All of us have been enveloped in the current COVID-19 pandemic health and humanitarian emergency over the last 18 months. Yet, despite the difficulty, we must as physicians continue to find a way through and bring out the best of humanity. In this setting, we have written this commentary on brain health and World Brain Day (WBD) 2021.

Neurological disorders are the leading cause of disability and the second leading cause of mortality worldwide. ¹ Despite these alarming statistics, the gaps and disparities in the distribution of neurological resources and therapeutics worldwide are enormous. The global median of the total neurological workforce, defined as the number of neurologists, neurosurgeons, and child neurologists available in a country, is only 3.1 per 100,000 inhabitants. Low-income countries report a median of 0.1 per 100,000 inhabitants, compared with 7.1 per 100,000 in high-income countries. The disparity in workforce distribution is paralleled by the same in health resources and access to medications. All relate to economic disparities which we, as physicians, can do little to remedy. What we can do is press for a change in priorities in all countries where disparity exists.

One of the best ways to address these disparities is through widespread global advocacy and campaigns. The WBD is an annual activity of the World Federation of Neurology (WFN) held on July 22, commemorating the establishment of the WFN in 1957. This is a global event for the WFN devoted to raising awareness and advocating for brain health and neurosciences. The previous topics for WBD have been “Our brains our Future” (2014), “Epilepsy” (2015) partnering with International League Against Epilepsy (ILAE), “Brain Health and the Ageing Population”(2016), “Stroke is a Brain Attack – Prevent it and Treat it” (2017) partnering with World Stroke Organisation (WSO), “Clean Air for Brain Health” (2018) partnering with the WFN Environmental Neurology Specialty Group and “Migraine, and the Painful Truth” (2019) partnering with International Headache Society (IHS) (for details, please see the WFN website). The focus of the 2020 WBD was Parkinson’s disease (partnering with International Parkinson’s and Movement Disorders Society). This year the theme is Stop Multiple Sclerosis. The WFN is collaborating with the Multiple Sclerosis International Federation (MSIF) with the ambitious plan of reaching out to 100 million people through the global advocacy campaign to raise awareness of brain health to stop multiple sclerosis (MS).

An estimated 2.8 million people live with MS worldwide. ^{Reference Walton, King and Rechtman2} Approximately 70% of people with MS are women. From 1999 to 2019, among adults 20–40 years of age, the ratio of women to men with MS has increased from 2:1 to 3:1. ^{Reference Mendibe Bilbao, Boyero Durán, Bárcena Llona and Rodriguez-Antigüedad3}

According to the latest iteration of the MS Atlas 3^rd Edition, 90,000 people are living with MS in Canada at present. This equates to 1:400 people in Canada are living with MS. It is expected that in 2031, the number of Canadians with MS will rise to 133,635, with a prevalence of 220 cases per 100,000 men and 620 cases per 100,000 women. ^{Reference Amankwah, Marrie and Bancej4} MS affects young adults during the prime of their lives with the associated heavy cost to health and the economy. In Canada, the total per capita healthcare cost, excluding out-of-pocket expenses, for adults aged 20 years and older with MS was reported as $16,800 in 2011 and the total annual health costs for MS (without taking into consideration out-of-pocket expenses) are expected to reach approximately $2.0 billion by 2031. ^{Reference Amankwah, Marrie and Bancej4}

The 2018 Global Burden of Neurological Disease analysis suggests the doubling of MS in many parts of the world, highlighting these concerns. ^{Reference Wallin, Culpepper and Nichols5}

How should we respond to this threat? History seems to show us the way forward. Just as the community changed behavior to stop the spread of COVID-19 and developed a concerted global approach with the COVAX program from the WHO with universal access to vaccines, a focused effort on resources and knowledge gaps in MS need to be addressed as a matter of priority. Despite the enormous advances in MS therapeutics, 70% of countries are not targeting early diagnosis and are not able to provide access to effective treatment; a situation that is unfair and unreasonable. Thus, as the healthcare systems re-arranged infrastructure, teams, healthcare delivery systems with the aim of providing the universal access to COVID-19 vaccines in the middle of the pandemic. We propose the access to optimal care for MS worldwide should be offered in the same manner. Just as the funders and policymakers devoted effort toward the universal access to vaccines against COVID-19, similar efforts are required to address access to MS treatment.

These can be achieved with a coordinated, collaborative, global advocacy action plan. WBD 2021-Stop Multiple Sclerosis is the opportunity to act immediately.

Our primary focus is to advocate five key messages for MS: