A "silent pandemic" of chronic disease is creeping up on poor countries and will force pharmaceutical firms to take a more tiered approach to pricing some of their most lucrative medicines.
Drugs for diseases which were previously dominant only in the rich, well-fed world, such as diabetes, heart disease and cancer, are increasingly in demand in poorer nations in Asia and Africa, whose populations are now living longer.
But the price of many of these medicines and their unsuitability for emerging markets are high barriers to access.
And yet unless those hurdles are overcome, experts say, chronic diseases could swamp developing health systems and kill many millions -- and the hopes of drugmakers like GlaxoSmithKline, Pfizer and Sanofi-Aventis of supplying vast new markets in emerging economies will struggle to come to fruition.
Discounting prices for poorer countries, a move already made by some big drug firms, is a start. But pharmaceutical bosses will also be under pressure to join patent pools to promote downward price pressure on drugs for major chronic diseases by increasing the number of producers, and may face legal challenges to force them to allow in more generic competition.
"Until now companies had been able to separate out drugs that are needed in developing countries from drugs that primarily make up their market in rich countries," Tido von Schoen-Angerer, director of Medecins Sans Frontieres' campaign for access to essential medicines, told Reuters in an interview.
"But the divide which saw infectious diseases as primarily affecting the poor and chronic diseases affecting the rich is now changing, and that will demand a change of strategy."
THE SHIFTING BURDEN OF DISEASE
Global health projections leave little doubt that chronic diseases are rapidly overtaking infectious diseases, such as malaria, AIDS and tuberculosis (TB), as the world's biggest killers -- a shift emphasised by a recent World Health Organisation (WHO) report on global health risks.
It said populations are ageing partly due to success against infectious diseases, and changing patterns of food, alcohol and tobacco consumption are creating a "double burden" for poor nations, piling chronic diseases on top of infectious diseases.
The World Economic Forum's 2010 global risks report, published ahead of its annual meeting in Davos next week, characterised the shift as a "silent pandemic".
It said that while deaths from infectious diseases, maternal conditions and poor nutrition will fall by 3 percent in the next decade, deaths from chronic disease will increase by 71 percent.
Cases of diabetes, heart disease and stroke, for which major weight gain is a big risk factor, are predicted to rise rapidly as the obesity epidemic takes hold in the developing world.
Diabetes, which the WHO says accounts for 5 percent of all deaths globally, with around 80 percent in developing nations, is seen rising by 42 percent from 2005 levels by 2015 in Africa, and by 39 percent in the same time frame in southeast Asia.
Cancer is already a bigger killer in developing countries than TB, malaria and AIDS combined and experts see a doubling of global cancer cases in the next 20 years.
WHO expert Colin Mathers says the shifting disease burden is the price of success against big killers, such as malaria and AIDS.
"Because people are living longer, they're living to ages where chronic diseases are an increasing problem," he said.
DRUGMAKERS TAKE FIRST STEPS
Some pharmaceutical firms are already making moves to cut drug prices for poorer people, hoping to smooth access to faster-growing emerging markets -- and make up for sluggish growth in markets like the United States, Japan and Europe.
GlaxoSmithKline and Sanofi-Aventis have both promised to cut prices in some developing countries.
Sanofi says drugs like Lantus for diabetes and cancer treatment Taxotere will be as low as half price in some southeast Asian nations like Indonesia and the Philippines.
Glaxo has promised to discount patented drugs in the poorest countries to no more than a quarter what they cost in the rich world and its chief executive, Andrew Witty, said on Wednesday the firm was "committed ... to a tiered pricing approach".
Glaxo, Sanofi and other drugmakers, including Pfizer, also plan to sell their own generics to capture business in emerging markets using cheaper versions of drugs now going off patent.
MSF's von Schoen-Angerer still says more innovative strategies -- such as extending drug patent pools like one set up by the international health funding agency UNITAID for AIDS drugs last month -- are needed if real progress is to be made on getting chronic disease drugs to the poor.
Developing nations may choose to take legal steps to beat down high-priced drugs, he said, like authorities in Thailand did in 2007 with a compulsory licence system allowing local generic makers to override patents on some HIV/AIDS drugs.
He also said greater "adaptive innovation" is needed from drug firms to make their medicines suitable for poorer nations.
"That might mean a new and different combination of pills, or adapting diagnostic tools to make them easier and cheaper to use in resource-poor settings," he said. "But it can't just be about taking the medicines we have from A to B."