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December 1999 Insights Issue #32
Back to Insights #32
Good for business, good for health?
Check-up time for corporate courtships
Are life-threatening diseases like tuberculosis staging a comeback?
What of the HIV and AIDS epidemic? And of the soaring rates of smoking
and similar background hazards? Has the combined impact of such threats
transformed the profile of public health campaigning as a new millennium
approaches? Today private and public sectors are burying traditional
feuds and forming trans-national partnerships, pooling resources to
counter this horde of problems. Such pacts can deliver real health gains
to many at the margins of society. But recent research suggests
cross-sector partnerships must themselves be open to tough scrutiny
before we can rest assured they work in the public interest.
Various factors gave rise to public-private health partnerships at a
global level. But the main catalyst was the ideological shift among
policymakers away from 'freeing' towards 'modifying' the role of the
market in public service provision. Alarm at lack of research and the
dearth of new medicines for tropical diseases such as malaria and new
ills such as AIDS, prompted intense discussions between public and
private health providers to find ways to work together. There was a rush
to propose and form partnerships designed to spur pharmaceutical firms
to invest in research and development for drugs and vaccines for
neglected diseases especially in poorer countries.
Public and private sectors have dropped the adversarial rhetoric and
adopted more conciliatory attitudes. Many 'new breeds' of partnership
have resulted. These global public-private pacts are a new and generally
welcome feature of the international health landscape but we know little
about them, and some cautions are necessary. In future they are bound to
raise questions of governance, not least:
- Agenda-setting. Who decides what priorities should be tackled?
Beneficiary national governments are not often represented on Boards
or governing bodies of such coalitions.
- Accountability. To whom do these partnerships answer and by what
performance criteria?
- Sustainability. What happens if a pharmaceutical donation is
withdrawn or reduced? Will governments be able to continue an
established programme?
- Equity. Will some countries always be favoured as safe bets for
fruitful partnerships, while others are neglected being seen as
'difficult' due to political instability or weak infrastructures?
The signs are that two strands of new research will be needed with a
view to:
- understanding what partnerships have worked and how they achieved
goals, so as to build a best-practice platform for the next
generation of public-private collaboration
- exploring the need for a global regulatory and accreditation
system which ensures that public-private partnerships are a net gain
for public health.
| Business to the
rescue
Merck & Co launched one of
the earliest corporate partnerships in public health campaigns by
donating its drug Mectizan (based on the compound Ivermectin) to
the Onchocerchiasis Control Programme in West Africa in 1987, to
use in river blindness prevention. Working with WHO, World Bank,
UNDP and various nongovernmental organisations, the Mectizan
Donation Programme has grown to include all thirty-four countries
where river blindness is endemic. The cumulative value of the
donation is US$500m. Following Merck's example, other
pharmaceutical companies have since sponsored donation programmes
in partnership with UN organisations, bilateral agencies and major
NGOs. Programme agendas include steps to:
- combat resistant malaria
- speed elimination of
lymphatic filariasis
- eliminate blinding trachoma
- eradicate guinea worm
New research and development
partnerships are also being formed, linking academic institutes,
foundations and international and national bodies. They are
advancing research and developing products with a view, for
example, to:
- improving diagnostic tools
for STDs
- developing a vaccine against
HIV/AIDS infection
- promoting and developing new
and affordable anti-malaria drugs
Finally, alliances have been
formed to tackle specific health promotion tasks. For instance the
Bill and Melinda Gates Children's Vaccine Programme is working
with others to match the rate of introduction of new vaccines for
children in middle or low income countries more closely to
industrialised country rates. In the first eight months of 1999
the Gates Foundation gave US$175m towards vaccines.
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Contributor(s): Kent Buse and Gill Walt
Date: 13 December 1999
Further information:
Kent Buse
Division of International Health
Department of Epidemiology and Public Health
Yale University School of Medicine
60 College Street
New Haven
Connecticut
06520-8034
USA
Tel: +1 203 785-2865
Fax: +1 203 785 6193
Email: kent.buse@yale.edu
Yale University
Gill Walt
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK
Tel: +44 (0)171 927 2388
Fax: +44 (0)171 637 5391
Email: gill.walt@lshtm.ac.uk
London School of Hygiene and
Tropical Medicine, UK
Other related links:
Search
Eldis for sources on Health and Population issues
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