Posts in: Demand Forecasting

 

February 8, 2010

Daddy Healthbucks: How Will the Gates Foundation Leverage the New $10 Billion for Vaccines and Immunization?

Posted by Ruth Levine in Demand Forecasting, Vaccines

VaccinesIn announcing a $10 billion, decade-long commitment for vaccine development and immunization in poor countries, Bill Gates made no claims that the vaccine financing challenges are solved. Quite the contrary. He and many others have highlighted the need for other donors, industry and developing country governments to up their own ante to immunization. As Orin Levine, head of the International Vaccine Access Center at Johns Hopkins, said in the Seattle Times, “The Gates Foundation cannot achieve the full promise of vaccines on its own. Manufacturers must increase their investments in vaccine research and development, donor countries must mobilize to help fund new vaccines, and developing countries must make the investments and take the steps necessary for delivering life-saving vaccines to their children.” Read More…

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October 26, 2009

Getting Down to Business in Global Health OR The Brain in Spain Works Mainly on Supply Chains (I think we’ve got it!)

Posted by Ruth Levine in Demand Forecasting, Uncategorized

When business expertise combines with an opportunity to contribute to a social mission, the results can be remarkable. Let me share one powerful example.

In mid-2006, as the Global Health Forecasting Working Group was underway, my co-chair Neelam Sekhri and I were feeling stuck. With working group members from a range of global health organizations, who brought perspectives from industry and international public health, we had been able to describe the magnitude of the challenge of forecasting the demand for global health products, particularly new ones like the rotavirus vaccine and artimesenin-based anti-malarials. We’d also developed a good understanding of how inadequate information about effective demand – how much money would be available to buy what, and at what pace countries would be likely to introduce – constrained the ability of firms to make the business case for investment in manufacturing capacity, let alone new R&D. What we were missing, though, was the deeper understanding about why the demand forecasting problem persisted, despite reasonably wide recognition that it caused shortfalls in supply, wasted of products, time and money. It’s often in answering the question, “So why hasn’t someone solved that yet?” that you discover the most interesting new ways to approach a problem. Read More…

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April 24, 2008

AEI Takes on Demand Forecasting for Malaria

Posted by Administrator in Demand Forecasting, HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases

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.

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April 22, 2008

Diagonal Health Care: Clever Cartoons Hide the Benefits of Complementarity and the Costs of Unbalanced Provider Incentives

Posted by Mead Over in Demand Forecasting, HIV/AIDS & Infectious Diseases, Malaria, Pharmaceuticals & Health Products

A paper by Gorik Ooms of Médecins Sans Frontières Belgium and co-authors introduces a new metaphor to the discussion of policy towards developing country health systems: “diagonalization.” This word adds a useful image to the still unresolved and increasingly sterile debate between advocates of “vertical” and “horizontal” health programs.

For those from outside the health sector (is anyone like that reading this blog?), a horizontal program is one which attempts to provide the population with access to generalist health care practitioners who can attempt to diagnose any patient, to treat some and refer others to more highly trained or specialized providers at “higher levels” of a health care referral structure. In contrast, a vertical program is one which is designed to deliver a single package of interventions, often aimed at a single disease or at a group of diseases that can all be addressed by that package.
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January 28, 2008

Agriculture & ACTs: New USAID Working Paper

Posted by in Demand Forecasting, Donor Community, HIV/AIDS and other Infectious Diseases, PEPFAR, Uncategorized

The market for artemisinin-based combination therapies (ACTs) for malaria is notoriously complicated, and has received a great deal of recent attention as the subject of the proposed Affordable Medicines Facility-malaria. But in order to truly understand the complexities involved – and the potential impact of donor interventions – the global health community would do well to consider the entire value chain for ACTs and the implications for the agricultural market as well. Over the past several years, an entire industry has emerged to supply the active biological ingredient, Artemisia annua, but has received relatively little attention from the malariologists, who have typically focused further downstream. USAID agricultural economist Dana Dalrymple has been following this topic closely and has summarized his findings and observations in an ongoing working paper, “Agriculture, Artemisia, ACTs and Malaria Control in Africa: The Interplay of Tradition, Science and Public Policy.”

I highly recommend a thorough read of the most recent draft, which paints a truly comprehensive picture of the critical linkages between agricultural and medical market dynamics. As this is still a work in progress, Dr. Dalrymple warmly invites comments and suggestions from the broader global health community. Feedback should be sent to ddalrymple@usaid.gov.

Please consult Dr. Dalrymple before quoting, citing or reproducing any part of the paper.

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January 28, 2008

Agriculture & ACTs: New USAID Working Paper

Posted by cgdadmin in Demand Forecasting

The market for artemisinin-based combination therapies (ACTs) for malaria is notoriously complicated, and has received a great deal of recent attention as the subject of the proposed Affordable Medicines Facility-malaria. But in order to truly understand the complexities involved – and the potential impact of donor interventions – the global health community would do well to consider the entire value chain for ACTs and the implications for the agricultural market as well. Over the past several years, an entire industry has emerged to supply the active biological ingredient, Artemisia annua, but has received relatively little attention from the malariologists, who have typically focused further downstream. USAID agricultural economist Dana Dalrymple has been following this topic closely and has summarized his findings and observations in an ongoing working paper, “Agriculture, Artemisia, ACTs and Malaria Control in Africa: The Interplay of Tradition, Science and Public Policy.”

I highly recommend a thorough read of the most recent draft, which paints a truly comprehensive picture of the critical linkages between agricultural and medical market dynamics. As this is still a work in progress, Dr. Dalrymple warmly invites comments and suggestions from the broader global health community. Feedback should be sent to ddalrymple@usaid.gov.

Please consult Dr. Dalrymple before quoting, citing or reproducing any part of the paper.

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September 28, 2007

A Whole New World of Vaccines

Posted by Ruth Levine in Demand Forecasting, Health Systems

In the “olden days” before the turn of the 21st century, immunization was not exactly headline-grabbing. Fascinating science, yes. One of the fundamental ways to keep children healthy, yes. But the object of intense business strategy-making, a key part of the fight against sexually-transmitted disease, and the focus of glamorous gatherings of the philanthropic elite – not so much. A few recent news items suggest that it’s a whole new world. For example:

  • In August, the New York Times described the extent to which pharmaceutical companies are banking on profits from their vaccine businesses, rather than from their therapeutic sides. This is a dramatic turnabout, given that the vaccine industry used to be the poor stepsister to the drug business. (We blogged about this phenomenon earlier.) Could it be that Big Pharma doesn’t see many blockbuster drugs on the horizon and, after the Vioxx debacle, sees fewer and fewer products that will sell in such large volumes? Perhaps vaccines are among the only remaining products for the masses.
  • The October 1st issue of Newsweek features an article on the science and financing of vaccines, with a helpful focus on the often-overlooked challenge of conducting large clinical trials, which are more difficult for vaccines than for most other products. (If you’re injecting healthy people with biologically active material, you’ve got to pay extra-special attention to safety. And in looking for evidence about effectiveness in protecting against infectious disease in a population, the sample size typically has to be much larger than if you’re measuring effectiveness of a product to treat people who have already been identified as being sick.) The pilot advance market commitment (AMC) for pneumo vaccine makes a cameo appearance in the article.
  • At the Clinton Global Initiative this week, a high-profile panel explored vaccine development, with particular attention to how to expand coverage while at the same time providing incentives for R&D. Of particular note: Suresh Jadhav of the Serum Institute of India was on the panel and brought a powerful message to the assembled members of the global health gang: its not just the multinationals who see the promise of vaccines both for health and for the bottom line – emerging manufacturers are seeing a bright future in this growing market, too. (You can access the full webcast via the Kaiser Family Foundation.)
  • In a remarkable display of (mostly) “girl-power,” luminaries (including at least two princesses) gathered in Brussels this week to talk about cervical cancer and HPV, with attention to when, where and how to introduce the new vaccine; the HPV vaccine could prevent the deaths of something like 200,000 women in developing countries each year. It’s pretty clear that the roll-out of the Merck and/or GSK products will depend on serious commitments from governments and donors, combined with – you guessed it – good demand forecasting. PATH already has a major project underway looking at precisely these issues, and at the CGI Merck just committed to contributing 3 million doses of their vaccine, Gardasil, to developing countries over the next five years.

All this is some combination of well choreographed public relations (of course) and something quite real: To achieve the broadly shared ambitions of better health in low-income countries, there’s a growing recognition among donors and developing country governments of the potential of immunization. At the same time, the commercial interests are intensifying, both among Big Pharma and emerging suppliers – and they are carefully watching for potential opportunities to reach both rich and not-so-rich markets. Meaning that maybe there’s a chance for genuine win-win solutions (the AMCs and more) to be developed.

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