Time to embrace access programmes for medicines: lessons from the South African flucytosine access programme

Area of Science:

• Infectious Diseases
• Pharmacoeconomics
• Global Health

Background:

• Cryptococcal meningitis (CM) causes significant mortality, particularly in Sub-Saharan Africa.
• Flucytosine, recommended by WHO for CM, is largely inaccessible due to market failure.
• Lack of access to quality-assured flucytosine limits its potential to reduce CM mortality by up to 40%.

Purpose of the Study:

• To address the market failure preventing public sector access to flucytosine for CM treatment in South Africa.
• To evaluate the feasibility and impact of a flucytosine clinical access program.
• To identify requirements for sustainable national scale-up of flucytosine access.

Main Methods:

• Established a flucytosine clinical access program providing the drug freely to tertiary hospitals in South Africa.
• Provided flucytosine to 327 CM patients between November 2018 and September 2019.
• Described the program's necessity, catalytic potential, and ongoing efforts for national scale-up.

Main Results:

• Successfully provided flucytosine to 327 cryptococcal meningitis patients within the first year.
• The program highlighted the catalytic potential for addressing medicine access issues.
• Ongoing efforts are focused on achieving sustainable national scale-up.

Conclusions:

• South African flucytosine access program offers a model for overcoming market failures in essential medicine supply.
• Access programs can help break the cycle of low demand and limited manufacturer interest.
• This initiative provides valuable insights for broader application in ensuring global access to critical treatments.