August 19th 2008

Dear Colleague:

In this issue of CGD's monthly e-newsletter devoted to news and information about the global problem of drug resistance, we highlight two recent policy moves in developed countries that are intended to respond to growing antimicrobial resistance.

One is the report from an international symposium hosted by the British Royal Society on "Innovative mechanisms for tackling antibacterial resistance. The symposium stemmed from a 2007 report on "Tackling antibacterial resistance in Europe." In the report, the European Science Advisory Council said that short term action alone (such as the restriction of antibiotic prescription) would not reverse the problem of resistance. The Royal Society, a member of the Council, held the symposium to consider the need for investment in science and support for industry innovation. The recommendations from the symposium will be used by the UK Department of Health in its strategy for combating antibacterial resistance and to inform its research priorities.

The other item is a May 2008 Choice Research report, which highlights how pharmaceutical advertising in Australia promotes inappropriate use of medicines and increases reimbursable costs. A major concern of the report is the use of drug representatives to promote medicines.

Two observations about these reports occur to me. First, it is encouraging that the CGD Working Group, in its meeting on 10-11 July, 2008, considered both industry innovation and the use of drug representatives in its deliberations about what needs fixing in regard to resistance. Both have emerged from our tri-partite framework as areas of policy interest. Second, while we are glad that rich country governments are paying more attention to the problem of drug resistance, there is still silence from the developing world. We will rest easier when we see more reports from developing country governments or science boards that indicate the issue is being recognized. (I welcome subscribers to send in any reports that they are aware of to me at [email protected].)

Finally, in this month's feature column (see below), we highlight an innovative mechanism for educating the general (especially young) public about resistance: using comics!

Thank you for subscribing to this e-newsletter. As always, we welcome your comments and suggestions on our program of work.

Regards,

Rachel Nugent
Deputy Director for Global Health
Center for Global Development

FEATURED COLUMN

The World Tuberculosis Cup and the Goal of Global Health Innovation *

On July 24, the WHO-hosted Stop TB Partnership released a comic book aimed at teaching children and teens about tuberculosis and how to prevent it. In the comic book, The Stop Tuberculosis Team is captained by the Portuguese soccer star, Luis Figo, who in the story leads his team to victory against an opposing team of tuberculosis germs. In a statement issued on the occasion of the comic book launch, Figo urges young people to take the comic book’s message seriously: "I am passing the ball to you -- you can help reach the goal of stopping tuberculosis."

The comic book is the result of a global competition launched in January 2008 to reward the best comic design aimed at preventing TB. At stake in the competition was a US$5000 cash prize from the Stop TB Partnership, along with worldwide acclaim from cartoon and comic circles and various exhibits throughout Europe.

This idea of using a prize to incentivize global health and development innovation is a somewhat recent fad, drawing from positive results experienced with reward models in science and technology. Prizes have also been promoted by many as a way to overcome the lack of investment in drugs for neglected disease as we noted in 2005. The progenitor of all of these recent competitions is the X-Prize, launched in 1994, which awards $10 million to those who achieve technological breakthroughs benefiting humanity.

There is a great need for new incentives for various players in drug resistance to take steps in effectively deterring resistance to drugs treating malaria, HIV/AIDS, tuberculosis and microbial infections. Incentivizing innovations in R&D with rewards, prizes or competition is an option that is under increasing investigation.

A large amount of scholarly work assesses the value of prizes and reward incentives as effective mechanisms for innovation. Both Brian Wright in 1983 (AER) and Shavell and Van Ypersele in 2001 (JLE) challenge the dominance of the current intellectual property rights system for drug R&D by concluding that it does not have a fundamental advantage over a reward system, and they stipulate that rewards or prizes are superior and undervalued. More recently, a flurry of inquiries into whether medical innovation prizes would indeed spur new research, reduce monopolies and lower drug prices within a reward based system have surfaced in many publications. Experts argue that models such as the Medical Innovation Prize Fund Act of 2007, proposed by Senator Bernie Sanders, are too ambitious, given the lack of supporting evidence. Others, such as economist Joseph Stiglitz, believe that awarding prizes for medical innovation would be “more efficient and more equitable.” Others suggest prizes to be effective in combination with other incentives provided by governments or donors:

“Under certain circumstances, inducement prizes may act as a useful complement to grants and contracts as a way to encourage technological innovation. Inducement prizes and AMCs cannot substitute for robust research funding, protection of intellectual property, and development of a world-class workforce, but they can be a powerful complement to those efforts.” (Thomas Kalil, Brookings Institution Discussion Paper, December 2006)

There is still much to learn regarding optimal levels of investment in prizes. Great strides, however, are being made towards harnessing the potential that prizes may provide. In May, the 61st World Health Assembly adopted the Global Strategy on Public Health, Innovation and Intellectual Property, which includes proposals of possible incentive schemes; Barbados & Bolivia submitted proposals to the WHO IGWG (Intergovernmental Working Group) process this year calling for prize funds for priority medicines and vaccines.

Although there is more to consider regarding health impact prize funds, the World TB Cup displays its incentivized innovation with a cross-cultural array of cartoons for increasing awareness, and there's always room for more of that global public good.

*This article expands upon a post at the Global Health Policy blog, The World Tuberculosis Cup Score One for Global Health Innovation (Kristie Latulippe; August 14, 2008) where we invite you to contribute your own comments to the conversation.

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