11 Feb From Innovation to Impact
On Tuesday January 26, KIT hosted and co-organized the event “From Innovation to Impact”, in close cooperation with KNCV Tuberculosis Foundation and the Bill & Melinda Gates Foundation. Frank Cobelens represented AIGHD in the Panel debate with his introduction about vision and leadership in Global Health.
450 guests attended a very inspiring afternoon of lectures, debates and discussions on how to have a positive impact on global development.
Introduction by Frank Cobelens (spoken text)
Innovation in health care delivery
I want to acknowledge that it’s the local context that determines whether innovations will be picked up and have impact. This is certainly valid in the health field.
Indeed, the rural poor may hardly benefit from product innovation for health as roads, poor sanitation and poor nutrition that keeps them trapped, but also bad health itself. This is what I call the vicious cycle of poverty diseases: these diseases are driven by poverty and at the same time perpetuate poverty.
The key to getting out of this dilemma is, I think, innovation in health care delivery. For the rural poor health care is not accessible, because the institutions that should deliver this care are dysfunctional. We need innovations such as low-tech diagnostics or mass treatment campaigns that can bypass dysfunctional institutions while responding to the local context and disease cycle.
Non-communicable diseases
Another observation. Urban poverty is on the rise and is changing the face of poverty diseases. By now more than half of the world’s population lives in towns and cities. Over the next two decades, urban populations in Africa and South Asia will double. Many are very poor, living in slums: cities within cities with unhealthy, violent environments and disrupted social systems.
This demographic transition is transforming disease patterns. Urban lifestyle and environment are pushing up the burden of non-communicable diseases. Infectious diseases remain a problem, but change from parasitic and vector-borne diseases, such as malaria, often with high mortality in children, to diseases such as HIV and tuberculosis that come with high mortality in adults. TB now is the biggest infectious killer worldwide with 1.5 million deaths every year.
The shift to urban poverty also changes what innovations are needed and feasible. In slums health care is not absent, but often of poor quality and accessible only if you can pay. Innovations in delivery must address affordability and quality, and can build on technologies such as mobile phones and social media.
Global epidemic threats
My third observation is that these demographic transitions are increasingly driving health security at global level. The Ebola epidemic in West Africa and emergence now of a Zika virus epidemic in Latin America are examples of local disease outbreaks that can quickly have global consequences as urban centers across the world are increasingly interconnected.
With poor quality care comes misuse of antibiotics and antimicrobial resistance. Tuberculosis is again a case in point. Global surveillance, to which Dutch groups have had major contributions, show that multidrug resistant TB is a problem of middle income countries: rich enough to have drugs, too poor to deliver them properly. Emerging data suggest this is true for other antimicrobial resistance as well. In TB the biggest drug resistance problem is in fact in Eastern Europe, on our very doorstep.
AMR and other epidemic threats don’t just happen far away. For health the North-South paradigm is no longer valid – these problems are interconnected and truly global, and require innovations that have global impact.
Solutions
What are the solutions? It all coalesces around vision and leadership. Vision and leadership in science and innovation, in industry, in the health sector and those organizations that support it – but above all in politics.
Then what should that leadership bring?
First, we need research into better products for poverty diseases.
We need effective vaccines, drugs and diagnostics for which we must stimulate basic research and product development. This requires political leadership, but also a willingness of researchers and research funders to create and follow research agendas that lead to innovations that matter.
Second, we need to overcome market failures. Diseases of poverty are by definition faced with market failures in product development and delivery. Big pharma is pulling out of antimicrobials, which is felt hardest in poverty diseases. Service delivery is often dysfunctional, leading to poor access for patients to drugs or diagnostics, or innovative products being underutilized, as we also see in TB. We need vision and leadership to create new models for engaging manufacturers, to maximize access to innovative products and to improve our understanding of local context and overcome failures in delivery.
Finally, we need vision and leadership to get us out of our silos. Ownership of global health innovation is moved around between sectors like a ‘hot potato’. The science and education sector perceives health issues as a field to be addressed by the health sector. The health sector regards poverty diseases as outside their realm, so refers to international development. International development may see health as within their scope but for innovation points to science or economic affairs. And economic affairs has little interest because there is little market potential.
This siloed approach is visible in our country and at EU level. We need vision and leadership to take ownership of global health and poverty diseases in a holistic approach. Our minister of Health, Edith Schippers is giving a good example by clearly taking the lead in addressing antimicrobial resistance in a One-Health approach across Health and Agriculture, here and in Europe.
Vision and leadership
Vision and leadership that draws together all relevant actors can translate into global impact. There is a great example from recent history, to which we, in The Netherlands, have contributed. Only fifteen years ago few people believed it would be possible to provide antiretroviral treatment to poor AIDS patients at scale. Then came: vision and leadership in science, such as by the late Joep Lange; overcoming market failures, such as through negotiated pricing for drugs and, for large-scale delivery and impact, the creation, with strong Dutch support, of the Global Fund; and above all decisive global political ownership to tackle the problem. Such a multifaceted approach seeking synergy and coordination between all actors is, to me, the example to follow for antimicrobial resistance, tuberculosis and other global health crises.
Watch the video impressions of the event