Archive for March 2008
March 31, 2008
Malaria: Getting to Technical Consensus
Posted by Ruth Levine in HIV/AIDS & Infectious Diseases, Health Systems
Every major global public health success has had technical consensus as one crucial element. That message came out prominently in the large successes we looked at in Millions Saved; in virtually all cases, major progress was spurred when the technical community met, reviewed evidence, argued and finally came up with a way of thinking about a particular problem and an agreement about the public health approach to support. This is distinct from proclamations by funders or politicians that force a sort of “party line”; it’s a genuine agreement among those whose day job is working on the scientific and technical issues related to improving health.
To date, that technical consensus has been sorely missing in the malaria field, which has been characterized by an often unproductive combination of infighting and championing particular interventions (the bednet people, the ACT people, the DDT people). That’s why when global health leaders have promised big gains against the disease, or even eradication, I’ve been a skeptic on the sidelines. But the article “A New Global Malaria Eradication Strategy” (Download file) by Richard Feachem and Oliver Sabot in the Lancet opens the door to just the sort of discussion, evidence-building and debate that will get the community where it needs to go.
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March 24, 2008
Fighting the White Plague: World TB Day 2008
Posted by Rachel Nugent in Donor Community, HIV/AIDS & Infectious Diseases
Today is World TB Day. It would be nice to be celebrating it as the day that TB was wiped out. Instead, this day commemorates the discovery of the TB bacillus 126 years ago. Yes, that’s right: 126 years. It’s pretty clear that TB bacillus is a wily foe. We’ve made some progress since Dr. Robert Koch’s “eureka!” moment, but not nearly enough. A big reason for the stalled progress in fighting TB is growing resistance to the drugs used to treat it.
March 19, 2008
PEPFAR Reauthorization Responds to Some Evidence from First Five Years
Posted by Nandini Oomman in Donor Community, HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases, Health Systems
Last week, Congress took a major step towards re-authorizing PEPFAR, and global malaria and TB programs, for another five years. A congressional press release explains:
Legislation sponsored by the Chairman of the Senate Foreign Relations Committee Joseph R. Biden, Jr. (D-DE) and Ranking Member Richard G. Lugar (R-IN) authorizing $50 billion for global HIV/AIDS, malaria and tuberculosis programs for the next five fiscal years was approved by the Senate Foreign Relations Committee today. This legislation closely mirrors a bipartisan reauthorization bill approved by the House Committee on Foreign Affairs late last month, which will facilitate a prompt conference with the House.
Great news, of course, that the process is well on its way, with a hefty tab of $50 billion ($9 billion of which is for malaria and TB) that should build on the accomplishments of the first five years of PEPFAR and strengthen its performance in the global fight against HIV/AIDS. A quick scan of the House and Senate bills and various analyses that have followed suggest one major accomplishment in the reauthorization process – that our legislators and their incredibly dedicated staff have looked closely at the evidence, and in large part, have responded to the lessons learned in the emergency phase of the last 5 years. In particular, we are encouraged by the following highlights of the legislation (and pleased that the HIV/AIDS Monitor’s research and the work of other CGD colleagues have contributed to the growing body of evidence about these issues):
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March 17, 2008
Tearing Down the Barriers: Increasing Access in Emerging Pharmaceutical Markets
Posted by in Drug Resistance, HIV/AIDS & Infectious Diseases, Tuberculosis
Yesterday, the Financial Times reported GlaxoSmithKline’s exciting new strategy to expand markets and increase access to medicines in low- and middle-income countries. Through an internal policy known as “tearing down the barriers,” the company has established differential pricing schemes within and between India, South Africa and other developing countries, in hopes of shifting to a new low price, high volume business model. While similar initiatives have existed for AIDS antiretrovirals (in part through the work of the Clinton Foundation), the GSK strategy notably moves beyond the “Big Three” infectious diseases to tackle the growing challenge of diabetes and other noncommunicable diseases with a dual market among the rich and poor.
Although variants on this idea have been around for quite some time (for example, see related papers by Jenny Lanjouw or Patricia Danzon), GSK is the first company to implement such a policy openly and systematically across a broad range of products. But they almost certainly won’t be the last. Tiered pricing and the “middle markets” were prominent themes throughout last week’s Partnering for Global Health Forum, where biotechnology leaders came together with pharmaceutical manufacturers and global health funders to identify opportunities for collaboration in this new environment. Several biotech companies are seeking opportunities in emerging markets and are seeking novel business approaches that would serve the full spectrum of needs and abilities to pay in those countries. Here, too, the conversation frequently turned towards ways to price products to better serve the poor without eroding prices in their major markets. (Keep tabs on the Kaiser Family Foundation’s HealthCast, which should be broadcasting many of the sessions soon.)
Here at CGD, we hope to continue the dialogue over the next several months under the auspices of our new Global Health Frontiers project. It will be interesting to see whether the low-price high-volume approach taken by GSK can be sustainably extended to other companies and product areas, and whether there are other business models (such as joint ventures, in-country manufacturing, or voluntary licensing) that could profitably serve both those who can afford to pay a lot alongside those who can only afford to pay a little. It seems that some forward looking companies are willing to step into the new frontiers. This is a delicate time when the public health community can be either be supportive of these early efforts or send companies scurrying for less risky opportunities.
