Breakthroughs Blog: UHC

On Monday, the United Nations (UN) members unanimously adopted a high-level political declaration on universal health coverage (UHC), which World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus called a “landmark for global health and development.” While the adoption of the declaration is welcome news, in many ways it represents a starting point for the next phase of UHC, in which the thornier issues of financing, follow through, and accountability will rise to the forefront. UHC declaration adopted unanimously at United Nations High-Level Meeting It was a bit of a bumpy journey to Monday’s political declaration. After months of tense negotiations among member states, the UHC debate had stalled over two hot-button issues—sexual and reproductive health and the rights of migrants and refugees—which weren’t resolved until a few days before the High-Level Meeting. Thankfully, countries were able to push the UHC declaration across the finish line, with a several countries, including the United States, disassociating themselves from the provisions linked to those thornier issues. It was encouraging to see that the final declaration was inclusive of GHTC-supported language on research and development (R&D), focused in particular on innovative financing for new products and technologies, emphasizing the role of the private sector and new models for sustainable investment.  “This declaration represents a landmark for global health and development,” Dr Tedros Adhanom Ghebreyesus The UHC process now moves into a new phase: countries are tasked with developing their own strategies or national action plans to fulfill these commitments and advance UHC within their own borders. The agreement is intended to be country-led, and as member states adopt the commitments to their own geographic contexts, they must outline a clear path for how they will mobilize their governments and increase investment in UHC.  Assessing gaps in the tools to mitigate each countries’ priority health challenges also needs to be considered as part of this new phase.  It’s all about the money Now that countries have committed to UHC, how will they pay for it? That question seemed to be on everyone’s mind as numerous events throughout the week of the UN General Assembly focused on the financing side of UHC. The message was clear: not enough is being done, particularly on domestic resource mobilization. Most countries don’t have a UHC investment strategy to achieve the lofty goals set forth in the UHC declaration and the Sustainable Development Goals. As countries start to develop their health investment plans, it is crucial that investment in R&D remain an integral pillar. UHC cannot be achieved without stepping up the fight against the world’s endemic and emerging infectious diseases. This will require new tools and technologies, as was echoed by stakeholders throughout the week, including Global Fund Executive Director Peter Sands and Dr. Tedros. We also need to invest more in the uptake and scaling of innovations and technologies and ensure that we are thinking of end-to-end solutions.  "Existing tools won't be enough"@PeterASands highlights that innovation hasn't been fast enough. We need to push more aggressively to scale up innovation and integration of new tools. @GlobalFund #TBinnovation #HealthForAll pic.twitter.com/7tSluSlIL5— GHTC (@GHTCoalition) September 22, 2019 There were several side events this week on financing reforms, tax redistribution into UHC—from the tobacco industry, for example—and the need for innovative financing approaches. Outcomes-based finance such as social impact bonds and blended finance models, in particular, attracted some attention. All countries did commit to spending one percent or more of their GDP on public health as part of the declaration. That is likely insufficient to achieve UHC, but money isn’t the only factor for success. Some countries, such as the United States, already spend more on health care but still lack access to coverage for all citizens.  Accountability emerges as central focus after the political declaration Now the real work begins. Many speakers this week devoted time to discussing the challenge of accountability and follow through, drawing on past experiences from other high-level meetings.  Stakeholders recognized that the declaration is just a starting framework and that the lofty language needs to be translated into tangible actions and investment. While this declaration symbolizes a major shift for the global health agenda, fears persist that the momentum will dissipate and that countries won’t be able to follow through on their commitments by 2030—just over a decade from now.  Those fears are warranted. Just last week, WHO published a report stating that while advances have been made on UHC, as many as five billion people will be left without full access to healthcare in 2030 at the current rate of progress. Countries must set clear targets for moving their populations on the journey towards UHC and create specific metrics through which progress can be monitored. Mechanisms and incentive structures must be put in place to allow for follow-up and accountability, underscoring the political will expressed in New York this week. In adopting the declaration, member states have committed to investing in policies which would allow everyone, everywhere to have access to quality health care products and services without financial hardship. Leaders must now pivot to move from commitment to concrete action.

Universal health coverage (UHC)—the idea that everyone, everywhere, should be able to access quality health services—will take center stage at the World Health Assembly (WHA) later this month. World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus has made UHC a top priority, as his institution estimates that at least half of the world’s population still does not have full coverage of essential health services.While there are many building blocks to achieve UHC—from galvanizing political will and investment to strengthening health systems and training health personnel—one integral pillar that is too often overlooked is innovation—the creation of new and improved drugs, vaccines, and diagnostic tools. Global health research and development (R&D) is indispensable in delivering on the vision of quality health for all. R&D a vital component to achieve UHCHealth systems cannot meet the fundamental needs of their populations without high-quality and accessible drugs, vaccines, and diagnostics with which to treat, prevent, and detect disease. Today, we still lack many of the tools needed to combat diseases and conditions that exact a tremendous health burden in the world’s poorest places. No preventative vaccines exist for many neglected diseases, including Chagas, leishmaniasis, and chikungunya, and treatments available are often inadequate or toxic. Tuberculosis (TB) sufferers today face six to twenty months of treatment, involving thousands of pills and painful injections. We still don’t have the right tests to diagnose many infectious diseases at point of care, leaving patients wondering and waiting for care. The goal of ending AIDS will remain out of reach without a vaccine or cure. Meanwhile, growing antimicrobial resistance (AMR) against malaria, TB, and other infectious diseases threatens to roll back progress and is adding even greater urgency to the need to develop new innovations to prevent emerging resistance. Neglected diseases affect hundreds of millions of people worldwide and jeopardize achieving UHC for the most vulnerable among us.As the global community invests in policies and programs that support UHC, it must also prioritize R&D for new health technologies, especially where markets don’t catalyze these investments on their own. It will be impossible to truly deliver quality care for all without new innovations. Delivering the next generation of lifesaving health technologies will require strong political commitment and increased investment from all nations. To make that happen, it’s critical that the world explicitly acknowledge the importance of global health R&D to attaining UHC.WHO’s role WHO has a crucial role to play in strengthening R&D and access to achieve UHC. Through its global convening power, WHO sets the agenda and is often the institution policymakers rely upon to frame their countries’ health priorities and lead the implementation of important programs vital to improving access to quality treatment and services. For example, WHO’s essential medicines and diagnostic lists are highly vetted, evidence-based recommendations that provide member states with a robust framework to determine key investment, health service, and policy priorities. WHO also provides technical expertise and capacity-building programs to build regulatory frameworks that accelerate access to medicines and create stronger enabling environments for global health R&D. This includes supporting the development of laboratory systems and infrastructure, as well as clinical trial capacity. For everything ranging from establishing safety standards, to producing treatment guidelines for infectious diseases, to designating good clinical research practices, WHO sets the normative technical standards and provides clear targets for low- and middle-income countries for health system strengthening. WHO must continue to use its global convening power to facilitate coordination and alignment of priorities in order to advance the UHC agenda. This is why the 72nd WHA meeting presents the global health community with an opportunity to ensure that WHO continues to play a significant role in supporting R&D by stepping up its efforts to catalyze additional investment, build capacity, and provide resources to stakeholders to facilitate the development and effective deployment of tools to patients globally. While governments can, and should, play a leading role in the global UHC movement, WHO will also play an important part in making the vision of quality health for all a reality. As the world gets ready to descend on Geneva for WHA week, global health advocates should remember that there is no UHC without R&D.

The 72nd session of the United Nations General Assembly (UNGA) featured a number of firsts: It was the first UNGA for new United Nations (UN) Secretary-General António Guterres, as well as the first for recently elected World Health Organization (WHO) Director-General (DG) Dr. Tedros Adhanom Ghebreyesus. Both used this annual gathering of world leaders to solidify their signature issues in a public forum. DG Ghebreyesus’ signature issue was achieving universal health coverage (UHC), in which all people can access a basic standard of necessary health care without being driven into poverty. DG Ghebreyesus publicly stated at multiple events and in numerous tweets that he views achieving UHC as a political decision to support human rights. Research and development (R&D) and innovations in health care are a vital part of any agenda to achieve UHC. At a US Pharmacopeia event, President Ameenah Gurib of Mauritius discussed drug development as not only a key economic driver in her country, but also as a core part of achieving UHC. South African Minister of Health, Minister Aaron Motsoaledi, speaking at a Stop TB Partnership reception, stated that the fight against tuberculosis (TB) would never be won without accelerated investments in R&D to advance the next generation of tools needed to make treatment more effective. “Research and development (R&D) and innovations in health care are a vital part of any agenda to achieve UHC.” Using the example of TB, it is easy to see that the prospect of achieving overall UHC is dependent on innovations that will increase efficiency and drive down costs. Current analyses indicate that countries would need to spend an average of about 5 percent of their gross domestic product to achieve UHC—a goal that, for many nations, is “aspirational in the short term.” Multi-drug resistant TB (MDR-TB), which typically takes two years or longer to treat, can exact an enormous burden on a country’s financial resources. For example, data from the United States shows that MDR-TB is at least US$100,000 more expensive to treat than standard TB, with an estimated $134,000 spent treating every MDR-TB patient compared to $17,000 for regular TB treatment. Imagine if a new drug regimen could reduce treatment time to under a year. The savings in both human suffering and resources within the health system would be enormous. Fortunately, MDR-TB treatments in development today hold promise to offer faster, simpler, and more affordable solutions. “…It is easy to see that the prospect of achieving UHC overall is dependent on innovations that will increase efficiency and drive down costs.” Beyond the hugely positive impact of new technologies within health systems, global health R&D has other wide-reaching, positive externalities. To explore these, GHTC convened a panel discussion with Dr. Peter Singer of Grand Challenges Canada, Bumpei Tamamura of the GHIT Fund, and Jan-Willem Scheijgrond of Philips. Each of the panelists noted a variety of reasons their organizations view investments in global health R&D as not only the right thing to do, but also as good business. From the perspective of a government-supported innovation agency, Dr. Singer noted that through its investment in global health R&D, Grand Challenges Canada has achieved phenomenal bang for its buck. The agency has supported over 800 innovations with an investment of roughly $200 million. Further, two-thirds of this investment goes directly into low- and middle-income countries (LMICs), where it not only supports technological development, but also builds the human capital and innovation economy that will allow these countries to achieve long-term prosperity. Bumpei Tamamura highlighted how fostering multi-sector, multi-country partnerships can advance a nation’s health technology sector. Supported by both the Japanese government and Japanese pharmaceutical and technology companies, the GHIT Fund views its role as creating the incentives to support partnerships between Japanese companies and their global counterparts to leverage respective strengths. Noting the Fund’s success in supporting product development, Mr. Tamamura explained that the Fund is now looking to expand its portfolio of partnerships into manufacturing and distribution, potentially with developing country counterparts. From Philips’ perspective, Jan-Willem Scheijgrond explained investing in global health R&D is not about charity—it is about good business. He noted that Philips operates under a corporate mandate to improve the lives of 3 billion people worldwide, but can only reach half of those people through operations in developed markets like Europe and the United States. “We need to stop seeing health care as a cost, and instead see it as an investment,” he stressed. For Philips, investing in technologies to serve LMICs is part of meeting its core mandate. By investing in health for low-income groups, Philips helps improve health, create jobs, and lift families out of poverty while simultaneously building a new customer base for other products, especially as income levels rise. This can help build a virtuous cycle for both the public and the company, Scheijgrond explained. “Investing in global health R&D is not about charity—it is about good business.” Ultimately, global health R&D is vital not only to health, but also to achieving overall development in economic and social contexts. It improves the efficiency of health systems, allowing countries to move more quickly toward UHC. It creates jobs and generates economic impact across the world, raising incomes and lifting families out of poverty. It also creates bridges between industry in LMICs and global leaders, setting up the conditions for LMIC entrepreneurs to take their place on the global business stage. When asked to sum up the value of investing in global health R&D, Dr. Singer encapsulated it best: “You can reach your own goals that you’ve set for your own people, working with your own people, better, faster, and cheaper.” “[By investing in global health R&D] you can reach your own goals that you’ve set for your own people, working with your own people, better, faster, and cheaper.” For an UNGA session not explicitly focused on global health, the GHTC secretariat was pleased to see UHC—and the role global health R&D plays in contributing to UHC—recognized so prominently in the multi-stakeholder dialogues. We are looking forward to maintaining this momentum heading into the upcoming WHO Executive Board meeting, where a number of critical issues are on the agenda.