Administrator

Profile
Full Bio: http://www.cgdev.org/

Posts:

April 24, 2008

AEI Takes on Demand Forecasting for Malaria

In honor of World Malaria Day tomorrow, AEI research fellow Roger Bate has issued a new policy brief and related magazine feature decrying the state of global demand forecasting for artemisinin-based cominbation therapies (ACTs):

WHO estimates often rely on ‘need,’ a normative concept of how many people should be treated, rather than on demand, a positive concept of what can and will be bought. In 2004, the WHO projected that the global need for ACTs in 2005 would be over 130 million treatments. This projection proved to be way too high; in 2005, maximum demand was only 25 million treatments. Major suppliers such as Novartis and Sanofi-Aventis relied on WHO estimates and, as a result, were forced to either destroy unused products or declare substantial losses when the anticipated demand never materialized. In December 2006, Novartis temporarily shut down its production facility in Suffern, New York, to prevent the production of too much medicine with a short shelf life; Chinese farmers had begun to complain that they had no buyers for their Artemisia annua. With an excess of supply, prices of Artemisia annua have plummeted, and now the WHO fears that farmers and artemisinin producers may withdraw from the market, reducing the overall supply of drugs and creating a risk of future shortages.

In the short run, unrealistically high demand estimates are costly for companies. In the long run, they are costly for the millions of people afflicted by malaria. If drug companies must weather too many losses as a result of misjudging malaria demand, they may decide to invest in drug development for other diseases. The WHO argues that its forecasts are better today. But to be useful to companies, they have to be provided at least 12 months in advance, and the WHO forecasts are not.

1 Comment »

July 3, 2007

Global Fund Grant Programs: An Analysis of Evaluation

By Administrator

The Global Fund to Fight AIDS, Tuberculosis and Malaria has quickly become one of the world’s largest funders of health programs. Just five years after its founding, it has approved proposals worth $6.8 billion for 448 programs in 136 countries, and disbursed over $3 billion. In this article, originally published in The Lancet, Steve Radelet and Bilal Siddi analyze the first 140 program grants evaluated by the Global Fund and the association between the programs’ evaluation scores and various characteristics of the grants themselves (e.g., financial size, disease target, type of recipient), the health sector (e.g., physicians per capita, donor concentration) and the recipient country (e.g., income level, governance ratings).

Key findings include:

Programs implemented by civil society/private sector recipients receive higher scores than those implemented by the government.
AIDS and TB programs receive higher scores on average than malaria programs.
Smaller grants tend to receive higher scores than larger ones, as do grants that were rated more highly at the original proposal stage by the Global Fund’s Technical Review Panel perform better.
With respect to health sector characteristics, evaluations scores are higher in countries with more physicians per capita and high immunization rates, suggesting that capacity and institutional strength in the health sector have a strong influence on program success.
Scores are also higher where the health sector has fewer donors and where Global Fund grants are a larger share of donor funding.
Lower-income countries tend to have higher evaluation scores; countries with larger budget deficits tend to receive lower scores; and countries that currently have or have had socialist governments tend to receive higher scores.
Acess the full article (pdf)

Comment »

January 16, 2007

Health Affairs on Cardiovascular Disease

By Administrator

The latest issue of Health Affairs includes a feature article on policy recommendations to reduce cardiovascular disease in the developing world:

A global CVD epidemic is rapidly evolving, and the burden of disease is shifting. Three times as many deaths from CVD now occur in developing countries as compared with developed countries. The economic and social costs of this burden will be great, particularly because many developing nations are still grappling with poverty-related diseases such as malnutrition, infectious diseases, and poor health care facilities. However, a broad range of individual- and population-based strategies exists at affordable prices and, if implemented, could reduce the burden of CVD disease by more than half. Reductions in tobacco use should be the cornerstone of these interventions. Simultaneously, efforts can be adopted to prevent the further development of CVD risk factors. These interventions are often less expensive per capita but often do not yield the benefits until much later. The interventions that are most cost-effective target those who are at highest risk for death, such as those with advanced disease or overall high risk for CVD.

Comment »

October 30, 2006

CGD Report Identifies Key Tasks for the Global Fund’s New ED

By Administrator

Global Fund Working Group

Many aid-giving institutions talk the talk about “country ownership,” “accountability” and “transparency,” but the Global Fund to Fight AIDS, Tuberculosis and Malaria has taken those principles to a whole new level by structuring its entire organization around them. This innovative model has achieved a number of real successes, but has also led to a variety of challenges, as described by Steve Radelet in a recent CGD Q&A. Now nearly five years old, the Global Fund faces a critical juncture next week when the Board of Directors appoints a new Executive Director. The five final candidates are assessed in a new Lancet editorial (free registration required), which effectively endorses Michel Sidibe for the position. Mr. Sidibe, in turn, has co-authored a separate article in the Journal of the Royal Society of Medicine discussing many of the same challenges and lays out four key questions facing the Fund moving forward.

No matter who is selected, the new Executive Director is certain to play a central role in addressing the Fund’s challenges, a daunting task given the complex environment in which the Global Fund operates. Luckily, the ED is not alone — a CGD working group has just released a report that identifies the seven most critical tasks facing the new ED and issues recommendations on how to tackle them. We welcome comments on the report, and hope that it serves as a good starting point to ensure that the Global Fund maximizes its potential impact going forward.

Comment »

August 11, 2006

Australia finally caves in to GAVI

By Administrator

From the GAVI press release:

This week, Australia becomes the 17th public donor (including the European Commission) contributing to GAVI’s life saving mission of preventing the spread of deadly diseases in the world’s poorest countries. As it launches a new overseas aid health policy, the Australian Government is committing to a US$20 million contribution to the GAVI Alliance over the next 4 years.

Comment »

June 17, 2005

Financial Times Worries that APCs May Crowd Out Other Policies

By Administrator

In today’s Financial Times (subscription only link, full text reproduced here), Andrew Jack says that policy-makers are divided about how to promote development of new vaccines. He says that “In practice, APCs have sparked dissent.”

The article is somewhat thin on detail of this supposed controversy. The claim seems to be that advance purchase commitments might divert resources from more pressing needs, or that that there are already increasing incentives for the development of new vaccines.

Owen’s comment
I wrote a letter to the editor in reply to this article, which was published on 21 June. It said:

Sir,

Policymakers are rightly turning their attention to finding ways to use scientific knowledge to address the health needs of the developing world. As Andrew Jack reports (’Rich World Divided Over The Health Of The Poor’, 17 June), there is no single solution which will ensure that new medicines and vaccines are developed and affordable. But it is not true that policy-makers are “sharply divided” about which approach to adopt: on the contrary, there is a clear consensus among experts that we need a mixture of publicly funded research, public-private partnerships, and commercial investment to accelerate development of new medicines. It is not surprising that this combination has such wide support: it is the mixture of funding and incentives that has led to the development of medicines for the health needs of the rich world.

Private sector investment is constrained by the absence of a valuable market for medicines for poor countries. The G8 Finance Ministers communique endorsed advance purchase commitments as an additional policy which would create a market incentive for more private sector investment, to complement public and charitable funding of research. As your other report (”Drug Companies Appeal for G8 Backing to Fight Diseases”, 17 June) explains, public and charitable funding alone are not sufficient for new medicines to be developed and brought to market.

There is no competition between these approaches. A benefit of advance purchase commitments is that payments are only needed if and when a new vaccine has been developed; so in the meantime the donors can and should increase public funding of research. Without an advance purchase commitment, many medicines will remain stuck in the pipeline, and there is no guarantee that poor countries will be able to afford them if and when they are developed.

Yours sincerely

Owen Barder
Center for Global Development, Washington, DC 20036.

Comment »

May 10, 2005

Answering concerns about Making Markets for Vaccines

By Administrator

The authors of Making Markets for Vaccines, respond to a submission to the Commission for Intellectual Property in Health (Concerns Regarding the “Making Markets for Vaccines”)

Read the response (PDF)