A special edition of the Director’s Corner

*By Gwynn Stevens, Carel IJsselmuiden, and Kubata Bruno Kilunga

GENEVA/JOHANNESBURG/NAIROBI — After months of planning, it was exciting to meet with health and development experts from around the world to imagine a new paradigm for health research partnerships in African and other low- and middle-income countries (LMICs). The consensus we reached at a special session of the 14th global meeting of the COHRED Group’s Global Forum for Health Research held on 26 April of Forum 2012, was that the time is right for African countries to drive their national health research agendas, and to make efforts to finance it more fully.

“Low- and middle-income countries, particularly African countries, must increase their ownership of health-related research and development processes, and reduce dependency on donor funding,” Yogan Pillay, deputy director-general of strategic health programmes for the South Africa Department of Health, told us. Partnerships will be key to accomplishing this goal.

We represent three different organisations. The International AIDS Vaccine Initiative (IAVI) is a product development partnership (PDP), a non-for-profit group that connects government resources, private sector technologies, and research and academic institutions to accomplish our goal—a safe and effective HIV vaccine available to all who need it (USAID supported IAVI-invited participants at the session).

The New Partnership for Africa’s Development Agency (NEPAD Agency), the technical arm of the African Union, provides a common platform for the eradication of poverty in Africa through sustainable growth and development and African ownership.

The COHRED (the Council on Health Research for Development) Group supports research for health, equity, and development in LMICs by engaging all the relevant entities, including research institutions and councils, ministries, civil society and the media.

We convened the session to explore the current roles and future potential of international partnerships, broadly conceived, in advancing development through health research. Attendees sought to identify the elements of partnerships that would bring the greatest benefits to research and capacity-development in Africa and, at the same time strengthen health and development systems on the continent.

A core issue is the vertical, disease-specific research model that currently characterises much health research in developing countries. Carel IJsselmuiden, Executive Director of the COHRED Group, said that funders and research programs must consciously build systems and capacity in their areas that can extend beyond silos and support other campaigns. Partnerships, he said, “are a key element of responsible vertical programming.”

Bruno Kilunga Kubata, Coordinator of Health Sector at the NEPAD Agency, noted that: “Despite substantial external funding for health in Africa, science, technology and innovation and research for health systems remain weak in most African countries.” He added that the events of the 21st century call for a new type of partnership model. “With the current global financial turmoil and rapid growth in several African countries, it is imperative that we re-think health and research for health financing in Africa, and international partnerships that strengthen African research capacity and ownership are key.”

We developed a number of specific and general recommendations. Most crucially, perhaps, research for health programs must design capacity building for development and health systems into their programs from the earliest stages, i.e., this must be a goal and not merely an incidental, even unexpected collateral benefit. Partnering organisations should be selected with attention to their commitment to ensuring that the infrastructure and human expertise which will be developed for the program is sustainable and transferable. Country ownership will benefit from locally anchored partners, such as national universities, who will still be there when a particular research program is concluded.

Finally, it was clear that the benefits of international partnership are valuable for all regions, not only low-income African countries. A report of the session will be released shortly.

………

*This special edition of the Director’s Corner is authored in collaboration with the following partner colleagues:

• Dr. Gwynn Stevens is Director of Clinical Laboratories, IAVI, in Johannesburg, South Africa.

• Prof. Dr. Kubata Bruno Kilunga is coordinator of NEPAD Agency – Research for Health Initiative in Africa & Pharmaceutical Innovation, in Nairobi, Kenya.

• Carel IJsselmuiden, Executive Director of the COHRED Group, in Geneva, Switzerland.

For a quick snapshot of what happened at Forum 2012, check out our blogs from the proceedings

(l-r): Yvonne Chaka Chaka, global activist and musician, Carel IJsselmuiden of the COHRED Group and Gwen Ramokgopa South Africa's Dep. Minister of Health at the closing of Forum 2012

The Forum examined the prospects for a new vision of development that looked ‘beyond aid’, by focusing on developing capacities in low-and middle-income countries and emerging economies. This engagement probed how global collaborations can be used to support research and innovation processes that can enhance this new era of development.

Participants at Forum 2012 had the opportunity to share experiences on how to set their own priorities for research, build capacities and provide incentives for innovation. Innovation was identified as a key factor in compensating for the lack of infrastructure and resources, especially in the form of new information and communication technologies (ICTs): Virtual collaboration, sharing of data and mobile health technology, to reach rural areas, are some of the exciting possibilities.

Although governments in developing countries find it difficult to meet recommended targets for research and development spending, it is a misconception that they rely purely on international aid, as they remain the major funders of research in their countries.

Whilst building self-reliance for countries is essential, participants at Forum 2012 argued that there are benefits to collaborating with neighboring countries – such as pooling resources and knowledge.  Additionally, participants called for greater cooperation between sectors within countries to drive improved health. Participants from the private sector were urged to create public private partnerships in order to share funding and knowledge.

A strong and recurring theme at Forum 2012 was the need to always ensure the involvement of communities in setting the priorities for health research.

High on the Forum 2012 agenda was the issue of women’s health, although it was stressed that the focus should be on sexual and reproductive health and not simply on maternal health.

Forum 2012 was credited for an inclusive and diverse approach particularly around the presence of young people through the ‘Youth in Motion’ sessions. Youth in Motion is a platform for young people to have discussions and create youth networks with the goal of achieving global equity.

Tennyson Magambo spoke at the closing ceremony on behalf of Youth in Motion. He called for the increased use of ICTs and new media, and for action and social change around issues of health, equity and development. Youth in Motion is in the process of setting up a health research network portal for sharing experiences, knowledge and peer learning.

Forum 2012 was held from 24 to 26 April 2012 and jointly organised by the Council on Health Research and Development Group (The COHRED Group), and both the  Department of Science and Technology and the Department of Health, of South Africa.

Ends

For more information, contact us on: info@forum2012.org and/or visit the Forum 2012 website on www.forum2012.org

20 April 2012 | EN

It’s time to move from debate to action with new mechanisms for funding research into diseases faced by developing countries.

In the current financial and political climate, it is brave — some might say foolhardy — to propose a binding international treaty on the funding and coordination of research into health problems facing the developing world.

Nevertheless this is what the World Health Assembly (WHA), the body responsible for the policies of the WHO, is being asked to consider at its annual meeting in Geneva next month (21–26 May).

The proposal comes from the WHO’s Consultative Expert Working Group on Research and Development (CEWG), which has spent the past year analysing various ways of enhancing research and development (R&D) of treatments for diseases prevalent in developing countries.

Its report, released two weeks ago (5 April), lists measures that could bridge the continuing gap between the potential that science offers for creating such treatments, and the failure of the market to provide adequate incentives to make them affordable.

Top priority, it says, is starting negotiations on a binding convention on R&D. A central idea is that governments should commit to spending 0.01 per cent of GDP on R&D that is relevant to the needs of developing countries.

It also examines possibilities for new sources of sustainable funding, in particular through taxation — for example on air travel, alcohol or financial transactions — according to each country’s preference.

But the proposal deserves support. Disease is not only an endemic problem with social implications in developing countries; it is also a financial burden, depriving them of the healthy workforce needed to reach anything like their full potential.

There are therefore both moral and economic grounds for finding more effective ways to combat health problems in these countries.

The problem of the gap between what science can offer and what it has delivered was first identified in the 1990s. The best way of addressing it has been hotly debated over the past decade, for example at the bi-annual Global Forum for Health Research, the latest of which, Forum 2012, takes place in Cape Town next week (24-26 April).

A succession of committees and working groups has looked at a range of proposals to address the fact that selling drugs to the poor reaps fewer profits for the pharmaceutical industry than R&D for diseases of the rich.

In its report the CEWG recommends promoting “open knowledge innovation” as a priority. The idea is that new medical innovations are developed most effectively, and at the lowest cost, if research results are shared freely without the restrictions of registering them as intellectual property.

Other ideas that meet the CEWG’s feasibility criteria range from providing direct grants to small and medium-sized companies, to extending the practice of patent pools, in which patent-holding drug companies agree to forgo their patent rights in selected countries to allow local companies to make medicines generically at mutually-agreed licence fees.

But putting all these ideas into practice needs coordination. And this is more likely to be effective if it is linked to a funding mechanism — which is where the idea of a new treaty comes in.

Equally unsurprising is its lukewarm reception from the pharmaceutical industry. Falling short of open opposition, a spokesperson for the International Federation of Pharmaceutical Manufacturers and Associations argues that “there is not a one-size-fits-all approach to stimulating R&D” into diseases affecting developing countries.

The real test will come at the political level. Even if the WHA decides to endorse it, implementation of a binding convention — particularly if it included funding commitments — is likely to be a lengthy and challenging task.

But that is no excuse for failing to move from debate to action. Even with the intervention of bodies such as the Bill & Melinda Gates Foundation, the gap between needs and solutions in medical health research for developing countries remains as wide as it was ten years ago. How much longer will we have to wait until a serious government-backed attempt is made to bridge it?

David Dickson
Editor, SciDev.Net

Link to CEWG report

Source: www.scidev.net

African countries must adopt a strategy for developing human resources with the skills to manage and deliver health research, argue Carel IJsselmuiden and colleagues from the Council on Health Research for Development (COHRED).

Although Africa’s health research capacity has grown in recent years, it remains uncoordinated, small-scale and driven from outside the continent, they say. The international community should support efforts to make human resources planning a key part of global and national agendas. This is essential for research into homegrown solutions for better health.

Efforts to strengthen human resources capacity for health research must include training individuals but also creating enabling environments — a “system with people who have skills including administration and management, priority setting, networking and leadership, translation into policy and action, dissemination, advocacy, and ethics”, write the authors.

Human resource building activities currently overlap between sectors — health, science and technology, and higher education — and, as a result, gaps are not addressed systematically.

IJsselmuiden and colleagues recommend that African countries develop a coordinated strategy to build capacity; that greater collaboration between international funders must be encouraged to make capacity building part of research programmes; and that current efforts should be diversified and evaluated to measure their effectiveness.

Link to full article in South Africa Medical Journal

Source: http://www.scidev.net/en/health/opinions/africa-needs-human-resources-strategy.html

The overarching theme of the first thirteen meetings was “Closing the 10/90 gap” – by encouraging high-income countries to spend more on the health problems of low and middle income countries.

From Forum 2012, we are taking a different route. The world has changed. The “10/90 gap” is less relevant today for two major reasons: the total burden of communicable and ‘tropical’ diseases is reducing so that the importance of non-communicable diseases (NCDs) increases – NCDs were always there, but we chose not to see them. Secondly, the capacity and eagerness of low and middle income countries to deal with their own research and innovation challenges is much higher now than it has ever been – as are their own investments in research, science & technology and innovation. Our host, South Africa, is a great example of this – but this Forum will hear the experience of many other countries as well.

Forum 2012 operates in this new world – one in which the spending of high income countries on the problems of low income countries is increasingly being replaced by the spending of low income countries themselves – in finance, trade and in technology. And better health and less inequity in health are two of the best outcome measures to guide this process.

This and future Forum meetings will concentrate less on “Closing the 10/90 gap” and more on operationalizing “Research and Innovation as key drivers for Health, Equity and Development” – with an emphasis on national capacities and systems that can operationalise this. For Africa in particular, we believe that this strategy is of great relevance to use the increasing economic growth as best as possible – and move into a ‘Beyond Aid’ mode as soon as possible. We want to highlight the central need for including research and innovation in national development strategies as a critical step towards maximizing health, equity and socio-economic development.

Healthier people drive development, and development brings good health. This is expressed clearly by the new paradigm of ‘research and innovation for health’ which takes us well beyond the health sector and forces us to involve all other sectors needed to impact on health and equity.

During Forum 2012 in Cape Town, we bring together people from a variety of backgrounds – researchers, policymakers, business leaders and entrepreneurs, members of government, civil society organizations, the youth and the media, and finance. The art of the Forum will be to bring together the right mix of people, ideas, evidence, means and inspiration to initiate action – what we term ‘improbable partnerships for action’. They are ‘improbable’ because they do not happen easily. But they are essential if action and innovation is to occur.

The impact of the Forum will therefore have to be measured by the action it generates, catalyses, initiates or inspires – to improve health, equity and development – and, especially, the action it generates for low and middle income countries to get into the driver’s seat of research and innovation growth in their own countries.

We are moving away from simple communication of evidence from research towards honing in on solutions tailored to the local context and this requires a change of attitude. We anticipate that those joining us in Cape Town will contribute in forging this change, and help in bringing research closer to the people by linking its results to applicable solutions that contribute to better lives.

Forum 2012 is also the first Forum organised by COHRED following the merger of our two organisations in 2011. We think we are on the right track. We are encouraged by the positive attitude and commitment of the dozens of colleagues representing many different organisations, sectors and areas of work, who were involved in preparing the programme with the enthusiastic support of a new and great Forum team – that includes our hosts in South Africa’s Ministries of Science & Technology and Health – a unique combination to start our new Forum series with.

This Forum will, in the end, be about what the participants make of it. We count on your energy and ideas to make the most of the collective potential that is gathered in Cape Town this April, and work towards new way forward.

This particular edition of the Director’s Corner is jointly authored by Carel IJsselmuiden, the Executive Director of the COHRED Group and Dr. Francisco Songane the Chair of the Forum 2012 Steering Committee.

Dr. Francisco Songane

Chair

FORUM 2012 Steering Committee

You can keep up with Forum 2012 on:

Twitter: @SAForum2012

Facebook: https://www.facebook.com/cohredforum

Many resource-poor countries, especially those in Africa, have always depended on other countries for their drug supplies, either through foreign aid or buying cheap generics from the pharmacy of the developing world — India.

Next month, policymakers and researchers will gather at a global health conference to discuss how developing countries can move beyond aid. The Council on Health Research for Development (COHRED) forum, to be held in South Africa in April 2012, will discuss how resource-poor nations can become more self-sufficient. Most importantly, the meeting is based on the premise that they are capable of doing so.

To break free of its dependence on donor money and supplies from India, Africa must develop its own pharmaceutical pipeline by creating policy frameworks that encourage a fledgling drug industry.

Time is precious

According to WHO estimates, less than 60 per cent of people in the developing world have access to generic medicines that are available at a fraction of the cost of brand-name drugs.

Like other stakeholders in global health, COHRED has been pushing for some time for African countries to boost their own drug-development capacity — and this has never been more urgent.

Although India’s drug industry continues to churn out generics against killer diseases such as HIV/AIDS, malaria and tuberculosis, there is no end to resistance from global pharmaceutical companies wanting to extend the duration of market exclusivity on their brand-name drugs to prevent competition from generics.

This month, for instance, drug giant Novartis is going to India’s supreme court to challenge patent laws in a case that has many health activists, such as Médecins Sans Frontières, extremely worried.

And a free-trade agreement between the European Union and India, still in protracted negotiations, could hamper the country’s ability to supply cheap drugs to the rest of the developing world.

There’s another reason why African countries should experiment with developing a drugs industry — the least-developed nations have until 2016 before they are bound by the international agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), which dictates patent protection for new drugs.

With careful negotiation they might be able to extend the deadline, buying precious time to develop the framework for a robust pharmaceuticals industry.

Laying the foundations

One major driver of drug development is the presence of a market — but most Africans who need essential drugs can’t afford them.

A recent report by the UN Conference on Trade and Development (UNCTAD) recommends that African countries take steps to ensure a market exists. For example, a government can provide advance purchase commitments to guarantee the purchase of drugs from a company that are then donated or sold to poor patients at a lower price.

With limited initial capacity, countries need to be prudent about which drugs are developed. Different countries have different needs, and selection must be made through dialogue between government ministries, pharmaceutical companies, and local drug regulatory authorities, suggests the UNCTAD report.

Good regulation is crucial, yet could prove most challenging. Many African states have patchy regulatory systems for quality assurance and little means to ensure drugs testing follows ethical guidelines. They will need to create and enforce watertight regulations to ensure that substandard or ineffective medicines don’t flood the market.

A joint report by the WHO, UNCTAD and the International Centre for Trade and Sustainable Development (ICTSD) points out that “local producers find it difficult to meet regulatory standards, including those for WHO prequalification, and medicine regulatory authorities in Africa are not considered to be meeting their own national or international standards.” [2]

Building capacity

Some African countries are already making moves towards self-sufficiency. In February South Africa announced a US$211 million venture with Swiss therapeutics firm Lonza to manufacture the key chemical components (the ‘active pharmaceutical ingredients’) of antiretrovirals — the first time an African country has set out to develop any active ingredients.

This is a critical move in the right direction, as South Africa’s HIV/AIDS epidemic requires a quarter of all antiretrovirals used worldwide.

But the development of a robust pharmaceutical industry in Africa can’t, and shouldn’t be, uniform. States are extremely varied in their scientific ability, level of manufacturing regulation, and financial capacity to invest.

Some countries could first set up a system to simply manufacture drugs based on existing formulations, before progressing to research and development. Others with more advanced biotech industries, such as South Africa, will have the know-how to innovate in drug development.

Africa will not bolster its pharmaceutical capacity without considerable incentive — by subsidising land to build manufacturing plants, for example, or reducing import taxes on chemicals — from national governments, and perhaps from donors in the short term.

It will require extraordinary collaboration between industry and government agencies. But if it works, it will produce the most important set of public-private partnerships yet.

Source: http://www.scidev.net/en/science-and-innovation-policy/opinions/biomed-analysis-why-africa-must-make-its-own-drugs-1.html

IN THE past five years, African economies have experienced tremendous economic growth rates. However, the continent is still confronted with the world’s most serious health crises. Of the 20 countries with the highest maternal mortality ratios worldwide, 19 are in Africa; more than 90% of the estimated 300-million to 500-million malaria cases that occur worldwide every year are in Africans, mainly children under five years of age; only 58% of people living in sub-Saharan Africa have access to safe water supplies; and 60% of those with HIV/AIDS live in Africa.

Donor aid has gone some way to reducing infection and mortality rates, improve health conditions and access to treatment and medicine. However, donor aid has done little to create conditions that drive self-sustaining healthcare systems in Africa and pharmaceutical innovation towards solving Africa’s health problems. There is only one World Health Organisation (WHO)-approved laboratory in Africa that produces a vaccine — the “Institut Pasteur de Dakar” in Senegal.

‘In 1986, the estimated investment into health research globally was about $30bn, with only 5% spent on the needs of low- and middle-income countries. In 2005, the global total was $160bn, a considerable increase, while the proportion spent in low- and middle income countries is unclear, but is more likely to be over 5% as countries themselves are beginning to invest in their own health research. Accurate figures on health research spending in LMICs are lacking, but work on this is underway at COHRED’.

New ways to prevent disease and new methods to distribute medical supplies and treatment can result only from health research and innovation.

Fortunately, the world is changing. In 1993, the model of research support was unidirectional, from “north” to “south”. In 2010, many low-and middle-income countries have become research and innovation leaders themselves, such as India, Thailand and Brazil.

So how can we go “beyond aid” and put in place systems with which African countries can design their own self-sustaining and effective health solutions through research and innovation?

Tanzania has one such success story. In the mid-1990s, the Tanzania Commission for Science and Technology began conducting research on the efficacy of insecticide-treated nets to reduce exposure to malaria and parasites. With the support of the WHO, further research revealed that the nets could help to improve child survival by 23%.

The commission then started to put this research into action. It adopted a social marketing approach to disseminate bed nets, which resulted in a 27% improvement in child survival. The results led to the establishment and revamping of a national malaria control programme, which included the signing of a memorandum of understanding between a local manufacturer, Moshi District, and the ministry of health to standardise nets and distribute them.

The government reformed its tax system on nets by waiving taxes and tariffs on bed nets and worked with the commission, manufacturers, c ivil s ociety o rganisations and financial services providers to create a voucher system through which individuals could redeem vouchers for nets.

Now, 60% of children in Tanzania sleep under bed nets and there is four times more bed-net coverage across the country. The manufacturing firm has strengthened its capabilities by creating almost 7000 new jobs and is now also one of the leading bed-net manufacturers across Africa.

To date, this enabling approach to developing countries’ research and innovation has not been well supported as a development strategy. It is with this in mind that the Council on Health Research for Development is taking action. At the end of next month, the council, in collaboration with the Department of Science and Technology, will launch a new series of meetings on research for health on the theme, “Beyond aid … research and innovation as key drivers of health, equity and development”. The focus will be on making research and innovation work for health, equity and development.

Three main themes need to be investigated: improving and increasing investments in research and innovation; networking and partnerships for research and innovation; and creating enabling environments for research and innovation. An investment in improving systems, governance and management for research for health in African countries is a direct investment in the continent’s economic future.

The above article first appeared in South Africa’s Business Day newspaper on the 7th of March 2012. Source: Business Day. http://www.businessday.co.za/articles/Content.aspx?id=166769