With rigorous economic research and practical policy solutions, we focus on the issues and institutions that are critical to global development. Explore our core themes and topics to learn more about our work.
In timely and incisive analysis, our experts parse the latest development news and devise practical solutions to new and emerging challenges. Our events convene the top thinkers and doers in global development.
Rachel Silverman is a policy fellow at the Center for Global Development, where she leads policy-oriented research on global health financing and incentive structures. Silverman’s current research focuses on the practical application of results-based financing; global health transitions; efficient global health procurement; innovation models for global health; priority-setting for UHC; alignment and impact in international funding for family planning; and strategies to strengthen evidence and accountability. Before joining CGD in 2011 she worked with the National Democratic Institute to support democracy and governance strengthening programs in Kosovo. She holds a master’s of philosophy with distinction in public health from the University of Cambridge, which she attended as a Gates Cambridge Scholar. She also holds a BA with distinction in international relations and economics from Stanford University.
In this note, we summarize the changing context and its relevance for Gavi, exploring the specific issues relevant to transitioning countries, never-eligible MICs, and countries dealing with complex emergencies or large-scale protracted displacement. We then offer four recommendations to increase Gavi’s relevance and effectiveness in a changing world.
Researchers highlight big issues with drug purchasing and generic drug markets
Eva Taylor Grant
Center for Global Development
WASHINGTON – Basic, everyday drugs can cost up to 20 to 30 times more in some poor countries than others, according to a new study released today by the Center for Global Development. The study examined billions of dollars of health spending on common, life-saving medicines in developing countries, mostly in Africa and Asia. To date, it is one of the largest-ever studies on global health procurement.
“Developing countries are often paying far more for everyday drugs than they should be. Why do some poor countries pay 20 to 30 times as much as others for common medicines to relieve pain or treat hypertension? In large part, because of flawed drug buying practices and broken generic medicines markets,” said Amanda Glassman, one of the authors of the study and the executive vice president at the Center for Global Development.
“A robust market for generic drugs is a core part of an affordable health system. But in way too many countries, generic drug markets are broken and patients are paying the price,” said Kalipso Chalkidou, the director of global health policy at the Center for Global Development and an author of the study. “You need enough competition to keep prices low and quality assurance that consumers trust, or essential medicines are going to be much more expensive than they should be.”
The study had three main findings:
In developing countries, prices for basic generic medicines can vary widely and far exceed wealthy-country prices. Some purchasers in low- and middle-income countries pay as much as 20 to 30 times more for basic generic medicines like omeprazole, used to treat heartburn, or acetaminophen (also known as paracetamol), a common pain reliever.
Low- and middle-income countries purchase more expensive branded generic drugs rather than unbranded quality-assured generics. In the US, most drugs are either on-patent medicines or unbranded generics, but in many developing countries more expensive brand-name generics are widely used, because people are concerned about unsafe or counterfeit drugs. In the poorest countries, unbranded generics are only 5 percent of the pharmaceutical market by volume—in comparison to the US where unbranded quality-assured generics are 85 percent of the market by volume.
There is little competition in the supply of essential medicines in low- and middle-income countries. The largest seller of products like contraceptives, cancer medicines, and antiparasitics can account for upwards of 85 percent of all sales in some countries.
“We’re talking about access to common medications for pain or high blood pressure, not the latest cutting-edge cancer drugs,” Glassman said.
“It’s not as exciting to talk about procurement as new health technologies or biotech breakthroughs,” she continued. “But drug purchasing is incredibly important, and if it’s done badly you end up with the poorest countries in the world paying some of the highest drug prices.”
You can read the full study at www.cgdev.org/better-health-procurement.
Attention presidential transition teams: The first hundred days of the new administration should kick start an ambitious agenda in global health alongside long-needed reforms to enhance the efficiency and effectiveness of US action. Building on our earlier work, we suggest seven priority actions within three broad categories.
Christmas came early this year for the wonkiest of PEPFAR-watchers. Our gift: the preliminary report on the pilot of PEPFAR’s Expenditure Analysis Initiative, an important and exciting move by PEPFAR towards evidence-based decision making and greater transparency.
Each of the G20 summits of the past seven years has suffered in comparison with the London and Pittsburgh Summits of 2009, when the imperative of crisis response motivated leaders, finance ministers, and central bankers to coordinate effectively with each other. Subsequent summits have lacked the same sense of urgency and have failed to deliver any kind of agenda that can be pinpointed as clearly as “saving the global economy.” This week’s summit in Hamburg, Germany promises more of the same, with the real possibility that the G20’s stock could fall even further at the hands of a non-cooperative US delegation.
You’ve probably already heard about the pharma outrage du jour. In short: start-up Turing Pharmaceuticals, led by combative ex-hedge fund manager Martin Shkreli, recently acquired Daraprim, a 60+ year-old drug to treat a parasitic infection called toxoplasmosis – the only available treatment for this rare infection – which can become deadly for HIV+ individuals and others with weakened immune systems. Turing then promptly raised the price by more than 5000%, from $13.50 to $750 per tablet, such that a single individual’s treatment can now cost up to $634,000.
In July 2012, world leaders gathered in London to support the right of women and girls to make informed and autonomous choices about whether, when, and how many children they want to have. There, low income-country governments and donors committed to a new partnership—Family Planning 2020 (FP2020). Since then, the focus countries involved in the FP2020 partnership have made significant progress. Yet as FP2020 reaches its halfway point, and new, even more ambitious goals are set as part of the Sustainable Development Goals, gains fall short of aspirations.
Health products—including drugs, devices, diagnostics, and vector control tools—are essential for meeting the healthcare needs of any population. Right now, many low- and lower-middle-income countries rely on donor-managed mechanisms to procure a large share of these health commodities. But this status quo won’t stay static for long, and the global health community must prepare for sweeping changes in global health and procurement over the next 10–20 years. Here’s some of what we see happening now and on the immediate horizon.