“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
This sentiment was enshrined in the WHO’s constitution in 1946. With health as a human right, universal and equitable access to the vaccines and therapeutics that are essential to achieve good health are by default a fundamental human right also. However, despite this recognition of vaccines and therapeutics as lifesaving commodities, 2 billion people globally still lack access to medicines.
Access to Medicines & LMICs: A challenge at every step
Low- and middle-income countries (LMICs) face access to medicines challenges due to structural factors that disrupt the traditional pharmaceutical business model across the value chain. These market challenges have not only led to availability and affordability constraints for existing medicines and vaccines but has also resulted in a lack of investment in diseases specifically affecting populations in LMICs such as neglected tropical diseases and maternal and neonatal conditions. Tackling barriers to access to medicines is an arduous and lengthy affair. Several global health initiatives have been set up to overcome these structural factors with funding predominantly through official development assistance (ODA). These initiatives cover the whole value chain including mechanisms to bolster research and development (R&D) for diseases of poverty through Product Development Partnerships as well as mechanisms to procure and deploy commodities to the poorest communities such as the Global Fund to Fight Aids, Tuberculosis and Malaria and Gavi, the Vaccine Alliance.
At the forefront of the access agenda, the UK’s Department for International Development (DFID) has long been recognised for its refined and dynamic health portfolio with the UK ranking as the second largest government donor to global health behind the US. So naturally, news of a merger between the DFID and the Foreign & Commonwealth Office (FCO) has made access to medicines advocates and the wider international development sector nervous.
A balanced approach
DFID’s access to medicines portfolio encompasses a multipronged approach delivered through bilateral and multilateral support. This comprehensive portfolio adopts a ‘bench to bedside’ approach from boosting R&D, guaranteeing delivery to the last mile and ensuring healthy markets.
When it comes to global health R&D, the UK is the second largest funder after the US with $230 million allocated for developing products for poverty related and neglected diseases in 2018. DFID was responsible for the largest share of this $230 million global R&D spend accounting for 53% (US$ 121 million). The bulk for this funding was channelled through Product Development Partnerships (PDPs)- not for profit entities bringing together private sector, public, non-profit and academic partners to overcome barriers to product discovery. PDPs have been central to unleashing much needed medicines and vaccines for diseases impacting the poorest communities globally including Malaria, TB and a whole host of neglected tropical diseases amongst others. DFID funds an array of these PDPs including Drugs for Neglected Diseases initiative, Medicines for Malaria Venture, TB Alliance etc.
More recently the UK has become the largest donor to international efforts to find a coronavirus vaccine with a £210 million donation for the Coalition for Epidemic Preparedness Innovations (CEPI). CEPI is a global alliance working to develop a portfolio of vaccines targeted at pathogens that have potential to be future epidemic threats. In other words, the world’s insurance policy against a future event like Covid-19.
When it comes to delivery systems and infrastructure, the UK’s contributions to various multilateral organisations accounts for a third of ODA spend. The UK is one of the largest donors to the WHO, the largest donor to Gavi, the Vaccine Alliance as well as being one of the founding members and largest donors of the Global Fund to Fight Aids, Tuberculosis and Malaria. Through these initiatives , DFID adopts a pragmatic value for money approach as well as a strong stance on equity and sustainability through transformative investments. Furthermore, DFID health teams are renowned for their high calibre experts, well versed in a range of Global Health disciplines. The clout and expertise of these teams have allowed the UK to play a central role in shaping the Global Health agenda to achieve SDG 3 of Good Health and Well Being. It has allowed DFID staff to meaningfully engage as part of the governance structures of these multilateral mechanisms. More importantly, health teams within DFID have developed robust working relationships with NGOs and civil society organisations within the wider global health and access to medicine sphere. This integration of community voices has helped cement equity at the heart of DFID’s development agenda.
DFID has also played a key role in strengthening pharmaceutical markets in LMICs through sophisticated market shaping initiatives. This includes funding the Access to Medicine Foundation which tracks pharmaceutical companies on how they make medicines, vaccines and diagnostics more accessible in LMICs through capturing their activities within R&D, pricing, use of intellectual property and capacity building etc. This is achieved through an index ranking and pharmaceutical market analysis published every 2 years. DFID’s other market shaping initiatives include the pneumonia advanced market commitment (AMC) which is an innovative mechanism designed to spur the development of much needed vaccines for the world’s biggest killer of children, pneumonia. This was achieved by rectifying market failures in the vaccines market by assuring demand and guaranteeing predictable financing thereby giving pharmaceutical companies the incentive to invest in developing pneumonia vaccines.
Protecting the ‘DFID way’
As the Government looks to integrate departments and DFID country offices into the UK diplomatic system, we must not lose the technical global health expertise nor the established networks. Now more than ever, in an interconnected world, global Health R&D is a matter of national and global security. With the UK’s funding levels for Global Health R&D having doubled since 2016, it is critical that this positive trend is maintained. Global health research coordination mechanisms such as the joint ‘DFID-DHSC global health research working group’ and the ‘Strategic Coherence of Official Development Assistance-funded Research Board (SCOR)’ must be empowered to continually drive this agenda forward. The new “super department” must ensure that DFID’s ethos to sustainable development through predictable financing, long term vision and complementary bilateral and multilateral support does not fall victim to the volatile and unpredictable nature of foreign policy. The FCDO must leverage its clout and influence to ensure the multilateral systems and pharmaceutical markets are meeting their obligations to serving the needs of the world’s poor.
Read more from our blog series on The Future of British Aid.
