A blueprint for equity
A new UNICEF report proposes a framework to help ensure equitable access to life-saving supplies in different types of public health emergencies
The COVID-19 pandemic caught the world off guard. We were unprepared for the speed at which it spread and the severity of its impact – with millions of lives lost, a colossal economic fallout, and backsliding in essential public services, especially for children. Low- and middle-income countries were the hardest hit, with access to vaccines, medicines and tests arriving later than in high-income countries.
Learning from this experience, UNICEF has published an analytical framework that proposes strategies that international and regional agencies, including UNICEF, should prioritize in different types of health emergencies. It offers a series of ‘playbooks’ that can help improve countries’ access to essential medical supplies depending on the scale of the outbreak and availability of products.
Nagwa Hasanin, Senior Health Advisor with UNICEF Supply Division, explains more.
COVID-19 exposed major inequities in access to medical supplies. That’s why it’s important that we avoid using the pandemic as the sole blueprint for public health emergency preparedness and response. We developed this report to help us get ready for a wide range of potential outbreak scenarios, not just one that resembles COVID-19.
The report studied the main obstacles that block access to medical supplies during outbreaks. These include a lack of incentives for companies to develop products, unstable demand, and countries competing for limited supplies. The report grouped outbreaks based on how often they happen, how big they are, and their potential to cause a pandemic, while it looked at how these factors cause difficulty in accessing supplies for each type of outbreak.
Using this information and data, the report proposes a way to identify the best evidence-based solutions to overcome obstacles and get life-saving supplies to children and families affected by whatever public health crisis occurs next.
We organized disease outbreaks into groups because the commercial incentives to make new vaccines, medicines, and tests can vary a lot. Think of it like this: when there are rare outbreaks that affect a small population, such as Ebola, companies aren't as likely to develop high-tech medical products. But if a disease is more common, like cholera or yellow fever, they might see it as a good idea. And when a disease affects the entire world – a pandemic – there's a huge need, so companies have many reasons to make vaccines and medicines.
Medical products were categorized into three stages – early research and development, the clinical trial phase, and the point at which products are licensed for use.
We combined the types of outbreaks with the stages of medical product development, and this gave us nine different situations, or archetypes. Each one has its own set of challenges when it comes to getting the right medical products to diagnose, prevent or treat diseases to the right people. For example, a disease that causes a small outbreak requiring vaccines and therapeutics that are still in the early stages of development might not get much attention from companies. Alternatively, during a pandemic, if a treatment has been approved and licensed, there's a big rush to make a lot of it quickly.
By sorting the outbreaks and supplies this way, we can make plans – or supply ‘playbooks’ – for each situation. These supply playbooks help us figure out the best way to make sure vaccines and treatments are available when and where they're needed.
“These playbooks offer quick, research-backed actions to ensure we can get medical countermeasures where they're needed as fast as possible.”
Each playbook offers specific plans for different health emergencies. For diseases that cause rare outbreaks where no treatment or vaccine is available, the framework found that creating competitive markets for these supplies is not a realistic goal. Instead, we suggest that governments help to make financial research investments less risky so that at least one product comes through regulatory approvals. Production can then be funded for a small stockpile. For pathogens that cause more frequent and larger outbreaks, we suggest having agreements in place to buy the supplies and support local companies that are close to the target population to produce them.
When facing a pandemic, we recommend setting aside funds for the immediate purchase of key medicines and, where necessary, sharing vaccine doses from countries with greater access to those unable to get a supply. We also encourage the transfer of knowledge and technology between companies that develop treatments and those that produce them.
These playbooks offer quick, research-backed actions to ensure we can get medical countermeasures where they're needed as fast as possible.
The report sets out several recommendations to be considered by governments, medical research institutions, manufacturers, international organisations and financing bodies. Perhaps the most important one is the need to form strategic alliances and design policies and funding packages tailored to each type of disease outbreak. This will help us start on the right footing and offer a structured approach for determining which market incentives should be prioritized.
Another major point, of which there is growing international attention, is that to handle disease outbreaks effectively, we need to really grasp the market challenges unique to each one. And it’s about more than just inviting affected countries to discuss emergency responses; it’s about empowering local manufacturers in those regions to produce affordable medicines close to where they're needed.
“I am hopeful about our ability to rise to the challenges of future public health emergencies. The stakes are too high not to.”
While COVID-19 exposed many flaws and inequities, it also generated momentum for change. I hope we can apply the lessons learned to be better prepared for diverse disease outbreaks. I would also like to see customized approaches that create equity and access to key medical products because a one-size-fits-all approach does not work. Likewise, there should be constant investments in regional manufacturing capacity, knowledge and technology transfers, regulatory changes and much more to increase the availability and affordability of medical products that children, their families and their communities need.
Across all efforts, we must embrace the principle of equity. Timely, affordable access to life-saving supplies should not be dictated by chance. With openness to new approaches, sustained commitment, and collaboration, I am hopeful about our ability to rise to the challenges of future public health emergencies. The stakes are too high not to.