Archive for the ‘Public Private Partnerships’ Category
Milwaukee: hub of water technology in global health?
It’s been more than two years since we reported on Seattle as the new Geneva, that is, as the new epicenter of global health activity. An article in this morning Journal-Sentinel (Water-engineering firms see potential, challenge in developing countries) – which includes an exclusive interview with the Acumen Fund’s chief executive Jacqueline Novogratz – suggests that Milwaukee is angling to do the same for water technology:
It’s an issue that almost certainly will preoccupy business leaders in metro Milwaukee in their strategy to brand the region as an international hub of water technology. The metro area is home to scores of water-engineering companies. Gov. Jim Doyle and the University of Wisconsin-Milwaukee this month announced plans to invest millions of dollars for UWM to become a center of freshwater research.
An 2008 article from the same newspaper (Area’s tide could turn on water technology) provides more evidence:
[F]our of the world’s 11 largest water-technology companies have a significant presence in southeastern Wisconsin, according to an analysis of data from a new Goldman Sachs report.
…
Wall Street has tracked automakers, railroads and retailers almost since there were stocks and bonds. But water remains a novelty. Goldman Sachs Group Inc. didn’t begin to research water treatment as a stand-alone industrial sector until late 2005.
While several large MNCs have shown an active interest in clean water in developing countries (e.g., Procter and Gamble, Vestergaard Frandsen, Dow) open questions remain as to what role large MNCs will play in providing access to safe water for the one billion people who don’t have it.
(Thanks to Dr. Jessica Granderson for sending the link)
Microbicides – Where are they Now? How much have we spent?
I was just sent this information (thanks to Becky!) about a new round of funding for microbicides, which comes on the heels of promising results from a trial of the PRO2000 microbicide candidate. We covered this a couple of years ago and at the time I said – the potential of this drug is revolutionary. With microbicides there was great excitement and hope, then there was failure and now there is some maturity. Okay, maybe I am overstating the case, the take home point is that we still don’t have a product and this is not cheap, easy, or quick. Developing a drug is complicated, involves huge risk, can take decades and is highly uncertain. Let’s review the drug development time line again for those of you not familiar – the graph below gives the most simplistic picture:
The early microbicide discussions took place almost 15 years ago (International Working Group on Vaginal Microbicides, source). Over half that amount of time, from 2000-2007, $1.1 Billion has already been invested in microbicide R&D! It takes anywhere from $200M to $1 Billion to bring a single novel drug to market. Let’s hope one of these compounds works and makes it through phase III. But how much will we have spent? $2 Billion, $3 billion? If it works, it will have been worth the money, however, we must ask if we took the most efficient financial route to get to the end point and if there were better financial models – that is a valid question.
Donation Mapping Tool
“The Partnership for Quality Medical Donations (PQMD) Mapping Tool, provides unprecedented access to information about the medical product donations being made…to the world’s most vulnerable populations. [Anyone] can easily determine where PQMD member donations are sent, find information on how the donations are being used by the communities who receive them and access a library of medical donation resources…” Source: Google Map Technology Enhances First Global Medical Donations Map
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I was alerted to the newly launched donation mapping tool by Jessica over at GHP (Global Health Progress). Thanks to her I got to sit in on a presentation of the tool which I found fascinating (but not sure anyone else did based on the lack of questions in the audience). The tool is a mashup of Google maps and donation metrics globally (location, type of donation, organizations involved, what type of supplies, volume, staffing on the ground to name some). The goal is to help collaboration, answer questions and facilitate the process of identifying who is working where and what are they doing? Second they wanted to bring to life the impact of donations (places, faces and outcomes). Other things I took away from the presentation:
- Massive unmet need for medical supplies. Poor infrastructure & distribution are key challenges
- Donations are meeting up to 40% of health needs in some areas
- PQMD has 27 members total (non cash EX US dollar volume was $4 Billion dollars, including non PQMD members)
- Private sector + NGO + Academia combo mix: The tool was incubated at Loma Linda School of Public health and is a joint effort with PQMD and industry.
They have put a lot of work into this and I think they have lots of neat information. The data comes from primary and secondary data sources. For example they use actual donor member shipping records and augment that with onsite data collection, interviews and site visits on ground with facility staff (location, staffing, needs). The public view is different from the private view so as not to compromise security of the facilities. There is a lot more I could write about this, but I’ll stop here and let you play around with the tool yourself:
A few other things to note – the PQMD site has various interesting resources. Here are some more notes, and things to check out:
- PQMD case studies
- PQMD fellowships
- PQMD educational resources on proper documentation, storage, distribution, see their basic primer on health care logistics
Have comments about the tool, leave them here:
Google Flu Trends for developing countries?
A few days back Aman wrote a post about Google Flu Trends. Thought I’d add a few thoughts here after reading the draft manuscript that the Google-CDC team posted in advance of its publication in Nature.
By the way, here’s what Nature says: Because of the immediate public-health implications of this paper, Nature supports the Google and the CDC decision to release this information to the public in advance of a formal publication date for the research. The paper has been subjected to the usual rigor of peer review and is accepted in principle. Nature feels the public-health consideration here makes it appropriate to relax our embargo rule
Ginsberg J, Mohebbi MH, Patel RS, Brammer L, Smolinski MS, Brilliant L. Detecting influenza epidemics using search engine query data. Draft manuscript for Nature. Retrieved 14 Nov 2008.
Assuming that few folks will read the manuscript or the article, here’s some highlights. I should say I appreciated that the article was clearly written. If you need more context, check out Google Flu Trends How does this work?…
- Targets health-seeking behavior of Internet users, particularly Google users [not sure those are different anymore], in the United States for ILI (influenza-like illness)
- Compared to previous work attempting to link online activity to disease prevalence, benefits from volume: hundreds of billions of searches over 5 years
- Key result – reduced reporting lag to one day compared to CDC’s surveillance system of 1-2 weeks
- Spatial resolution based on IP address goes to nearest big city [for example my current IP maps to Oakland, California right now], but the system is right now only looking to the level of states – this is more detailed CDC’s reporting, which is based on 9 U.S. regions
- CDC data was used for model-building (linear logistic regression) as well as comparison [for stats nerds – the comparison was made with held-out data]
- Not all states publish ILI data, but they were still able to achieve a correlation of 0.85 in Utah without training the model on that state’s data
- There have attempted to look at disease outbreaks of enterics and arboviruses, but without success.
- For those familiar with GPHIN and Healthmap, two other online , the major difference is in the data being examined – Flu Trends looks at search terms while the other systems rely on news sources, website, official alerts, and the such
- There is a possibility that this will not model a flu pandemic well since the search behavior used for modeling is based on non-pandemic variety of flu
- The modeling effort was immense – “450 million different models to test each of the candidate queries”
So what does this mean for developing world applications?
Here’s what the authors say: “Though it may be possible for this approach to be applied to any country with a large population of web search users, we cannot currently provide accurate estimates for large parts of the developing world. Even within the developed world, small countries and less common languages may be challenging to accurately survey.”
The key is whether there are detectable changes in search in response to disease outbreaks. This is dependent on Internet volume, health-seeking search behavior, and language. And if there is no baseline data, like with CDC surveillance data, then what is the best strategy for model-building? How valid will models be from one country to another? That probably depends on the countries. Is it perhaps possible to have a less refined output, something like a multi-level warning system for decision makers to followup with on-the-ground resources? Or should we be focusing on news+ like GPHIN and Healthmap?
Another thought is that we could mine SMS traffic for detecting disease outbreaks. The problem becomes more complicated, since we’re now looking at data that is much more complex than search queries. And there is often segmentation due to the presence of multiple phone providers in one area. Even if the data were anonymized, this raises huge privacy concerns. Still it could be a way to tap in to areas with low Internet penetration and to provide detection based on very real-time data.
India’s Supply Chain: Impact on Global Health?
‘The Biggest Challenge Is There Is No Organized Supply Chain’
This headline in Wharton’s newsletter intrigued me, only time for a quick posting, but this is certainly food for thought. Wal Mart is expanding operations in India and there are two quotes of note that we should think about in the context of culture; delivery and distribution of medical/health goods to those in need; and in the context of refrigeration of medication and/or vaccinations:
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“The biggest challenge is that there is no organized supply chain in India. We’ve even been surprised by some of the leading manufacturers in India like Unilever, Procter & Gamble, and some other big names, who are actually welcoming the arrival of organized supply chains in India and Wal-Mart pioneering that effort. Because of the lack of that supply chain today, there is no forecasting, there is no understanding of how demand is. It’s largely a push based system. So, I think, getting that transparency across the supply chain will be very unique.”
“The other thing is, there is no refrigerated cold chain for fresh produce in India, so therefore a lot gets wasted. By McKinsey’s own work, which the consulting firm has done, almost 40% of fresh produce in India gets wasted from farmland to the time it reaches the consumer.”
“India is very unique. In fact, I have lived in China, so maybe I can say it with a little bit more liberty that the only thing common between India and China is the one billion people. If you really operate in the two countries, I think, there are very different consumers, very different kinds of legislation, very different levels of economic development, social infrastructure, and governmental management of the economy.”
Global Health Council 5: We ♥ Margaret Chan
Friday ended with an impressive lineup of global health leaders discussing the disconnect between horizontal and vertical funding in the plenary session titled Meeting Along the Diagonal: Where the First and Last Mile Connect. A webcast of this session, and 2-3 others from the Global Health Council Conference, will be available on kaisernetwork.org starting Tues-3-Jun-2008. It’s nearly 2 hours long, but brings together ideas from the Gates Foundation, WHO, the Global Health Council, and USAID. As much as it was about these organizations and the types of organizations (foundation, multilateral, advocacy, bilateral), it was about the individuals who spoke their minds:
- Jaime Sepulveda, Director, Integrated Health Solutions Development, Bill & Melinda Gates Foundation
- Margaret Chan, Director-General, World Health Organization
- Nils Daulaire, President and CEO, Global Health Council
- Henrietta H. Fore, Administrator, U.S. Agency for International Development, Director, U.S. United States Foreign Assistance
- Fore: “horizontal aspects to vertical programs”
- Sepulveda: “integration”
- Chan: “connect”
- Nils: “fractal”
- Stewardship
- Financing
- Delivery (personal and non-personal services)
- Resource Generation (people, information, vaccines, technology)
- Walsh J A & Warren K S. Selective primary health care: an interim strategy for disease control in developing countries. N. Engl. J. Med. 301.967-74, 1979.
- An “forgotten” article that Sepulveda wrote in the 1980s in the Bulletin of the WHO on the topic of “diagonalism”, but perhaps not in those words. (I wasn’t able to find it, but if you know of the article, please post a link as a comment.)
- Dentzer told her she was “the James Brown of global health”, a reference to her work ethic
- “What works for Hong Kong doesn’t work for Zambia.” This sounds obvious, but there was quite a lot of talk at this conference about exporting successful models from one country to another. I’m not saying you can’t learn from successes, but there is at least some better work we need to do in adapting those models to different situations.
- “Primary healthcare faded from the vocabulary of global health.” She cited Periago’s “crushed” comment from earlier in the day. In fact, she brought in a lot of examples of what other people were saying throughout the day, so it’s clear that she was listening.
- One of the other examples she brought up was a Johns Hopkins professor who in a morning comment advocated for “health impact assessments” like “environmental impact assessments” prior to doing something new. (Sorry, don’t know the name of the JHU professor.)
- “Famous soft drink”. She didn’t name it because she didn’t want to advertise for it, but asked “why can’t we get to the same areas of the world?” (a reference to technologies like vaccines and medicines). If we can’t do that, “we fail our people”.
- “It’s easy to blame people when you fail.”
- In referring to her 30+ years of experience: “I look young, but I’m not”.
- “Primary healthcare was alive” in places like Brazil, India, and Argentina, even though it wasn’t in the “official vocabulary”.
- “I’m not going to repeat the WHO definition of health. To me health is a social objective.”
- In indicating that we need to train more mid-level professionals: “For the clinicians in the audience, don’t worry, there’s plenty of work.”
- “We have not listened enough.” “We underestimate the ingenuity of the community.” “If you say ‘talk is one thing, walk is another’, I rest my case.”
- “We are insular. We only look at the health sector.” We need to look at safe water and sanitation, education, etc.
- “Ministry of Health [alone] cannot handle the complexity of the situation.”
- “Let’s be realistic. Even NGOs are making profits.”
- “Why is it that working with industry is seen as dirty?” “Industry is part of the solution.” We need to work with food and pharmaceutical industries.
- Peer review is “another elephant in the room”- Chan identified most of the elephants. It is a process by which “your friends condone your work”.
And my favorite, because it directly addresses the work I do and that we need to advocate for in the development of new technologies and services:
- “I didn’t realize that the color of bednets makes a difference.”
- “It wasn’t until we brought in the anthropologists that we found out that the color red represented death.”
- They changed the color to yellow and people started to use them.
Mobile Phones for Global Health: Vodafone-UN Partnership
The UN Foundation and the Vodafone Foundation released a new report this week – Mobile Technology for Social Change: Trends in NGO Mobile Use. Thanks to Mark over at the UN Dispatch blog for telling me about this in the first place. Credit for the below description goes to an email I recieved (thanks very much Adele!) from folks at the UN Foundation, which is reproduced below:
Case studies exploring use of ‘mobile activism’ for public health projects include:
Mobile health data collection systems ( Kenya and Zambia ): Collecting and tracking essential health data on handheld devices, in countries where statistical information was previously gathered via paper and pencil, if recorded at all.
Monitoring HIV/AIDS care ( South Africa ): Using mobile devices to collect health data and support HIV/AIDS patient monitoring in a country with the world’s highest HIV/AIDS infection rates, and where rural populations often otherwise go unassisted.
Sexual health information for teenagers (US and UK ): Connecting youth to important information on sexual and reproductive health via anonymous text messaging, to empower young people to make informed sexual health decisions.
Continuing medical education for remote health workers ( Uganda ): Providing medical updates and access to vital information via mobile phones for doctors and nurses working in some of the most destitute regions, where continuing medical education services are lacking.
A total of 11 case studies identify emerging trends in ‘mobile activism,’ and investigate both the promise and challenges of innovative use of mobile technology to meet international development goals.
Public-private investment partnerships in health systems
Richard Smith at the BMJ Blog wrote about last week’s Private Sector Health Systems conference [program PDF] in Wilton Park. The full text is at the BMJ, but here’s my summary. In many developing countries, the poor are much more likely to use private providers than public sector, if they use healthcare at all.
People in Bangladesh get 80% of their healthcare from the private sector. Across Sub-Saharan Africa it’s 60%, and the proportion is increasing. The poorer people are the more likely they are to receive private care, and the middle classes consume more publicly funded care than the poor…Much of the private care that the poor receive in developing countries is, of course, of low quality. It is often provided by unqualified practitioners and is undermined by corruption, but there are – a McKinsey study in Africa showed – “islands of excellence.”
As Smith indicates, private healthcare in many low-income countries isn’t the only sector suffering from highly inconsistent quality.
government provided health care is also commonly poor, throughout Africa public health systems are derelict, and governments cannot fund, provide, and regulate care.
Smith’s intended audience of high-income country donors and policymakers may be reluctant to engage with private sector actors. Some caution is understandable but the need for practical solutions to dramatically improve healthcare provision leads to private sector mechanisms (for a good review of competitive contracting, performance-based finance and similar tools check out “Getting Health Reform Right” by Roberts, Hsiao, Berman, and Reich). The interesting thread I don’t hear as often, but have run across in my own work, is the challenge that low-income governments will have regulating the purchase private sector healthcare. Smith didn’t address it at length but the comments that followed focused on government’s regulatory role. The first response from Nigeria Health Watch blogger Chikwe Ihekweazu got to the point.
The major problem in many African countries in addition to the resistance of the concept is ‘management’ and ‘strategic thinking’ in the health sector. In Nigeria, where I am from, there is a proliferation of private health care facilities at all levels with no regulation, no accountability and no governance. …the private sector has a huge role to play…but only if there is the strategic leadership by governments to drive and regulate this.
As has pointed out more and more in the literature, private healthcare deals in volume in many low-income countries, but for these schemes to succeed governments need to lead and donors ought to be willing to invest in building effective public management of broad (diagonally funded?) health systems.
One Net One Pill One Life
These were the words of Forest Whitaker (academy award winner for his leading role in The Last King of Scotland) on tonight’s inspired 2nd annual two and half hour Idol Gives Back show which raised funds for six causes. Forest was the ambassador for Malaria No More, and definitely gave an emotional appeal for people to call in and donate money.
Earlier today I was lucky enough to be on a conference call with the medical director (Steven Phillips) for ExxonMobil’s foundation which is a major supporter and funder of the malaria component of tonight’s American Idol show. Phillips traveled to Angola twice this year, once with American Idol contestants and winners and the second time with Forest Whitaker to get them involved in combating malaria. I was joined on the call by Bill Brieger, professor at Hopkins and an expert in malaria, definitely check out his blog – Malaria Matters. Rob Katz of NextBillion and the Acumen Fund fame was the other “blogger” on the call.
According to Phillips, ExxonMobil teamed up with American Idol because they are the most watched TV show with over 30 million viewers and because their first experimental show last year was a huge hit. Exxon is reaching out to of course let their work be known and also because he feels that “one of major issues with malaria is that it (malaria) had historically been among one of most neglected diseases.” Their funding breakdown is: 25% for advocacy, 10% for R&D (e.g partnerships with MVI, MMV, others), and 65% for disease control (goes to African NGOs or iNGOs).
The Idol show had a blockbuster lineup, some of the celebs included: Bono, Alicia Keys, Heart, Brad Pitt, Robin Williams (who was beyond awful), Gloria Estefan, Mariah Carey, Celine Dion and many others. One of the highlights was Gordon Brown, prime minister of the UK, making an appearance to announce the equivalent of $200 million in funding for bednets. The three presidential candidates were also supposed to make an appearance, but perhaps this got cut. For a great recap of the show check out Kristin’s post.
Last year the show raised $76 million, it will be interesting to see what happens after tonight. Despite various criticisms and those much more cynical than I, credit has to be given to all the corporate sponsors for reaching out… I’ll post more on this if I get a chance this weekend.
Harvard Study in PLOS Medicine: Brazil’s ARV Policy Saved US$1 Billion
BBC reports that “a study published in the Public Library of Science journal by researchers from the Harvard School of Public Health suggests the policy has saved Brazil around $1bn between 2001 and 2005.” The article itself is available freely online as a part of the open access policy of PLoS.
From the Harvard School of Public Health press release:
The results showed that, although costs for Brazil’s locally produced generic antiretroviral drugs (ARVs) increased from 2001 to 2005, the country still saved approximately $1 billion in that time period through controversial price negotiations with multinational pharmaceutical companies for patented ARVs. Since 2001, Brazil has been able to obtain lower prices for patented ARVs by threatening to produce AIDS drugs locally. Though these negotiations initially prompted major declines in AIDS drug spending, HAART costs in Brazil more than doubled from 2004 to 2005. The steep increase reflects the fact that more people living with HIV/AIDS began treatment and are living longer. The increase also reflects the challenges associated with providing complex, costly second- and third-line treatments as people develop resistance to first-line drugs, live longer and require more complex treatment regimens.
Figure 6 from the article – Impact of Alternative Price and Quantity Scenarios on Total ARV Costs, 2001–2005 – shows how the increase in spending is primarily related to increases in quantities rather than costs (Figure 6.A). This figure also shows how much would have been spent if there were no price changes (6.B) and the theoretical minimum that could have been spent by buying the lowest-priced generics on the market (6.C).
SSIR Issue: Private Equity Public Good, Microfranchising, High Impact NFP
The latest issue of the Stanford Social Innovation Review is out. There are a few interesting pieces I have linked below on both the non-profit and for profit world. The first story on the HealthStore Foundation has been well covered by NextBillion, I am actually dissapointed that SSIR did not select another model to profile as HealthStore is by now very well known. There are a few other interesting pieces as well (see link above to see what articles are free):
Micro-franchise Against Malaria
How for-profit clinics are healing and enriching the rural poor in Kenya.
Creating High-Impact Nonprofits
Conventional wisdom says that scaling social innovation starts with strengthening internal management capabilities. This study of 12 high-impact nonprofits, however, shows that real social change happens when organizations go outside their own walls and find creative ways to enlist the help of others.
http://www.ssireview.org/articles/entry/creating_high_impact_nonprofits/
Private Equity, Public Good
Many businesses serving lower income communities languish because they cannot raise enough money to fund their growth. To meet their needs, a new breed of private equity investment—development investment capital—has emerged. Not only does development investment capital fund growth and social benefits in lower-income communities, it also gives investors a competitive return on their investments. Although this style of investing is still in its infancy, it is already showing promise.
3FOUR50 – Collaborating Online against Chronic Disease
Ever gone to a conference and wished you could continue the work and discussions sparked there? The Oxford Health Alliance (OxHA) has come up with an online site, 3FOUR50, to encourage ongoing collaborations on chronic disease prevention.
The name 3FOUR50 comes from the combination of:
3 Risk Factors: tobacco use, physical inactivity and poor diet.
that lead to FOUR Chronic Diseases: cardiovascular disease, diabetes,chronic lung diseases and some cancers.
which cause over 50% of worldwide mortality.
As the fight against infectious disease progresses, we are in the midst of an epidemiological transition. Shortly, causes of mortality in the developing world will begin to mirror the mortality profile of developed nations – infectious disease mortality will drop, and the majority of mortality will be due to chronic disease.
3FOUR50 was conceptualized as an ‘open space for health’, to harness the social networking power of the internet to promote chronic disease prevention. All content is user-generated, and includes stories, blogs and vlogs (reflecting different cultural perspectives on health and comments/ideas from those wishing to share their views), high-profile guest interviews, photos, and full video coverage of the OxHA 2006 Annual Summit. 3FOUR50 was created by Tommy Hutchinson, Equator Media and Eddie McCaffrey of Joose TV, as a way of reaching a wider audience beyond the annual OxHA conference.
The mission of 3FOUR50, according to Eddie McCaffrey, is “to create an online space where anyone and everyone who has something to offer in the fight against chronic disease can come together to connect, collaborate and contribute. The space itself is about participation. We encourage a two-way (or even multi-way!) conversation, unlike many typical websites that simply offer users information without the ability to have their say.” He continues, “The success of the site will be measured by reaching a critical mass of people all over the world: researchers, health workers, academics, young people, business CEO’s, NGO’s, designers, whoever, wherever – who will exchange and share ideas, plans and projects with each other.”
The site concept was inspired by the idea of tapping into audiences that could not attend the OxHA conference and the ‘huge explosion in domains like myspace, youtube’ says Hutchinson. ‘Because we work so closely with young people, we see a lot of young people engaged in all of this.. up to now [these tools] haven’t been effectively applied in a social sphere. That really is our inspiration – [to take] some of the tools, techniques, the psychology behind a lot of this and apply it to a social sphere, and health is an extremely interesting area. How big [will it be?], we don’t think in terms of numbers, no one ever has any idea of how large, how far these things will go. Let’s just enjoy it and hope it makes a difference.’
The website was just relaunched with a new design and improved tools for collaboration:
Searchable new additions include:
A network page, where people can upload information about themselves.
Private collaboration space, where you can invite people to work jointly on a project (using Basecamp software)– has proved to be very popular in testing.
A ‘Soapbox’ channel, where you can upload information on your work with chronic disease prevention and share best practices with others, and get comments from around the world.
Africa Malaria Day 2007
On Monday I was lucky enough to be on a conference call with the heads of the four organizations below. In a nutshell, the organizations seemed to be truly interested in a collaborative effort and are willing to do what it takes to get the message out and get more people involved. In short, I was impressed, the call was very interesting and I will put up a digest of the conversation later this week. Today is Africa Malaria Day, please spread the word to your networks. Additionally, April 25th is the first ever US Malaria Awareness Day. Some basic facts about a treatable disease:
350,000,000 new cases/yr (think the entire US & UK population)
1-2 Million children dead annually
3000 African children die every day
$1 to treat children under five
Malaria No More
Engages individuals, organizations, and corporations in the private sector to provide life-saving bed nets and other critical interventions to families in need. Check out their involvement page.
Medicines for Malaria Venture (MMV)
A nonprofit organization created to discover, develop and deliver new antimalarial drugs through effective public-private partnerships. MMV is managing over 30 projects (pipeline-PDF), the largest portfolio of antimalarial drugs in history. Four new artemisinin combination therapies could be approved for use within the next two years.
ExxonMobil-Africa Health Initiative
The ExxonMobil Foundation established the Africa Health Initiative in 2000 to fund and support activities related to the prevention, control and treatment of malaria in Africa. The Foundation has donated approximately $40 million to help fund programs at an individual community level, to promote the research and development of new drugs, and projects to advocate for awareness and support internationally.
President’s Malaria Initiative
In June 2005, President Bush launched PMI. He pledged to increase U.S. malaria funding to $1.2 billion over five years to reduce deaths due to malaria by 50% in 15 African countries. PMI is a collaborative effort led by USAID, in conjunction with the CDC, the Department of State, the White House, and others.The PMI goal will be achieved by reaching 85 percent of the most vulnerable groups with proven prevention and treatment measures. See also White House Summit on Malaria.
Here Sachs talks at the Norte Dame Forum on Malaria and tries a different approach to getting people involved. He argues that people in the US should care about malaria because one day it could impact everyone. I like his use of different tactics here, but it is also a bit on the scare tactic side.
Other sources:
Idol Gives Back – Ryan Seacrest advocating for bednets
Malaria Matters – Malaria Day Advocacy (fantastic blog btw)
Using Google technology to view Darfur crises
This is a grim use of Google technology, however for good reason. People can see second hand aerial views of the destruction that has taken place and hopefully use this information to mobilize people and resources. There was some previous ability to do this, but there was an official announcement yesterday that: “The United States Holocaust Memorial Museum has joined with Google in an unprecedented online mapping initiative. Crisis in Darfur enables more than 200 million Google Earth users worldwide to visualize and better understand the genocide currently unfolding in Darfur, Sudan.”
Beyond the tremendous ability to view the destruction, it is significant that Google is involved because they are currently commanding constant global attention in the business world and one can only hope that Google’s attempts at having a social impact will influence the philosophy and perspective of others in the business community. I previously blogged about Google’s foray into BOP markets that you can check out. In the second picture I have borrowed part of a screen shot from Class V. To see the full screen shot check out their posting.
Google Earth maps atrocities in Darfur
Search engine Google and the U.S. Holocaust Memorial Museum launched an online mapping project on Tuesday to provide what the museum said was evidence of atrocities committed in Sudan’s western Darfur region. More than 200,000 people have been killed in Darfur since 2003 and some of this carnage has been detailed by Google Earth, the search engine’s mapping service (http://earth.google.com).
Using high-resolution imagery, users can zoom into Darfur to view more than 1,600 damaged or destroyed villages, providing what the Holocaust Museum says is evidence of the genocide.
“When it comes to responding to genocide, the world’s record is terrible. We hope this important initiative with Google will make it that much harder for the world to ignore those who need us the most,” said Holocaust Museum director Sara Bloomfield in a statement.
“Crisis in Darfur” is the first of the museum’s “Genocide Prevention Mapping Initiative” that is aimed at providing information on potential genocides early on in the hope that governments and others can act quickly to prevent them.
“At Google, we believe technology can be a catalyst for education and action,” Elliot Schrage, Google’s vice president, said in a statement.
Blogs on Darfur: Sudan, Daily Darfur
Blog on GoogleEarth: Ogle
SMS and Text Messaging for Health
Following on the announcement of the Voxiva $10 million Phones for Health program, I’ve pulled together other programs using text or SMS messaging to improve access to health care and health information in developing countries.
There has been a lot of hope for cell phone technologies for a number of years now. Warren Kaplan’s paper helps bring to light some of the challenges and points to the need for more rigorous evaluation of these programs.
Below are a few services used in developing and developed countries. If you’ve used any of these or others, what’s your experience?
- DocVia.com – a pilot project with the Perinatal HIV Research Unit (PHRU) in Soweto, South Africa to provide drug and appointment reminders.
- SIMpill – On-Cue Compliance Service – drug and appointment reminders among others. Their TB work in Cape Town, South Africa is described.
- Mobile for Good – a program in Kenya delivering health, employment and community content. Users can access health info and ask HIV and breast cancer related questions.
- Frontline SMS – a downloadable SMS platform for NGOs. Looks great for testing the utility of SMSing before scaling up.
- The South African Depression and Anxiety Group has launched a program that enables teens to communicate with counselors
- Kenyan National AIDS Control Council – HIV information program.
- Health-SMS – aims to bring health information services to the UK National Health Service.
Indonesia, Avian Influenza & Global Inequities in Technology Access
Two weeks ago Indonesia announced that it would no longer provide samples of the H5N1 (Avian Influenza) virus to the World Health Organization (WHO). The decision by Indonesian Health Minister Siti Fadilah Supari was based on reasoning that commercial entities would use information derived from freely donated Indonesian samples to develop vaccines that would not be accessible to most Indonesians.
Indonesia is faced with with various challenges (world’s 4th most populous nation, 6000 inhabited islands) to dealing with a human epidemic, should one occur. And should one occur, Indonesia is a likely to be hit hard – currently 38% of mortalities worldwide (63 out of 167) have been identified in Indonesia (source: Wikipedia).
Instead of providing the viral samples with the WHO, Indonesia’s plan was to share exclusively with Baxter HealthCare (USA) in exchange for technology to develop the vaccine domestically. This arrangement has met with considerable sympathy (The Lancet), but the WHO was of course very interested in continuing to receive samples.
More recently, Indonesia has agreed to “resume sending avian flu virus samples to the [WHO] as soon as it is guaranteed access to affordable vaccines against the disease” (source: Indonesia Offering Samples of Bird Flu, NY Times).
One Indonesian reporter’s view is in agreement with Indonesia’s position, but in more direct language (source: RI must stay angry, but temper its anger with wisdom, The Jakarta Post):
Treating poor countries as Petri dishes for the robust growth of diseases so pharmaceutical companies can produce vaccines, and perhaps life-saving drugs, only for countries able to afford them is obliviously discriminative.
…
There is a local saying cacing pun marah ketika diinjak, literally translated as even a worm gets upset when stepped upon. This must seriously be pondered upon by those with greater power to review their initial righteous intentions of creating a better world.
Indonesia has made a bold, but necessary, move on behalf of itself and other developing countries. Upcoming developments will tell how much of an impact such an action can have.
Advance Market Commitment for Vaccines Takes Off: A Partial Solution
CGDev reported on Monday (also covered in BW) that some G7 nations, together with the Bill and Melinda Gates Foundation have agreed to provide an advance market commitment of $1.5 billion for purchase of vaccines against pneumococcal disease. Why is this commitment important?
By promising in advance to pay for life-saving vaccines once they are produced, these countries are creating incentives for biotechnology and pharmaceutical companies to produce vaccines appropriate for use in poor countries, and to sell them at affordable prices.
The reports bring up some interesting points. First, who contributed – in addition to 5 nations, the Gates Foundation contributes $50 million – and who did not – the U.S. refrained due to ‘budgetary restrains‘
Second, while the AMC is hailed as a big step forward, as a pilot it targets only the low hanging fruit of vaccine research. After all, a vaccine for pneumococcal disease exists already, and costs about $60 in the U.S. Further, other vaccines are in development, for instance by GlaxoSmithKline, which heralded the agreement as an “innovative financing mechanism” (what else will they say, as an interested party?).
More information came from Owen (thanks to Aman for the reference), who writes on his blog about the genesis and evolution of the AMC. He also provided the GAVI presentation on the subject, slides 10 and 11 of which explain the AMC pricing mechanism. So, we now know that the AMC will work by guaranteeing to (any) manufacturers, a certain price. A small part of the price would be paid by the recipient developing country, while the rest by the AMC, till such time as costs come down.
Problem One: Where are the numbers?
So, now I know how the mechanism works. But what I do not know is significantly more important. Have the numbers been worked out? For instance, what is the target cost to a developing country? What is the mark-up the AMC will pay? In essence, how many vaccines will this $1.5 billion pay for, under various scenarios?
It may not be obvious, but these questions are important to understand just how useful the AMC really is. I realize that it targets vaccines that are currently under development, but that would take years to become available in developing countries. But $1.5 billion is a lot of money for research that has already been mostly done. Besides, what if a vaccine is not being developed for a particular strain?
Problem Two: An Unsustainable AMC Model
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Phones 4 Health Partnership with PEPFAR
At the 3GSM World Congress just this morning in Barcelona, a new public-private partnership was announced between Motorola, MTN (a leading African mobile operator), Voxiva, and PEPFAR.
Excerpts from Earth Times, Feb 13, 2007:
“Leading players in the mobile phone industry and the U.S. Government have joined forces to fight HIV/AIDS and other health challenges in 10 African countries. Phones for Health is a cutting-edge US$10 million public-private partnership, which brings together mobile phone operators, handset manufacturers and technology companies – working in close collaboration with Ministries of Health, global health organizations, and other partners – to use the widespread and increasing mobile phone coverage in the developing world to strengthen health systems.”
“Health workers will also be able to use the system to order medicine, send alerts, download treatment guidelines, training materials and access other appropriate information,” said Paul Meyer, Chairman of Voxiva, the company that has designed the software. “Managers at the regional and national level can access information in real-time via a web based database.”
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Controversy over WHO Compulsory Licensing Comments
Today we are lucky to have another guest blogger, Tim France, who brings a wealth of qualifications to the table. Tim is Technical Adviser at Health & Development Networks, and an active member of the HDN Key Correspondent Team. Tim obtained his PhD at the University of Wales College of Medicine (Cardiff, UK). In 1990, he switched careers to focus on promoting the public understanding of science and health. He has since held positions with the World Health Organization Global Programme on AIDS, the UN Joint Programme on AIDS, and various non-governmental organizations, mostly writing and editing HIV/AIDS-related technical guidelines and policy materials, as well as developing information dissemination strategies. He has also been Scientific Editor of two popular scientific journals: the British Journal of Hematology and the European Journal of Cancer. Tim’s blog is called Just a Minute.
Tim has written a piece on the recent controversy regarding Dr. Chan’s comments on compulsory licensing. This post is cross-listed on Tim’s blog and the HDN website listed above. Enjoy:
More Trust Needed on Shared Health Goals, by Tim France
Despite unprecedented investment in international health programmes, seven specific diseases still claim one in every four deaths worldwide. There has never been a more acute need or opportunity for the World Health Organization (WHO) to do its job. To do so, the agency must achieve an extraordinary partnership among diverse stakeholders. Hasty criticisms of WHO in the past week reveal some of the challenges working together presents.
With expectations rising about her leadership of WHO, Dr Margaret Chan’s recent unconsidered comments about compulsory licensing of essential drugs raise real concerns. But over-interpretation of her brief remarks by the media spawned a new analysis of WHO’s ‘position’ on compulsory licensing. AIDS organisations’ willing transformation of that analysis into an accepted truth appears increasingly like an unstrategic goal with each passing episode.
Chan was in Thailand to take part in a conference on neglected diseases. Her keynote speech praised drug companies for their donations of drugs against diseases such as trypanosomiasis, lymphatic filariasis and schistosomiasis. These are medicines that are otherwise impossible to obtain for most of the people who need them. Media reports later referred to Chan as having “praised the pharmaceutical industry lavishly in her address,” without referring to the specific context of the drug donation programmes.
Thailand approves production of patented HIV, cardiovascular drugs
The titles of these two articles – Thailand to break AIDS, heart drugs patents from ETNA (Thailand) and Thailand backs patent drug copies from the BBC – suggest different actions on behalf of the Thai government, but they both report on the same: Thailand has approved production of patented HIV and cardiovascular pharmaceuticals. The drugs in question are Kaletra, an antiretroviral protease inhibitor produced by Abbott Laboratories, and Plavix, an anti-clotting agent from Sanofi-Aventis and Bristol-Myers Squibb.
From the ETNA article:
BANGKOK, Jan 30 (TNA) – The Thai Public Health Ministry confirmed Monday that it has issued compulsory licenses for the production of two drugs, one for the treatment of HIV/AIDS and another for a cardiovascular drug, paving the way for immediate production and imports of lower-cost generic versions.
…
[Thai Public Health Minister Dr Mongkol na Songkhla] said the decision to break the patents was not taken lightly but the move was necessary to ensure that the affected Thai patients have access to cheaper generic versions of the life-saving drugs.
He added that generic production of Plavix, for instance, would reduce the cost from about 70 baht (US$2.06) a pill to less than six baht (18 cents).
This is the second time Thailand’s military-backed government has broken an international drug patent in the interest of the health needs of the country’s poor.
In November it introduced Thailand’s first compulsory licencing for Merck’s Efavirenz anti-retroviral AIDS treatment.
Call for Private Sector Involvement in Malaria Efforts
Public-private partnerships have been all the rage, here are two recent articles on that front. The first is an opinion piece calling for more private sector involvement and the second is a demonstration of using private businesses to distribute insecticide resistant mosquito nets.
Increased innovation needed in the fight against epidemics , Jan 11, 2007
In a Jan. 1 editorial, the P-I rightly pointed to the need for partnerships to address global health challenges and meet goals to reduce disease and death. However, the editorial overlooked the integral role of the private sector in developing new solutions to fight epidemics… “The only way to win the war against malaria is to find new and even more effective ways to prevent infection and treat those who are sick. That includes the development of new drugs and diagnostics, as well as a malaria vaccine that has the potential to offer widespread protection against the disease… While the research that will fuel new tools is often found in academia and in the government sector, we need the involvement of industry — namely pharmaceutical and biotechnology companies — to turn research into life-saving products.”
Public-Private Cooperation Helps Fight Malaria, Jan 18, 2007
Dr. David McGuire is the director of USAID’s NetMark Project, which promotes the use of bed nets and helps African businesses distribute them. He says NetMark is partnered with nearly 40 companies in eight countries (Ghana, Nigeria, Mali, Senegal, Zambia, Uganda, Ethiopia and Zimbabwe), which in turn sell more than 15 brands of ITNs…Health experts say there are many advantages to such private-public partnerships; donors are able to stretch their dollars by taking advantage of the private sector’s efficient distribution network, stimulate the local business community in high unemployment areas, and create competition among venders to keep prices low…The involvement of the private sector has also led to the creation of Africa-based factories, including several in Tanzania, that can manufacture the nets, rather than relying on imports.
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