|
Independent research & practical ideas for global prosperity
|
|
|
|
Independent research & practical ideas for global prosperity
|
|
June 9, 2009Chronic Diseases – Posing a Greater Global Risk Than a Fiscal Crisis?Posted by Rachel Nugent in Chronic Disease, WHO Tags: Global Risk Network, WHOThis is a joint post with Andrea Feigl. Chronic diseases (heart disease, cancer, chronic respiratory diseases, diabetes, and the like) are the world’s leading cause of death, and greatest contributor to the global burden of disease. To some of us working in the health field, this is not news. To others, it comes as a surprise that chronic diseases kill more people in the developing world than HIV, malaria, and other infectious diseases combined (WHO). Yet it was a surprise to us when the World Economic Forum described the global threat of chronic diseases to be more imminent and threatening than – yes, indeed – a global fiscal crisis. Read More… Comment »May 8, 2009The IMF and the Swine Flu? WHO’s on First!Posted by Mead Over in IMF, WHO Tags: Swine flu, WHO, World BankThis is a joint post with David Goldsbrough. As the possibility of a one trillion dollar supplement in IMF funding comes closer to fruition in the midst of alerts about the possibility of a new pandemic of influenza, some of us at CGD have been asked about the possibility of connections between IMF adjustment programs and health. Some of the questions are a bit loopy, like: Did the IMF cause the current flu epidemic? And even weirder: should the IMF prevent future flu epidemics? Read More… 1 Comment »May 1, 2009In the Halls of CGD, on the WHO…Posted by Rachel Nugent in WHOA joint posting by members of the CGD health team (April Harding, Mead Over, Rachel Nugent, Andrea Feigl, and Danielle Kuczynski) Scene 1. Thursday was a typical morning at CGD: birds chirping, sun shining, the health team arrives at their computers and sits down with a hot cup of coffee to tackle the challenges of the day- only to find that April Harding has circulated an article by Anne Applebaum (AA), on why the World Health Organization (WHO) should focus on infectious diseases, which April called “A really nice piece on why we should care about (and fix) the WHO”. Email frenzy ensues. Read More… 1 Comment »December 9, 2008The Public versus Private Debate: Inching Toward the Middle . . .Posted by April Harding in Uncategorized, WHOAn exchange in the pages of PLoS Medicine underscores a promising trend in global health: a shift toward more pragmatism and less name-calling on the role of the private sector in developing country health systems. Comment »October 3, 2007FDA Priority Review Vouchers for Neglected Diseases: A Little Goes a Long WayPosted by in Donor Community, HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases, Malaria, WHOThe global health community is an ambitious group; we often gravitate to the “big ideas” that revolutionize the way that things are done. But sometimes you don’t need to change the rules to make a difference – you only need to apply them creatively. In a 2006 Health Affairs article (subscription required), Duke University professors David Ridley, Henry Grabowski and Jeffrey Moe did just that by proposing the US Food and Drug Administration grant transferable “priority review vouchers” to companies that successfully obtain approval for a drug or vaccine against neglected diseases, which can then be used to jump the queue for a review of another of the company’s FDA applications – shaving up to a year off the time to market for a potential blockbuster product. This accelerated approval could be worth over $300 million to major pharmaceutical companies; moreover, this also benefits smaller biotechnology companies (who could sell such a voucher to a larger company) and generic firms (who can also enter the market sooner given the earlier patent expiration). All in all, these priority review vouchers could act as a “pull mechanism,” like Advance Market Commitments, to create incentives for manufacturers to increase their R&D investments in diseases of the poor. (These are complementary ideas: While the more generous AMCs are targeted at developing and delivering vaccines for which there are sizable donor resources, the priority-review voucher can be applied to a wider class of neglected diseases by encouraging developers to salvage existing projects that were initiated for other diseases.) Instead of calling for a new global initiative or massive injections of donors funds, the Duke team sensibly called for a mere tweak to the existing rules – so small and simple that it almost slipped below the global health radar. But thankfully, it didn’t quite make it past Senator Sam Brownback, who recognized the concept’s true lifesaving potential and incorporated it into the Elimination of Neglected Diseases amendment to the FDA Revitalization Act (.pdf), which was co-sponsored by Senators Sherrod Brown and Joseph Lieberman and ultimately signed into law on September 27, 2007. This is a truly powerful example of how policy research can be translated into action, and it just goes to show that it really is the small things that matter. See also: The Health Affairs blog shares a letter from Senator Brownback about the amendment, which is also featured in a Duke MBA newsletter. Finally, BIO Ventures for Global Health has an excellent summary of the HA proposal and the resulting legislation. Comment »June 11, 2007Lighting Up the IP DebatePosted by Kimberly Ann Elliott in Avian Influenza, Demand Forecasting, HIV/AIDS & Infectious Diseases, Pharmaceuticals & Health Products, Vaccines, WHO
The Economist, June 7, 2007 The recent decisions by Thailand and Brazil to issue compulsory licenses for AIDS drugs, and in Thailand’s case a heart-disease drug, triggered strong responses from around the world – anger from drug companies but support from many development NGOs. Often, however, one finds more heat than light reflected in this debate over intellectual property rights and access to drugs in developing countries and it is useful to keep in mind both what we know and what we don’t. What we know: First, socially optimal levels of protection for intellectual property rights (IPRs) always represent a balance between the need to provide incentives for innovation and the social benefits of disseminating the fruits of innovative activity, for example new and better drugs, as widely as possible. Poor countries with little or no innovative activity gain little and can even lose from enforcing strong IPRs. As reflected in the article in a quote from an official of Ranbaxy, an Indian drug company, as innovative activity increases, developing countries do gain from strong IP protection and can be expected to enforce those laws more effectively. Second, developing countries are fully within their rights under the World Trade Organization agreement on IPRs when issuing compulsory licenses in the case of national health emergencies and AIDS has been recognized as such an emergency. Third, very little R&D spending is devoted to tropical and other diseases that primarily affect developing countries. Although dated, a World Health Organization study estimated that only 4 percent of global public and private R&D spending “was related to health problems of low- and middle-income countries” in 1992 (cited in a CGD Working Paper by Jenny Lanjouw). A more recent analysis by the Global Forum for Health Research estimates that 90 percent of research funds are spent studying diseases that affect just 10 percent of the world’s population. Stronger IPRs will not change this situation because these countries are simply too small and too poor to generate the returns required to cover the R&D costs. Still, there is much that we do not know. How important are the middle-income countries as a source of profits for multinational drug companies? What is a “fair share” for them to pay and for which drugs? In addition to Advance Market Commitments, are there other mechanisms that could be developed to stimulate research into diseases that affect primarily developing countries? Chronic and noncommunicable “rich-world” diseases, such as diabetes and heart disease, are growing problems in developing countries but these are not generally regarded as constituting “emergencies” or as posing global health threats (like avian flu). For many common diseases that have drug therapies, are patents the major obstacles to access? One analysis (.pdf) of WHO’s Model List of Essential Medicines finds that only 17 of 319 items are patentable and that many of those are not under patent. There are no easy answers to these questions. But the aim of the Center is to continue to analyze them in a rigorous way in hopes of shifting the balance in the debate from heat to light. 1 Comment »December 18, 2006Flu Vaccine WoesPosted by Ruth Levine in Avian Influenza, Demand Forecasting, Donor Community, GAVI, Gates Foundation, Global Fund, HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases, News, Pharmaceuticals & Health Products, Tuberculosis, WHOOnce again, volatile demand for flu vaccine is giving everyone a headache. A mere two years ago supply fell badly short of demand, turning US seniors into “immunization tourists” to Canada, and putting President Bush on the defensive during the 2004 campaign. This year, demand is way off, and suppliers can barely give the vaccine away; they face the prospect of wasting valuable doses because the vaccine is developed specifically for this year’s strain. Paradoxically, despite the aggregate surplus some geographic areas are experiencing a shortage. As the New York Times reports, “The situation underscores the fragile nature of the nation’s supply system for flu vaccine, a risky and volatile business, in which the federal government has a limited role.” The consequences, aside from the immediate financial losses to suppliers and doctors who purchased in bulk, may be a decrease in future production and, yes, more shortages. “I’m concerned that we’ll throw away 20 million doses,” said Dr. L. J. Tan, the co- chairman of the National Influenza Vaccine Summit, a group of 140 companies, nonprofit groups and public agencies. “If we keep on doing that, I can guarantee that the following seasons we won’t have 115 million doses anymore.” The mismatch between supply and demand is as predictable as the flu season itself: we know it’s going to happen, we just don’t know how bad it’s going to be. So what to do? Prashant Yadav, a supply chain expert at the MIT Center for Transportation and Logistics in Zaragoza, Spain (and a consultant to our Global Health Forecasting Working Group), thinks the reason policymakers haven’t yet come up with a workable solution is because they haven’t thought about the poor flow of information and product in the complex supply chain, which includes a host of players from patients to physicians, hospitals, transportation providers, insurers and manufacturers. The approach that he and co-investigator David Williams have arrived at in a recent study include:
The challenge of dealing with volatility in demand in a complex supply chain is familiar to those who are trying to get live-saving drugs, diagnostics and vaccines into wider use in developing countries. It’s worth thinking about whether there are ways to apply some of these ideas to a broad range of products – one of the angles the Forecasting Working Group is looking at closely. 1 Comment » |
|
|
CENTER FOR GLOBAL DEVELOPMENT
1800 Massachusetts Avenue NW, Third Floor
Washington DC 20036
Tel 202.416.4000 | Fax 202.416.4050
|
|
|
Print
Share
