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1. Addressing Antimicrobial Resistance

Author:
Aspen Health Strategy Group
Publication Date:
04-2020
Content Type:
Working Paper
Institution:
Aspen Institute
Abstract:
In June 2019, the Aspen Health Strategy Group met for three days to explore the topic of antimicrobial resistance. We are pleased to present the final report from our work, based upon the group’s rich discussion. In the tradition of the thought-provoking conversations and dialogue on how to address critical societal issues — the hallmark of the Aspen Institute — the report includes five big ideas to address antimicrobial resistance.
Topic:
Health, Public Health, Resistance, and Medicine
Political Geography:
Global Focus

2. Enforcement of Drug Laws: Refocusing on Organized Crime Elite

Author:
Global Commission On Drug Policy
Publication Date:
05-2020
Content Type:
Special Report
Institution:
Global Commission On Drug Policy
Abstract:
In this first report of this decade, the Global Commission on Drug Policy outlines how the current international drug control regime works for the benefit of transnational organized crime. It highlights how years of repressive policies targeted at nonviolent drug offenders have resulted in mass incarceration and produced countless adverse impacts on public health, the rule of law, and social cohesion, whilst at the same time reinforcing criminal elites. The report argues that the top layers of criminal organizations must be disempowered, through policy responses and political will. It provides implementable recommendations for the replacement of the current policy of targeting non-violent drug offenders and resorting to mass incarceration. Law enforcement must focus on the most dangerous and protected actors and primary drivers of the corruption, violence, and chaos around illegal drug markets. The control of psychoactive substances in a rational and efficient way must be centered on people and their needs, and on a repressive approach against criminal elites who benefit from the illegal drug markets’ proceeds, and have access to high-level networks, financial and legal support as needed. Only responsible legal regulation of currently prohibited drugs, with careful implementation, has the potential to disrupt criminal organizations and deprive them of their most lucrative sources of income. The report contains research on the prerequisites for a successful transition towards the reform of the outdated ideology-based international drug control regime, and provides cutting-edge recommendations on how to ensure that international criminal organizations are effectively disempowered by the transition towards a legally regulated drug market under the control of governments.
Topic:
Crime, Health, War on Drugs, Drugs, Public Health, and Medicine
Political Geography:
Global Focus

3. Synthetic Biology and the Risks of Misuse

Author:
Gigi Gronvall
Publication Date:
07-2020
Content Type:
Journal Article
Journal:
Fletcher Security Review
Institution:
The Fletcher School, Tufts University
Abstract:
Synthetic biology is a relatively new scientific field that aims to make biology easier to engineer and, thus, more useful. It is already delivering on its enormous promise, yielding FDA-approved chimeric antigen receptor (CAR) T-cell cancer therapeutics, as well as non-medical products such as laboratory-produced fabrics, flavorings, adhesives, and detergents.[1][2] Despite such progress, however, the rapid growth and democratization of synthetic biology — almost all of which is taking place in the private sector — brings security challenges. Like all areas of the life sciences, it is “dual-use” and able to be exploited. To make misuse more limited and difficult to en‐ force, the United States will need to partner with other nations, international organizations, and international businesses to govern areas of the synthetic biology field...
Topic:
Science and Technology, Biology, and Medicine
Political Geography:
Global Focus and United States of America

4. Can Transparency Lower Prices and Improve Access to Pharmaceuticals? It Depends

Author:
Kalipso Chalkidou and Adrian Towse
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
spending on pharmaceuticals and other healthcare commodities is high and makes up a large proportion of healthcare spending in rich and poorer markets alike. A popular response to the problem of escalating drugs budgets has been transparency of drug pricing within and across borders. In a rare alignment of policy priorities, the Trump administration, the US Senate, and the World Health Organisation are calling for more transparency of the prices paid for prescription drugs as a means of tackling the ever-growing pharmaceuticals bill. Recently Italy’s health minister joined in, calling for a World Health Assembly resolution which would mandate WHO to “provide governments with a forum for sharing information on drug prices, revenues, research and development costs, public sector investments and research and development subsidies, marketing costs and other related information.” But is price transparency really the answer to healthcare systems’ fiscal sustainability challenges as they strive to expand access to new technologies or even merely sustain provision within strained public budgets? Well, it depends!
Topic:
Transparency, Medicine, Pharmaceuticals, and Price
Political Geography:
Global Focus

5. WHO Technical Report on Cancer Pricing Misses the Mark—It Should Focus on the “Demand Side”

Author:
Kalipso Chalkidou, Adrian Towse, and Richard Sullivan
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Criticising cancer medicine pricing as too high is what football fans know as an "open goal"—a target that is hard to miss. Yet somehow the World Health Organization (WHO) Technical Report on Cancer Pricing manages to do just that with a paper to the WHO Executive Board calling for price and cost transparency. The assumption goes that transparency will reduce the prices and costs of cancer medicines, a mantra that has united the Trump administration, the US Congress, and the Italian health minister with many NGOs who have called for “greater cost and price transparency”—a sentiment echoed by KEI, which states that “international action is required to improve transparency in reporting the costs of R&D and production, including public sources of funding.”
Topic:
World Health Organization, Health Care Policy, Medicine, Cancer, and Price
Political Geography:
Global Focus

6. Pooled Procurement of Drugs in Low and Middle Income Countries

Author:
Pierre Dubois, Yassine Lefouili, and Stephane Straub
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
We use data from seven low and middle income countries with diverse drug procurement systems to assess the effect of centralized procurement on drug prices and provide a theoretical mechanism that explains this effect. Our empirical analysis is based on exhaustive data on drug sales quantities and expenditures over several years for forty important molecules. We find that centralized procurement of drugs by the public sector allows much lower prices but that the induced price reduction is smaller when the supply side is more concentrated.
Topic:
Drugs, Medicine, Centralization, and Price
Political Geography:
Global Focus

7. Who Benefits from Pharmaceutical Price Controls? Evidence from India

Author:
Emma Boswell Dean
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
With the goal of driving down drug costs, governments across the globe have instituted various forms of pharmaceutical price control policies. Understanding the impacts of such policies is particularly important in low- and middle-income countries, where lack of insurance coverage means that prices can serve as a barrier to access for patients. In this paper, we examine the theoretical and empirical effects of one implementation of pharmaceutical price controls, in which the Indian government placed price ceilings on a set of essential medicines. We find that the legislation resulted in broadly declining prices amongst both directly impacted products and competing products. However, the legislation also led to decreased sales of price-controlled and closely related products, preventing trade that would have otherwise occurred. The sales of small, local generics manufacturers were most impacted by the legislation, seeing a 14.5 percent decrease in market share and a 5.3 percent decrease in sales. These products tend to be inexpensive, but we use novel data to show that they are also of lower average quality. We provide evidence that the legislation impacted consumer types differentially. The benefits of the legislation were largest for quality-sensitive consumers, while the downsides largely affected poor and rural consumers, two groups already suffering from low access to medicines.
Topic:
Medicine, Pharmaceuticals, Price, and Price Control
Political Geography:
Global Focus

8. Aggregating Demand for Pharmaceuticals is Appealing, but Pooling Is Not a Panacea

Author:
Cassandra Nemzoff, Kalipso Chalkidou, and Mead Over
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
As low- and middle-income countries reduce their reliance on donor aid, they are increasingly obliged to assume some degree of financial responsibility for donor projects. This challenge will be particularly complex in the procurement of health commodities. In recent decades, recipient countries have benefitted from donor-aggregated demand and pooling mechanisms, negotiated prices, purchasing, and delivery of commodities. However, as countries shift away from donor support, their challenge will be finding a way to aggregate demand in order to achieve the benefits that the pooled purchasing arrangements of vertical health programs now provide. As a first step in tackling this challenge, much can be learned from a diverse group of pooled procurement initiatives that have developed over the past 40 years in high-, middle-, and low-income countries. This note reviews the rationale and functions of these initiatives, notes their potential benefits and barriers, and draws lessons regarding how best to incorporate pooled pharmaceutical purchasing models into the design and implementation of health financing reforms in countries in transition. We first provide a brief background on the procurement challenges faced by countries in transition. In section 2, we provide an overview of different types of pooling initiatives, highlighting the key features of each. Leveraging our research and key interviews, we outline the real and potential benefits of pooling in section 3, and the most pressing barriers that organizations or countries will face as they seek ways to aggregate demand in section 4. In section 5 we discuss some of the issues that countries and development partners should address when considering pooled procurement initiatives and make two recommendations: (1) countries and development partners should conduct further research on the merits of pooled procurement, and (2) they should develop a straw model of a pooled procurement governance structure that could be tested using a series of pilots.
Topic:
Budget, Public Health, Medicine, and Pharmaceuticals
Political Geography:
Global Focus

9. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Amanda Glassman, Kalipso Chalkidou, and Janeen Madan Keller
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive.
Topic:
Health, Public Health, Pandemic, Procurement, and Medicine
Political Geography:
Global Focus

10. Accelerating the Development of a Universal Influenza Vaccine

Author:
Aspen Institute
Publication Date:
07-2019
Content Type:
Working Paper
Institution:
Aspen Institute
Abstract:
The Sabin-Aspen Vaccine Science & Policy Group convened in 2018 to explore challenges and opportunities to develop a universal influenza vaccine. The group’s recommendations on how to overcome the scientific, financial and organizational barriers to developing a vaccine are synthesized in this report published in July 2019.
Topic:
Vaccine, Pandemic, Medicine, and Influenza
Political Geography:
Global Focus