Friday, October 24, 2014

Uncertain Health in an Insecure World - 2

"Won’t Get Fooled Again" 
(Pete Townshend, The Who)

Pandemics are proof positive of global interdependence. They demand that the developed world meaningfully engage with less developed communities.  Fragile developed world health care systems are struggling to effectively manage pre-existing chronic diseases in the face of infectious flare-ups. Long-term medical conditions are now also creating health burdens in emerging economies.

You’ve really got to “Smile and grin at the change all around”.

Communicable diseases (HIV/AIDS, malaria, tuberculosis, diarrheal diseases) kill ~10 million persons annually, mainly in low and middle income countries. The World Health Organization (WHO) categorizes TB as a global health “crisis”, estimating that 9 million people developed tuberculosis (TB) in 2013, of which 1.5 million died (20% of deaths were HIV/AIDS-associated). WHO states that, “$8 billion is needed each year to find and treat patients and to invest in better drugs and work on a vaccine”. By comparison, the 2014 Ebola death rate is approaching 5,000, mostly in three West African countries. The World Bank estimates the global economic impact of the current Ebola outbreak at $32 billion. 

More mind-boggling is the tectonic shift in the global non-communicable diseases (NCD) burden. In 2011, WHO reported that NCD deaths in developing countries doubled to 80% of global NCD deaths since 1990. By 2030, low-income countries will have 8x more NCD deaths than high-income countries. The familiar (to developed countries) risks are tobacco, alcohol, sedentary lifestyle and obesity. The predictable results are more cardiovascular disease, cancers, diabetes, lung disease and mental illness. The World Bank estimates the shocking global NCD price tag at $21 trillion over the next two decades!

This worldwide conflation of chronic diseases and pandemics generates vexing questions & answers:
Q: Can the same system that annually runs out of flu shots for millions of the vulnerable & elderly manufacture sufficient ZMapp™ monoclonal antibody doses for >10,000 Ebola victims? 
A: Pick your poison! – In population health terms, the erosive effect of dis-integrated medical care is at least as costly and socially damaging as the explosive and scary threat of global contagion.

WHO global TB program director, Dr. Mario Raviglione, recently opined “the pharmaceutical industry is less interested in developing countries, where potential gains are limited”. Less well appreciated is Big Pharma’s business model for addressing deadly co-existing chronic and communicable diseases. While aggressively growing their developed world markets +10-13%/year via high-margin diabetes specialty drugs and personalized cancer medicines, global pharmaceutical companies are also key players in the less developed world’s compassionate care of neglected tropical diseases (NTD’s) and HIV/AIDS-related multi-drug resistant tuberculosis (MDR-TB). Should Big Pharma cover the $2 billion annual shortfall in TB treatment & prevention funding in these countries by cost-shifting to the developed world?

Today, we’re all inside The Circle of risk.

So no matter where you walk in The Square, don’t be fooled again

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