In the time it takes you to read this preface, 100 people will die of diseases that can already be prevented with vaccines, and 150 more will die of malaria, HIV or tuberculosis.
If American or European children were dying at a rate of an average-sized high school every hour, it would lead the news every day. We would be devoting serious resources to finding a cure urgently.
But the people who die are too poor to command that sort of attention. Just 10% of the world's research and development on health is targeted on diseases affecting 90% of the world's people. Of more than a thousand new medicines developed over the last 25 years, just 1% were specifically for diseases of tropical countries.
There is not enough research and development because technological progress is a global public good. In the case of tropical diseases, no single individual enterprise has an incentive to pay for the full costs of developing new medicines. As a result, we invest far too little as a global community.
Nation-states have developed institutions, however imperfect, to invest in public goods, and these mutual commitments form part of the fabric of society. Nations provide security and financial stability, enforce contracts, protect the environment, limit inequality and poverty and invest in knowledge that enriches all their citizens. No doubt most countries could do these things better, but even so the provision of these common goods underpins the domestic social contract.
At the global level, by contrast, we lack institutions capable of providing and protecting global public goods. We have only sketchy arrangements to improve international security and maintain financial stability and little or nothing to preserve the environment, to provide a safety net against poverty or to invest in technological progress that would benefit all humanity. We lack adequate mechanisms to deliver a global social contract, in which those who can afford it make a fair contribution to the global society in which they live.
It is the poor who suffer most from the lack of public goods.
While the rich can to some extent insulate themselves through private affluence, the poor shoulder the burden of public penury.
Of course, the rich cannot shield themselves completely: in the long run, global public penury leads to an endless battle against illegal immigration, spread of infectious disease, proliferation of weapons, organized crime and drugs and spillovers of conflict.
Our failure to invest in the global commons flows not from our indifference but from our impotence, because we do not have incentives or mechanisms to coordinate our efforts to invest.
We at the Center for Global Development have sought ways to attack this problem to strengthen the mechanisms, the incentives and the institutions that could underpin a more comprehensive global social contract.
Nowhere are the potential benefits greater than in the production and distribution of new vaccines to prevent the diseases that needlessly take lives and destroy livelihoods in developing countries.
In 2003 we established a Working Group, including economists, public health professionals, lawyers, experts in public policy and pharmaceutical and biotech experts, with the mandate to develop a practical approach to the vaccine challenge: to go from ideas to action. The result is this report.
My colleagues propose an elegant solution to enable the high income countries to work together to accelerate the development of vaccines for diseases of low-income countries to guarantee to pay for such vaccines if and when they are developed. The solution is simple and practical. It unleashes the same combination of market incentives and public investment that creates medicines for diseases that afflict us: arrangements that have been spectacularly effective in improving the health of the rich nations in the last century. It creates incentives for more private investment in these diseases. And it will ensure that, once a vaccine is developed, the funds will be there to get the vaccine to the people who need it.
Adequate investment in global public goods should be a cornerstone of foreign assistance. By definition, we all benefit from global public goods, and we share a responsibility to see that they are properly funded and available to everyone. These are investments with high returns and low risks of corruption and appropriation. Furthermore, this proposal ties funding directly to results: if the commitment does not succeed, there is no cost to the sponsors.
Every so often, an idea comes along that makes you ask: now why didn't I think of that? This is such an idea.
President
Center for Global Development
April 2005