EventThe Long Tail of Global Health Equity: Tackling the Endemic Noncommunicable Diseases of the Bottom Billion
The advent of new biomedical tools—vaccines, diagnostics, and drugs—has helped transform many age-old scourges into preventable, curable, or manageable ailments. And though the pace of biomedical innovation is famously slow, the COVID-19 pandemic has demonstrated that research and development (R&D) cycles can happen at previously unthinkable “Warp Speed”—if there’s sufficient financing and political will to expedite regulatory bottlenecks.
Yet biomedical innovation comes with a hefty price tag. The chance of failure is highest in the earliest stages of the R&D pipeline, often requiring significant upfront financing. Most R&D money (60 percent) flows from the private sector, which is (by design) looking to maximize returns on investment. As a result, health R&D largely skews towards rich countries’ priorities and health system technical capacities, leaving significant gaps in diseases that primarily affect poor and marginalized populations. Communicable, maternal, perinatal, and nutritional diseases comprise 55 percent and 38 percent of the disease burden in low- and lower middle-income countries, respectively, yet account for only 9 percent of health products in development. These countries collectively house over half of the world’s population.
A proposed agenda for biomedical innovation
In our new policy paper, we share findings from a horizon-scanning exercise in late 2021 to source ideas for biomedical innovations with significant potential to transform health, quality of life, and health security. Our paper has two goals: (1) clarifying the global health innovation agenda; and (2) motivating further investments in the health technologies that could be transformative for the world’s poor and vulnerable.
Our narrow focus on biomedical innovations does not reflect a judgment on its relative importance compared to innovations in service delivery, financing, logistics, telecommunications, or energy access; in many cases, bottlenecks in these other domains may be far more relevant barriers to improved health than biomedical innovation. And while we are confident in the relevance and importance of this global health innovation agenda, we are aware that our findings reflect our own interpretations and positions, and are therefore necessarily limited. Priority innovations selected for investment must be identified in partnership with affected countries and populations, and reflective of their own policy priorities and health needs.
We group the resulting agenda into three broad buckets:
1. The unfinished Millennium Development Goals (MDG) agenda: Despite progress, the world still has not achieved the MDGs–and backsliding during the COVID-19 pandemic has further compromised efforts to address many essential health challenges, including the “big three” (HIV, tuberculosis, and malaria), child mortality, family planning, and neglected tropical diseases. We propose nine innovations to help turn the tide and fully realize the MDG promise.
2. The noncommunicable disease (NCD) agenda: Although infectious diseases disproportionately burden LMICs, NCDs management is a growing challenge even in the poorest countries. Existing innovations to prevent and treat cardiovascular disease, mental/brain disorders, diabetes, kidney disease, cancers, asthma, heavy metal poisoning, and other NCDs are not available at scale in LMICs. Efforts are needed to improve the accessibility and affordability of existing products. within the scope of this paper, we suggest seven new innovations for five NCDs where more affordable and tailored health technologies could help close this access gap.
3. The global health security agenda: The next deadly global pandemic could very likely occur within our lifetimes, yet our outbreak surveillance, preparedness, and response infrastructure is not equipped to meet the challenge. We propose R&D investments for next generation pan-coronavirus and pan-influenza vaccines, new classes of antimicrobials, and multiplex genomic sequencing/next generation diagnostics to better position the world for new and emerging infectious disease threats.
Digitalization can unlock additional value
While our paper focuses on biomedical R&D, the full agenda is more expansive. In the expert interviews that informed our findings, particular emphasis was placed on the potential to pair biomedical innovations with investments in digital health, e.g. by linking diagnostics results to digital health infrastructure and information systems.
Digitally enabled healthcare—such as remote clinical management and health workforce training/support—could help mitigate health worker shortages while also helping people access timely and appropriate services. Mobile app-based health education, such as Public Health Ambassadors Uganda’s PHAU App, and user instructions for self-tests, could both increase access to accurate health information while also improving the collection of health data, which can enhance targeting and decision-making/resource planning. Finally, streamlined, routinized collection of certain forms of clinical data (e.g., positive COVID-19 rapid tests, or some yet-developed rapid test for detecting novel pathogens) would also support pandemic preparedness and response by enabling real-time reporting of outbreaks. Digital innovations can also support supply chain management and help biomedical innovations to reach the people who need them; for example, companies such as Ghana’s mPharma and Kenya’s Maisha Meds use data and digital tools to enable supply chain predictability for pharmacies across Africa.
Biomedical innovation is a complement–not substitute–for universal health care and social development
We present a global health R&D agenda for potential game-changing innovations. That said, we also want to be clear that any given biomedical advance is unlikely to serve as a silver bullet across complex, context-specific health challenges. Addressing the social and structural determinants of health—poverty, nutrition, housing quality, environment, sanitation, inequity, and access to quality primary health care services—are all foundational for long-term health improvement. Biomedical innovation (and delivery) must be accompanied by measures to address the underlying drivers of collective vulnerability; it is not a substitute for social and economic development.
We also recognize that new health technologies can only save and improve lives if they reach people in the places and times of need. This means that the central challenges of access and affordability, which plague many health products already on the market, must remain important priorities for policymakers, regulators, and innovators. In developing these proposed innovations, we also urge funders, researchers, and policymakers to think critically about scaleup feasibility, regulatory harmonization, and appropriateness to specific local contexts. One potential path forward is via strengthened R&D/manufacturing capacity within LMICs; innovators such as DIATROPIX showcase the promise of regionally-based innovation hubs for enhancing access.
Biomedical innovation matters for health progress
These caveats aside, transformational progress in improving health, quality of life and global health security is possible with sufficient, sustained investments in biomedical innovation for these relatively neglected health needs. When paired with investments in structural drivers of health and health systems strengthening, substantial health, social, and economic gains are within reach.
We are grateful to the 33 experts who took the time to speak with us for this project and their invaluable insights on high-priority health R&D.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.