NCDs are top global killer but trust fund coffers are empty

Noncommunicable diseases account for 74% of deaths globally. But a trust fund meant to provide initial support for countries that want to curb these deaths has not yet raised money for its work.

The Health4Life Fund is a multipartner trust fund dedicated to NCDs and mental health. It was established in May 2021 and led by the World Health Organization, UNICEF, and the United Nations Development Programme. The fund aims to raise $250 million in five years, and 25 countries have to date expressed interest in accessing the fund, including Sierra Leone, which hopes to use the funding to carry out a survey to fully assess the burden of NCDs across the country.

But without funding at the moment, it’s unclear when the trust fund would be able to issue grants.

“It’s difficult to say for sure what day we would start putting out the first grants, but we are hopeful that we are in a really advanced stage of discussion with a few partners. And so, if things go the way we hope, then by early next year, we should start giving grants. But we cannot say that for sure 100%,” said Dr. Mamka Anyona, the policy and strategy lead for the trust fund.

Dr. Nick Banatvala, head of the Secretariat for the U.N. Interagency Task Force on the Prevention and Control of Noncommunicable Diseases, said the fund is in startup phase — it has received funding from the European Union for that — and has received some pledges for its work at the sidelines of last week’s 77th U.N. General Assembly in New York.

The Aspen Institute has committed to raising over $5 million over the next three years, and Unexia — a new blockchain project that Anyona said is using decentralized finance to pool global health funding — has pledged to raise $50 million for the trust fund. Meanwhile, Uruguay, Kenya, and Thailand are also considering how they can support the fund, Banatvala said.

But the trust fund needs actual funding to be operational.

“That was a point that people were making … at the meeting that funds need to come in now speedily so that countries can utilize this,” Banatvala said.

He added that the task force has also been in discussions with the usual donor countries from the Organisation for Economic Co-operation and Development-Development Assistance Committee. But said they are “not yet in a position” to make a full commitment for the fund.

Asked if he’s disappointed with the lack of donor commitment to the trust fund, Banatvala’s response was a short “yes.” But he said he’s hopeful from the discussions with donors that funding will come soon.

A sudden killer

According to WHO, NCDs kill 41 million each year, with 17 million dying before the age of 70 years old. A large chunk, or 77% of all NCD deaths, happen in low- and middle-income countries. Most NCD deaths are due to cardiovascular diseases, followed by cancer, chronic respiratory diseases, and diabetes.

Country-level data from WHO’s NCDs portal also show the extent of the NCD burden in individual countries. It shows, for instance, that 96% of all deaths in North Macedonia are due to NCDs and that 49% of people over the age of 15 in Nauru use tobacco.

But in some places, the issue of low funding is compounded by the lack of data.

In Sierra Leone, the true extent of the burden is unknown, but a few small studies show it’s a growing health problem. There has also been anecdotal evidence of deaths caused by NCDs, said Steven Shongwe, WHO’s country representative.

“Many people here just die from sudden death. And then you know that actually it was NCDs. Some of them have … risk factors, but others it may not be so obvious,” he said.

Sierra Leone is prone to infectious disease outbreaks, such as malaria and Ebola, which receive more attention than NCDs. WHO faces challenges in bringing attention to the NCDs because of lack of data. The last survey conducted there to assess the burden of NCDs was in 2009, and it was only done in the capital of Freetown.

Shongwe said a countrywide survey is due to get a more accurate picture of the NCD burden in the country. However, a World Bank grant of $100,000 only covers a portion of the half a million dollars needed to carry out the survey, Shongwe said.

“It is not enough. So we need additional support. That's why we applied to the U.N. multipartner trust fund,” he said, adding that the total amount they hope to get from the trust fund is $2.7 million. Part of the funding will be to implement NCD interventions, such as tobacco control, and to integrate mental health services in primary health care.

Off track

Alexey Kulikov, an external relations officer at WHO, said that in some countries where they work, NCDs are costing economies up to 11% of their national gross domestic product.

But the return on investment of a few dollars in proven interventions, such as increasing tobacco and alcohol taxes, could have trillions in benefits for health and the economy. According to the latest WHO report on NCDs, if countries in LMICs invest an additional $18 billion per year in NCD interventions and treatments, it could generate $2.7 trillion in net economic benefits.

But there is very little international funding for NCDs. According to the WHO report, only 5% of external aid that goes to health in LMICs goes to NCDs prevention and control. And there is no The Global Fund to Fight AIDS, Tuberculosis and Malaria-like model for NCDs either.

“There is, as far as I can see, very little appetite for a similar mechanism,” said Dr. Bente Mikkelsen, director of NCDs at WHO.

In addition, she said the global financial instruments in place today were set up during the Millennium Development Goals era, which had a huge focus on communicable diseases as well as maternal and child health. Most of those instruments continue to focus on interventions addressing communicable diseases, even if many of the people they reach end up suffering from NCDs such as cancer.

A way forward, she said, is for countries to demand and include NCDs in their proposals for funding from existing global financial instruments.

But while international investments are important, she said countries themselves should prioritize and invest in NCD interventions for their own populations. Most of the investments for NCDs, she said, have to be domestic.

That would be critical if countries want to meet the Sustainable Development Goals on NCDs, which include reducing by one-third premature deaths from NCDs, which Mikkelsen said is “absolutely off track.”

“And this is despite three high-level meetings and a lot of political commitment and also tools available which [are] cost-effective to reach the targets,” she said.