In a recent in-depth interview conducted by the Skoll World Forum’s Rahim Kanani, Executive Director of UNICEF Anthony Lake discussed the urgent need to create a commodities market of life-saving medicines in the developing world, arguing that healthy children are good for business.
Rahim Kanani: A number of new reports were released last fall – ‘Levels and Trends in Child Mortality’, from the UN Inter-agency Group for Child Mortality Estimation, ‘Committing to Child Survival: A Promise Renewed’ from UNICEF, and now a plan from the UN Commission on Life-Saving Commodities for Women and Children on improving access to life-saving medicines and health supplies. What sparked such an in-depth engagement on these issues?
Anthony Lake: Urgency. Every day thousands of children are dying of unnecessary causes. And every day we get closer to the Millennium Development Goal deadline of reducing child mortality by two-thirds by 2015. So, these reports are part of our efforts to see what progress we’re making, identify further challenges and, most of all, accelerate the results we’re achieving.
We also know of the responsibility we have to donor governments and partners to show that we’re using the resources they so generously provide to achieve real results and be cost-effective in doing so.
All the reports add to the urgency because they show that progress is possible. And, therefore, there is no excuse for not achieving all the progress we can.
In the 1980s, 36,000 children under five died each day from largely preventable causes. In 1990, that figure was 33,000. In 2000 it was 26,000. Last year, it was 19,000.
This dramatic drop came about through a combination of vaccination programs, nutrition programs, and better water and sanitation. But we cannot celebrate until all children can share in this progress.
It should anger us that most of these 19,000 children die daily from causes we know how to prevent. We have the products and the potential to save these lives. The UN Commission on Life-Saving Commodities for Women and Children shows us how.
By increasing access to thirteen overlooked life-saving medicines and health supplies, care-givers — including health workers — will have a better chance to reach the women and children in greatest need. This isn’t just the right thing to do; it’s the smart thing to do. The economics are compelling.
It should anger us that most of these 19,000 children die daily from causes we know how to prevent. We have the products and the potential to save these lives.
The Commission estimated that an ambitious scaling up of these 13 commodities over five years would cost less than US$2.6 billion and would save over 6 million lives. That is one of the ‘best buys’ in global health today.
Rahim Kanani: In the context of UNICEF’s work, what kinds of commodities or products are we talking about, and how would you describe the current landscape of the market for these products?
Anthony Lake: Commodities that make pregnancy, childbirth and early childhood safe and healthy; commodities that make a difference but get relatively little attention.
These include: Oxytocin and other medicines to prevent maternal hemorrhage; magnesium sulphate to treat eclampsia and save mothers’ lives; resuscitation equipment to treat new-born asphyxia; antibiotics to treat infant sepsis; Amoxicillin to treat pneumonia; and zinc and oral rehydration salts to treat diarrhea. All of these are simple, easy to deliver and cost-effective products.
But they can be out of reach for those most in need.
Too often, markets are not shaped for the poor or for vulnerable children and women. Returns on investments can be too low for manufacturers to enter the market or sustain sufficient levels of production. For instance, magnesium sulphate is highly effective in preventing and treating deadly seizures from high blood pressure during pregnancy. But because it costs very little and the volumes are relatively small, the pharmaceutical companies believe it may not make financial sense to produce it.
Even as we develop incentives for manufacturers to produce and innovate life-saving health supplies, we must also work with our local partners to raise awareness and, thus, demand within communities for these lifesaving commodities.
For example, Long-Lasting Insecticide-treated Nets (LLINs) are critical to fight malaria. Until recently, though, limited competition among producers meant that they were too expensive to scale up. In 2004, there were just 5.6 million bed nets in sub-Saharan Africa. In 2010, bulk buying, joint procurement, better financing and extending manufacturing capacity into Africa meant that that increased to 145 million. Today, 80 per cent of the population in sub-Saharan Africa has access to LLINs, which has contributed to a huge drop in malarial deaths.
Fewer cases of malaria mean that adults are more healthy and productive; more children stay in school and keep learning. In turn, this is good news for nations’ economies.
In short, healthy children are good for business.
Rahim Kanani: What are the challenges and opportunities for establishing competitive markets in this field?
Anthony Lake: The Commission showed that the thirteen “overlooked” commodities face similar challenges. Often the commodities represent little return on investment and, therefore, manufacturers are not encouraged to enter the commodities’ markets. This, in turn, impedes product innovations.
Some of the challenges are also compounded by regulatory issues. In many low-income countries, regulatory agencies are under-resourced and struggle with registering quality health commodities. This further discourages manufacturers from engaging in the market.
Take zinc. It is used to treat diarrhea, one of the two biggest killers of children under five in the world today. In industrialized countries, zinc is classified as a safe mineral supplement and is available in shops and pharmacies without a prescription. In many low-income countries, however, it’s registered as a prescription medicine which is a barrier to its widespread use in treating children with diarrhea. One of the Commission’s recommendations is to standardize and streamline regulation processes to make them more efficient.
To implement its recommendations for the thirteen commodities, the Commission has estimated that it will cost $200 million for three years. This cost could, reasonably, be shared by governments and donors – and it’s a cost that pales in comparison to the benefits that the estimated 6 million healthy and productive children and mothers would bring to their families, communities and nations.
Rahim Kanani: What kind of technology can be rolled out to boost progress?
Anthony Lake: Innovations in technology, delivery systems and creating demand are critical to accelerating our progress cost-effectively and efficiently.
Some recent examples include: auto-disable syringes which have a small internal valve to stop their being reused and spreading diseases; solar fridges that don’t need a battery so that vaccines can be stored in remote villages; and vaccine vial monitors with temperature sensitive stickers that change color if vials have been exposed to high temperatures and rendered unusable.
Often, it’s not about inventing new technologies, but repurposing existing ones.
For instance, mobile technologies, such as cell phones, are improving how we monitor and report on stocks of health commodities. Health workers can text patients to remind them about appointments and give them information about health or nutrition. These technologies are transforming how health is delivered in the developing world, especially in sub-Saharan Africa where there’s a steady expansion in cell phone usage.
Now on the cusp of great change and even greater results, we must work ever more with the private and public sectors to innovate and develop new products and new uses for existing technologies.
We can end preventable child and maternal deaths and if we don’t, shame on us. History will judge us harshly – as well it should.
This was originally published on Skoll World Forum.