Overview - Preface

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.