23 September 2015

New 15-year blueprint to tackle global issues, including health, by 2030

The Sustainable Development Goals (SDGs) under the motto “Leave no one behind” will replace the Millennium Development Goals (MDGs), which have guided development policies, including health, since 2000.

World leaders representing the 193 United Nations Member States will adopt the SDGs at the end of September in New York at a special Summit. The 17 goals and 169 targets will apply to all countries, rich and poor, and will tackle a wide range of global issues, including health, climate change, economic development, human rights and gender equality.

SDGs health and related targets

The aspirations for global health are set out in Goal 3: “Ensure healthy lives and promote wellbeing for all at all ages” and other SDG goals include targets that will impact on health. They include, by 2030:

  • end preventable deaths of newborns, children and pregnant women;
  • end epidemics such as AIDS, tuberculosis, and malaria;
  • guarantee broader access to healthcare, vaccines and medicines;
  • end malnutrition;
  • Improve hygiene and sanitation;
  • Improve emergency response;
  • achieve universal health coverage.

The SDGs are worthy aspirations, but as yet there is no clear plan for achieving them. Médecins Sans Frontières (MSF) wants to know how the health targets will become more than just wishful thinking. Why? Because MSF works in more than 60 countries and witness troubling development trends and funding levels that are out of step with people’s health needs and the ambitions for health expressed in the SDGs.  This misalignment continues to destroy people’s lives and cripple communities.

Inadequate support for research and development (R&D), and lack of access to vaccines and medicines

  • Support for R&D on behalf of developing countries is badly needed. Ebola is a prime example of the failure of the global R&D model. MSF’s medical teams did not have treatments, rapid diagnostic tests, or vaccines for the nearly 10,000 people admitted to its Ebola Management Centres, including the 5,200 people with confirmed Ebola diagnosis.


  • The cost of the basic package of immunisation is now 68 times more expensive than it was in 2001. This means that in many countries vaccines remain too expensive to be accessible by many governments or humanitarian organisations such as MSF.


  • There have been new TB drugs developed, but in many countries these remain unaffordable or unavailable. More needs to be done to address this serious public health emergency.


  • Meeting any target to treat hepatitis C will require considerable efforts by governments to reduce the prices of new medicines. At the moment, in the US and in EU countries, medication to treat the hepatitis C virus can often cost as much as US$1,000 per pill, or US$84,000 for a course of treatment.


  • Low-income countries should make better use of the trade flexibilities created to improve access to medicines by developing countries (the TRIPS flexibilities), but their ability to do so is under threat by increasingly restrictive new regulations and international trade agreements. India, the pharmacy of the developing world, is under sustained pressure by the US and other high-income countries to stop producing generic medicines and vaccines. If this happens, it will have a serious impact on many countries and MSF’s projects around the world as the cost of medicines and vaccines will rise considerably.

Funding for health is being reduced

  • Towards the tail-end of the MDG era, international funding for health has been reducing. Health has been relegated to an economic function rather than an urgent priority. For example, some countries are returning to charging user fees for health services.  For the poor, this will likely result in people being unable to get healthcare and countries providing poor health services to the poor rather than the aim of universal health coverage or “Leaving no one behind”. MSF has witnessed how user fees present difficulties for people living in extreme poverty in a country on less than a dollar a day. When a simple consultation costs the equivalent of 25 days of income, health care will simply not reach the poorest.


  • If the world is serious about meeting the SDGs health targets and bringing major diseases under control, there need to be realistic expectations as to how governments can fund adequate healthcare. Countries with significant gaps should receive support, including those classified as middle-income economies. International funding for health should not be reduced.


  • At present, MSF is seriously concerned that the efforts of some key donor countries are seriously off track due to a misguided effort to reduce critical investments fighting HIV, tuberculosis and malaria. The Global Fund and others needed to ensure the lowest sustainable price for new drugs to fight these diseases may be undermined by market shaping strategies.  

Activists from Doctors Without Borders protest vaccine pricing policies in front of the Pfizer World Headquarters in New York. Photo: J.Blue

Lack of political will and leadership on health

  •  Putting health needs at the heart of development interventions is still largely absent in most countries, while it never started in others. 
  • Governments are rarely held accountable to their pledges to fund the health sector and health assistance. Entire populations still lack access to adequate and necessary healthcare. Development must have improved and sustained health status, as a pre-requisite, not as just an outcome of a country’s economic growth and development.


  • Concrete and swift action plans based on needs, priorities, science and best practices for people can make a difference for existing health gaps as well as emerging threats. 


  • No one was ready for the scale of the recent Ebolaepidemic, and MSF found itself filling a gap left by a deficient global response. Not sounding the alarm on time, ineffective surveillance, slow international response, the absence of global leadership, and a lack of treatments, vaccines and rapid diagnostics were all part of the collective failure it represented. Governments must be held accountable for the health of their citizens and for the pledges they make to fund health initiatives. Health is a necessity, not a commodity.

Any vision of the ‘future’ should not ignore today’s reality.