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41. The Race Against Drug Resistance

Author:
Rachel Nugent
Publication Date:
06-2010
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
We are rapidly losing our ability to cure an alarming number of the most serious and common diseases of the developing world because of an invisible adversary: drug resistance. Resistance is inevitable—but careless practices in drug supply and use are hastening it unnecessarily. Without an immediate global effort to safeguard lasting treatment effectiveness, drug resistance will quickly become a widespread threat—claiming lives, raising the cost of curing patients, and making future generations increasingly vulnerable to deadly diseases that were easily cured in the past.
Topic:
Health and War on Drugs

42. Bridging the Gap: Better, Faster, and Cheaper Clinical Trials for Health Products for Neglected Diseases

Author:
Thomas Bollyky
Publication Date:
06-2010
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
There has been tremendous progress over the last decade in the development of health products for neglected diseases. These include drugs, vaccines, and diagnostics for malaria and tuberculosis, which kill millions of people annually, plus other diseases like chagas and dengue fever, which may less familiar, but nonetheless exact a large and often lethal toll in the world's poorest communities. Led by product development public private partnerships (PDPs) and fueled by the support of the Bill Melinda Gates Foundation, the National Institutes of Health, and other donors, there are now dozens of candidate products in the pipeline.
Topic:
Development, Health, Humanitarian Aid, and Infectious Diseases

43. Think Long Term: How Global AIDS Donors Can Strengthen the Health Workforce in Africa

Author:
Nandini Oomman and Christina Droggitis
Publication Date:
09-2010
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
For the past decade, global AIDS donors—including the U.S. President's Emergency Plan for AIDS Relief (PEFPAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), and the World Bank's Multi-Country HIV/AIDS Program for Africa (the MAP)—have responded to HIV/AIDS in sub-Saharan Africa as an emergency. Financial and programmatic efforts have been quick, vertical, and HIV-specific. To achieve ambitious HIV/AIDS targets, AIDS donors mobilized health workers from weak and understaffed national health workforces. The shortages were the result of weak data for effective planning, inadequate capacity to train and pay health workers, and fragmentation and poor coordination across the health workforce life-cycle. Ten years and billions of dollars later, the problem still persists. The time has passed for short-term fixes to health workforce shortages. As the largest source of global health resources, AIDS donors must begin to address the long-term problems underlying the shortages and the effects of their efforts on the health workforce more broadly.
Topic:
Development, Globalization, Health, Human Welfare, Humanitarian Aid, and Foreign Aid
Political Geography:
Africa

44. Start with a Girl: A New Agenda for Global Health

Author:
Miriam Temin
Publication Date:
08-2010
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
Improving adolescent girls' health and wellbeing is critical to achieving virtually all international development goals, from reducing infant and child deaths to stimulating economic growth and encouraging environmental sustainability. Governments and donors seem to recognize this, but they have yet to take the specific actions needed to genuinely invest in adolescent girls' health and, thereby, the health and wellbeing of generations to come.
Topic:
Development, Gender Issues, Health, Human Rights, and Border Control
Political Geography:
Africa and China

45. AIDS Treatment in South Asia: Equity and Efficiency Arguments for Shouldering the Fiscal Burden When Prevalence Rates Are Low

Author:
Mead Over
Publication Date:
02-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The slower spread of AIDS in South Asian countries, combined with the fact that most South Asian countries have higher per capita incomes than the most severely affected countries of other regions imply that the various impacts of the disease will be smaller in South Asia than in the worst affected countries in other regions. While justified with respect to the impact of the disease on economic output, on poverty, or on orphanhood, this conclusion does not follow with respect to the health sector, where the relatively minor public role in health care delivery and the entrepreneurial and heterogeneous private health and pharmaceutical sectors combine to magnify the potential impact of the epidemic.
Topic:
Health and Humanitarian Aid
Political Geography:
South Asia and Asia

46. Rice Crisis Forensics: How Asian Governments Carelessly Set the World Rice Market on Fire

Author:
Tom Slayton
Publication Date:
03-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The world rice market was aflame last spring and for several months it looked as if the trading edifice that had exhibited such resilience over the last two decades was going to burn to the ground. World prices trebled within less than four months and reached a 30- year inflation-adjusted high. Many market observers thought the previous record set in 1974 would soon be toast. The fire was man-made, not the result of natural developments. While the governments in India, Vietnam, and the Philippines did not to set the world market on fire, that was the unintended result of their actions which threatened both innocent bystanders (low-income rice importers as far away as Africa and Latin America) and, ultimately, poor rice consumers at home. This paper describes what sparked the fire and the accelerants that made a bad situation nearly catastrophic. Fortuitously, when the flames were raging at peak intensity, rain clouds appeared, the winds [market psychology] shifted, and conditions on the ground improved, allowing the fire to die down. It remains to be seen, however, if the trading edifice has been seriously undermined by the actions of decision makers in several key Asian rice exporting and importing countries. In describing the cascading negative effects of these seemingly rational domestic policies, this paper aims to help policy makers in the rice exporting and importing nations to avoid a repeat of the disastrous price spike of 2008.
Topic:
Agriculture, Economics, Health, Humanitarian Aid, Markets, and Political Economy
Political Geography:
Africa, India, Asia, and Latin America

47. Pricing and Access: Lessons from Randomized Evaluations in Education and Health

Author:
Michael Kremer and Alaka Holla
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper surveys evidence from recent randomized evaluations in developing countries on the impact of price on access to health and education. The debate on user fees has been contentious, but until recently much of the evidence was anecdotal. Randomized evaluations across a variety of settings suggest prices have a large impact on take-up of education and health products and services. While the sign of this effect is consistent with standard theories of human capital investment, a more detailed examination of the data suggests that it may be important to go beyond these models. There is some evidence for peer effects, which implies that for some goods the aggregate response to price will exceed the individual response. Time-inconsistent preferences could potentially help explain the apparently disproportionate effect of small short-run costs and benefits on decisions with long-run consequences.
Topic:
Development, Economics, Education, Health, Human Welfare, and Markets

48. Making Markets for Merit Goods: The Political Economy of Antiretrovirals

Author:
Ethan B. Kapstein and Josh Busby
Publication Date:
08-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
Topic:
Globalization, Health, and Markets
Political Geography:
United Nations

49. Countering Drug Resistance in the Developing World: An Assessment of Incentives across the Value Chain and Recommendations for Policy Interventions

Author:
Prashant Yadav
Publication Date:
09-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The emergence and spread of drug resistance is draining available resources and threatening our ability to treat infectious diseases in developing countries. Countering drug resistance requires pharmaceutical companies, government regulators, doctors, and patients to make difficult choices about drug treatment in order to balance efficacy, cost, safety, and sustainability of drugs. These complex tradeoffs are faced along the drug supply chain from the development of new products, procurement of drugs for donor and government distribution, distribution steps to ensure treatment heterogeneity along with quality and availability, and dispensing and use that requires affordability, patient adherence and rational use of drugs and diagnostics. An analysis of the incentives and risks in the drug supply chain reflects that many stakeholders who can influence optimal prescribing of existing drugs; affect higher patient compliance; and ensure the quality of drugs have weak incentives to carry out these activities optimally. This implies a high potential for drug resistance to accelerate. This paper recommends specific measures to better align the incentives of these stakeholders with resistance- countering activities.
Topic:
Development, Health, Human Welfare, and Third World

50. Making Markets for Merit Goods: The Political Economy of Antiretrovirals

Author:
Ethan Kapstein and Josh Busby
Publication Date:
08-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
Topic:
Health, Human Welfare, Humanitarian Aid, and Political Economy