• Ann-Lise Mikolajczak & Herb Riband - Switzerland

Invest now to beat NCDs

A world that rallied together to tackle the covid-19 pandemic must stay united in the fight against non-communicable diseases through timely and adequate funding



This year’s Global Week of Action on NCDs sends an important message to governments, donors, international agencies, and the private sector: Invest in NCD (non-communicable diseases) prevention and quality care today to save lives and money tomorrow. We support this call to action by the NCD Alliance, the Coalition for Access to NCD Medicines & Products, and many others in the global health community.


Financing health, including NCD prevention, must be top of mind for the global health community particularly after the huge losses collectively experienced over the past two and a half years. During this period, stakeholders worked together to develop new tools, resources, and approaches to combat the scourge of covid-19. While it was necessary to dedicate our attention to thwart a global pandemic, health systems worldwide have been severely strained, with significant consequences for many lives.


The covid-19 pandemic showed us that underinvestment in resilient health systems hampers NCD prevention and care, critical immunisations, and universal health coverage (UHC). It is clear that disease-specific approaches are inadequate to ensure global health security, leaving low- and middle-income countries (LMICs) particularly at risk. Health stakeholders must together build integrated programmes and services to bridge the gap between NCDs and other global health priorities.


Urgent investment is required. The WHO has obtained a commitment for increased contributions by member states over the coming decade. The Global Fund to Fight AIDS, TB, and Malaria is seeking US$18 billion from countries for its seventh replenishment. And The Lancet NCD Countdown 2030 calls on governments, international donors, and other stakeholders to invest US$18 billion annually during 2023-30 in interventions to meet UN Sustainable Development Goals (SDGs) targets.

Amid these calls for more resources for global health, the case for investment in NCDs has never been stronger. Despite commitments from UN member states over the past ten years, there has been no increase in financing for NCDs. As a result, most countries are nowhere near reaching UN SDG target 3.4 (a one-third reduction in preventable NCD mortality) and target 3.8 (achievement of UHC). People living with NCDs continue to lack access to prevention measures and quality care.


The NCD Alliance’s Invest to Protect policy brief highlights both the massive global burden of NCDs and the compelling need for investment to address them:

• The human and economic toll of NCDs is unacceptable, inequitable, and increasing around the world. NCDs drain the global economy, pose a powerful threat to human capital, and perpetuate poverty in households and communities. The cost of inaction on select high-burden NCDs in LMICs is estimated to be US$7 trillion during 2011-25, equivalent to 4% of LMIC GDP.

• Implementing the “WHO NCD Best Buys” in LMICs would save 7 million lives, avert 10 million cases of heart disease and stroke, add 50 million years of healthy life, and help realise US$230 billion in economic gains ¬— representing a return on investment of 7:1.

• The Lancet NCD Countdown 2030 asserts that 90% of countries can achieve UN SDG target 3.4 through cost-effective NCD interventions, which would avert 39 million deaths in LMICs during 2023-30. An additional investment of US$18 billion a year from 2023-30 would generate an average net economic benefit of US$2.7 trillion, or US$390 per capita, representing a return on investment of 19:1.





Despite this compelling projection, Invest to Protect reveals a huge and persistent investment gap. NCDs do not receive enough priority in most LMICs, evidenced by a dearth of local public, private, and philanthropic financing. While data for LMIC spend on NCDs is scarce, the WHO and others have highlighted that it is much lower, compared with the spend on infectious diseases, and out-of-pocket spending is much higher for NCD patients. At a global level, Development Assistance for Health (DAH) provided by international donors remains heavily focused on infectious diseases and maternal and child health, with just 0.6%-1.6% allocated specifically for NCDs over the past 30 years.


Making a compelling case for increased NCD funding rests on demonstrating that money will be well spent, leading to efficient NCD prevention and access to quality care, and, ultimately, improved patient health outcomes. This, in turn, calls for primary health care systems that are community-centered, and adequately staffed and equipped. To finance this, LMICs can leverage multiple sources — domestic, development, and innovative financing models, as well as philanthropic and private sector investments. A resulting “blended” stream of NCD funding will ensure sustainability.


In 2023, governments and international institutions, including the WHO and the World Bank, will meet for a second global dialogue on financing national NCD responses. We sincerely hope that this dialogue will set out specific goals and commitments to build on the post-pandemic momentum. We strongly urge the global health community to rise to the occasion — and demonstrate that increased investments are being made now to beat NCDs.


 

Ann-Lise Mikolajczak is Manager, Global Health and Access, for the Geneva-based International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).


Herb Riband is an independent global health and healthcare consultant based in Switzerland who serves as Senior Advisor, Global Health and Access, to IFPMA.


Acknowledgments

The Coalition for Access to NCD Medicines and Products was consulted in the drafting of this article, with thanks to Helen McGuire, David Heller, Jeremy Schwartz, Prashant Yadav, Kaushik Ramaiya, Andrea Feigl, Jean Claude Mbanya, James Reid, and Johannes van Dam.