THE TWO FACES OF ASIA

WRITTEN BY GABRIELLE BABBINGTON
The Two Faces of Asia
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The disease burden in Asia — or the years of healthy life lost through disabling disease and premature death — has traditionally been dominated by preventable infectious diseases related to poverty, poor sanitation and inequitable access to healthcare. Despite the doubling of per capita incomes since 2000, Asia’s rapid economic growth has barely ameliorated this situation. Half of Asia’s population still lives without basic sanitation, and one in five people live on less than US$1 a day.

The Asian Development Bank calls this duality in Asia’s socioeconomic development — while some live in poverty, others enjoy middle or high incomes — the ‘Two Faces of Asia’. This situation presents diverse opportunities for healthcare innovation, because it creates a similar duality in Asia’s disease burden. While the diseases of poverty remain, higher incomes have led to a whole new set of health problems. There is a rising incidence of noncommunicable diseases, such as heart disease and Type II diabetes, as those in Asia— better off than they were, but not quite affluent by Western standards — live longer, overeat, maintain sedentary lifestyles, and, of course, smoke.

This problematic rise in lifestyle diseases has sparked some innovative solutions. For example, the race is on to develop a polypill — a single tablet containing multiple medicines — for heart disease, which is the number one cause of death globally, and which puts enormous strain on health systems. The polypill will contain a cholesterol-lowering drug, a couple of blood pressure-lowering drugs, and aspirin. Although not without its critics, proponents of the polypill say it will keep treatment costs at a minimum and improve treatment compliance among the high-risk patients for whom it is intended.

Healthcare innovation should also be driven by conditions that adversely impact quality of life, even if they will not necessarily cause death.
medical innovation
Medical technology in Asia needs to cost less, use locally sourced material, have reusable components, be able to withstand harsh conditions and be easy to operate.

However, healthcare innovation should also be driven by conditions that adversely impact quality of life, even if they will not necessarily cause death. After all, life without wellbeing is no life at all. Depression affects up to one in ten people in Asia at any given time; and the World Health Organisation predicts depression will become the leading cause of the global health burden by 2030. Furthermore, some academic estimates suggest that the financial impact of depression on national productivity amounts to more than 20 times the cost of providing adequate mental health services.

Governments across Asia need to give community mental health services a much higher priority. “At least half of Asia directs less than one per cent of their total health budget to mental health services,” says Associate Professor Chee Ng, Co-Director of Asia-Australia Mental Health. The medical technology industry can help improve mental health services, by harnessing mobile communications technologies to train staff and deliver Cognitive Behavioural Therapy (CBT) skills programmes to patients far and wide. The pharmaceutical industry can help too, by developing more effective and less costly antidepressant medication. Studies show the most effective treatment strategy for depression is the combination of psychosocial interventions, such as CBT, and an antidepressant medication.

Given the complex healthcare infrastructure throughout Asia — involving a patchwork of public, private, non-governmental, multilateral and academic organisations — healthcare innovation will continue to rely on constructive public-private partnerships, or PPPs. From the earliest stages of thoroughly analysing a health need to identifying the most culturally appropriate responses, and from designing and gaining regulatory approval for solutions to marketing cost-effective and accessible products and services, PPPs have a synergistic effect on innovation.

Take drug discovery for neglected tropical diseases for example. At their best, PPPs bring together multidisciplinary and cross-sector networks of investigators, who openly share drug development information and technology across both developed and developing countries. This momentum not only fosters innovation, it also builds innovation capacity in emerging markets, where it is most needed. In addition, when there are various agencies carrying the load, the development of new vaccines, diagnostics and drugs becomes cheaper, faster and less of a commercial risk. Medicines for Malaria Venture and the Drugs for Neglected Diseases Initiative are two examples of the PPP approach to healthcare innovation.

The pharmaceutical industry has joined this fight against neglected tropical diseases, especially against malaria. A PPP between GlaxoSmithKline and the non-governmental organisation PATH Malaria Vaccine Initiative, with funding from the Bill and Melinda Gates Foundation, is on the cusp of developing a new malaria vaccine called RTS,S. Elsewhere in the world, Novartis has partnered with the Singapore Immunology Network, the Swiss Tropical and Public Health Institute, and The Scripps Research Institute. Together, they have discovered a new drug against malaria called spiroindolone NITD609. This breakthrough comes at a time when drug-resistant strains are becoming an increasing threat in the region due to irrational drug use and poor-quality or counterfeit medicines.

There is also the challenge of providing equitable access to essential medicines — a human right that is often neglected in the region, with fatal consequences. There is hot debate over how major pharmaceutical corporations can meet their human rights responsibilities, as their products are often too expensive for emerging markets. Some of them donate billions of doses of drugs to disease-elimination programmes, but market-based solutions are more sustainable than aid-based ones.

Perhaps better placed to respond to these challenges, than such corporations, are emerging-market firms that keep costs to a minimum with frugal engineering, while embracing technological leapfrogging. The Serum Institute, for example, uses technology from the Netherlands to dramatically scale up vaccine production, mixing 3,000 litres of product at a time, instead of the traditional amount of about 100 litres. This produces six million low-cost vaccine doses in one go — a single measles vaccination costs 19 US cents — and the innovation has given the Serum Institute the greatest market share in the developing world vaccine industry.

Unlike in the West, medical technology in Asia needs to cost less, use locally sourced material, have reusable components, be able to withstand harsh conditions, and be easy to operate. Take for example the problem of premature infants dying of hypothermia in poor and remote communities. A social enterprise called Embrace has developed a baby-warmer that costs less than one per cent the cost of a traditional incubator. Social enterprises take humanitarian ideals and bring them to fruition using tried and true business methods that are well suited to local markets.

The humble mobile phone is also a perfect fit for Asia’s healthcare industry. It is cheap, portable and easily replaceable, and it can do many things at once. Besides collecting real-time data on disease outbreaks, the mobile phone can facilitate patient follow-up, connect primary, secondary and tertiary health services, and provide health workers with decision-making tools and training.

As great as the non-governmental and private sector contributions to healthcare innovation in Asia are, though, we cannot forget the responsibility of the public sector to better meet health needs. Besides fostering PPPs, governments need to streamline regulatory approval processes, improve quality control, build the capacity of their health systems, collect better epidemiological data, combat corruption, and, ultimately, provide universal healthcare coverage. Collectively, everyone involved in battling Asia’s multiple disease burdens needs to work towards a common goal: providing equitable and transparent healthcare coverage across the region’s markets, while meeting the soaring demand for innovative drugs and medical technologies that are ideally suited to the local context.

GABRIELLE BABBINGTON GABRIELLE BABBINGTON Apr 2012

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