Universal Health Coverage: It’s on governments to ensure equity and access to lifesaving innovations

Despite global commitments, 4.5 billion people still lack access to essential health services, and over 2 billion experience financial hardship due to out-of-pocket healthcare costs. On Universal Health Coverage (#UHCDay) Day 2024, we emphasize the urgent need to strengthen health systems to provide equitable access to lifesaving innovations for neglected diseases expected by 2040.

Between 2000 and 2040, biomedical products for poverty-related neglected diseases are projected to save at least 40.7 million lives and avert 2.83 billion DALYs, with the majority of these impacts benefiting low- and middle-income countries (LMICs) where the disease burden is highest.

The societal benefits of investing in these biomedical innovations for neglected diseases are extraordinary: with a return of $405 for every $1 invested in R&D. To realize these gains, governments must take the lead in ensuring the equitable integration of biomedical breakthroughs into national plans for universal health coverage.

Neglected diseases, such as tuberculosis, malaria, and HIV/AIDS, impact the lives of millions of people worldwide every year and impose a significant health and economic burden particularly in  low- and middle-income countries. Neglected tropical diseases, specifically, affect more than 1 billion people, while the number of people requiring interventions for these neglected tropical diseases (both preventive and curative) is 1.6 billion.

Over the last 20 years, investments in research and development (R&D) for these diseases have led to the approval of life-saving innovations, including 183 products approved for neglected diseases since 1999. Over the last decade, there has been an increase in product approvals for neglected diseases. Of these 183 products approved, 46% target just three disease areas: 26% malaria, 11% diarrheal diseases and 10% tuberculosis (TB). The remaining 54% (89 products) is split across 12 different neglected disease areas, though with a heavy focus on: 7.7% leptospirosis, 7.7% hepatitis C, 7.1% HIV/AIDS, 6.6% helminth infections, 6.6% kinetoplastids and 6% hepatitis B.

Yet, much more needs to be done to ensure that the needs of the most vulnerable populations are met. Using the Portfolio to Impact tool, as well as our comprehensive pipeline analysis, we have modelled the landscape of products we expect to emerge and be approved in the future.

This modelling predicts an estimated 182 additional product launches by the year 2040.

In line with the distribution of the existing pipeline and of global R&D investments, almost 46% (84) of these predicted launches are for either tuberculosis (23%, 41), malaria (16%, 30) or HIV/AIDS (7.1%, 13), with no other diseases expected to receive more than 10 new products. Based on current assumptions, there could be more than 20 new vaccine launches by 2040 across all disease areas in the neglected diseases scope.

Source: The Impact of Global Health R&D, May 2024, Impact Global Health

UHC systems need to be ready to equitably absorb these innovations. Health systems must be resilient and inclusive to deliver these breakthroughs to those who need them most, particularly in sub-Saharan Africa and South Asia, where the burden of neglected diseases is highest​ and where the health, economic and societal impact of effectively introducing these innovations into universal health coverage plans is the greatest.

The successful deployment of these innovations requires health systems that are not only technologically prepared but also structured to ensure equitable access. This involves, among many other elements, training a sufficient number of healthcare workers in the use of new technologies and ensuring that supply chains can support the distribution of products such as vaccines, diagnostics, and treatments, strengthening manufacturing capacity in the regions where these innovations are most needed. Without deliberate efforts to integrate these advancements into UHC frameworks, policies and programmes, there's a risk that they may exacerbate existing health disparities, leaving vulnerable populations behind.

In these efforts to strengthen UHC policies and ready healthcare systems to make use of the biomedical innovations that will be approved by 2040, two areas require particular attention and government leadership:

1. Financing mechanisms: Investing in global health R&D and reinforcing UHC policies are mutually reinforcing strategies that benefit both individuals and economies. A wide range of investments approaches, incentives, advanced market commitments, pull and push mechanisms can be used to ensure that national and regional efforts to accelerate R&D and strengthen UHC policies remain well-resourced and self-reinforcing. For example, delaying investments in R&D for tuberculosis and healthcare systems would lead to catastrophic consequences. Between 2023 and 2030, the status quo could result in 43 million new TB cases, 6.6 million additional deaths, and a global economic cost of $1 trillion. The loss of 234 million DALYs highlights the immense human toll. Sustainable, country-led financing is critical to accelerate R&D for next-generation TB tools, delivering much needed new diagnostics, treatments, the much-awaited TB vaccine(s) and scaling up public health interventions to integrate these new tools into routine standards of care.
2. Streamlining regulatory and approval pathways: Efficient regulatory and approval pathways are crucial for ensuring that lifesaving innovations quickly go from approval to reaching those in need. The stark difference in the approval timelines of malaria vaccines over the years highlights the transformative potential of increasing efficiency in the regulatory and approval pathways. The RTS,S malaria vaccine took over a decade from Phase III trial completion to WHO endorsement, whereas the R21 vaccine achieved the same milestone in just two years. Accelerating timelines like this could save millions of lives and avert billions of DALYs. For example, if RTS,S had followed R21’s path, an additional 2 million lives and 181 million DALYs could have been saved by 2033, with an estimated economic benefit of $3.4 trillion to societies​.

UHC establishes the foundation of equitable access to healthcare. Health costs and illness should never be the reason why people and families are pushed into poverty. Investing in universal health coverage and financial protection not only enhances health and well-being but also fosters greater equity and social cohesion. Everyone should have access to an affordable core package of essential health services, including quality medicines and lifesaving biomedical innovations. 

Governments must adopt and enforce laws to protect people from catastrophic health costs and allocate sufficient budgets for affordable essential health services, including coverage for innovations targeting neglected diseases. Establishing tax-financed national public health schemes can provide comprehensive coverage for entire populations, while minimizing or eliminating user charges for those most in need, such as low-income individuals or those with chronic conditions. These measures are not merely aspirational — they are essential for achieving health equity and resilience.

When populations are healthy, communities and economies prosper. The next decade is pivotal for addressing the dual challenge of delivering lifesaving health innovations and achieving universal health coverage.

Policymakers, product developers, advocates, health professionals and others must collaborate to ensure sustained investments in global health R&D and the equitable integration of these breakthroughs into health systems. By doing so, we can build healthier societies and more robust economies, fulfilling the promise of health for all.

As we celebrate #UHCDay, it's crucial to recognize that the anticipated 182 health innovations will only achieve their full impact if integrated into equitable health systems. Let us reaffirm our commitment to #HealthForAll by prioritizing neglected diseases and ensuring that no one is left behind.

Together, we can create a healthier, more equitable, and more prosperous world.