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321. Operation Warp Speed, Encore: A Case for US Leadership to Drive Market-Based Global Health Innovation

Author:
Rachel Silverman
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
he experience of the COVID-19 pandemic—both in the US and around the world—has helped highlight the potential feasibility and importance of biomedical R&D for global health and welfare. In the midst of a very large, focused expansion of public expenditure for R&D on COVID-19—both direct (e.g. supporting trials) and indirect (e.g. promised revenue via advanced purchase agreements)—dramatic and rapid advancements in biomedical science took place, with very large commensurate social and health benefits. Drawing from this experience and momentum, this paper argues that the US should deepen its engagement and ambition in global health R&D to drive other similarly transformative improvements in global health outcomes and security—protecting American citizens from global health threats while also helping save and improve lives and livelihoods around the world. To provide illustrative evidence about the potential of such investment, it lays out three indicative case studies where US government investment, at least partially in the form of a pull mechanism, could help incentivize and drive high-value innovation: for new antimicrobials; a rapid, low-cost TB test; and for next-generation, accessible whole genome sequencing. Using clear and generally conservative assumptions, the case studies describe how such biomedical innovation could generate large returns on investment—in two of three cases exclusively from the perspective of US domestic welfare—while also saving and improving lives around the world. It concludes with a discussion of implications for research funders, emphasizing the need for large R&D investments to tackle commensurately large global health threats.
Topic:
Science and Technology, Hegemony, Leadership, Innovation, and COVID-19
Political Geography:
North America and United States of America

322. An Ambitious USG Advanced Commitment for Subscription-Based Purchasing of Novel Antimicrobials and Its Expected Return on Investment

Author:
Rachel Silverman and Adrian Towse
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Antimicrobial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure to those same drugs, driving “antimicrobial resistance,” or AMR. Already, drug-resistant infections kill an estimated 35,000 Americans and 1.27 million global citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. However, the R&D pipeline for new antimicrobials remains sparse, constrained by an array of market failures that prevent private companies from capturing a sufficient private return on investment (ROI) despite the very high social value of new antimicrobials. Widespread recognition of these market failures among experts and policymakers has driven a search for creative solutions, and generated enthusiasm for the use of pull mechanisms which could help incentivize antibiotic development. One particularly promising pull approach—so-called “subscription models”—would offer guaranteed annual payments to successful antibiotic developers delinked from sales volumes. A subscription approach is included in the pending PASTEUR Act, which is legislation introduced by lawmakers in the US House of Representatives and Senate and endorsed in President Biden’s 2023 budget request. In this paper, we consider the expected return on investment for such a program—that is, an ambitious new program to incentivize antibiotic development via a US government subscription-based pull mechanism (though not necessarily the PASTEUR Act, per se). We construct an illustrative subscription program from first principles, with parameters drawn (where possible) from the literature and some simplifying and deliberately conservative assumptions about program design and remuneration. We model the 10- and 30-year costs and benefits of such an initiative, both from the US domestic perspective and from a global welfare perspective. We find that the program is likely to generate a very high social ROI in both the short and long-term. From the US domestic perspective—considering both the value of averted death/disease and associated hospital costs—ROI is calculated at 6:1 over a 10-year time horizon and 28:1 over a 30-year time horizon. From the global perspective—exclusively considering the health value of DALYs (Disability Adjusted Life Years) averted—ROI grows to 27:1 over a 10-year time horizon and 125:1 over the full 30-year program duration. Sensitivity analysis suggests that the overall high returns are robust under a wide variety of alternative assumptions and scenarios. Based on these high social returns, we encourage the US Congress to urgently finance and authorize a subscription program for new antimicrobials, with particularly consideration for the PASTEUR Act.
Topic:
Health, Science and Technology, Innovation, and Medicine
Political Geography:
North America and United States of America

323. Costing Healthcare Services Using Time-Driven Activity-Based Costing: A Simple Step-By-Step Guide for Data Collection and Analysis

Author:
Lumbwe Chola, Ryan McBain, and Y-Ling Chi
Publication Date:
10-2022
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Cost information is essential for priority setting and optimized resource allocation in the healthcare sector, especially in low- and middle-income countries (LMICs) where resource constraints and opportunity costs are significant. In recent years, a costing approach labelled time-driven activity-based costing (TDABC) has gained prominence, as a means for more closely estimating unit costs. TDABC is a process-based micro-costing methodology that adopts a patient perspective to identify resources that are allocated over the course of service provision, mapping each step of a patient journey. Unlike other activity-based costing methods, TDABC includes the recording of the amount of time that resources are utilized for each activity. The manuscript is developed as a step-by-step guide for researchers, students and policy makers intending to undertake TDABC. While there are many academic resources explaining the theory and steps to conduct TDABC, in this paper, we provide easily accessible descriptions of methods for collecting data, tools that can be adapted to diverse research questions and settings, as well as practical data collection “tips” we learned from applying approaches on the ground.
Topic:
Science and Technology, Health Care Policy, Medicine, and Cost-Benefit Analysis
Political Geography:
Global Focus

324. The Next Game Changers: A Priority Innovation Agenda for Global Health

Author:
Cordelia Kenney and Rachel Silverman
Publication Date:
10-2022
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Over the last century, scientific and technological innovation has led to unprecedented improvements in health outcomes—yet research and development (R&D) investments and progress to address health threats has been uneven. Commercial R&D has focused where investors can expect substantial financial returns: rich countries, the diseases that affect them, and high-tech solutions designed for the richest and most sophisticated systems. Despite supplemental funding from philanthropic and government grants, R&D to address many leading causes of death and disability—especially those that primarily affect low- and middle-income countries (LMICs) or insure against future risk—has been consistently underfunded relative to potential health gain. This implies that many untapped opportunities remain to dramatically improve global health and welfare via biomedical innovation. In this paper, we report the results of a horizon-scanning exercise to source opportunities for global health R&D investment—that is, high-value potential biomedical innovations which are currently underfunded but which could be transformative for health, quality of life, and health security in LMICs and around the world. Drawing from a literature review and expert interviews with researchers, economists, funders, advocates, and implementers, we lay out an expansive and high-promise (though non-comprehensive) biomedical innovation agenda for global health spanning the unfinished MDG agenda; non-communicable diseases; and global health security. We conclude with a discussion of implications for research, funding, and practice.
Topic:
Development, Health, Science and Technology, Innovation, and Emerging Technology
Political Geography:
Global Focus

325. Governing the Global Commons: Challenges and Opportunities for US-Japan Cooperation

Author:
Kristi Govella, John Bradford, Kyoko Hatakeyama, Saadia M. Pekkanen, Setsuko Aoki, James Lewis, and Motohiro Tsuchiya
Publication Date:
12-2022
Content Type:
Policy Brief
Institution:
German Marshall Fund of the United States (GMFUS)
Abstract:
The global commons—domains beyond the sovereign jurisdiction of any single state but to which all states have access—are essential to the stability and prosperity of the international order. In addition to the high seas, outer space, the atmosphere, and Antarctica, which are defined as global commons by international law, analysts have also suggested that other domains such as cyberspace may also qualify as potential commons. These domains provide essential public goods such as trade routes, transportation and communication networks, fish stocks, satellite imagery, global positioning, and e-commerce infrastructure that benefit countries around the world. To successfully manage the resources of the global commons and ensure open access to their spaces, effective governance structures must exist to accommodate and integrate the interests and responsibilities of state and non-state actors. Consequently, states have tried to come to agreements in each domain about how to enable broad access, avoid conflict, and enable cooperation. Over time, these discussions have resulted in the creation for each domain of a “regime,” a set of implicit or explicit principles, norms, rules, and decision-making procedures around which actors’ expectations converge (see Box 1). These regimes can take shape in the form of international law, national law, local regulations, private standards, and institutional bodies. They differ dramatically in maturity and complexity: the governance regime of the oceans has developed over the course of centuries, while the rules and norms of cyberspace have only had a few decades to coalesce. However, all these regimes attempt to solve similar dilemmas surrounding shared access and resources.
Topic:
Foreign Policy, Science and Technology, Democracy, Economy, Trade, and Defense Cooperation
Political Geography:
East Asia, Asia, United States of America, and Indo-Pacific

326. AI Startups and the Fight Against Mis/Disinformation Online: An Update

Author:
Anya Schiffrin, Hiba Beg, Pablo Eyzaguirre, Zachey Kliger, Tianyu Mao, Aditi Rukhaiyar, Kristen Saldarini, and Ojani Walthrust
Publication Date:
07-2022
Content Type:
Working Paper
Institution:
German Marshall Fund of the United States (GMFUS)
Abstract:
The events following Russia’s invasion of Ukraine have shown again the power of online mis/disinformation. As it continues to grow and spread, there are new and continuing attempts to address this problem. These include supply-side and demand-side fixes (including media-literacy programs, fact-checking and, in Europe, new regulations) but few of these have scaled. This paper looks at one kind of supply-side attempt to tackle the prevalence of online mis/disinformation: the market for tech-based solutions that use some form of artificial intelligence (AI) machine/deep learning for content moderation, media integrity, and verification. This paper presents the findings of interviews of 20 niche firms that use AI to identify online mis/disinformation, many of which were previously surveyed for a 2019 paper on the role of AI startups in the fight against disinformation. These companies did not release their revenue figures but it seems that the market for their services is smaller than many entrepreneurs had originally hoped, and that Google and Facebook are not relying on such firms for help in identifying online mis/disinformation. The cost of the services provided by these startups and the desire to keep things in-house and protect their activities from outside scrutiny are part of why the tech giants do not rely on small startups for help with screening online mis/disinformation. This may be why funding for these startups does not seem to have grown significantly and so more than half of them are now focusing on the business-to-business market, selling mis/disinformation mitigation services to, for example, insurance companies, large public entities, and governments, among others. There also appears to be a limited market for business-to-consumer solutions for detecting mis/disinformation. However, continuing advances in AI as well as forthcoming regulation by the European Union and the United Kingdom will continue to spur innovation, which may stimulate demand. University initiatives, academics, journalism organizations, and cybersecurity experts are all also trying to come up with ways to identify and control the spread of mis/disinformation. Ultimately, despite its advances, technology alone will not solve the online mis/disinformation problem. Giant social media platforms have few financial incentives to crack down on this—quite the opposite, in fact. To push social media platforms to act against online mis/disinformation and illegal speech, regulation must deftly address the issue while preserving freedom of expression. There is a further problem in the form of the political polarization that has intensified in the United States and other parts of the world. Fixing this is likely to be well beyond the role of business and technologists.
Topic:
Science and Technology, Cybersecurity, Democracy, Artificial Intelligence, Disinformation, Misinformation, and Startup
Political Geography:
Global Focus

327. AI Audit-Washing and Accountability

Author:
Ellen P. Goodman
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
German Marshall Fund of the United States (GMFUS)
Abstract:
We are still some distance from a worldwide robot takeover, but artificial intelligence (AI)—the training of computer systems with large data sets to make decisions and solve problems—is revolutionizing the way governments and societies function. AI has enormous potential: accelerating innovation, unlocking new value from data, and increasing productivity by freeing us from mundane tasks. AI can draw new inferences from health data to foster breakthroughs in cancer screening or improve climate modeling and early-warning systems for extreme weather or emergency situations. As we seek solutions to today’s vexing problems—climate disruption, social inequality, health crises—AI will be central. Its centrality requires that stakeholders exercise greater governance over AI and hold AI systems accountable for their potential harms, including discriminatory impact, opacity, error, insecurity, privacy violations, and disempowerment. In this context, calls for audits to assess the impact of algorithmic decision-making systems and expose and mitigate related harms are proliferating1 , accompanied by the rise of an algorithmic auditing industry and legal codification. These are welcome developments. Audits can provide a flexible co-regulatory solution, allowing necessary innovation in AI while increasing transparency and accountability. AI is a crucial element of the growing tech competition between authoritarian and democratic states—and ensuring that AI is accountable and trusted is a key part of ensuring democratic advantage. Clear standards for trustworthy AI will help the United States remain a center of innovation and shape technology to democratic values. The “algorithmic audit” nevertheless remains ill-defined and inexact, whether concerning social media platforms or AI systems generally. The risk is significant that inadequate audits will obscure problems with algorithmic systems and create a permission structure around poorly designed or implemented AI. A poorly designed or executed audit is at best meaningless and at worst even excuses harms that the audits claim to mitigate. Inadequate audits or those without clear standards provide false assurance of compliance with norms and laws, “audit-washing” problematic or illegal practices. Like green-washing and ethics-washing before, the audited entity can claim credit without doing the work. To address these risks, this paper identifies the core questions that need answering to make algorithmic audits a reliable AI accountability mechanism. The “who” of audits includes the person or organization conducting the audit, with clearly defined qualifications, conditions for data access, and guardrails for internal audits. The “what” includes the type and scope of audit, including its position within a larger sociotechnical system. The “why” covers audit objectives, whether narrow legal standards or broader ethical goals, essential for audit comparison. Finally, the “how” includes a clear articulation of audit standards, an important baseline for the development of audit certification mechanisms and to guard against audit-washing. Algorithmic audits have the potential to transform the way technology works in the 21st century, much as financial audits transformed the way businesses operated in the 20th century. They will take different forms, either within a sector or across sectors, especially for systems which pose the highest risk. But as algorithmic audits are encoded into law or adopted voluntarily as part of corporate social responsibility, the audit industry must arrive at shared understandings and expectations of audit goals and procedures. This paper provides such an outline so that truly meaningful algorithmic audits can take their deserved place in AI governance frameworks.
Topic:
Science and Technology, Cybersecurity, Democracy, Regulation, Accountability, and Artificial Intelligence
Political Geography:
Global Focus

328. Has Globalisation Really Peaked for Europe?

Author:
Lucian Cernat
Publication Date:
11-2022
Content Type:
Policy Brief
Institution:
European Centre for International Political Economy (ECIPE)
Abstract:
This paper builds on the recent arguments put forward by Richard Baldwin and others debunking the myth that we enter a period of de-globalisation. The paper argues that globalisation is a complex phenomenon that requires detailed, firm-level indicators going beyond simple aggregate metrics. When using such indicators, the picture is much more nuanced and, in the case of Europe, the role of global trade is as important as ever for hundreds of thousands of companies and millions of jobs supported by global trade flows. A strong participation in the “new globalisation” is also key for the future EU competitiveness in technology-driven sectors.
Topic:
Globalization, International Trade and Finance, Science and Technology, European Union, and Trade
Political Geography:
Europe

329. US Power and the Multinational Tech Companies of the Digital Era: An Analysis of the Obama and Trump Governments Oligopolization

Author:
Cristina Soreanu Pecequilo and Francisco Luiz Marzinotto Junior
Publication Date:
08-2022
Content Type:
Journal Article
Journal:
AUSTRAL: Brazilian Journal of Strategy International Relations
Institution:
Postgraduate Program in International Strategic Studies, Universidade Federal do Rio Grande do Sul
Abstract:
Science and technology are relevant issues in the studies of international political economy. Innovation, at the same time, favors economic growth and impacts the States and non-States players nexus. In the competitive arena of global markets, highly developed innovative organizations tend to provide cheaper and more effective products in a larger scale. In the “anarchic environment” of the international system, technological and scientific supremacy has always been determinant to achieve and maintain power. As power resources do not remain static, their fluidity leads to technological (Kondratieff 1935; Perez 2003) and hegemonic (Arrighi 1996) “long waves” that oscillate during history. After 1945, the United States (US) rose as the hegemonic power and technology, amongst its power resources, was, and remains one of its significant assets of power projection.
Topic:
International Cooperation, Political Economy, Science and Technology, and Hegemony
Political Geography:
Global Focus

330. Microchips and Semiconductors: The U.S. Seeks Autonomy

Author:
Andrzej Dąbrowski
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
The Polish Institute of International Affairs
Abstract:
The United States has turned to support of the domestic microchip industry in response to the increased risk of Chinese aggression against Taiwan, one of the leading producers, as well as to address disruptions in supply chains caused by the COVID-19 pandemic. A law on this passed with bipartisan consent and is intended to help finance a more resilient American sector towards global changes in manufacturing these components. Thanks to the CHIPS Act, the U.S. can reduce its dependence on microchip imports and undermine China’s ability to dominate the market.
Topic:
Markets, Science and Technology, Autonomy, Industry, Supply Chains, Semiconductors, and Microchips
Political Geography:
China, Asia, North America, and United States of America