Center for Global Health R&D Policy Assessment

The undercurrent of this year’s annual Global Health Council Conference, “Securing a Healthier Future in a Changing World” is the growing challenge of addressing non-communicable diseases (NCDs) in low- and middle-income countries (LMICs).

The opening plenary reinforced the urgency of this problem—Dr. Felicia Knaul of the Harvard Medical School noted that 80% of preventable cancer deaths occur in low and middle income countries. Statistics for other NCDs, such as diabetes and cardiovascular disease, tell a similar story. Rather than succumbing to the debate of whether developing countries should invest in infectious disease or NCD strategies, Dr. Knaul explained that addressing NCDs does not require diverting funding away from infectious and neglected diseases. Instead, cancer prevention and screening activities can be diagonally layered onto existing disease programs.

But one difference between NCDs and neglected diseases is quite clear: NCDs will require different, and possibly new, ways of collaboration. Since there is significant potential to earn profit through sales to the upper and middle class in LMICs, intellectual property negotiations and licensing arrangements may be trickier. For NCDs, health impact based rewards could be an interesting alternative to the current approaches to advance neglected disease technologies.

The global economic burden posed by NCDs—an estimated USD $6-19 trillion in 2010 alone, as announced by Dr. David Bloom of the Harvard School of Public Health at a session on NCDs at the conference on Tuesday—certainly calls for their inclusion in health systems strengthening activities, but how should the R&D community respond? R&D for NCDs is not neglected in quite the same way as product development for the most neglected diseases. NCD technologies have significant market potential around the world, and firms in both low and high income countries are devoting substantial resources to address some of them. Perhaps it is just a question of access, of ensuring that products are available at reasonable cost to those who need them? Or of late-stage modifications to existing products to make sure that they meet local needs?

There are already emerging responses to the growing presence of NCDs in developing countries. For example, strong advocacy efforts for providing access to the HPV vaccine to prevent cervical cancer in LMICs are underway. A PDP could emerge to explore the NCD needs of developing countries that are missed in current research initiatives.

As NCDs are the world’s greatest cause of mortality and morbidity and as these conditions increase in both high and low income countries, it is important for the global health community to better understand the hurdles that we face and to explore new approaches in order to secure a healthier future in a changing world.