Infectious diseases still pose a significant burden on global health. New and collaborative approaches are needed to effectively combat widespread infections and defeat new epidemic and pandemic threats. The Clinton Health Access Initiative (CHAI) and FIND, an international nonprofit organization that focuses on poverty-related diseases, are two examples of how to find the right combination of partners and approaches.
Ira Magaziner’s work focuses on people who effectively are twice denied access to medical care. Not only do they lack the financial resources for medical care; they also live in remote areas that are cut off from basic medical services.
“We are talking about people who live on less than a dollar a day, and are often several days away from the nearest doctor,” says Magaziner, CEO of the Clinton Health Access Initiative. The foundation’s goal is to provide access to healthcare for millions of residents in low- and middle-income countries. Today, CHAI operates in 33 countries across the developing world that account for about one-third of the world’s population, and more than 70 countries access CHAI-negotiated price reductions for drugs, vaccines, medical devices and diagnostics.
Magaziner seems to be predestined for this venture: He worked as a consultant to multinational corporations, later he developed health reforms in the Clinton administration. In his current role at CHAI, he brings governments and corporations together for the benefit of people most in need.
Burden of disease
The urgency for such partnerships is great. Looking at reports such as the Global Burden of Disease Study published in the medical journal The Lancet, the absolute threat of infectious diseases is dwindling. In 2015, seven out of 10 deaths were attributable to life circumstances or age. Only two out of 10 people died from an infectious disease. In 1990 this figure stood at one-third. Since 2005, fatalities due to HIV/AIDS and malaria have fallen by more than 40 percent.
But the report reveals disturbing facts if it is broken down into individual regions and diseases. According to World Health Organization projections, in 2015 more than seven million people in Africa and Southeast Asia alone succumbed to infectious diseases. And the proportion of deaths from infectious diseases still differs vastly between low-income countries and industrialized regions. For many, a lack of diagnosis thwarts any hope of treatment.
At the same time, recent Ebola and Zika outbreaks show how vulnerable humanity remains to infectious agents in a globalized world. In addition, there are many “old acquaintances” that have so far defied all attempts to control them: tuberculosis is resurgent, especially in Eastern Europe, malaria is still responsible for millions of fatalities in Africa, and diseases such as West Nile or dengue fever spread as a result of climate change.
So how to tackle this problem? The eradication of an infectious disease requires a well-orchestrated action by different actors from politics and business as well as a lot of money. This is precisely the prerequisite that developing and newly industrialized countries lack.
“It is a tragic chain of negative developments that amplify themselves,” says Magaziner. In struggling African economies, for example, there is no demand for companies to scale production processes and thus lower prices. There is a lack of demand and therefore supply.
“This is exactly where we begin,” says Magaziner. Initially with what looks like a bad deal for companies: “We offer discounts for therapies or diagnostics that account for up to 80 percent of current market prices.”
But the deals actually work out to be profitable for companies. CHAI helps organize the markets in a way that can bring large, predictable volumes to companies allowing them to lower their cost of production and distribution, meaning they can offer the lower prices, achieve much higher volumes and still earn a profit.
“These agreements allow companies to plan on reliable sales volumes, for example, such as the assurance of several governments to purchase a fixed amount over a certain period of time. We organize a buyers club, so to speak,” says Magaziner.
In this way, for example, the cost of the annual therapy of first-line HIV drugs could be cut from more than $500 per person per year to $70 and companies could still earn a profit. A win-win-win-situation, Magaziner calls it. Governments, businesses, and especially people who otherwise have no access to the diagnosis or treatment of infectious diseases all benefit.
To date, CHAI has been able to enter into more than 120 agreements with pharmaceutical, medical device and biotechnology companies on behalf of the governments of developing countries.
Medicines and Coca-Cola
If these projects succeed, companies can optimize their production and marketing processes and scale up. “Often we also help organize the logistics, so that we can reach people in the most remote areas through our network.”
In Africa, for example, historically, studies show that up to 70 percent of the vaccine supply could expire because the cold chain is interrupted during transport. “We worked with companies to help develop refrigeration units that are guaranteed to hold their temperature up to three weeks, even without electricity,” says Magaziner.
In organizing drug distribution, CHAI cooperates with a company that may have one of the largest logistics network worldwide: Coca-Cola. “You can find the soft drink in any African village, no matter how remote it is,” says Magaziner. “Ultimately we find a solution – which can range from truck to donkey – for regions in each country.”
According to Magaziner, aid and profit are related: “Health built on charity does not work, at least not sustainably.” It is important that countries build their own systems for financing healthcare whether through government budgets or health insurance schemes, he says. Ethiopia, South Africa and Rwanda are already establishing such funds.
Building a diagnostic infrastructure
Diagnosis is of fundamental importance in developing healthcare systems. In these countries, not just treatment and drugs are missing but also laboratories and diagnostic technologies. This frequently forces patients to travel long distances, and it can take a long time to return the test results. Yet the fight against infectious and other diseases is lost if doctors can’t identify the enemy.
Together with QIAGEN, CHAI is currently preparing an human papillomavirus testing program in Africa utilizing a system called careHPV. QIAGEN specifically developed the system together with international health organization PATH and support from the Bill and Melinda Gates Foundation for use in low-resource settings. “HPV plus cervical cancer is still a death sentence in remote areas. With an extensive series of tests, we want to implement a screen-and-treat campaign,” says Magaziner. Efficient HPV diagnostics give a chance to begin treatment early, which gives patients a better shot at being cured, and at the same time lowers the cost per treatment.
This effect is likely to be duplicated for any infectious disease if profound diagnostics are a big part of the battle plan. As Magaziner says: “Even if we negotiate big discounts with companies, drug costs often remain considerable. It is all the more important to use them only when it is really appropriate.” A malaria drug is still more expensive than an antibiotic. Too often a common cold with a fever is assumed to be malaria and more expensive and less effective treatment is prescribed. For many people, a few dollars spell the difference between life and death.