The maps in this article show the dramatic decline in donor dependence, since the 1960s, among India and other Asian countries

Monday, 9th of May 2016

The maps in this article show the dramatic decline in donor dependence, since the 1960s, among India and other Asian countries

The Grand Convergence: Closing the Divide between Public Health Funding and Global Health Needs

Mary Moran

Correction

1 Apr 2016: The PLOS Biology Staff (2016) Correction: The Grand Convergence: Closing the Divide between Public Health Funding and Global Health Needs. PLoS Biol 14(4): e1002439. doi: 10.1371/journal.pbio.1002439 View correction

Abstract below; full text is at http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002363

The Global Health 2035 report notes that the “grand convergence”—closure of the infectious, maternal, and child mortality gap between rich and poor countries—is dependent on research and development (R&D) of new drugs, vaccines, diagnostics, and other health tools. However, this convergence (and the R&D underpinning it) will first require an even more fundamental convergence of the different worlds of public health and innovation, where a largely historical gap between global health experts and innovation experts is hindering achievement of the grand convergence in health.

Citation: Moran M (2016) The Grand Convergence: Closing the Divide between Public Health Funding and Global Health Needs. PLoS Biol 14(3): e1002363. doi:10.1371/journal.pbio.1002363

Published: March 2, 2016

Copyright: © 2016 Mary Moran. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The Article Processing Charges for this paper were funded by The Bill & Melinda Gates Foundation, who also provided funding for a commissioning fee of $2,000. The Bill & Melinda Gates Foundation had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The author declares that no competing interests exist.

Abbreviations: AFD, Agence Française de Développment; DALY, disability-adjusted life year; DANIDA, Danish International Development Agency; DFID, Department for International Development; DGIS, Directorate General for International Cooperation; EU, European Union; FICA, Flemish International Cooperation Agency; ITN, insecticide-treated net; MDG, Millennium Development Goal; NIH, United States National Institutes of Health; NORAD, Norwegian Agency for Development Cooperation; PPH, postpartum haemorrhage; R&D, research and development; SDC, Swiss Agency for Development and Cooperation; SDG, Sustainable Development Goal; SIDA, Swedish International Development Cooperation Agency; TB, tuberculosis; UNAIDS, Joint United Nations Programme on HIV and AIDS; UNEP, United Nations Environment Programme; UNFPA, United Nations Population Fund; UNICEF, United Nations Children´s Fund; UNODC, United Nations Office on Drugs and Crime; USAID, United States Agency for International Development; WHO, World Health Organization

Provenance:The paper was commissioned by the Collection Coordinators, Gavin Yamey and Carlos Morel, in collaboration with the PLOS Biology and PLOS Medicineeditors.

The Global Health 2035 report notes that the “grand convergence”—closure of the infectious, maternal, and child mortality gap between rich and poor countries—is dependent on research and development (R&D) of new drugs, vaccines, diagnostics, and other health tools. New tools alone are estimated to deliver a 2% decline each year in the under-5 mortality rate, maternal mortality ratio, and deaths from HIV/AIDS and tuberculosis (TB) [1].

However, this convergence (and the R&D underpinning it) is unlikely unless we first have an even more fundamental convergence of the parallel worlds of public health and innovation. At the moment, these worlds are often disconnected, with major gaps to be bridged at both the intellectual and practical levels before we can truly reach a grand convergence in health.

Promising Language

The new Sustainable Development Goals (SDGs), which will replace the Millennium Development Goals (MDGs) at the end of 2015, set out ambitious aims including—by 2030—“ending the epidemics of AIDS, TB, malaria and NTDs,” “ending preventable deaths of newborns and under-5 children,” and “reducing maternal mortality to less than 70 per 100,000 live births” [2].

Global health agencies explicitly acknowledge that these goals and strategies will need R&D of new tools and have reflected this in global plans for AIDS, TB, malaria, and other diseases. The Global Plan to Stop TB (2011–2015) states that “without sufficient investment in the development of new diagnostic methods, anti-TB drugs, and vaccines, we will not achieve the Partnership´s goal of eliminating the disease as a public health problem by 2050”[3]. The World Health Organization (WHO) notes that “it is unlikely that the ambitious HIV targets set for 2020 and 2030 can be achieved if we rely only on existing HIV technologies” [4].

. . . .

Solutions

If we are to see a grand convergence, global health and development agencies will need to address the structural R&D gap that exists between discovery and delivery today.

We recommend that global health and development agencies do the following:

Energetically advocate for a health R&D indicator to be included in the final list of (likely around) 120 SDG indicators. Without R&D and a metric to drive it, the health goal cannot be achieved, as noted by health agencies themselves.
Define their R&D needs (as is happening in this series of papers), rather than waiting to see what others have developed.
Urgently start providing serious global health R&D funding not just for traditional operational and health systems research but to global health R&D and in particular to new product development.
Rapidly increase their innovation expertise in order to make effective R&D prioritisation and funding decisions. In the short- to mid-term, this means bringing in or partnering with innovation and product development expertise, including from industry. Conflict of interest will be an issue, but there are better ways to manage this than by excluding innovation expertise from the room. Good innovation policy and well-targeted investments require public health expertise but cannot be built on this alone.
Engage far more closely with science agencies, to secure better sequencing of their activities and a better strategic alignment between what the science community does and what the global health community needs. To this end, the science community could also helpfully communicate more in the language of public health and less in the language of antibodies and targets.

With greater familiarity and knowledge, innovation can become an integral part of the global public health paradigm; built on the recognition that, rather than competing for aid dollars, innovation decreases the demands on aid funding by shrinking diseases ranging from measles, diphtheria, and polio to river blindness, meningitis, and malaria. As global health experts begin to routinely include not only today´s knowledge but tomorrow´s tools in their vision and actions, we can indeed hope for a grand convergence.

References

1.Jamison DT, Summers LH, Alleyne G, Arrow KJ, Seth S, Binagwaho A. Global health 2035: a world converging within a generation. The Lancet. 2013 Dec 7;382(9908):1898, 1921. doi: 10.1016/s0140-6736(13)62105-4

2.United Nations General Assembly. Report of the Open Working Group of the General Assembly on Sustainable Development Goals. 2014 Aug. Report No.: A/68/970.
3.Stop TB Partnership. The global plan to stop TB 2011–2015: transforming the fight towards elimination of tuberculosis. Geneva, Switzerland: World Health Organization; 2010 p. iv.
4.World Health Organization. Global Health Sector Strategy on HIV, 2016–2021. Draft for consultation. 2015.
5.Policy Cures. Neglected disease research and development: emerging trends. Sydney, Australia; 2014 Dec.
6.Policy Cures. Reproductive health: R&D for the developing world. Sydney, Australia; 2015 Feb.
7.World Health Organization. Malaria: fact sheet N°94 [Internet]. 2015 [cited 2015 May 21]. http://www.who.int/mediacentre/factsheets/fs094/en/
8.Fisk NM, Atun R. Market failure and the poverty of new drugs in maternal health. PLoS Med. 2008 Jan 22;5(1):e22. doi: 10.1371/journal.pmed.0050022. pmid:18215109

9.Policy Cures. G-FINDER public search tool [Internet]. 2015.https://gfinder.policycures.org/PublicSearchTool/
10.Department of Foreign Affairs and Trade. Research for better aid: an evaluation of DFAT´s investments. Canberra, Australia; 2015.
11.World Health Organization. Towards a monitoring framework with targets and indicators for the health goals of the post-2015 Sustainable Development Goals (Draft). 2015 Jan.
12.World Health Organization. Summary of WHO proposal to inform civil society consultation, 17 March 2015. 2015.
13.World Health Organization. Global reference list of 100 core health indicators. Working version 5 [Internet]. Geneva, Switzerland; 2014 Nov [cited 2015 May 21].http://www.who.int/healthinfo/country_monitoring_evaluation/GlobalRefListCoreIndicators_V5_17Nov2014_WithoutAnnexes.pdf
14.Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323–33. doi: 10.1016/S2214-109X(14)70227-X. pmid:25103301

15.Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? The Lancet. 2005 Mar;365(9462):891–900. doi: 10.1016/s0140-6736(05)71048-5

16.Statistics Division, Department of Economic and Social Affairs, United Nations. Millennium Development Goals: 2014 Progress Chart. United Nations; 2014.
17.United Nations. Rethinking poverty: report on the World Social Situation [Internet]. New York, United States of America; 2009 [cited 2015 May 21].http://www.un.org/esa/socdev/rwss/docs/2010/fullreport.pdf
18.Saez C. WHO reviews its essential medicines list; some new candidates under patent [Internet]. Intellectual Property Watch. 2015 [cited 2015 May 21]. http://www.ip-watch.org/2015/04/21/who-reviews-its-essential-medicines-list-some-new-candidates-under-patent/
19.Kochi A. Global challenge of tuberculosis (Letter). The Lancet. 1994;344:608–9. doi: 10.1016/s0140-6736(94)91992-5

20.Trouiller P, Olliaro P, Torreele E, Orbinski J, Laing R, Ford N. Drug development for neglected diseases: a deficient market and a public-health policy failure. The Lancet. 2002 Jun;359(9324):2188–94. doi: 10.1016/s0140-6736(02)09096-7

21.Bill & Melinda Gates Foundation Anchor Partner Summit. 2014; Seattle.
22.Health I panel discussion. Australasian Aid Conference. 2015 Feb 12; Australian National University, Canberra, Australia.
23.Maher D. Global challenge of tuberculosis (Letter). The Lancet. 1994; 344:610 doi: 10.1016/s0140-6736(94)91992-5

24.Program for Appropriate Technology in Health (PATH). Technology solutions for global health: vaccine vial monitors [Internet]. 2014 [cited 2015 May 21].http://www.path.org/publications/files/TS_update_vvm.pdf
25.Moran M. Financial incentives for global health R&D. Milken Institute: Financial Innovations Lab; 2012 Jun 26.
26.Malaria 2012: Saving Lives in the Asia-Pacific Summit. 2012 Oct 31; Sydney, Australia.

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