].

The framework [pdf] “confirms the industry’s crucial role in continued investment in R&D programmes dedicated to the development of innovative medicines for the prevention and treatment” of noncommunicable diseases (NCDs). NCDs include cancer, diabetes, cardiovascular disease, and chronic respiratory diseases.

IFPMA Director General Edouardo Pisani said, “The framework is just the beginning; our vision is to work with others to identify what can be done in practice to help poor people to access the care and treatment they need.”

[updated] Martin Bernhardt, vice president for relations with international institutions at pharmaceutical company Sanofi, said the issue has recently gained notice.

“Who knew 2 years ago what is an NCD? Who realised how much the four preventable diseases represent a high burden for all countries, heavier than infectious disease for the developing economies? Just a small specialists minority,” he told Intellectual Property Watch.

“The picture is very different today,” Bernhardt said. “With the coming September UN Summit, there is not a week without a dedicated event. Each actor wants to bring a contribution and one can feel an incredible energy. NCD is certainly today the number one global health issue. The challenge will be keeping a high level of attention after the Summit, when it will be time to implement concrete solutions.”

Academic institutions, which may hold events and do research with support of interested parties, have been lining up events on the topic. The Graduate Institute of International and Development Studies scheduled a public seminar entitled, “Preparing for the UN High-Level Meeting on the Prevention and Control of NonCommunicable Diseases” on 21 June.

And even groups that previously had a limited connection to the issue in Geneva have found a new purpose in NCDs. For instance, the Global Social Observatory, which appears to have sprouted from the former Geneva Social Observatory, has begun promoting meetings in Geneva around the issue with private sector support.

New Needs, Same Old IP Issues

Zafar Mirza, coordinator of the WHO Department of Public Health, Innovation and Intellectual Property, said that the NCD issue likely contains the same IP questions associated with other diseases and medical products.

A major international policy debate has revolved around patents on pharmaceuticals and other medical products that raise prices beyond the reach of the poor, or lead to a dearth of research on treatments for diseases disproportionately affecting the poor.

“We know that many medicines and health technologies are patent-protected, so I would say the same debates will kick in,” he told Intellectual Property Watch.

Rachel Kiddell-Monroe, president of the Board of Universities Allied for Essential Medicines, said NCDs are a serious problem for developing countries, and urged civil society to participate in the policymaking process going forward.

“NCDs is genuinely a huge issue for middle-income countries, Kiddell-Monroe told Intellectual Property Watch. “There is an unusually high [rate] of death and infant mortality in developing countries.”

The “double burden” of NCDs and communicable diseases is “hitting developing countries in a really massive way that hasn’t been acknowledged before,” she said.

It is generally good for organisations to be getting involved in NCDs, she said, as there is a “genuine” issue that needs to be addressed.

But she noted that “the issue has been leapt on by the pharmaceutical industry.” Therefore, she added, “NGOs must be present, otherwise I fear many of the gains that have been made in the last decade will be lost.”

“What we’re seeing in IP discussions is that the focus is on prevention,” such as stopping over-use of sugar or cigarette smoking, she said. But with NCDs, “very few have the ability to talk about that, because that leads to talk about access,” which leads to questions about the WTO TRIPS agreement, the same target of IP policy debates for several years.

NCDs are seen as having all drugs needed to address them, but there may be another side to the story, she said. “There is a big IP issue in this,” she said, and civil society needs to enter the discussion.

The absence at the recent UN meeting with civil society of the bigger NGOs that typically work on access to medicines issues was “really worrying,” she said.

“The voice of civil society and the experience of civil society is critical,” Kiddell-Monroe said.

Some say that NCDs is a generic drug issue so they will be affordable and easy to make. But “that is not the case,” she said, as the heightened focus on the issue is bringing new treatments that will be patented.

In comparison with the communicable disease debate, she did not see it as being much easier on the IP issues.

Though some developing countries are “raising these issues straight out,” she said, the pharmaceutical industry “is more savvy too, and don’t want to get caught in the same trap it was caught in before.”

Communicating the Non-Communicable

Meanwhile, the UN is counting on countries and stakeholders overcoming differences in order to address the bigger problem of NCDs.

“The message is clear that a health response alone to an epidemic that accounts for over 60 percent of global deaths, with much of the impact being felt in low- and middle-income countries, will not be enough,” said Garwood. “A whole-of-government and whole-of-society approach is needed, and this will be supported by strong policies being developed and implemented by countries.”

Participation at the heads of state level is needed at the UN high-level meeting, as called for by the WHA resolution, he said, adding, “Such high-level support for action against NCDs is critical.”