The Developing World & Non-Communicable Diseases: A Pandemic of Drug Shortages & Inequitable Access

Throughout the developing world, health demographics are rapidly shifting from communicable diseases to non-communicable diseases (NCDs) due to urbanization, lifestyle changes, and introduction of processed food. Although still retaining a significant portion of their communicable disease burden like tuberculosis and malaria, the prevalence of hypertension, diabetes, and cancer in developing countries has increased dramatically and is expected to cause every 7 out of 10 deaths by 2020. With the rise of these health ailments, the global health community has highlighted the importance and severity of these diseases through UN High-level meetings, incorporating relevant indicators in the Sustainable Development Goals (SDG’s), and forming interagency coalitions within countries to address the barriers of NCD prevention and treatment. However, NCD medication supplies have remained an underappreciated barrier that humans affected by global health inequalities confront each day. The complications of drug supplies range from common medications being out of stock to not having a vital class of medications available at the health facility. The medication shortages that plague developing nation states often have a more pronounced effect on underserved populations – essentially causing an impossible barrier to treating their chronic condition and preventing morbidity/mortality.

Last month on November 20thThe Lancet Diabetes & Endocrinology revealed predictions in the year 2030 regarding the world’s insulin supply that stunned health care professionals around the globe. From data gathered recently, the number of individuals diagnosed with Type 2 diabetes is estimated at 405 million people. Although some patients can be treated with oral or injectable diabetic medications like metformin or GLP1 inhibitors, there are approximately 63 million people on earth today that require the use of insulin to manage their diabetes. However, only 30 million individuals use insulin due to availability, affordability, and inequitable access to this essential class of medications. Although these numbers provide a clear indication of the necessity for change in regards to access to insulin globally, the scientists at Stanford that conducted the aforementioned study in The Lancet predicted that the number of individuals diagnosed with Type 2 diabetes will increase to 510 million in 2030 – 79 million of those will need insulin to proper manage their health disorder with only 38 million having equitable access to insulin. These statistics exhibit that, in 13 years, less than half of the people on this planet will be able to access insulin, a medication developed 97 years ago. Though over half of the world’s diagnosed Type 2 diabetics will reside in China, India, or the United States, the study continued and stated that the insulin supply shortage will distress those inhabiting Africa and Asia most significantly. The reasons formulated to explain this health disparity include the fact that three pharmaceutical industries control almost 100% of insulin being manufactured in the world, the complexity of insulin which is a hormone produced by living cells, and generic companies’ lack of interest in producing a biosimilar at an equitable price.   

Cardiovascular diseases (CVDs) pose an implausible health burden on the global society with 30% of all deaths worldwide being attributed to these ailments. Of this mortality caused by CVDs, it is estimated that 80% occurs in the developing world with projections suggesting a steady increase in this percentage. However, with equitable access to cardiovascular medications, approximately 75% of recurrent CVDs can be prevented causing a decrease in both mortality and morbidity for humanity. To determine the access to common cardiovascular medications like atenolol, captopril, hydrochlorothiazide, losartan, and nifedipine, the BMC Cardiovascular Disorders journal published findings in 2010 of a survey within 36 countries. The findings revealed that the drug shortages transcended more complex medications like insulin and affected the access of medications that are considered ubiquitous in the developed world. The analyzed data revealed that of the abovementioned medications in the 36 countries, only 26.3% was available in the public sector and 57.3% in the private sector. The study also stated that in several nations, the wages earned within one working day was insufficient to meet the cost of one day of purchasing treatment. When considering situations where monotherapy is inappropriate, this finding would disclose that treatment would be particularly unaffordable.

When considering access to NCD medications generally, wealth has been a substantial determinant of inequitable access to treatment of hypertension, asthma, cancer, and others classified as NCDs. In many low-income to middle-income countries (LMICs), a wealth gradient has even been observed. In order to gather information to disprove or support this theory, the BMJ Global Health Journal published a study conducted in Kenya in August 2018. The study administered surveys to patients prescribed hypertension, diabetes, and asthma medications and collected data on those medications available at their home, including location and cost of the service. When analyzing the data, the results clearly indicated a wealth gradient for each of the three diseases included in the study in terms of access. As household income increases, so does the likelihood that a family has an opportunity to obtain proper medication. In addition, the results showed that poorer patients had to travel further to obtain treatment than those with a higher income. Finally, and most meaningfully, poorer patients paid more for their medications than their fellow humans inhabiting other parts of the country.  

These global health inequalities are unjustifiable in a global society where the quantity and quality of medications on the market is incredible. The drug shortages and inequitable access differ between the developed world and developing world, but also by socioeconomic stratifications within countries themselves. In order to provide compassionate care to every human suffering from any of these ailments, governments need to begin initiatives to make insulin, losartan, albuterol, and every vital NCD medication available to every citizen in their country. Heads of states, pharmaceutical industries, ministries of health, and health care professionals need to accompany their citizens and patients with a health mindset moving away from health as a commodity to health as a right. Most urgently, universal health care coverage needs to be at the forefront of every national health agenda to properly address this pandemic of drug shortages and inequitable access.

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Global Health Weekly News Round-Up

Politics and Policies:

  • The Food and Drug Administration has announced that it will begin exercising its authority given under a 2009 law, power to regulate cigarettes and other tobacco products that they believe pose public health risks.
  • In an effort intensify campaign to publicize new health insurance options and to persuade consumers, the White House is recruiting mayors, county commissioners and other local officials.

Programs:

  • A health check program has been launched in Accra, in order to reach out to the people of Ghana who are challenged with non-communicable diseases (NCDS), in an affordable and effective way.
  • The United Kingdom (UK) is starting a rotavirus vaccination program to protect the babies from infection which causes diarrhea, vomiting, abdominal pain, fever and dehydration.
  • Ben & Catherine Ivy foundation grants more that $9 million for brain cancer research.

Research:

  • To help avert 3 million AIDS deaths by 2025, the World Health Organization (WHO) through its guidelines is recommending the patients the start medicine at earlier stage of the deadly disease.
  • According to global Diabetes attitudes, wishes and needs 2 study one in five people with diabetes feel discriminated against them because of their condition. About 16% people suffering from this condition are at risk of depression.
  • According to the United Nations Program on HIV/AIDS (UNAIDS), Ghana cuts new HIV infections among children by 76% since 2009. It states that one three in ten children in need of treatment have access to it.
  • A report released by the United Nations state that Nigeria has highest number of children with HIV/AIDS virus in the world. It states that the incidence rate has not increased much but the increase in the prevalence rate has remained stagnant.
  • According to the scientists, new World Health Organization (WHO) test- based approach against malaria does not work everywhere. There must be a hard diagnosis before the disease is treated.
  • According to the research results published in the Journal of Infectious diseases, infant rotavirus vaccine is effective against this disease in Ghana. Results showed a significant response in parameters of efficacy, safety and immune impact of vaccine.
  • A study published in the journal’ Diabetologia’, ethnicity should be considered while making guidelines for physical activity. They state that south Asians need more exercise than white Europeans to reduce diabetes risk.
  • According to a research review published in BMJ, high consumption of fish reduces risk of breast cancer by 14%. It replenishes the body with all omega 3 essential fatty acids which can only be acquired from external sources as body cannot manufacture it.
  •  In a study published in Cell Transplantation journal, type 2 diabetes patients who receive self-donated bone marrow stem cells require less insulin. According to the scientist’s good glycemic control appeared as a critical factor in the transplanted and non-transplanted control group.
  • A study indicates that consuming more than 2-3 standard alcohol drinks per day is linked to deadly digestive tract cancers including mouth, throat, larynx and esophageal. They also warn of risk of bowel, breast and prostate cancers.
  • The scientists have found out that the patients of Crohn’s disease also have a virus – enterovirus in their intestines as compared to those who did not have this disease. It also said that the genes associated with the onset of this disease are vital for the immune response against this virus.
  • According to the researcher’s malaria parasite are full of iron which they cannot digest nor can excrete them. Their invention- hand-held battery operated malaria detector will use the power of magnets to detect them.

Diseases & Disasters:

  • Reports state that Lusaka (Zambia) records approximately 185 new HIV/ AIDS infections every day. It has high prevalence rate of 20.8 percent as compared to the other districts of Zambia.
  • The cholera epidemic in the Democratic Republic of the Congo claims lives of 257 people. Lack of proper sanitation and clear water are stated to be the main cause of the outbreak.
  • Polio outbreak in Somalia jeopardizes global eradication. Before this there was no case of this disease for more than five years. This outbreak is reported in its early stages and WHO experts see more cases coming in next few weeks.
  • A report released by Greenpeace suggests that a Chinese herbal medicine contains a variety of pesticides. It is increasingly accepted in the western countries for medicinal use.
  • Reports have shown a new trend of HIV infection among the youths of Manipur (India). Unsafe sex practice has been indicated to be the major mode of HIV transmission among them.
  • According to the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA). Diclofenac, a common painkiller raises the risk of heart attack and stroke among the patients with serious underlying heart conditions.
  • Health officials are warning that tularemia cases are on rise in New Mexico. Four cases have been so far been reported.
  • Japan and Poland are facing epidemic of rubella. Travel warnings have been issued by the Centers for Disease Control and Prevention for the pregnant females visiting these countries.

Global Health Weekly News Round-Up

  •  April 25, 2013 was World Malaria Day.
  • The International Labor Organization celebrates the World day for Safety and Health at Work on the 28th of April, 2013.

Politics and Policies:

  • The State House of Representatives voted to allow physicians to prescribe marijuana to patients with specific terminal illnesses or debilitating medical conditions.
  • Health officials in Australia have recommended a heavy government subsidy for the abortifacient drug RU-486.

Programs:

  • First online mapping tool was launched in Kenya to tackle the burden of malaria by tracking insecticide resistance in malaria causing mosquitoes.
  • Healthcare workers expanding their vaccination programs in Somalia. The country is among the first few African Nations to receive new vaccines against five deadly diseases- diphtheria, tetanus, whooping cough, hepatitis B and influenza.
  • Peace Corps volunteers on the occasion of World Malaria day participated in malaria eradication activities worldwide.
  • In their sixth ordinary session at the African Union the African Union Commission has called for more domestic investment in health to fight the increasing burden of non-communicable diseases and tropical diseases.
  • The Ministry of Heath of Ghana receives mobile clinic facilitates to boost health delivery and improving health care access to people.
  • Health groups at the United Nations –backed Global Vaccine Summit announced that they will get rid of polio by 2018 with $5.5 billion vaccination and monitoring plan to stop this disease.
  • The U.S Food and Drug Administration has announced the development of a new hand held device called C-3 capable of detecting substandard or counterfeit anti-malaria medicines.
  • World athletics governing body IAAF will open a blood test center (BTC) in Kenya’s rift Valley town of Eldoret for Kenyan and Ethiopian runners.
  • A donation of US $2.3 million has been announced by the Government of Japan to the United Nations World Food Program to assist people of Lesotho to help to boost food security.
  • Japan donates US$1.5 million to Nambia for its rapid reduction of child mortality, malaria related deaths and mother-to-child HIV transmission rates.
  • The Federal government of Canada will allocate $250 million between 2013 and 2018 to support eradication of polio in Afghanistan, Nigeria and Pakistan.
  • European Union has pledged more than 14.5 million euros to support Sudan health-related programs.

 Research:

  • The International Union against Tuberculosis and Lung disease has issued guidelines for multidrug resistant tuberculosis bacteria management – appropriate treatment.
  • According to an analysis of previous studies published in the British Medical Journal, smokers with HIV were at double risk of contracting bacteria pneumonia compared to HIV-positive non-smokers.
  • According to the data obtained from a recently published study, childhood malaria admission rates in three out of four hospital chosen for the purpose of study in Malawi has increased between 2000- 2010. An increase from 41 to 100% was noted.
  • According to a survey more men die due to HIV related deaths as compared to women. It was due their living in denial and failed access to treatment.
  • A study published in American College of Nutrition suggests that intake of minerals zinc and chromium or taking zinc and or chromium supplements helps people suffering from type 2 diabetes.
  • According to a survey in done in the U.K., parents risk children’s future health by failing to understand sun protection.
  • In a study done by the Chinese scientists there is no evidence that new bid flu passes between people.
  • Haiti launches its vaccination campaign against fatal childhood diseases.

Diseases & Disasters:

  • The U.S. Department of State has issued a travel warning to the people who are planning to travel to Democratic Republic of Congo.
  • The Centers of Disease Control and Prevention (CDC) has announced a nationwide shortage of products used in Tuberculosis skin testing.
  • The reports state that the outbreak of meningitis has killed at least 40 people in Guinea since the beginning of 2013. About 379 cases of this disease have been reported.
  • According to the reports communities in Northern Mali – Gao, Timbuktu and Kidal- are affected by food crises.
  • The bird flu H7N9 cases are rising in China. A total of 120 cases have been reported till now of which 23 deaths have been confirmed.
  • Air pollution rising in China. The level of air pollutants has risen to more than 40 times the recommended exposure limits.
  • According to the press release, two more human cases of avian influenza virus A – H7N9 has been verified by the Centre for Health protection (CHP) of the Department of Health of Hong Kong.
  • Reports have confirmed H7N9 bird flu in Taiwan.
  • According to the CDC, salmonella outbreak linked to cucumbers grown in Mexico.

Global Health Weekly News Round-Up

  • National HIV testing day is Wednesday.

Politics and Policies

  • Health care proposal gives Louisiana more Medicaid spending flexibility.
  • Azerbaijan can prohibit abortion.

Programs

  • U.S. forces support anti-malaria health campaign in Africa.
  • Commonwealth to tackle non-communicable disease in West Africa. Meetings will explore plans to deal with NCD’s such as diabetes, cardiovascular diseases and chronic respiratory diseases.
  • Scientists at the University of Saskatchewan have teamed up with researchers in Ethiopia and Kenya in the two innovative projects to help deliver safer and more nutritious food in Africa through better plant breeding and soil management and a state-of-art vaccine for cattle.
  • McCann Health pledges to help end preventable child deaths; joins USAID’s new public-private partnership. It has announced $5 million commitment of in-kind resources and technical assistance to accelerate progress towards ending this problem.
  • United Nations and its partners have made a global appeal for $1.6 billion to provide humanitarian relief to Nigeria, Burkina Faso, Mali, Mauritania, Chad, Niger, Cameroon, Gambia and Senegal.
  • The United Nations Children’s Fund (UNICEF) office in Gambia has recently supported the government of Gambia to respond to the severe malnutrition of children, by providing highly nutritious products.
  • DHL (Gambia office) donates 150 cartons of long lasting insecticide treated mosquito nets (LLINS) to the Ministry of Health and Social Welfare as a part of contribution towards the fight against malaria in this country.
  • The government and donors have finalized plans for a Sh400 million cancer treatment and chronic diseases center in Eldoret (Kenya).
  • Council of Ministers in South Sudan has approved U.S. $173 million to construct 100 health units.
  • The Global Fund has resumed support to Zambia with a $100 million grant to help the country to fight AIDS.
  • India to receive Rs 20 crore healthcare grant from Norway to improve rural health services to further reduce child and maternal mortality.
  • Recall stops New Zealand tuberculosis vaccinations.

Research

  •  The scientists from the University of Cambridge Metabolic Research Laboratories at the Institute of Metabolic Science, UK, have found the genes responsible for a disease in which parts of the body grow disproportionately. They found this disorder was linked to a mutation that drives cell growth.
  • According to recent study done by the researchers from Glasgow outdoor physical activities like walking, running, biking had a 50 percent greater positive effect on mental health than going to gym. They found that the activities through green space lowered the stress level.
  • A study published recently describes the biodiversity and epidemiology of drug-susceptible and drug-resistant tuberculosis in Ibadan, Nnewi and Abuja, using 409 DNAs extracted from culture positive TB isolates.
  • A research published in BMC Public Health by the researchers from the London School of Hygiene and Tropical Medicine indicates global weight gain more damaging than rising numbers. They say if the increasing levels of fatness are replicated globally it could mean the equivalent of an extra billion people on the planet.
  • A study brings forward unwanted pregnancy and associated factors among the pregnant married women in Hosanna town in Southern Ethiopia.
  • A survey named as ‘Integrated Biological and Behavioral Surveillance among Migrant Female Sex Workers in Nairobi’ indicates that female sex workers from Somalia have a little knowledge about the deadly HIV/AIDS.
  • A new research at MIT could improve the ability of untrained workers to perform basic ultrasound tests, while allowing trained workers to much more accurately track the development of mental conditions such as the growth of a tumor or the buildup of plaque in arteries.
  • A study indicated that the oral health status of patients with mental disorders in Southwest Ethiopia is poor. There is a need to impart education about the oral hygiene to them.
  • A study shows how easily pandemic H5N1 bird flu could evolve. Their main conclusion was that this virus can acquire the ability of aerosol transmission between mammals. Mutations as low as 5 (but certainly less than 10) are sufficient to make H5N1 virus airborne.
  • A study reveals that the teens that spend more time indoors in front of screens are more likely to feel lonely and shy, while those who spend their time outdoors are much happier.
  • Study shows that the genetically modified cows produce healthier milk. This milk can be consumed by the lactose intolerant people. One more study shows that this milk contains healthy fat like that found in fishes. Chinese have produced this milk which has same properties as human breast milk.
  • A study suggests that cauterization of a peculiar population of stem-like sells in a part of cervix when infected by human papilloma virus can be a method of prevention of this deadly infection.
  • A team of scientists in Singapore have discovered a human antibody that can kill the dengue virus within two hours.
  • According to a study, to reduce the diabetes risk we should eat slowly.

Diseases and Disasters

  • Two fatal cases of Vibrio vulnificus infection investigated in Hong Kong.

Noncommunicable Disease conference – March 2012

APHA members may be interested in an upcoming conference concerning Non Communicable Diseases (NCDs) in Children and Adolescents in Global Health.  The conference is being organized by a consortium known as NCD Child, which includes Caring and Living and Neighbors, the Public Health Institute, and the Global Health Council.  It will take place in Oakland, California during March 19-21, at the California Endowment’s conference center.  Themes to be covered include prevention, access to essential medicines, and health systems strengthening/work force development for NCDs in these vulnerable groups.  Individuals working in the field of NCDs, maternal and child health, social determinants of health, prevention as well as those advocating on behalf of these issues, are warmly welcome to apply.  A limited number of scholarships for students and individuals from outside the United States is available.

A draft program and application is here: www.ncdchild.com

This link also contains a call for abstracts, which closes on February 6.

Questions about this conference may be directed to APHA International Section member Jeff Meer of the Public Health Institute, at jmeer@phi.org.