One criticism of the UN High Level Meeting on Non Communicable Diseases (NCDs), held in New York over September 19-20, is that donor nations came to the table, but made no real financial commitments to deal with the rising tide of NCDs. In part because of the global financial crisis that is squeezing all major sources of development assistance for health, but also because of the enormity of the problem, few nations stepped forward with significant new resources to combat illnesses like cancer, heart disease, lung disease, diabetes and mental illness that were the focus of the meeting. Some commentators singled out the US Government for special criticism, noting that the United States typically leads the planet in providing funding for global health. In some quarters, unfavorable comparisons were drawn between the commitments made by the Bush Administration following the first UN High Level Meeting on a global health topic (AIDS in 2001).
But the Obama Administration announced two important new commitments with potential significant impact on NCDs just prior to the New York meeting, oddly enough by a US Government agency known mainly in the health sphere for its work on an infectious disease. On September 13, the State Department and the George W. Bush Institute announced a significant expansion of the President’s Emergency Plan for AIDS Relief (PEPFAR)’s existing work to combat cervical cancer. Because of that cancer’s connection to reproductive health -- many cervical cancers are caused by infection from human papilloma virus (HPV) transmitted sexually – and the fact that HIV-positive women also infected with HPV are at increased risk for cervical cancer, PEPFAR announced it would be increasing the US Government commitment to screen and treat for this type of cancer from $20 million over five years to $30 million, a 50 percent increase. The goal of this activity will be to reduce deaths from cervical cancer by an estimated 25 percent among women screened and treated through the initiative. Adding to this effort, the announcement also included significant in-kind donations from companies including GlaxoSmithKline, Merck, Becton Dickenson, and QUIAGEN. Together, this initiative known as Pink Ribbon Red Ribbon (PRRR), amounts to new commitments of $75 million.
But the significance of PRRR only becomes clear in its second element – breast cancer education. Through PRRR’s highly innovative public-private partnership, Susan G. Komen for the Cure is also adding funding to expand breast cancer awareness and prevention among the same target population of women receiving care at PEPFAR-funded HIV service sites. Of course this sort of integrated prevention program makes good public health sense; one would always provide as much health-related information to women in a clinic setting as possible, dealing with cervical and breast cancer awareness together. However, even though PEPFAR has been one of the most successful global health programs in history, its success has been limited to work only on HIV/AIDS and closely-related conditions, in part because its Congressional authorization limits PEPFAR funds to HIV/AIDS prevention, treatment and care. For example, contraceptives provided to women in PEPFAR-supported clinics must be purchased by other programs of the host government, the U.S. government, or another donor, where available, rather than by PEPFAR. Through PRRR, the wonderfully robust PEPFAR prevention and treatment platform, considered one of the great global health achievements in recent times, has been made available to a whole new type of prevention – in this case for an NCD.
This intriguing and creative model has potentially far-reaching consequences. Imagine if other private funders decided to provide resources for diabetes or cardiovascular care, and were able to utilize PEPFAR clinics to make these services available. In the end, the opening up and integrating of the PEPFAR platform could turn out to be one of the most revolutionary “outcomes” of the UN High Level Meeting. Today, because of PRRR, women in Africa will receive HIV/AIDS prevention and care and integrated breast cancer education. Will tomorrow see the integration of an entire spectrum of NCD prevention?