Experts Offer Perspectives On R&D Policies In The Public Health Domain

A panel of experts gathered at the Graduate Institute in Geneva last week discussed how to secure collective action to provide global public goods through research and development (R&D) for the particular public health needs of low and middle income countries.

Some panellists stressed the central role the state plays in this regard and the need for cooperation mechanisms. Other experts shared their experiences in different sectors to propose a cross-sectorial dialogue in order to learn from these other sectors to secure fair and sustainable contributions that guarantee the provision of health as a global public good.

The discussion was organised on 24 April by the Graduate Institute of International and Development Studies (IHEID Geneva) Global Health Programme in partnership with Harvard University Global Health Institute.

Suerie Moon, from the Harvard Global Health Institute and Harvard School of Public Health, said that policy choices regarding access to medicines are crucial. For her, it is through policy choices – both domestic and global – that drugs can be made available. She pointed out that such policy choices rest on national institutes and highlight governments’ responsibility for their peoples’ health.

With a similar perspective, Inge Kaul, adjunct professor at the Hertie School of Governance in Berlin and former director of the United Nations Development Programme (UNDP) Office of Development Studies, explained that the issues in access to medicines are not caused by the market but rather by a state failure.

“The market works well” she said. According to her theory, it is the state that shapes the functioning of the market, so if the market fails it is because the state fails to correct it.

Explaining her theory on R&D in the public health context, Kaul described the responsibility policymakers have to address their domestic health problems. She said technology and knowledge are the key ingredients of health, and highlighted that if the balance inherent in intellectual property rights is biased in favour of inventors, it is up to political authorities to change that. If poor people lack the power to buy drugs, she said, this is primarily caused by a state failure to adjust to reality and to find solutions like incentivizing inventors to share their IP knowledge.

On universal access to health across countries and R&D for the diseases affecting the populations from the global South, Kaul explained that “the money can be found, there are ways to meet the health concerns of all and to do R&D for neglected diseases.”

She encouraged more actions and initiatives, especially from developing countries. In her view, developing countries must be the leaders of the R&D strategy for diseases affecting their populations. She proposed that these countries turn to their regional development banks to ask for resources and to pool resources among developing nations in order to conduct R&D for diseases suffered in the global South and hardly addressed by pharmaceutical companies from the North.

Carolina Gómez, from the Colombian Ministry of Health, said that some companies are very influential and more powerful than some states. In that respect, those states need the support of the international community and are too weak to act on their own. To that, Kaul said, “We need civil society’s pressure on the state and on the market,” though according to her theory the state must remain the crucial decision-maker.

Kaul further discussed an inclusive model that focusses on global partnership commitments, where the centre of attention should be on incentivizing the different actors in global health while keeping in mind that the state is the main actor. She gave an example of donations from the private sector like pharmaceutical companies as an illustration of early actions of actors involved in the health domain based on their emerging recognition of public health as a global public good and as interconnected with human rights.

On this partnership idea, Marie-Paule Kieny, from the World Health Organization, explained that in areas were R&D is poorly dealt with by pharmaceutical companies because the market is too small, there is a necessity to adopt a platform approach where efforts would be combined to find partnerships.

Michel Kazatchkine, the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, shared his experience as former director of the Global Fund to Fight AIDS, Tuberculosis and Malaria as a way to draw cross-sectorial learning. One of the main reasons for the Global Fund’s success is that it was not designed to fund R&D but rather to create incentives amongst the various actors, he said.