Kyle Poplin

Weekly Roundup – New models to fund global health care

Gavin Yamey, like lots of people, has grand ideas about how to improve global health. What makes Yamey different from most is he’s worked out a way to fund his plan with “new” money.

Yamey, a physician who leads the Evidence to Policy initiative (E2Pi) in the Global Health Group at the University of California, San Francisco, got our attention with his recent talk at TEDxBerlin. “This moment in time is unique,” he said. “If we make the right choices … we can, in one generation, achieve a grand convergence in global health” and save 10 million lives annually, starting in 2035.

Every dollar invested in achieving that convergence between now and 2035, he said, would return nine to 20 dollars. He’s got research to convince us.

The cost is estimated at $70 billion in new health investments a year. A big number to be sure, but Yamey, nonplussed, says it’s merely 1 percent of additional gross domestic product that will become available to low- and middle-income countries by 2035.

“An investment of just 1 percent of GDP growth could avert 10 million deaths, year on year,” he said. “That surely represents the single most important, most promising opportunity for improving human welfare.”

The trick, he says, is convincing the world of the need to invest in global health, specifically in three critical areas: getting medicine in the hands of those who need it, building strong health systems globally and developing new health tools.

He emphasized the importance of his plan by highlighting insufficiencies elsewhere. While the World Health Organization has been criticized for its slow response to Ebola, Yamey says it was predictable. WHO’s budget has been falling since 1994, he said, and even before Ebola the organization was “struggling to carry out its basic functions.” Its entire flu budget for 2013 was $7.7 million, or “less than a third of what one city, New York, spends on its public health preparedness.”

Check out the full talk below:

WHO isn’t alone. We read this week in The Lancet that even with a boost in funding for Ebola research, the fiscal year 2015 budget of the U.S. National Institutes of Health – the largest source of funding for medical research in the world – was its lowest in years. And there was also news of just how little universities in Britain invest in global health.

How sick rich people can help the poor

Clearly, fresh thinking and new models are required in global health. That’s why we suggest you read about Alexander Masters in Mosaic magazine. (With a special tip of the hat to Ben Schiller of Fast Company’s Co.Exist.)

Masters has a plan that enlists rich people – including sick rich people – to help fund drug research and development. Specifically, it allows the wealthy to buy themselves into clinical trials so that if the drug proves effective, they get access to it.

More good news for rich people, right? Well, if the drug works, it’s also good for poor people who happen to share the ailment with the rich.

Finding cures, Masters writes, is often “a matter of funding, not science: There is not enough money in the public or private sector to run clinical trials on every exciting proposal that comes out of research labs.”

There are 12 million millionaires in the world, Masters says, and “they must between them have every disease going.” He proceeds to lay out his model and details how benefits would trickle down to those unable to pay.

Importantly, he addresses the ethics involved, too. (Is the rich person being exploited? Or dictating the research? How do you deal with the possibility of the millionaire receiving the placebo during testing?)

There’s much to consider, obviously. But there’s also much to be gained, potentially.

Market dynamics in practical terms

And while we’re on pharma R&D, there was a related flare-up this week between Doctors Without Borders (MSF) and Bill Gates.

MSF called out giant pharmaceutical firms GlaxoSmithKline and Pfizer, saying they should cut the price to $5 per child for a pneumococcal disease vaccine that is needed, but unaffordable, in much of the developing world.

Gates publicly countered, saying such criticism serves as a disincentive. “You have some pharma companies that choose never to do medicines for poor countries because they know that this always just becomes a source of criticism,” he told The Guardian. “So they don’t do any R&D on any product that would help poor countries. Then they’re not criticised at all because they don’t have anything that these people are saying they should price at zero.”

It’s an old, frustrating debate. Millions are dying around the world of diseases that could be treated, if only medicines were more available and affordable. It’s easy to criticize for-profit drug firms for not filling the obvious need, and even the industry itself admits it’s got a pricing image problem in much of the world, but they also have an obligation to make decisions that enable them to remain viable and in business.

It all gets back, eventually, to market dynamics and emphasizes the vital importance of the work being done on this front by organizations such as USAID, PATH, the Clinton Health Access Initiative and Results for Development Institute. And, if we could be allowed a self-serving plug, it also explains why we’re so excited about our initiative that documents these efforts. Check it out.

Kyle Poplin is the editor of NextBillion Health Care.

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