Thu Jan 20 2022 | null

Global Pharma Social Business: Addressing global health inequities through the principles of social business

Nafisa Fariba

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Background

COVID 19 was a reality check about how global inequalities affect health. It bared how race, ethnicity and class makes the difference between life and death both within and among countries. In countries of the global North, the worse off were minorities, disadvantaged and the marginalized people. If you are a person of color in the USA, there is a greater chance of you dying from COVID. The same can be seen in other developed countries as well. However, the developed countries because of their strength of economy, a better healthcare system and access to vaccines are likelier to rebound sooner. The story is different in the global South where health systems had crumbled and deaths have become only growing numbers. Healthcare systems of even bigger economies in the global South such as Brazil, India and Mexico have crumbled under the pressure of COVID 19. All of this indicate, how much the world, especially the Global South requires innovative solutions to rebuild the healthcare system and even replace it with something much better.

The Grameen Family under the guidance of Nobel Laureate, Professor Md. Yunus aims to work to reduce health inequities and ensure an equitable and dignified access to health particularly in the Global South. Through a series of expert stakeholders’ consultations summed up in this paper, the idea is to build a Global Pharma Social Business that leverages understanding the needs of the people, support development of a social business ecosystem involving public, private and civil society stakeholders to these inequities through a systemic approach and leverage relevant technology to achieve these goals.

Below we outline the problems that creates global inequities at a systemic and behavioral level, probable solutions to these problems and how an inclusive Global Pharma Social Business could address them.

Problem:

The problem with the healthcare system is multi-level and thus requires an understanding of the system. The stakeholder consultations mentioned above identified the following problems:

a. Complex supply chain: In the Global South, the supply chain of the medicines is so long and complicated that often by the time it reaches the clients, consumers or patients, the price of the medicine has gone out of reach of the poor who usually pays the most. The poor also tend to have more out of pocket healthcare expenditures.

b. Access to essential medicines and vaccination: In Africa, because of climate and other topographical conditions there are different types of diseases than other continents or the Global North. These diseases are preventable with correct information and access to medicines and vaccines. According to WHO, lack of access to essential medication and vaccines leads to preventable deaths of half a million children in the Sub-Saharan Africa1. To prepare for the next health challenge, steps should be taken to make these medications available to people from low-income countries particularly the minorities, vulnerable and marginalized. This could save millions of lives and prevent economic shocks due to health.

c. Lack of production capacity: There is a need to create local manufacturing capacity in the Global South especially in Africa for vaccines and medicines. access is not the only health challenge that global South countries face. The health challenge also lies in the lack of capacity of the health sector in these countries. An UNCTAD report stated that East African countries are operating on less than 50% of their production capacities due to problems in importing materials from abroad[1]. It is thus safe to say enhancing local capacity of companies will save preventable deaths. International health organizations such as UNCTAD and WHO are teaming up with governments to address this challenge, but the sheer amount of work and effort needs more diverse partners especially businesses to step up. The delivery or distribution mechanism of the pharmaceutical products to a massive scale.

d. Lack of representation in clinical trials for new drugs and vaccines are also not mostly equitable and representative. This means that the impact of drugs and vaccines on all age, gender and races are not always clear and can make the difference between life and death. Usually what the pharmaceutical companies do is they do many clinical trials, but once the medicine is out, there is clearly not enough online data and how the medicine is performing on a larger company. In a study of cancer trials, it was found that 82% of participants were white2 and often medical trials are done more on man than women pointed out in the book Invisible women by Author Caroline Criado-perez. This has serious implications for health and contribute to preventable inequities in health and survival. Now there are different devices, which are now turning into digital therapeutics and the challenge here is that this digital therapeutics is at a very early stage and doesn't have the kind of clinical support that a pharmaceutical company will have.

Solution:

a. An integrated approach: To address a disease and make healthcare equitable an integrated approach is needed. For example, when essential medication sale comes with health education, consumers are getting much more in value than buying only medicines. A collaboration of public and private stakeholders is needed to ensure vaccine equity for all along with a supporting regulatory framework.

b. Leveraging technology: It is also important to leverage technology to provide access to medicine and doctors for people in hard to reach areas. The core of the digital health ecosystem is the patient doctor relationship. Digital health can bring in enough data for pharmaceutical in the global social pharma concept to bring in those data in and help the pharmaceutical company to fine-tune their research and development as has escaped.

c. Creating capacity of local manufacturers: One of the most important thing is that the social business pharmaceutical company shall link-up with companies with other countries where they can setup subsidiaries on medicine as we have the technology and the expertise we need. The idea is to enable an organization privately run publicly governed and enable this organization to have a steady revenue stream on one hand and to focus on the service delivery component to create a vaccine manufacturing hub and addressing Anti-Microbial Resistance.

The Global Pharma Social Business:

Keeping all the above-mentioned solutions in mind, the Grameen Family envisions a social business company that can locally produce essential vaccines and medicines with an built-in health education component. Many private companies working in this sector don't have experience in the actual implementation. The Pharma Social Business thus will aim to get rid of the unhealthy intermediaries and being closer to where the actual needs are on the ground. There is a massive potential for local social business to incur, and there is an opportunity for global players to take part.

The Grameen family brings a very in-depth understanding of how social businesses are executed. As the discussion is about structuring the strategy of setting up a global pharma, the Grameen family can contribute a lot regarding how the pharma will operate based on the whole social business ethos and the principles.

Notes:

1 https://unctad.org/news/covid-19-heightens-need-pharmaceutical-production-poor-countries

2 Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer (nih.gov)