Global Health: The Need for Consensus

Greg Perry

As a Brit living and working abroad, I am transfixed by what I’m witnessing together with many others, as the fallout from the June 2016 referendum continues to wrack the UK political landscape. As scenarios, timelines, policy implications (including for the pharmaceutical industry), costs to people and the economy are being traded from all sides, I’m hard put to find anything positive to learn from it all – except that you can’t make progress without consensus.

This holds true for those of us who are passionate about global health and would like to grasp the unparalleled opportunity that the WHO Roadmap report on Access to Medicines and Vaccines[1] presents. It will be considered by all 193-member states at this year’s World Health Assembly and is on the agenda of the WHO Executive Board this month.

I believe that the access roadmap is an unparalleled opportunity for WHO to address immediate patient needs worldwide. But I am strongly of the view this will only be possible if a pragmatic approach that focuses on a limited set of specific and measurable priorities which command widespread international consensus.  Therefore, work in “ensuring the quality, safety and efficacy of health products” should by and large take priority, as they have a high impact on health outcomes. This is critical to avoid any potential stalemates.  I guess you might say, this is the equivalent of avoiding a “no deal Brexit” that will only lead to further lengthy wrangling, not to mention the impact on people and the economy.

The access roadmap will only make a significant impact on patients if its implementation is based on work which is consensus-based, financially viable, and measurable in terms of health outcomes. Surely this is the end goal that we all want to put our names to.

Today, the WHO estimates that nearly half of all medicines are inappropriately prescribed, dispensed or sold, making this an urgent issue for the global health community to focus on. Reversing this trend would significantly improve health outcomes, especially when it comes to appropriate stewardship of antimicrobials. We also need to focus on improved patient adherence: according to the IMS Institute for Health Informatics, a staggering $269 billion per year could be saved if health systems worldwide tackled patient adherence to treatment. 

Prioritizing these issues would also help foster wider collaboration among governments, payers, health care professionals, pharmaceutical manufacturers, distributors, wholesalers, retailers, and national regulatory and enforcement agencies. More generally, the roadmap report provides an opportunity for the WHO to make a timely and significant impact in promoting stronger regulatory systems, appropriate prescribing, dispensing and use of medicines, good procurement and supply chain management. 

One thing that focuses minds is prioritizing, streamlining and establishing the budget and resources needed.  The access roadmap is an ambitious workplan made up of dozens of actions. The way forward should be to assess resource allocation needs and prioritize as necessary. Armed with the information, the WHO can then focus on achievable outcomes that provide adequate return on investment to its members and, ultimately, to patients and society at large. Then at least the decisions to reach a consensus can be taken in the full knowledge of their feasibility and the added value.   

As Member States work with the WHO over the coming months, we need pragmatism, focus on what really matters to patients, and finding the win/win rather than getting stuck in the weeds on the lose/lose.

My message of goodwill for 2019 is that of Charles Darwin more than 150 years ago: “In the long history of humankind (and animal kind, too), those who learned to collaborate and improvise most effectively have prevailed.”

Greg Perry is Assistant Director General of the International Federation of Pharmaceutical Manufacturers & Association (IFPMA).