Improving Access to Medicines for Heart Disease in Poor Countries: A Student-Led Campaign
Sandeep Kishore is one of the winners of The Lancet-GHEC 2008 prize for his work in petitioning the WHO to include simvastatin (Zocor), a statin drug used for heart disease, on the Essential Medicines List (EML). The WHO approved the petition in 2007, adding the drug to the EML. A summary of Sandeep’s work is below.
Heart disease has now become the leading cause of death globally, with nearly 80% of worldwide deaths occurring in the developing world. Long considered a disease of affluent countries, heart disease presently claims twice as many lives as HIV/AIDS, tuberculosis and malaria in low-income countries. Higher rates of urbanization and tobacco use help explain this trend. However, while there has been much effort to enhance access of basic, essential medicines for infectious diseases, there has been comparatively little attention paid to curbing heart disease and related chronic diseases in the developing world.
To address this problem, our student group at Weill Cornell initiated a campaign to identify schemes to enhance access to life-saving medicines for heart disease. We petitioned the World Health Organization (WHO) that a statin drug be included on the Essential Medicines List (EML) or Model List. This list was established to provide guidelines for developing countries for selecting high priority drugs, which should be supplied to their citizens inexpensively. We chose simvastatin (Zocor), originally manufactured by Merck, based on its worldwide availability, cost-effectiveness and the interest of generic firms in producing it. According to the International Drug Price Indicator Guide and our consultations with global pharmaceutical firms, generic versions of the medicine presently cost $40/year –10 cents/day - down from the nearly $1,200/year a couple of years ago. Efficacy data consistently show that statins reduce low-density lipoprotein cholesterol (LDL) levels by 25-30% in individuals at high risk for heart disease. Critically, our research indicated statins were effective in different ethnic populations globally. Through collaboration with the Clinton Foundation, we felt confident that a high quality, reliable supply of statin drugs could be made available to developing countries.
In April 2007, the WHO approved our petition, adding simvastatin to the EML. This qualification now enables mass drug donations of the heart drug by all United Nations’ organizations to 156 national pharmaceutical inventories. Furthermore, national governments that work with the WHO are encouraged to recognize heart disease as a serious health concern. The EML has a proven track record of enhancing access to essential medicines. It is too early to know whether access to statins in poor countries has increased. We recognize that efforts to increase statin use in the developing world must be taken in parallel with similar cost-effective interventions, such as, national diet and exercise programs and campaigns to reduce global tobacco consumption. However, increased statin availability is a first step. We note that that this work was student-led, researched with assistance of medical librarians and supported by the Dean of our medical college. Its success indicates that activist university students and faculty can be primary players in making significant changes to global public health policy.
The application is publicly accessible via the WHO here: http://mednet3.who.int/EML/expcom/expcom15/applications/newmed/statins/Statins.pdf
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