PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

95 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceGreece increased pharmaceutical R&D investment offsets from €150 million to €200 million, providing incentives for companies to invest in local research capacity (Government Gazette, 2024d). Italy committed €324 million for 311 research initiatives by 2025, supplemented by €8.7 million from the €95.5 million Joint Action Prevent NCD project (JA PreventNCD, 2024). However, these investments, whilst significant nationally, are marginal in global terms. A single large pharmaceutical company may invest more in R&D annually than entire countries, creating dependencies on commercial priorities that may not align with population health needs. Canada faces clinical trial infrastructure challenges, with insufficient core funding forcing units to operate on cost-recovery basis and rely heavily on industry sponsorship, often prioritising commercially drive trials interests over investigator-led or academically valuable studies (Bentley et al., 2020). Patient recruitment is further hampered by the Government of Canada’s Clinical Trials Database, which uses technical language inaccessible to the public and poses barriers for rural and Indigenous communities with limited internet access (Government of Canada, n.d.). Multi-site studies are additionally delayed by fragmented provincial systems, where redundant ethics reviews and regulatory requirements complicate coordination (Canadian Institutes of Health Research, n.d.). POLICY LEVERS: MEDICINES AND TECHNOLOGIES Access to innovative NCD medicines and technologies reveals systematic delays and inequities that undermine early intervention potential. Delays exceeding 600 days from approval to reimbursement, three-fold regional variations in diagnostic equipment, and molecular testing restricted to late-stage disease create barriers throughout the care pathway. Digital health adoption statistics mask fundamental interoperability failures that prevent care coordination. The evidence of countries losing competitive position in clinical trials despite strong infrastructure suggests structural barriers that investment alone cannot overcome. Without addressing these access delays, infrastructure gaps, and digital fragmentation, advances in precision medicine and digital therapeutics cannot benefit the populations who need them most. Based on the evidence examined, countries should consider the following approaches: ■ Reduce market barriers to accelerate access to high-value innovations Reform approval and reimbursement pathways to reduce lengthy delays between regulatory approval and patient access, which can exceed 600 days in some countries. This requires fast-track processes for breakthrough NCD therapies with clear timelines, early access programmes that bridge regulatory and reimbursement decisions, and dedicated innovation funds providing temporary coverage during price negotiations. Consider risk-sharing agreements for expensive therapies with uncertain benefits to balance access with sustainability, and to monitor for potential adverse events and safety concerns. ■ Invest in diagnostic infrastructure and sustainable renewal programmes to ensure equitable access Address regional disparities in availability of imaging equipment. This requires minimum standards for technology availability, systematic equipment replacement programmes with dedicated funding protected from operational budgets, mobile diagnostic units for underserved areas, and hub-and- spoke models linking rural to urban facilities. Expand coverage for molecular testing and precision diagnostics when results influence treatment decisions, as current restrictions to late-stage disease miss opportunities for effective intervention.