How to strengthen healthcare systems against future shocks

Chronic inequalities in access to medicine long predate the current global crisis of COVID-19 vaccine inequity. As an example, each year around 5.7 million people die because they cannot access or afford antibiotics – and the stark reality is that this figure comes from a typical year, rather than one affected by a pandemic. Essential healthcare products remain unaffordable and unavailable in much of the world, particularly affecting the 83% of the world’s population who live in low- and middle-income countries.

Over the past two years, we have witnessed just how worryingly fragile and fragmented our current healthcare systems are, and how vulnerable to disruption. The pandemic showed where the cracks in the system were, and split them open – revealing deep issues with global vaccine inequity and access to medical oxygen, to name two prime examples.

This situation must – and can – be changed. It is certain we will face many other future shocks, whether it be another pandemic caused by a novel influenza virus, the worsening of the already simmering pandemic of antibiotic resistance, or a climate-related disaster affecting critical points along medical supply chains.

To strengthen global and local healthcare systems against these future threats, we must look across the whole spectrum of healthcare. We must ask questions like: how can we make sure hospitals in low-income countries have access to a constant and affordable supply of medical oxygen, so that, for example, a child with pneumonia can receive life-saving treatment, or an operation can be safely carried out under anaesthesia?

Are the right antibiotics always available, so that an infection does not linger or become fatal? Does a doctor have access to the correct diagnostic tools to identify type-1 diabetes in a patient, and does the patient then have long-term access to affordable insulin, needles and monitoring equipment to manage the condition? And can we ensure medical supply chains are strong enough so that access is always guaranteed – even during a period when healthcare systems come under intense strain?

Building a robust and resilient healthcare system requires leadership from the pharmaceutical industry. At the Access to Medicine Foundation, we track performance by companies in this sector through our long-established Access to Medicine Index and other research programmes, and we've recently seen promising changes by some of the largest R&D-based pharmaceutical companies and generic medicine manufacturers in the world, demonstrating what can be achieved when the big players take deliberate steps to address access.

Those companies are making greater use of long-term planning for access in a variety of countries and markets so that key medical products increasingly reach patients living in lower-income countries with a high burden of disease and risk. Some pharma companies have also made progress in building up local capacity, resetting corporate priorities and reshaping long-term investment strategies to impact more lives.

Yet, despite these efforts, progress has been concentrated among a handful of companies, and focused on a limited range of diseases in a small number of countries. Many new treatments – such as breakthrough cancer drugs – remain out of reach to the vast majority in low- and middle-income countries.

The 20 large pharma companies tracked in the Index make use of ‘access strategies’ for less than half of the key products they collectively control. Those strategies could dramatically improve people’s lives by making medicines both available and affordable. Yet as things stand, 930 million people worldwide live on the brink of poverty due to healthcare expenses exceeding 10% of their household budget.

A system is only as strong as its weakest point, and currently, our global healthcare system’s weakest point is access to medicine. In order to change healthcare systems on the vast scale required, we must take a multidimensional, collaborative approach. Vaccine manufacturers, medical gas companies, diagnostics companies and generic medicine manufacturers all play critical roles in increasing access and preparing our system for future shocks, and that is why we plan to mobilise key groups of companies in each of these sectors as we go forward – and move them in the right direction.

There have been promising signs that progress is possible as seen with the recent series of roundtables to explore opportunities to increase access to medical oxygen in low- and middle-income countries. Those outside the healthcare sector can make a difference, too. Investors have the power to steer the long-term strategies of companies, and we are seeing an increasing number of investors ready to make a change. In the public sector, governments and procurers can incentivize industry partners through innovative policy-making, such as the subscription-style 'Netflix model' for antibiotics that is currently being trialled in the UK.

The key lesson of COVID-19 is this: we cannot assume equitable access will simply emerge from the status quo. Even a year after the first vaccines were approved and released in late 2020, 93% of people living in low-income countries have yet to receive a single dose. COVID-19 vaccine inequity is an unsurprising, yet unacceptable, example of the chronic problem in our health system – and it shines a light on the wider issue.

Put simply, we will not solve the scale of access issues, nor will we be able to protect the world’s healthcare systems from future shocks, without a more diverse group of healthcare companies taking decisive action. Healthcare systems are complex and interconnected, and it is only by looking at the weak spots that we can strengthen the system as a whole. Moving the most important companies across the breadth of healthcare sectors will transform millions of lives and prepare us all for whatever challenges the future brings.