Nov 3, 2006

Pull vs. push for global health

My recent retirement has given me the opportunity to go through all the issues of the New Yorker I'd been saving. An article by James Surowiecki in the December 20, 2004 talks about a pull system for pharmaceutical research. Great Britain's Chancellor of the Exchequer promised to buy up to 3 million doses of a successful malaria vaccine for the developing world.

Research is more often funded by grants for work someone says they are going to do, whether it's successful or not. That means the taxpayer underwrites a lot of waste, if waste is defined as work that doesn't result in a usable product. The money is pushing research.

Pharmaceutical companies don't fund the research because there's no payoff. Where the drugs are needed, there's virtually no money to pay for it. Where there's no money, there's no customer and no market, whatever the desperate need is. There's more money in arthritis in the developed world.

So Britain's promise ought to spur competition for the hundreds of millions of dollars or pounds at stake, the pull of a customer initiating the processes that build the product the customer needs and is able to pay for.

Will it work? Sadly, like other simplistic notions, it may be doomed. Andrew Farlow at Oxford authored a report, The Science, Economics, and Politics of Malaria Vaccine Policy, in April 2006 that exposes a lot of flaws, especially where it became an "understanding" with Glaxo-Smith-Kline.

But it sounded good, didn't it?

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