The COVID-19 pandemic exacerbated patients’ difficulties in accessing medication for non-communicable diseases (NCDs), but there is a range of measures countries can take to mitigate this – and a pandemic accord could address some of the structural weaknesses.

COVID-19 had a disproportionate and far-reaching impact on people living with NCDs. Not only were they more vulnerable to severe COVID-19, but their access to health services and medicines was also disrupted. 

Across countries, similar stories were seen among people living with cardiovascular disease, diabetes, mental health conditions and cancer. 

These shortcomings are documented in a new WHO report Access to NCD medicines: emergent issues during the COVID-19 pandemic and key structural factors, jointly developed by WHO’s Departments of NCDs and Essential Medicines and Health Products.  The report describes how essential NCD medicines were in short supply or simply not available during the pandemic, resulting in compromised care. 

Interruptions in access were more severe in low-income countries with fewer resources, as well as in other countries disadvantaged by medicines markets, such as landlocked countries, dependent on air cargo and ports in other jurisdictions, and countries subject to international trade sanctions. 

For instance, 31% of low-income countries (LICs) reported medicine unavailability or stockouts in 2020, increasing to 41%, or 11 out of 27 countries surveyed, in 2021, according to two successive WHO Country Capacity Surveys.

In comparison, only two out of 57 high income countries (4%) reported stockouts in 2021.  Beta-blockers, insulin, statins and steroid inhalers were in particularly short supply in LICs in 2021. Globally, 15% of countries experienced shortages in 2020, rising to 21% in 2021. 

Patients in LICs have often struggled to get access to NCD medicines, which have not traditionally received nearly as much attention in global health and development fora as infectious disease treatments.  

But the COVID-19 pandemic is a vivid example of how long-standing access issues were exacerbated during the global crisis. It highlighted the complex, cross-sectoral pathway from the production of medicines to the patient – underscoring how routine drugs need attention in future pandemic preparedness and response – along with medicines specific to any future crisis. 

Pandemic import restrictions 

During the pandemic, there were difficulties sourcing active pharmaceutical ingredients and materials, delays caused by export restrictions, transport and freight disruptions, and staff shortages due to sickness, curfews and quarantines. 

By April 2020, just a month after WHO declared that COVID-19 was a pandemic, 20 countries had already introduced export restrictions on medicines, according to the World Trade Organization (WTO).

Other obstacles to accessing NCD medicines included the lack of forecasting tools to accurately predict demand and limited financial resources and administrative capacity, including the absence of donor-sponsored NCD medicine programmes. 

Patients also struggled to pay for their medicines as a result of their loss of income from lockdowns – in stark contrast to donor-sponsored medicine programmes for diseases such as HIV, tuberculosis, and malaria, where patients can get free medicine.

NCDs are responsible for over 70% of all deaths globally, most of which occur in low and middle-income countries. A lack of access to NCD medicines can have devastating consequences.

It is critical to heed the lessons learned during the pandemic and adopt innovative national response and preparedness plans to care for people with NCDs. 

This involves ensuring supply chain continuity as well as supporting better integration of NCD diagnosis and treatment into the primary health care systems of  developing countries – so as to help ensure treatment during future health emergencies. 

Mitigating future supply chain risks

There are a large variety of measures available for governments to improve the resilience of supply chains for NCD medicines. 

Firstly, governments and key stakeholders need to assess risks and potential breakage points in terms of factors such as the availability of raw materials, diversity of suppliers, and opportunities to boost local production of critical inputs or finished products.

The global supply chain is interdependent, and one key challenge identified in the pandemic was the  limited data availability and information sharing across sectors. Going forward, more transparency and data-sharing among relevant actors is critical.   

To support countries in meeting these challenges, WHO is working on initiatives to improve supply chain resilience for NCD medicines, including a suite of tools that countries can use. This would include methods for NCD medicines demand aggregation at national, regional and global levels to enable better medicines forecasting and quantification.

Engagements with private sector entities can help encourage commitments that could increase accessibility of NCD medicines, such as voluntary licensing arrangements enabling more diversified production. Harmonization of definitions and rules around “essential medicines” eligible for “priority lanes” in international shipping and customs control would also be important. 

Public and private distribution

Secondly, investments in innovative and integrated medicine service delivery models should be promoted to improve access to NCD treatments, as demonstrated in the latest WHO guidance on integrating the prevention and control of NCDs, which addresses both structural and emergent barriers. 

The guidance suggests, for instance, that countries could introduce models of care that use a mix of private and public sector primary health care centres and dispensaries to distribute NCD medicines and related health products.  

Measures such as multi-month NCD medicine dispensing, which proved effective in resource-limited settings during the pandemic, could be considered not only for future health emergencies but also as to bolster more routine delivery.

Thirdly, governments and donor agencies need to improve the governance and financing mechanisms available for NCD medicines, as the medicines supply chain is a critical element in strengthening the resilience of the overall health system. 

Here, too, new tools under development by WHO can support country assessments of health facility availability for NCD service delivery. 

As we continue negotiations on a new pandemic accord, as well as charting the road to the next high-level meeting on NCDs in 2025, WHO, partners, and the global health community need to make concerted efforts to develop and implement a longer-term strategy to strengthen access and delivery mechanisms for medicines, including NCD medicines, particularly during emergencies. 

Only in that way, we can ensure that people living with NCDs have access to the medicines and care needed to manage their conditions, for healthy, productive lives. 

Dr Bente Mikkelsen, is the World Health Organization’s Director of Noncommunicable Diseases 

Image Credits: KSchermbrucker/PiH, World Economic Forum.