Shawview Consulting’s Brendan Shaw looks back on a sombre United Nations High Level Meeting on Universal Health Coverage in New York last month, as stakeholders reflected on the long road still to travel if the goal of securing UHC for the world’s population by 2030 is to be met. Shaw outlines his recommendations for what needs to happen next to supercharge the currently stalled progress and highlights what role pharmaceutical companies need to play.

 

Ultimately, universal health coverage is a choice – a political choice

Dr Tedros Adhanom Ghebreyesus, Director General, World Health Organization, September 2023

 

The world is off track to make significant progress towards universal health coverage (UHC) (Sustainable Development Goals (SDGs) target 3.8) by 2030 as improvements to health services coverage have stagnated since 2015, and the proportion of the population that faced catastrophic levels of out-of-pocket health spending has increased

WHO and World Bank, Tracking Universal Health Coverage 2023 Global Monitoring Report, p. xi, September 2023

 

Spare a thought for World Health Organization Director General, Dr Tedros Adhanom Ghebreyesus.

For years, he has been calling for greater leadership from governments and political leaders on the need to implement universal health coverage (UHC).

Yet, at the half-way point in our agenda to improve global health, there was a sombre mood at the United Nations High Level Meeting on Universal Health Coverage in New York last month.

The normally placid diplomatic environment was marked by palpable regret as governments, international organisations and other stakeholders gathered to mark the world down on progress in achieving the often-stated goal of securing UHC for the world’s population by 2030.

At what is now the half-way mark to achieving this goal by 2030, the news is not good.

But amid all the gloom and doom, there’s an opportunity here for pharmaceutical companies.

 

Progress towards UHC is stalled

The key message coming out of the UN High Level Meeting on UHC, the follow-up meeting to the first one held in 2019, is that progress towards securing UHC has stalled. In many cases, progress has gone backwards.

Back in 2015, world leaders agreed to purse the UN 2030 Sustainable Development Goals (SDGs). Building on the back of the earlier Millenium Goals, the 2030 SDGs include a wider range of commitments to improve global health.

The commitment to UHC made in 2015 was to “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”

Even at the first High Level Meeting on UHC held in September 2019 before the COVID-19 pandemic, world leaders identified that progress in achieved the SDGs was too slow to meet the 2030 target. Back then, there were calls for more political leadership, priority and action from all countries and stakeholders to drive the implementation of UHC.

Then the COVID-19 pandemic happened.

While the final declaration from last month’s second High Level Meeting notes that the pandemic played a part in delaying progress, the global UHC agenda was already in deep trouble long before COVID-19.

And now, the situation is worse.

Today, at the half-way point of that 15-year period between 2015 and 2030, we as a planet are at risk of not achieving anything like the goals that we set ourselves.

 

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The High Level Meeting’s final declaration makes for grim reading.

For a diplomatic document, the language in the final declaration is pretty blunt. Member States expressed their:

“deep concern that the level of progress and investment to date remain insufficient to meet target 3.8 (Health) of the Sustainable Development Goals, and that at the current pace of progress towards universal health coverage up to one-third of the world’s population will remain underserved by 2030.”

As the UN media statement on the meeting notes, Member States themselves highlighted that:

“no progress has been made since 2019 in expanding health coverage globally.”

In what some have called a ‘litany of failures’, the list of indicators and targets where we are falling short is sobering. The pages of the declaration note Member States’ “regret” about the lack of progress and are filled with missed targets, botched attempts and policy drift. Just a few examples include:

  • Trends in financial protection are worsening, with the incidence of catastrophic out-of-pocket spending on health (ie. spending where the patient or the family must pay themselves) has increased from 12.6 percent in 2015 to 13.5 percent in 2019.
  • Four percent of the world’s population were pushed further into extreme poverty due to out-of-pocket payments for health.
  • We have missed the global target to provide 1 billion additional people with quality essential health care, medicines, vaccines, diagnostics and health technology by 2023 by a long shot – 523 million people, to be exact.
    • Over half a billion people – the equivalent to more than the combined populations of the United States and Indonesia – were supposed to have health coverage by now but do not.
  • Progress on achieving a range of health objectives, like reducing communicable disease, non-communicable diseases, improving vision, antimicrobial resistance, infant and child mortality ranges from mixed to woeful.
    • For example, world leaders noted that progress in reducing maternal deaths during childbirth has “stagnated”, with almost all of the 800 women in the world dying each and every day from pregnancy and childbirth living in low- and lower-middle income countries.
    • Another example is childhood immunisation, where 25 million children under the age of 5 years missed out on routine immunisation in 2021, this is a five percent decline in immunisation rates since 2019 and is the largest sustained decline in childhood vaccinations in around 30 years.

The message to world leaders from the WHO and the World Bank in its latest report on progress towards UHC was equally blunt:

“improvements to health services coverage have stagnated since 2015.”

So, while the world has made progress since 2000 with the original Millenium Development Goals, since the SDGs were launched in 2015, not much additional progress has been made.

 

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As the WHO and World Bank highlight, most countries (108 out of 194) experienced worsening or no significant change in universal health service coverage since the launch of the UN SDGs in 2015.

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What did we learn from the pandemic?

And all of this today in the shadow of probably the worst global pandemic the world has experienced in a century; one that has killed somewhere between 5 million and 30 million people in the last 4 years.

For all the talk over the last 4 years about how important health systems, health policies, health technologies and health workers are to global prosperity, social cohesion and economic prosperity, the High Level Meeting declaration says that we have a lot more to do.

If we are going to have any chance of even getting close to achieving the UHC goals we’ve set ourselves by 2030, it is going to take a level of international commitment, investment and cooperation like many countries are currently trying to invest in decoupling the global economy, decarbonising society and building up military capability.

Here, at the half-way point to 2030, and with the benefit of a lesson from COVID-19 on the importance of health to society, we still have a long way to go.

The upshot is that today we have 7 years left to achieve 15 years of work in getting universal health coverage to everyone in the world.

 

What needs to happen?

As the High Level Meeting on UHC made plain, we need political leadership to renew investment and priority in implementing UHC.

And fast.

In the lead-up to the High Level Meeting, the World Health Organization warned that the one thing needed to get things moving was leadership. Political leadership – which, clearly, has been lacking.

Various academic studies and WHO reports have for years highlighted that lack of political priority and leadership attached to UHC is a key stumbling block to implementation.

WHO head, Dr Tedros, has been saying for years that political leadership is needed to drive the UHC agenda.

The good news is that the ‘vibe’ at the High Level Meeting, and the various statements and commitments from world leaders, governments, politicians and other stakeholders at the meeting focussed on the need for a renewed commitment to achieve the world’s UHC goals.

 

What’s the role of pharmaceutical companies?

The High Level Meeting declaration also says that the high prices of some health products, and the financial hardships associated with these, “continue to impede progress towards universal health coverage”.

While a lot of this financial hardship will be directly due to the chronic underinvestment in health care identified earlier, the opportunity for pharmaceutical companies here is twofold.

The good news is that pharmaceutical companies are already addressing these issues. The last 10 years has seen a flurry of individual company and industry initiatives and programs to improve access to medicines in low- and middle-income countries.

Many of these company programs directly confront the issue of affordability in low-income settings.

There doesn’t seem to be a year that goes by now without a pharmaceutical company or industry group announcing a new access to medicines strategy – and this is a good thing.

The Access To Medicines Foundation’s Reports over the last 15 years paint a picture of an industry that is lifting its game and working hard to provide medicines, vaccines and medical technologies to those people and countries that can’t afford it.

There is still a lot of work to do, be it developing better metrics and reporting on progress, better transparency and understanding about what works and what doesn’t, and ensuring such programs have long-term sustainability plans.

But the pharmaceutical industry is, in a practical way, working to address a key issue in ensuring UHC in 2030.

Pharmaceutical companies have a real opportunity to practice what they preach, to meet their ‘ESG’ goals in a practical way and demonstrate that they are part of the solution to achieving UHC by 2030.

And that leads to the second opportunity for pharmaceutical companies: to get active.

Companies that are demonstrably taking concrete actions to improve things earn the political credibility to advocate for UHC.

Companies that are part of the solution get to demonstrate they’re meeting their ESG goals, build successful commercial businesses, and advocate for governments, politicians, health funders, insurers and other stakeholders to do more.

They get to ask the pointed question to others: ‘We are doing our bit, what are you doing?’

In parallels with what is happening in the climate change debate, imagine if companies in the pharmaceutical sector earned the right to take leadership in driving UHC because to date the political class had failed to lead.

With renewed global commitment, and tight deadlines for completion, pharmaceutical companies could help drive the political agenda on UHC.

That might sound fanciful, but it would be amazing to watch.

 

Brendan Shaw is Principal of Shawview Consulting and an Adjunct Professor at the Pharmacy School, Faculty of Medicine and Health, at the University of Sydney.