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1241. 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

1242. 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

1243. The Dos and Don’ts of USG Humanitarian Reorganization

Author:
Jeremy Konyndyk
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The FY 2020 budget request released by the White House last month contained a sweeping proposal to rationalize and streamline US government humanitarian assistance programs overseas. The proposal would merge the three humanitarian budget accounts (International Disaster Assistance, Migration and Refugee Assistance, and Food For Peace Title II); strip programming responsibilities from the State Department’s refugee bureau and consolidate them entirely in a new humanitarian bureau at USAID; and establish a vaguely described “dual hat” senior leader role to oversee humanitarian activities at both USAID and the State Department. The proposed changes would be the most significant overhaul of USG humanitarian structures in decades. The proposal in its current form is unlikely to get much traction in Congress, where it is seen on both sides of the aisle as dramatically weakening US leadership on refugees. In light of other moves by the administration—like slashing refugee resettlement numbers and treating asylum seekers roughly—that is a legitimate and vital concern. There is ample reason to approach the proposal with caution, particularly the idea of stripping away the refugee bureau’s resources.
Topic:
Foreign Aid, Budget, Refugees, and Humanitarian Crisis
Political Geography:
United States and North America

1244. 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

1245. Making Basel III Work for Emerging Markets and Developing Economies

Author:
Thorsten Beck and Liliana Rojas-Suarez
Publication Date:
04-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
A sound financial regulatory framework is critical for minimizing the risk imposed by financial system fra­gility. In the world’s emerging markets and developing economies (EMDEs), such regulation is also essential to support economic development and poverty reduc­tion. Meanwhile, it is increasingly recognized that global financial stability is a global public good: recent decades have seen the development of new inter­national financial regulatory standards, to serve as benchmarks for gauging regulation across countries, facilitate cooperation among financial supervisors from different countries, and create a level playing field for financial institutions wherever they operate. For the worldwide banking industry, the international regulatory standards promulgated by the Basel Com­mittee on Banking Supervision (BCBS) stand out for their wide-ranging scope and detail. Even though the latest Basel recommendations, adopted in late 2017 and known as Basel III, are, like their predecessors, calibrated primarily for advanced countries, many EMDEs are in the process of adopting and adapting them, and many others are considering it. They do so because they see it as in their long-term interest, but at the same time the new standards pose for them new risks and challenges. This report assesses the implica­tions of Basel III for EMDEs and provides recommen­dations for both international and local policymakers to make Basel III work for these economies.
Topic:
Development, Economics, Emerging Markets, and Markets
Political Geography:
Global Focus

1246. 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

1247. Strategic autonomy for European choices: The key to Europe's shaping power

Author:
Giovanni Grevi
Publication Date:
07-2019
Content Type:
Working Paper
Institution:
European Policy Centre
Abstract:
Multi-level competition is on the rise in the international system and the standoff between the US and China risks becoming a defining feature of international affairs. However, the future is not predestined: the European Union (EU) will play a major role in the development of the international order, whether through its absence or its engagement. This Discussion Paper follows recent European Policy Centre publications and debates dedicated to revamping Europe’s approach to an increasingly challenging international context, which have delivered recommendations to: equip Europe with the tools to govern interdependence and mitigate confrontation; take a strong stance in defence of Europe while not endorsing a zero-sum interpretation of global affairs; turn the EU into a global shaping power by pursuing a ‘rules-first’ strategy; and frame Europe’s strategic autonomy in comprehensive terms, including the economic, technological and security and defence dimensions.
Topic:
Foreign Policy, International Affairs, European Union, and Strategic Autonomy
Political Geography:
China, Europe, and United States of America

1248. Diminishing safeguards, increasing returns: Non-refoulement gaps in the EU return and readmission system

Author:
Olivia Sundberg Diez
Publication Date:
10-2019
Content Type:
Working Paper
Institution:
European Policy Centre
Abstract:
Increasing the rate of return of third country nationals without a legal right to remain in the EU looks set to remain a policy priority for this European Commission. Nevertheless, the European Union and member states must ensure that their return and readmission policy complies in full with their international obligations, particularly the principle of non-refoulement. In this discussion paper, Olivia Sundberg Diez argues that recent trends are creating a growing accountability gap over how returns are conducted, with implications for refoulement: First, procedural safeguards are increasingly diminished in order to accelerate returns. The Recast Return Directive proposal, and the Council’s partial general approach, could curtail access to effective remedies within return procedures. Regarding readmission, cooperation with third countries is becoming ever more informal and frequently bypasses democratic and judicial scrutiny. Second, significant divergence remains between national return practices. EU mechanisms are sometimes strategically avoided when pursuing controversial agreements that are EU-wide or involve the Union, leading to a blurring of responsibility. At the same time, problematic bilateral agreements continue to be concluded with limited data and without EU guidance. Third, there is a lack of suitable monitoring mechanisms within return practices and readmission agreements. This hinders the EU and member states’ ability to guarantee returnees’ safety, and is worsened by the recast Return Directive proposals. In particular, considerations regarding the risk of indirect refoulement are notably absent. These three trends amount to structural shortcomings in EU and member states’ efforts to prevent refoulement. This paper analyses the risks at hand so that they can be better addressed in the next legislative cycle, and calls for strengthening safeguards and accountability measures in future readmission cooperation and the negotiations for the recast Return Directive.
Topic:
European Union, Refugees, Asylum, and Non-refoulement
Political Geography:
Europe

1249. The European Union makes a new push for democracy

Author:
Andrew Duff
Publication Date:
11-2019
Content Type:
Working Paper
Institution:
European Policy Centre
Abstract:
European Union leaders will not be able to dodge the growing constitutional crisis. They are bound to improve the way the Commission president is chosen by reforming the electoral procedure of the European Parliament and by advancing federal political parties. Angela Merkel has dropped her opposition to transnational lists and now agrees with Emmanuel Macron to return to the EU’s institutional agenda. This means treaty change. President von der Leyen promises to help MEPs initiate the reforms and broker the deal in the European Council. Andrew Duff explains what these reforms mean for the balance of power within the Union, and in annexes to this paper, he sets out proposals. He argues that the Conference on the Future of Europe is the right forum to plan how to rectify the weak government of the Union and to strengthen its democratic legitimacy. But he urges swift progress on the related items of Spitzenkandidaten, transnational lists and seat apportionment. Duff favours a direct role for citizens in the work of the Conference, but warns against using this as an excuse for evading tough and complex constitutional questions. The Conference will only succeed if it has a clear and meaningful mandate backed throughout by the three EU institutions.
Topic:
European Union, Institutions, and European Parliament
Political Geography:
Europe

1250. The future of work: Towards a progressive agenda for all

Author:
Claire Dhéret, Simona Guagliardo, and Mihai Palimariciuc
Publication Date:
12-2019
Content Type:
Working Paper
Institution:
European Policy Centre
Abstract:
The world of work is changing, fast. Globalisation, coupled with the fragmentation of production and value chains, ageing societies, and digitalisation are all having a transformative impact on European labour markets and are putting pressure on our social welfare systems. The challenges that these disruptions pose are tremendous, and policymakers are still unsure of how to address the implications of the changing nature of work. In this Issue Paper, the result of the European Policy Centre research project “The future of work – Towards a progressive agenda for all”, authors Claire Dhéret, Simona Guagliardo and Mihai Palimariciuc take an in-depth look at how labour is evolving throughout Europe and put forward a set of policy recommendations for the EU, which despite its limited competences, can still be the driving force behind a progressive agenda for the future of work. Their analysis focuses on four different areas: the impact of new technologies on jobs in various sectors; the rise of ‘atypical’ work; the impact of labour market transformations on the welfare state and social contracts; and the effect of policy responses so far. Based on their findings, they argue that instead of trying to push back against new technologies and forms of work, we must embrace the changes brought on by the fourth industrial revolution. At the same time, the EU must endorse and support policies that align welfare state reform with emerging working structures and the conscious and controlled deployment of new technologies. The overall aim should be to establish an inclusive and competitive European labour market that is reinforced by future-fit social protection systems. Previous industrial revolutions upended traditional structures and led to widespread social malaise and suffering in the short term, despite major socio-economic gains in the long run. Many fear that this latest iteration will leave millions of people in precarious employment or even without jobs altogether. But this is not a given. How the future of work unfolds is still in human hands. With sound decision-making, the EU and its member states can harness the benefits of new technologies, counter the polarisation of labour markets and make sure that no one is left behind.
Topic:
Globalization, Science and Technology, Labor Issues, European Union, and Economy
Political Geography:
Europe