Team:UPMC PARIS/State of art

Impact UPMC

STATE OF ART

Introduction

The WHO defines the access to healthcare as the availability of affordable and permanent health facilities in less than an hour's walk.

The example of Africa is a representative of this global problem :
In 2015, about 1.6 million of Africans died from diseases that could be treated through rapid access to proper medicines, vaccines and other health needed services. There is one crucial need for an appropriate and affordable local medicine. Indeed only 2% of the drugs used in Africa are produced on site. This results in a compelling need for imported medicines which are too expensive to be a sustainable solution.
According to 2013 statistics from the World Bank, about 80 percent of Africans, mostly those with low or middle incomes, depend on public institutions for medical needs. However, these institutions suffer from chronic shortages of drugs. Patients then die of easily curable diseases.
According to WHO, there are many origins of the lack of access to care. The main ones are the lack of financial and material resources as well as qualified personnel.
In addition, many African countries do not have the technical, financial or human resources to comply with current Best Practices regulation (installed by the USA) for the large-scale production of some drugs. However, it has been proven that local production improves access to medicines while decreasing the cost of production.
Thus only 37 out of 54 African states produce drugs, like South Africa, Morocco and Tunisia for instance. The quantity and the price of the available medicines does not allow their access to the whole population.
Many humanitarian organizations such as MSF or UNICEF are viewed as a current solution. They work to fill this lack of access to care by being the logistical and financial link between suppliers and regions in need. The expanded programs they implement prove their worth more and more. However, they also have to deal with obstacles like developing countries have to face.
To sum up, the main issues come from low financial means, the transport of medicines, the lack of qualified personnel and from the lack of institutes developed for the stock and the manufacturing of drugs. They all lead to a crippling dependence of certain countries of Africa toward industrialized countries regarding their own access to healthcare.
http://www.un.org/africarenewal/fr/magazine/décembre-2016-mars-2017/mourir-faute-de-médicaments

Health status

WHO provides protocols and guidelines for assessing the disease burden using a variety of methods such as disease surveillance, rapid assessments, or population-based studies
http://www.who.int/immunization/monitoring_surveillance/burden/estimates/en/

Hepatitis B levels vary widely by WHO Regions. The heaviest burden lies in the African Region and the Western Pacific Region.
Western Pacific Region: 6.2% of the population (115 million)
African Region: 6.1% of the population (60 million)
Eastern Mediterranean Region: 3.3% of the population (21 million)
South-East Asia Region: 2% of the population (39 million)
European Region: 1.6% of the population (15 million)
Region of the Americas: 0.7% of the population (7 million)

http://www.who.int/mediacentre/news/releases/2017/global-hepatitis-report/fr/

Maternal death: The two main causes are hemorrhage and eclampsia

Amongst developing countries with a mortality rate of 450*, sub-Saharan Africa and South Asia have the highest maternal mortality rates which run to 920* and 500* respectively. As a reference 400 * is the world average rate. Western countries, for example, are clearly below average with a rate of 8*. NB(*): The mortality rate was calculated per 100,000 live births, by region (2005)

The risk of maternal death is 1 out of 22 births in sub-Saharan Africa compared to 1 out of 8000 in industrialized countries (2005)

The main causes of maternal death are related to anesthesia and caesarean section in major occidental countries.
In developing countries, it is mainly caused by hemorrhage (sub-Saharan Africa and South Asia) and hypertension-related disorders during pregnancy (Latin America / Caribbean).

https://books.google.fr/books?id=FIpEwwGZbkkC&pg=PA26&lpg=PA26&dq=hémorragie+décès+asie&source=bl&ots=5uwnSN8M-c&sig=j9BdpzKKutT1Mh0Xs7RFQXs0uJg&hl=fr&sa=X&ved=0ahUKEwjA78_X7uvWAhUQEVAKHT68Br4Q6AEIKzAI#v=onepage&q&f=false
http://www.who.int/mediacentre/factsheets/fs348/fr/

The lack of access to healthcare: The example of vaccines in Africa

In the same logic as for all medicines, vaccine sales in low- and middle-income countries were estimated at 1.6 billion in 2008. This represents only 10% of the global market. Of this 10%, 40% is sold by occidental countries to UNICEF, which represents about 4% of the global vaccine market

On the one hand, the multinationals producing them, such as Merck or Sanofi, sustain high development cost, required for the production of these drugs. Along with profit these companies make, this explains the high price of vaccines and the fact they have been developed by and for the richer countries, their main consumers. On the other hand, emerging public or private providers do not have the financial means and knowledge of regulatory mechanisms to invest in research and development. This results in a high-volume commercial model of less complex and older vaccines. These vaccines are sold to neighboring countries and to NGOs such as UNICEF.
In the end, the local population only has access to the old and locally produced vaccines, without constant strict regulatory oversight or to the one often provided during humanitarian campaigns.
Vaccines are therefore good representatives of the problems that revolve around access to medicines. Indeed, the population lacks vaccines adapted to current needs for financial reasons and local production logistics.

Immunization+for+All+-+FR.pdf

The vaccine against HBV (Hepatitis B virus) [We could think that the cause of the issues regarding the absence of widespread use of this vaccine is the result of an absence of implication of the governments. In fact, the major problem is financial. It’s no use for the concerned states to authorize the use of treatments they can’t afford. This is one explanation of the huge gap between the awarness of the HIV epidemia and the dramatic lack of ressources dedicated to the HBV epidemia in Africa. The HBV epidemia began centuries before the HIV epidemia and will continue for a long time without proper effort from the states. Its number of victims in Africa is comparable to the one of HIV, tuberculosis or malaria. Moreover, the mortality due to hepatitis tends to rise in the last years. https://humanitaire.revues.org/3142

« There are vaccines and drugs to fight HBV and WHO is committed to ensure these medicines cover anyone who needs them » said Dr Margaret Chan, Director-General of WHO

Although overall hepatitis mortality increases the number of new HBV infections is declining thanks to a better coverage of HBV vaccination on children. Indeed, in 2015 the mortality was mostly concerning the 257 millions adults born before the introduction of the hepatits B vaccine, who lived with chronic infection of the virus. Therefore, in order to reduce the mortality of the next generations, it is necessary to find ways to sustain the future vaccination campaigns and ensure the sustainability of the treatments.
http://www.who.int/mediacentre/news/releases/2017/global-hepatitis-report/fr/

Conclusion