It’s been gratifying to see the World Health Organization (WHO) use its voice to insist that universal health coverage – the idea that everyone everywhere should be able to access quality health services and medicines – is an essential component for achieving the Sustainable Development Goals. It has successfully put universal health coverage, or UHC, high on the agenda at this autumn’s United Nations General Assembly.
But in a world where half the population lacks essential healthcare, key questions immediately arise: how do we achieve UHC and how do we pay for it?
We expect both questions will be on the menu when G20 health and finance ministers sit down for a working dinner in Japan on the sidelines of the G20 Leaders Summit in Osaka. It’s the first meeting of its kind, but something that will need to be commonplace to create a world where health coverage is a human right, not a luxury.
As people whose work is devoted to leveraging the power of research and innovation to reduce global health disparities, we have been closely attuned to the increasing focus on UHC, and the very real challenge of mobilizing financing to address the health needs of the world’s poorest populations. We think our experience can offer a few insights relevant to both achieving and financing UHC.
First, we believe that achieving this goal will require significant new public sector investments in research and development (R&D) to deliver targeted innovations to underserved communities in low and middle-income countries.
We also believe that two decades of innovative financing and public-private partnerships (PPP), which have delivered breakthrough global health solutions, provide a model for using government investments to leverage industry assets that can move us closer to the goals of universal coverage.
Innovation is critical
But first, it’s fair to ask: why is innovation critical to UHC? Isn’t essential healthcare something that is already available somewhere, just not accessible to everybody everywhere? Actually, that’s not true.
Consider tuberculosis (TB), which now affects one quarter of the world’s population, mostly people in low and middle-income countries. So for about 2 billion people, essential health coverage requires effectively diagnosing and treating TB.
Yet most TB treatments are nearly 50 years old and require six months to two years of swallowing a mind-boggling assortment of drugs. Some are toxic, and they are failing against the growing number of drug-resistant infections.
But new solutions are emerging. Earlier this month, an advisory panel at the US Food and Drug Administration voted in favour of a new drug regimen for highly drug-resistant forms of TB. The regimen emerged from a consortium that uses funding from a number of governments and philanthropies to encourage industry partners to develop new TB treatments.
Another PPP model, Japan's Global Health Innovative Technology (GHIT) Fund, was originally conceived, conceptualized, and institutionalized by the leadership of Japanese pharmaceutical companies to utilize their innovations and technologies for patients around the globe who are suffering from neglected diseases.
The GHIT Fund established an innovative financing model to drive global health innovations through partnerships between the Government of Japan, pharmaceutical and life science companies, the Bill and Melinda Gates Foundation, and the Wellcome Trust. For example, GHIT Fund has invested in a partnership between FUJIFILM Corporation and the Foundation for Innovative New Diagnostics to develop a rapid diagnostic test for TB in HIV-positive patients. It requires just a urine sample, an alternative to poor quality, invasive tests that cause many TB infections to go undetected and untreated.
Meanwhile other PPPs are producing new solutions for a number of neglected diseases, such as malaria, Chagas, and sleeping sickness. Because these diseases disproportionately impact poor countries, there is a lack of commercial incentive to attract industry investment. Going forward, achieving UHC in many parts of the world will require more innovative financing for innovation.
The quest for government funds
It’s been gratifying that world leaders, in organizing the upcoming United Nations High-Level Meeting on Universal Health Coverage, have explicitly acknowledged the need for public-health driven R&D, as well as incentives that bring together public and private sector partners to advance new health products. But how do we convince finance ministers to animate these worthy goals with significant new funding?
For starters, they can look at how the partnerships now delivering global health innovations have successfully used an infusion of new government funds to de-risk a sizeable industry investment that otherwise would be impossible to justify to shareholders.
But the benefits for G20 countries go beyond wisely allocating government dollars. The G20 is an economic alliance, and health is increasingly an economic issue. For example, in malaria endemic countries alone, a 10% reduction in infections has been associated with a 0.3% bump in economic growth. That’s a figure worth noting at the Japan G20 as drug-resistant malaria continues to spread among critical Japanese trading partners like Thailand and Vietnam. And the only solution is to make the investments that can deliver new malaria innovations.
Meanwhile, global health R&D can stimulate growth in donor countries as well. A 2017 study found that in the United States, over an eight year period, US government investments in developing global health technologies generated 200,000 domestic jobs and $33 billion in economic growth.
An achievable endeavour
It’s a lot to ask of G20 ministers sitting down for a mere two hour dinner to digest all of the many reasons greater investments global health R&D are critical to meeting the goals of UHC, and why making substantial new commitments to innovative financing can deliver a range of global health advances that offer G20 countries a rich diversity of economic returns.
But for too long the agendas of health and finance ministers have seemed to exist in separate, sometimes even antagonistic orbits. And private sector interests have had a hard time seeing the business case for investing in global health equity.
But the good news is that there are proven approaches that deliver tangible results and effectively leverage co-investments from government as well as industry partners that can help bridge these divides. They can also start transforming the push for UHC from a seemingly quixotic journey to a realistic, achievable endeavour.