Person:

Moon, Suerie

As part of a cluster of articles leading up to the 2012 World Health Report and critically reflecting on the theme of “no health without research,” Suerie Moon and colleagues argue for a global health R&D treaty to improve innovation in new medicines and strengthening affordability, sustainable financing, efficiency in innovation, and equitable health-centered governance.

The article discusses the changing quality of global health institutions. It cites the factors that affect the change including variety of civil society, nongovernmental organizations, and private firms, changing relationships of health ministries, and new partnership of organizations. It also mentions that the global-level transformation is the biggest challenge of the global health institutions.

The global health system is in a period of rapid transition, with an upsurge of funds and greater political recognition, a broader range of health challenges, many new actors, and the rules, norms and expectations that govern them in flux. The traditional actors on the global health stage—most notably national health ministries, the World Health Organization (WHO) and a relatively small group of national medical research agencies and foundations funding global health research—are now being joined (and sometimes challenged) by a variety of newer actors: civil society and nongovernmental organizations, private firms, and private philanthropists, and an ever-growing presence in the global health policy arena of low- and middle-income countries, such as Kenya, Mexico, Brazil, China, India, Thailand, and South Africa. We present here a series of four papers on one dimension of the global health transition: its changing institutional arrangements. We define institutional arrangements broadly to include both the actors (individuals and/or organizations) that exert influence in global health and the norms and expectations that govern the relationships among them. We focused on three central questions regarding the global health system: (1) What functions must an effective global health system accomplish? (2) What kind of institutional arrangements can better govern the growing and diverse set of actors in the system to ensure that those functions are performed? (3) What lessons can be extracted from analysis of historical experience with malaria to inform future efforts to address them and the coming wave of new health challenges?

This workshop report is a summary of themes discussed by five panels during a daylong workshop on “Innovation and Access to Technologies for Sustainable Development: A Global Perspective” at Harvard University on April 24,2014. The workshop brought together a diverse group of scholars to explore how the technological innovation needed for sustainable development can be promoted in ways that assure equitable access in current and future generations.

Three key themes that emerged from the workshop include:(1) The central role of power, politics and agency in analyzing technological innovation and sustainable development -an important aspect of this includes the articulation of the roles of actors and organizations within frameworks and models of innovation systems.(2) The importance of focusing both on supply-push and demand-pull mechanisms in innovation scholarship and innovation policy.(3) The need to focus on more innovation scholarship around the goals of sustainable development.

Lawrence Gostin and colleagues offer a set of priorities for global health preparedness and response for future infectious disease threats.

The development of new technologies to combat disease, whether drugs, diagnostics, vaccines, or other health tools, has long been an important part of public health efforts. This paper traces the evolution over the past century of governance regimes for new product development (NPD) for health, using the case of anti-malaria tools as an illustration. There have been major shifts in conceptions about who should benefit from, and who should pay for NPD, with gradual movement away from a primarily national to an increasingly global approach. Innovative institutional arrangements, such as the 'public-private product development partnerships (PDPs),' have begun to take into account the need to develop tools that are adapted for use in developing countries, and to incorporate considerations of affordability into the early stages of development. However, thus far such efforts have been limited to a small set of infectious diseases. The PDPs, as currently organized, are not likely to be the appropriate model for providing NPD to counter the rapidly rising burden in developing countries of chronic non-infectious conditions such as heart disease and mental illness. At the same time, the debate over access to HIV/AIDS drugs has contributed to global norms that frame health tools as global public goods; therefore, political mobilization to demand access to tools with significant therapeutic benefit is likely to rise. To meet the coming epidemiological and political challenges, a new wave of innovation in the governance of NPD will be necessary, based on two key principles: 1) that tools should be adapted and accessible to a global population of end-users (as with the PDPs), and 2) that contributions to NPD, whether of human, scientific, or financial capital, should be a globally-shared burden.

Tisagenlecleucel (Kymriah), one of several promising chimeric antigen receptor T cell (CAR-T) therapies, is the first gene therapy to get US approval. Novartis announced in September 2017 that the leukaemia treatment would cost $475 000 (£340 000; €390 000)—double the median house price in the US, or 60 years of mortgage payments for the average family.

In the 18 years since a six part series by Abbasi in The BMJ argued that the World Bank merits greater attention from the health community, the institution has received little scrutiny from global health scholars.1 This is despite its substantial and growing role in the health sector. A recently published series of articles by Sridhar and colleagues does much to fill this gap.2-6 The authors paint a detailed picture of the bank’s historical activities, growing investments, and considerable evolution in its approaches to health. They also critically analyse more recent developments. Whether considering the growth of health related trust funds at the bank,3 its role in universal health coverage,4 the recently launched global financing facility for women and children’s health,5 or the pandemic emergency financing facility,6 the series persistently grapples with two key questions: firstly, can the bank’s market oriented approach be consistent with health equity objectives such as the globally endorsed goal of universal health coverage? Secondly, how can the bank’s immense economic and intellectual power be appropriately governed?

The Medicines Patent Pool (MPP) was established in 2010 to ensure timely access to low- cost generic versions of patented antiretroviral (ARV) medicines in low- and middle-income countries (LMICs) through the negotiation of voluntary licences with patent holders. While robust data on the savings generated by MPP and other major global public health initiatives is important, it is also difficult to quantify. In this study, we estimate the savings generated by licences negotiated by the MPP for ARV medicines to treat HIV/AIDS in LMICs for the period 2010–2028 and generate a cost-benefit ratio–based on people living with HIV (PLHIVs) in any new countries which gain access to an ARV due to MPP licences and the price differen- tial between originator’s tiered price and generics price, within the period where that ARV is patented. We found that the direct savings generated by the MPP are estimated to be USD 2.3 billion (net present value) by 2028, representing an estimated cost-benefit ratio of 1:43, which means for every USD 1 spent on MPP, the global public health community saves USD 43. The saving of USD 2.3 billion is equivalent to more than 24 million PLHIV receiving first-line ART in LMICs for 1 year at average prices today.