Building More Resilient Health Systems
Last week, the Philippines became yet another country in a growing list to caution women to delay pregnancy[i] as the country braces itself against an outbreak of the Zika virus. The virus is already spreading rapidly across Latin America and the Caribbean, as well as parts of the US, causing the World Health Organization to declare it a “global public health emergency”[ii]. At the root of it all is the mosquito, a deadly animal that kills millions of people a year by transmitting several diseases. In this case it is the Aedes mosquito, which also transmits dengue, Chikungunya, West Nile fever and yellow fever.
Like the Ebola outbreak in 2014, Zika has sent the world into a frenzy and is once again exposing the gaps in the ability of health systems to respond. The spread of the virus highlights the inadequacy of health services for women; the siloed management of mosquito-borne diseases; and the cumbersome policy and regulatory environments that limit innovation of and access to new products by disease-affected countries. It is reminding us all that the vector management community lacks sufficient financing and support to execute thorough research and product development. I will briefly discuss these issues and why, as a global health community, we can and should do more.
Expand Access to Women’s Sexual and Reproductive Health Services
Zika is the latest in a long list of challenges affecting the reproductive and sexual health of poor women in developing countries. The focus of governments on cautioning against pregnancy brings to the fore the lack of family planning and sexual and reproductive health services available to women around the world. Some 300,000[iii] women died in 2013 due to difficulties in pregnancy and childbirth, largely because they lacked reliable and high-quality health services for themselves and their families. Millions of women[iv] who would opt to delay starting a family, for example, still cannot access effective contraceptive methods. Some remain unable to access timely health services when complications arise during pregnancy – as is the case with many women in countries currently suffering from Zika. When they do, they typically receive inadequate care as health workers aren’t properly trained, and/or generally lack the resources to deliver the services optimally. According to the United Nations Population Fund, it would cost USD $39.2 billion annually to deliver a comprehensive package of sexual and reproductive health services to all women. In other words, for USD $25 per year per woman of reproductive age (or the cost of a meal in most Western cities) countries could do more than simply caution women to delay pregnancy. They can, and should, give women the means to do so safely.
Enhance Coordination of Vector Management Approaches
The key to limiting the outbreaks of dangerous diseases like Zika and Ebola is to ensure there is sufficient technical capacity for affected countries to control and prevent these diseases at their source. Good knowledge on the species of vectors of various human diseases and the mode of transmission is necessary to determine the best approach to control disease. Of the 4000+ known species of mosquitoes, those belonging to three genera – Aedes, Anopheles and Culex – do the most harm to humans, and the approaches we take to preventing and killing them have cross cutting similarities. Yet, for so many decades we have underutilized limited resources on single-intervention, single-genus approaches in ecological and operational settings that would warrant integrated targeting of these vectors. The tools we currently have at our disposal stand to have greater impact if we design and implement programs that are evidenced-based, efficient and cost-effective. In reality, this means identifying and implementing rational changes to the various roles and responsibilities currently in our disease management systems. A primary focus of change would be to ensure that agencies and ministries from both health and non-health sectors, whose actions or inactions have an impact on disease burdens, are working together to control the transmission of the disease in the first place.
Develop a Policy and Regulatory Environment to Encourage Product Entry to Market
Finally, the current system of bringing vector control products to market lacks efficiency to the point that it effectively dis-incentivizes innovation. This contributes to the limited toolkit we currently have to respond to disease outbreaks such as Zika. Most of the insecticides used in public health are more than thirty years old. Given the rather limited market size[v] for vector control commodities (estimated to be maximum USD $0.7 billion, compared to the agrochemical market at approx. USD $100 billion), there is little incentive for manufacturers to invest the critical resources needed to develop new products. Further, there is a lengthy and exorbitant process for testing and approving new products. It has been estimated[vi] that it takes up to 10 years from initial discovery to first commercialization of a new public health insecticide product. In spite of the joint attempts by the malaria community to address these bottlenecks, there remain significant obstacles in disease-affected countries, hindering national programs from timely access and deployment of new vector control products, even after these products have been approved at the global level.
Zika Today… Another Disease Tomorrow….
The world is replete with very dangerous diseases, several with the capacity to become pandemics. If we are to effectively prevent future outbreaks, there is a need for renewed focus at the global level to mobilize the relevant technical and financial resources, and to inspire the necessary political will for policymakers to proactively engage in disease prevention and control. This will have to include providing better sexual and reproductive health services to women, a coordinated approach to vector management and new patent regimes that promote effective public-private partnerships aimed at accelerating access to new and innovative products, tools and methods.
Sancia Dalley is Vice President at GBCHealth where she manages the organization’s strategy, business development and partnership activities including its malaria portfolio. Sancia leads the Corporate Alliance on Malaria in Africa, a coalition of companies working in support of malaria elimination through advocacy, workplace engagement, and region-wide initiatives. Sancia also serves as Focal Point for thePrivate Sector Members Council to the Roll Back Malaria Partnership. Learn more at www.gbchealth.org.
This article first appeared on gbchealth.org and is reproduced with permission.