Health Technologies Require Policy Innovations

Health technologies have value if and only if they are used -- or, as we wrote in Millions Saved after reviewing 17 large-scale successes in global health, what's needed is "innovation within an effective delivery system, at a sustainable price." That simple observation bears repeating as a caravan of new drugs, diagnostic products and vaccines for diseases that predominantly affect poor countries move through the R&D pathway, and yet face speed bumps when it's time for scaled-up manufacture and delivery to those in need.

In Sunday's Washington Post, Mary Moran, author of a study describing the multiple products whose development in commercial or non-profit pharmaceutical firms is primarily being funded by the Bill & Melinda Gates Foundation, highlights a disconnect between product development and product deployment. While some of the R&D efforts are making headway -- Moran predicts that by 2010, we'll see six or seven major new drugs for malaria and tuberculosis -- she criticizes a narrow focus on technology: "That's the problem with a technology-led solution. There's a lot of medicines out there that aren't used."

Roger Glass and co-authors, in this week's Lancet (subscription required), similarly bring attention to the potential health benefits of two recently licensed vaccines, GSK's Rotarix and Merck's RotaTeq, and then go on to fret about the practicalities of buying and using the products. If these products are suitable for developing country conditions, and if they can be introduced and delivered broadly, these oral vaccines could prevent a large share of the estimated 600,000 child deaths due to diarrheal disease associated with rotavirus. But, as Glass and colleagues point out, the vaccines have not yet been subjected to efficacy testing in Asia and Africa, so the health benefits have not been confirmed. Beyond the science and the epidemiology lie the financial and organizational challenges of introducing and sustaining the use of these new products in poor countries: how will firms be convinced to produce them in large quantity, how will countries faced with multiple competing priorities decide which ones to use, what will be the role of the private distribution channels, and how will product purchase be financed over the medium-term?

In some ways, this is a set of problems we should be happy to have. Better to have the challenge of paying for drugs for major killer diseases than not to have the drugs ready to go. Better for countries to face lots of choices about which drugs and vaccines to use than to have no options at all. But surely there are still improvements to make on our way of doing business. One improvement might be to make sure that a strategy for purchasing the products at an affordable price over the long-term is part and parcel of way R&D is funded -- as, for instance, has been proposed with an Advance Market Commitment. Another would be a more rational means of determining which product or set of products donors subsidize, to avoid the near-chaos of the current advocacy-driven financing priorities. And still a third would be a set of actions to improve the ability of both developing countries and donors to provide credible demand estimates to pharmaceutical companies, so they can build and produce with confidence that products will be used (see the description of our Forecasting Working Group). Like drugs themselves, each of these policy innovations merits focused and accelerated R&D.