Financing Global Common Goods for Health: When the World is a Country

Figures & data

FIGURE 1. Donor Funding for Global Vs. Country-specific Functions, Years 2013, 2015, and 2017.

Source: Ref. 3. © 2019 The Authors. All Rights Reserved.

FIGURE 2. Donor Funding for Global Functions by Global Function Category, Years 2013, 2015, and 2017.

Source: Ref. 3. © 2019 The Authors. All Rights Reserved.

TABLE 1. How the Term “Common Goods for Health” Relates to the Term “Global Functions”

Terminology
Common Goods for Health	Global Functions
Public goods	Provision of global public goods
	Fostering of global health leadership and stewardship
Market failures and large externalities	Management of negative regional and global cross-border externalities

TABLE 2. Taxonomy of Global Functions

Function	Examples
Supporting global public goods	Development of new health products Setting of international norms, standards, and guidelines Intellectual property sharing Knowledge generation and sharing Global surveillance of biological, chemical, and physical pathogens/threats Market shaping Population, policy, and implementation research Risk shifting and bearing
Managing cross-border & global externalities	Control of cross-border disease movement Curbing the cross-border marketing of addictive and other unhealthful goods Outbreak preparedness and response Responses to antimicrobial resistance
Fostering leadership & stewardship	Global advocacy and agency for marginalized and neglected sub-populations (e.g., refugees, men who have sex with men, transgender people) Convening for consensus building on policies and priorities Health and cross-sectoral advocacy (e.g., education, environment, trade)

BOX 1. Estimating the Finance Gap for Product Development for Neglected Diseases

With the exception of a one-off injection of funding for Ebola R&D, funding for product development for neglected diseases fell steadily from 2009–2015. There are many different barriers to mobilizing financing for such R&D—one of them is the lack of consolidated information on (i) which product candidates are in the pipeline, (ii) the estimated costs to move them through the pipeline, and (iii) the likelihood of specific launches. In a new study, Young and colleagues tried to fill in some of these information gaps.^Citation33 First, working with Policy Cures Research, they conducted a global review of the pipeline for 35 neglected diseases. These diseases were defined in the following way: “the disease or health issue disproportionately affects the developing world; there is a need for new products (i.e., there is no existing product, or improved or additional products are needed); and there is market failure (i.e., there is insufficient commercial market to attract private R&D investment).” The authors found 685 product candidates for 35 different neglected diseases in the pipeline as of August 31, 2017; 538 candidates met inclusion criteria for input into the portfolio-to-impact (P2I) model, a financial modeling tool.^Citation34 The P2I model is based on assumptions for the cost, attrition rate, and cycle time per development phase for a number of different product types, or archetypes (e.g., simple new chemical entities, complex new chemical entities, simple repurposed drugs, complex repurposed drugs). Thus the next step was to classify each of the 538 candidates into their respective archetypes and then to input these into the P2I model. The modeling suggested that it would cost about 16.3 billion USD to move these candidates through the pipeline, with three-quarters of the costs incurred in the first five years, resulting in about 128 anticipated product launches by 2030. For several diseases and product types (e.g., highly efficacious vaccines for HIV, TB, malaria, and hepatitis C), the model suggested that product launches by 2030 would be unlikely. In order to estimate the costs to develop such products—i.e., those that are likely to be “missing” but are highly needed—Young and colleagues examined the suggested list of “important” or “game changing” diagnostics, drugs, and vaccines prioritized by the Commission on Investing in Health. The authors found that 18 of these “important” or “game changing” products are likely to still be missing by 2030 (Table 3). Estimated additional costs to launch one of each of 18 key missing products were 13.6 billion USD assuming lowest product complexity or 21.8 billion USD assuming highest complexity (8.1 billion USD–36.6 billion USD). Over the next 5 years, total estimated costs to move current candidates through the pipeline and develop these 18 missing products would be around 4.5 billion USD (low complexity missing products) or 5.8 billion USD/year (high complexity missing products). The authors conclude that “since current annual global spending on product development is about $3B, this study suggests the annual price tag over the next 5 years is at least $1.5–2.8B.”

TABLE 3. Important or Game Changing Products Proposed by the Commission on Investing in Health that Could Help Achieve a Grand Convergence in Global Health by 2035. Source: Ref. 1.

	Diagnostics	Drugs	Vaccines
Short Term (available before 2020)
Important	POC diagnostics for HIV, TB, malaria; POC viral load for HIV	New artemisinin co-formulations for malaria; new TB drug co-formulations*; curative drugs for hepatitis C; new antivirals for influenza; long-acting contraceptive implant; safe, effective, shorter duration therapy for active and latent TB; new drugs for NTDs* (with high efficacy and few side effects)	Moderately efficacious (50%) malaria vaccine; conjugated typhoid vaccine; heat-stable vaccines; new adjuvants to reduce multiple dosing of vaccines; more effective influenza vaccines in elderly people
Potentially game-changing		Single encounter treatment for malaria: a one dose therapy for vivax and falciparum
Medium Term (available before 2030)
Important		Antimicrobials based on a new mechanism of action	Combined diarrhea vaccine* (rotavirus, enterotoxigenic E. coli, typhoid, shigella), protein-based pneumococcal vaccine; RSV vaccine; hepatitis C vaccine*
Potentially game-changing		New classes of antiviral drugs	HIV vaccine*; TB vaccine*; highly efficacious malaria vaccine*; universal influenza vaccine

Abbreviations: POC: point-of-care, NTDs: neglected tropic diseases; RSV: respiratory syncytial virus; TB: tuberculosis

*The 18 missing products based on modeling the current pipeline (highly efficacious vaccines against HIV, TB, malaria, and hepatitis C; combined vaccine against multiple diarrheal diseases, complex new chemical entity [NCE] for TB; NCEs for 12 NTDs [based on the WHO list of NTDs at https://www.who.int/neglected_diseases/mediacentre/factsheet/en]).

BOX 2. The WHO’s Six Core Functions as Described in Its Thirteenth General Programme of Work 2019–2023⁵⁶

Providing leadership on matters critical to health and engaging in partnerships where joint action is needed Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge Setting norms and standards and promoting and monitoring their implementation Articulating ethical and evidence-based policy options Providing technical support, catalyzing change, and building sustainable institutional capacity Monitoring the health situation and assessing health trends.

TABLE 4. WHO’s Sources of Financing (US Dollars). *derived from Charges against Voluntary Contributions. **approved for Current and past Bienna

Source	2014–15	2016–17	2018–2019
Voluntary Contributions Specified	3,445,427K	3,617,729K	4,068,958K
Flexible Funds	1,436,818K	1,441,300K	1,396,922K
Assessed contributions	929,000	929,000K	956,900K
Core voluntary contributions account	251,218K	168,000K	119,262K
Programme support costs*	256,600K	344,300K	320,830K
Projected	0	0	613,902K
Shortfall	−905,045K	854,316K	−92,189K
Total Approved Budget**	3,977,200K	5,913,345K	5,987,662K

Source: https://open.who.int/2018-19/budget-and-financing/gpw-overview.

TABLE 5. The Highest Priority Global Functions Requiring Investment, as Ranked by the CIH

	Investments to achieve grand convergence	Investments to control non-communicable diseases	Highest priority investments ranked by the Lancet Commission on Investing in Health
Supplying global public goods	Product development for poverty-related neglected diseases, including tuberculosis; market shaping for convergence-related products; population, policy, and implementation research to improve health system quality and resilience	Population, policy, and implementation research for national non-communicable disease control programmes; market shaping for national non-communicable disease technologies; collective purchase of drugs and other key commodities	Development of much better drugs and vaccines against tuberculosis; preparation for severe influenza pandemic, including in commodity stockpiles, surge and manufacturing capacity, and development of universal influenza vaccine; policy and implementation research, market shaping for technologies, and collective purchase of commodities; population, policy, and implementation research to improve health system quality and resilience
Managing negative cross-border externalities	Implementation of international health regulations; global rules for antimicrobial resistance	Global framework to prevent the unregulated spread of unhealthy products across borders	Control of drug-resistant tuberculosis
Fostering leadership and stewardship	Strengthening of WHO core functions for convergence-related areas	Strengthening of WHO’s national non-communicable disease department	Adequate funding for WHO and other technological UN agencies, including strengthening their financial and legal capacity to reduce cross-border transmission of drug-resistant tuberculosis and other pathogens, pollution, harmful substances, and counterfeit health products

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