Over the past century, the global population’s health has experienced a profound transformation. While diseases such as tuberculosis, malaria, or typhoid (infectious or communicable diseases) dominated, now we see those diseases such as diabetes, cancer, heart disease, and chronic respiratory conditions (non-communicable diseases – NCDs) are more prevalent. This shift, known as the epidemiological transition, has reshaped public health priorities, healthcare systems, and the conversation around innovation in treatment access.
While this transition started earlier in developed countries, reaching later the global south, it has been nearly universal. However, the ability to access modern, innovative treatments remains deeply unequal. The divide between developed and developing nations is not just economic, it is also about life expectancy, quality of life, and health equity.
The epidemiological transition
In the early 20th century, infectious diseases were the leading cause of death globally. However, improvements in sanitation, vaccination, antibiotics, and overall living conditions drastically reduced these diseases in many parts of the world. But as economic progress was taking place, NCDs were gaining prominence, mainly due to sedentary lifestyles, tobacco use, poor diets, aging populations, urbanization, and environmental factors.
Today, NCDs account for over 70% of global deaths. This trend isn’t limited to wealthy nations. Low- and middle-income countries (LMICs) now bear nearly 75% of the global NCD burden, often while still grappling with outbreaks of infectious diseases.[1]
The access gap to innovation
Healthcare innovation has increased exponentially in recent decades. We can now see things like precision medicine, targeted cancer therapies, wearable health tech, and AI-assisted diagnostics are transforming healthcare. Although access to these advancements remains highly uneven. To better visualize the difference in access to innovative treatments in developed and developing countries, we can observe the following table:
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High-income countries |
Low and middle-income countries |
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· There is often faster regulatory approval for new drugs and devices. · Public or private insurance may subsidize expensive therapies. · Healthcare infrastructure is generally equipped to deliver complex treatments. · Patients benefit from better health literacy and routine checkups that catch disease earlier. |
· Many innovative treatments are delayed or never reach the market due to pricing, patent laws, or weak health systems. · Out-of-pocket spending is often the norm, leading to catastrophic health expenses. · Infrastructure may not support advanced diagnostics or treatment protocols. · A shortage of specialists and trained professionals can make the implementation of complex therapies nearly impossible. |
This gap is closely linked to public policy decision-making, as governments play a crucial role in shaping access to new technologies and treatments. Healthcare innovations are often concentrated in high-income countries due to policy prioritization, funding, and infrastructure. To shorten the differences and avoid perpetuating healthcare inequalities, LMCs need to implement targeted policy interventions, such as tiered pricing, investments in healthcare systems, and public-private partnerships.
The challenges and how to overcome them
There is a clear divide between wealthy and non-wealthy countries in terms of healthcare innovation availability. To better understand the differences previously presented, let’s explore some of the main challenges to accessing advanced sanitary technologies:
Affordability: Innovative treatments often come with high price tags. Even when breakthrough drugs become available, they may be financially inaccessible for most patients, especially where public healthcare covers most of the population and funding is very limited.
Infrastructure gaps: Delivering, for instance, immunotherapy treatment requires more than just the drug; it requires specialized equipment, storage, diagnostics, and a trained workforce. Many health systems, particularly in LMICs, are not equipped to administer such treatments precisely due to the lack of those resources
Regulatory barriers: Some LMICs face long delays in regulatory approval processes, lack of health technology assessment (HTA) frameworks, or insufficient intellectual property regulations to attract pharmaceutical investment.
Research and data: Clinical trials are often concentrated in high-income countries, leading to a lack of data on how innovative treatments affect diverse populations. This can discourage adoption in regions where the benefits are not yet well-documented. On top of that, and thinking of a more basic barrier, usually LMICs lack updated registries or databases of their patients and their diagnoses, making it difficult to determine who needs and can access these new treatments.
Despite them, there are measures that LMICs can implement to try to overcome this complex challenge, at which requires coordinated efforts on multiple fronts:
Universal Health Coverage: Strengthening public health systems to extend coverage beyond essential treatments, thus including some innovative therapies without financial hardship.
Tiered pricing: Encouraging pharmaceutical companies to adopt pricing models that reflect countries’ ability to pay, particularly in lower-income regions.
Public-Private Partnerships: Combining resources and expertise from governments, NGOs, and private industry to invest in infrastructure and training.
Localized Innovation: Supporting research and innovation within LMICs to develop treatments that can also reflect other local contexts and more affordable solutions.
A success story of how a LMIC can improve access to innovation comes from Rwanda. The African country has implemented a multi-faceted, coordinated approach, involving government action, international partnerships, and local innovation. A closer look at some of the measures can help us understand what they have done.
Firstly, Rwanda has invested heavily in expanding its mutuelle de santé (community-based health insurance program), which covers over 90% of the population. This program allows citizens to access a range of treatments at affordable rates. In recent years, the government has prioritized the inclusion of innovative therapies, including cancer treatments, under this coverage.
Besides, the country has leveraged tiered pricing models through negotiations with pharmaceutical companies. By working with international organizations such as the Global Fund and the WHO, the government has been able to secure more affordable prices for essential medicines and treatments tailored to local purchasing power. Furthermore, Rwanda has formed public-private partnerships to invest in healthcare infrastructure, such as training programs for doctors, acquiring diagnostic equipment, and improving hospital facilities. This has helped create a more robust healthcare system capable of administering advanced therapies like immunotherapy.
On top of that, Rwanda has supported localized innovation by establishing research centers and improving patient data collection through electronic health records, ensuring more effective and targeted healthcare delivery. As a result of all these efforts, Rwanda has significantly increased access to cancer care and other innovative treatments, achieving better health outcomes.
As the burden of disease shifts from infectious diseases to more chronic conditions, the need for equitable access to modern healthcare becomes more and more urgent. Innovative treatments hold enormous promise, but only if they can reach the people who need them, regardless of geography or income. The epidemiological transition presents not just a challenge, but an opportunity to reshape healthcare for a healthier world.
[1] World Health Organizations (Dec 2024). Noncommunicable diseases
Inés Marrache
Consultant
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