Speech - Eastern Europe and Central Asia (EECA) Second Regional Consultation on Expanding Access to Affordable and Quality Assured Medicines and Diagnostic Technologies

Honourable ministers, partners, and civil society representatives,

Ladies and gentlemen,

I warmly welcome you to this Second Regional Consultation on Expanding Access to Affordable and Quality Assured Medicines and Diagnostic Technologies in Eastern Europe and Central Asia. Firstly, I would like to thank the Government and the Ministry of Health of the Republic of Belarus for hosting this consultation, and our partners UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Stop TB Partnership for their organizational support.

Member States in eastern Europe and central Asia are still confronted by a severe triple burden of HIV, drug-resistant tuberculosis and viral hepatitis epidemics.

In 2017, 130 000 people acquired HIV in eastern Europe and central Asia. Since 2010, the number of new infections has increased by 29%, making it the fastest growing HIV epidemic in the world. In addition, this region faces the highest levels of multidrug-resistant tuberculosis in the world: one in six newly diagnosed and one in two previously treated tuberculosis patients is estimated to have multidrug-resistant tuberculosis. This exceeds the global average by several times. Moreover, the eastern European and central Asian region is one of the most affected by chronic hepatitis C virus infection globally, and accounts for the largest proportion of HIV-infected persons with past or present hepatitis C infections.

Prompt health systems responses, including early diagnosis and effective treatment of all infected people, are of paramount importance for effectively and sustainably reversing the epidemics of HIV, tuberculosis and viral hepatitis in the region.

In line with the joint commitments to achieve universal health coverage, end the epidemics of HIV and tuberculosis and eliminate viral hepatitis as a public health threat by 2030, significant strides have been achieved during the last 10 years in eastern Europe and central Asia. These include a substantial increase in the number of people who know their HIV, tuberculosis, and viral hepatitis status and receive treatment.

Countries are revamping their political commitment and are scaling up efforts to implement the evidence-based actions and interventions outlined in the WHO Action Plan for the Health Sector Response to HIV in the WHO European Region, which was unanimously endorsed by all 53 Member States during the 66th Regional Committee for Europe in September 2016. This commitment was most recently confirmed during a ministerial policy dialogue on HIV and related comorbidities in eastern Europe and central Asia, organized by the WHO Regional Office for Europe jointly with the Government of the Netherlands and UNAIDS in July 2018, and attended by 11 ministers or deputy ministers of health. Country-specific roadmaps for accelerating efforts to reach the UNAIDS and WHO 2020 targets are being prepared as a follow-up action from the ministerial policy.

The adoption of the first regional action plan on viral hepatitis in September 2016 served as a trigger for many Member States to rapidly increase the scale of their response to hepatitis through development of national strategies and action plans and – in some countries – adoption of national hepatitis elimination targets.

Yet the eastern European and central Asian region is still facing severe challenges. It finds itself among those regions in the world that provide low treatment coverage.

Only 37% of people living with HIV are currently receiving antiretroviral therapy in this region, while for viral hepatitis, a low diagnosis rate is the first barrier preventing people from accessing care – it is estimated that less than one third of people living with chronic hepatitis are diagnosed and, in most countries, only a small proportion are receiving treatment.

The delay and inadequate coverage of treatment means that HIV, tuberculosis and viral hepatitis related diseases and deaths increase, and the risk of transmission rises – posing a major barrier to curbing this triple burden. The most vulnerable members of our societies are hit the hardest.

The rollout of the innovative rapid diagnosis tool for TB is growing fast in the Region. However, only half of all TB cases benefit from rapid TB diagnostics, such as GeneXpert, while the remaining half been lately enrolled in TB treatment. Nevertheless, while 99% of those patients diagnosed with TB are tested for drug resistance, 92% of those diagnosed with multidrug-resistant TB are enrolled in the relevant treatment.

What are the main challenges to achieving higher treatment coverage?

Early diagnosis and access to quality assured medicines at affordable prices are of paramount importance in expanding treatment coverage and ultimately curbing the triple burden of HIV, tuberculosis and viral hepatitis in the countries of eastern European and central Asia. Yet providing antiretroviral therapy in a context of rising HIV prevalence, along with the commitment to implementing the WHO “test and treat” recommendations and reaching the three 90-90-90 targets by 2020, have substantial cost implications for national HIV responses.

The same holds true for the treatment of multidrug-resistant TB: the high costs of second-line drug regimens and inefficient procurement practices have a further huge economic impact on the region. This is accompanied by challenges in ensuring access to TB medicines, entailing a very slow uptake of new regimens.

Fortunately, the cost of direct acting antivirals to treat chronic hepatitis C has dramatically decreased in recent years – especially where generic direct acting antivirals are available – leading to a 1000-fold decrease in the price of a three-month curative course in some countries. Yet, low diagnostic coverage, due to high costs of diagnosis and inadequate diagnostic pathways, represents a major barrier to scaling up treatment coverage.

The effective and sustainable response to these challenges requires universal access, for all people in need, to affordable and high-quality HIV, tuberculosis and viral hepatitis health-care services, including state-of-the-art diagnostic technologies and life-saving drugs. This, in turn, calls for strengthened health systems with effective and transparent national regulatory systems, policy and legal environments, that enable access to be provided to affordable and quality assured medical products, on the basis of efficient procurement and supply chain management systems.

Providing access to simpler, safer, less toxic, affordable and practical treatment is an important element of HIV, tuberculosis and viral hepatitis national strategies. Doing so requires a combination of prevention, improved diagnostics and effective care so that these elements mutually reinforce each other.

Our joint efforts to ensure coordination between health system strengthening and disease-specific programmes will expedite the progress towards universal health coverage, and ensure access to needed medical products and provide financial protection for vulnerable people.

One key milestone in efforts to leverage expanded and rapidly scaled up access to affordable quality assured antiretroviral and tuberculosis medicines in eastern Europe and central Asia was the first Regional Consultation on Expanding Access to Affordable and Quality Assured Antiretroviral and Antituberculosis medicines in Minsk two years ago. Representatives of the eastern European and central Asian countries jointly endorsed the Minsk Statement, “HIV and Tuberculosis: Treatment for All”, thus reaffirming your commitment to accelerating the fight against HIV and TB and creating a historical moment in the regional response to these diseases.

A good regulatory system gives people in a country confidence that the products they need and use are safe and will work as intended. A weak regulatory system has the potential to undermine access initiatives, for example by taking too long to approve products for use in a country or by not detecting and removing unsafe, substandard or falsified products. Investment in regulation has a positive and significant impact on access. Since our first Regional Consultation, several national regulatory authorities have – with WHO guidance and support – undertaken self-assessments of their functions and improved their regulatory systems. Let’s jointly continue the work and set a target of reaching a level of system maturity commensurate with a stable, well-functioning regulatory environment for medicines and medical devices. As countries move towards more independent approaches to health product procurement, including through local production, pressure is building to ensure that regulatory systems are adequately resourced and fit for purpose.

Closing the gap to cost-effective, equitable and sustainable access to quality medicines and diagnostic technologies requires further effective, collaboration and political leadership in the eastern European and central Asian Member States.

The WHO Regional Office for Europe and our partners are committed to strengthening regional cooperation in response to countries’ needs by providing direct technical assistance, as well as policy support, through regional platforms like the Inter-Parliamentary Assembly and Eurasian Economic Union. Together we can, and should, ensure sustainable access to affordable and quality assured medicines in countries to enable them deliver cost-effective, equitable and sustainable solutions for common challenges.

I am looking forward for our fruitful discussion today and productive cooperation in the nearest future.

I thank you!