Global Health Policy
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September 10, 2006
Polypills on the Horizon: Are We Ready?
Posted by Ruth Levine at 08:33 PM
When the World Congress of Cardiology met last week in Barcelona, the global health crowds didn't flock the way they did to the Toronto International AIDS Conference in August. But maybe they should.
Heart disease is the world's leading killer, accounting for close to 18 million deaths a year. With a dramatically increasing toll in India, South Asia, China and Indonesia, about half of all deaths from heart disease now occur in Asia. And far from being a disease only of the rich and well-fed, heart disease and other non-communicable diseases in developing countries are more properly thought of as ailments of urbanization; studies clearly show that risk factors like high blood pressure, tobacco use and others are far more prevalent among all residents -- and especially among the poorest -- in cities. A recent article by Michael Birt in Foreign Policy (registration required) highlights the issue, making a good case for paying serious attention to non-communicable diseases in developing countries because of the large numbers affected.
Those who are already focused on this problem found plenty of exciting news at the cardiology meetings. According to World Heart Federation President Valentin Fuster, Spanish researchers are making rapid progress toward development of a "polypill," a medicine combining three generic drugs taken by individuals with heart disease; if shown to be effective in clinical trials, the inexpensive, easy-to-administer pill could dramatically reduce premature death. The particularly good news is that those who are working on the product have low- and middle-income countries very much on their radar, and are seeking to ensure that the products are affordable and widely adopted in the parts of the world where they can have the greatest impact.
This welcome advance puts pressure on the global health community to think seriously and creatively about how to address prevention and treatment of non-communicable disease, given that the global discussions about policy, finance and delivery are largely oriented toward the quite distinct challenges of malaria, childhood immunization, HIV/AIDS and waterborne disease. Perhaps preparing for the polypill is a good starting point for a new conversation.
Update: Additional information can be found here.
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Comments
At the recent meetings of the World Congress of Cardiology in Barcelona, there was more enthusiasm than at previous meetings to see heart disease and stroke (cardiovascular disease or CVD) prevention placed high on the global health agenda, even added as an addendum to the Millennium Development Goals. The impact of these disorders in less economically advanced nations differs from that experienced today in the US where CVD is principally an affliction of those aged 80+. One third of the deaths due to CVD in developing nations occur in those aged less than 65.
The Polypill excites interest beyond its potential value for treating people with established CVD. It could find wide application in populations where individuals are, by virtue or increasingly urbanized lifestyles and greater age, at high risk but currently without overt health problems. Versions using generic statins, antihypertensives and aspirin, are being developed in countries that include India. Current estimates are that one month’s treatment could cost as little as US$2 per person.
There is a convergence occurring between CVD and HIV in developing nations as both conditions are responsive to long term drug treatment. The infrastructure needed to deliver antiretroviral therapy and that required for Polypill administration have much in common, as do the barriers to effective uptake of both therapies. Community and commercial support for both therapies and necessary infrastructure could have a huge impact in sub-Saharan Africa where both conditions are prevalent.
Posted by: Stephen Leeder at September 11, 2006 07:34 AM