Atlas of MS Identifies Key Barriers to Effective Clinical Management of Multiple Sclerosis Worldwide
In April 2021, the MS International Federation released Part 2 of the Atlas of MS 3rd Edition: Clinical management of multiple sclerosis around the world. The report investigates clinical management of MS globally and shines a spotlight on the barriers to accessing diagnosis and therapies for people with MS worldwide. The report collected data from 107 countries and covers 82% of the world’s population. Below, we summarize the main findings of the report.
An early diagnosis is important to enable early treatment with disease modifying therapies (DMTs) and implement lifestyle changes to help manage the disease and improve quality of life. The report indicates:
- The majority (83%) of countries worldwide experience issues that prevent early diagnosis of MS.
- Globally, the most common barrier is lack of awareness of MS symptoms among the general public and healthcare professionals. For countries in the low and lower middle income groups, early diagnosis is additionally hindered by lack of qualified healthcare professionals to provide the diagnosis as well as the availability and cost associated with diagnostic equipment and tests.
Disease-modifying therapies for MS
Early treatment with DMTs can change the course of a person’s MS and reduce future disability. It is important that people with MS have access to a wide range of therapies to suit their disease course and personal circumstances. The report finds:
- Access to DMTs is not universal. Approximately 14% of countries report having no licensed DMTs available for people with MS and 25% do not use high efficacy licensed DMTs. These figures are even more pronounced in low and lower middle income countries.
- Globally, the most common barrier to accessing DMTs is the cost to the government, healthcare system or insurance provider.
Rehabilitation and symptom management
Rehabilitation and symptomatic therapies help people with MS maintain function and have a good quality of life. The report indicates:
- There is a high unmet need for rehabilitation and symptom management services around the world, especially for low and lower middle income countries. Therapies for the more invisible symptoms of MS, such as fatigue, cognitive impairment and vision problems, are not available in two-fifths of countries worldwide.
The wider healthcare system
Availability of healthcare professionals who specialize in MS care, along with the implementation of guidelines and standards of care for MS, can help improve MS healthcare and reduce inequalities of access between and within countries. The report indicates:
- There is a huge variation in the number of neurologists in countries worldwide. On average high income countries have 4.6 neurologists per 100,000 people compared to 0.05 neurologists per 100,000 people in low income countries.
- At least 1.8 million people (two-thirds of the world’s population of people diagnosed with MS) are living in countries that do not have national guidelines for the diagnosis and treatment of MS and do not have national standards in place to guide MS care.
It is important to note that the clinical barriers and inequities identified in the report are likely exacerbated by the ongoing global pandemic, as services are cut and health professionals are redeployed to focus on COVID-19. The report also outlines a series of recommendations on how the current data may be used by countries worldwide to advocate for improvements in MS management to ensure that people with MS and similar conditions get the care and treatment they need:
- Each country should have a national plan or guidelines for the healthcare of people with MS.
- A range of DMTs should be available, to provide people with MS the most appropriate treatment for their disease and individual circumstances.
- Affordability of DMTs needs to be improved.
- Organizations/networks that focus on neurological conditions should work together to enable earlier diagnosis, effective treatment and support for neurological conditions, including MS.
- Healthcare authorities, research institutions, MS organizations, and healthcare professionals should collaborate in the collection of data relating to MS and data needed to establish and monitor standards for MS healthcare.
Read the full report here. This report is currently available in English. A French translation will be made available soon.
Read Part 1 of the Atlas of MS 3rd Edition: Mapping multiple sclerosis around the world – key epidemiology findings. The corresponding MS update is also available here.
Read about the MS International Federation.