Getting basic drugs to poor better than grandiose schemes

With the weekend's G8 meeting in St Petersburg dominated by the crisis in the Middle East, plans for a bold but risky new plan to develop vaccines for major infectious diseases fell somewhat by the wayside. Perhaps this was a good thing, as these kind of eye-catching initiatives distract attention away from the hard and unglamorous effort that it takes to fight disease in the poorest parts of the world.

In the run up to the summit, much had been made of the G8’s commitment to fight malaria by helping finance the quest for a vaccine. While there are already effective drugs against malaria, the Holy Grail is a vaccine that could, in theory, consign the disease to the history books.

But the G8 plan (called Advance Purchase Commitment) has a novel twist. Instead of offering a prize, donor money will create an artificial market and price, so pharmaceutical companies will compete with each other at their own expense to develop a vaccine or vaccines. Only when a new vaccine meets all the clinical criteria will the governments pay up, at a price negotiated (by an unspecified mechanism) to reflect the winner’s development costs plus a degree of profit. So all the basic hard work and financial risk would be borne by the private sector -- without knowing the price of the product or the size of the market -- while the politicians hope for the kudos for initiating such a grand scheme.

This vision plays well with G8 leaders, who revel in the apparent media-friendliness of such ploys. However, in among the feel-good drama, the politicians seem to have forgotten the boring bits.

First off, before we go pouring millions of dollars into new schemes, we should examine whether we are using properly what we know already works.

Two-thirds of all African children who die under the age of five could be saved by low-cost treatments such as vitamin A supplements, oral rehydration salts and existing combination-therapy drugs against malaria. Better water management and spraying inexpensive insecticides inside dwellings have been proven to reduce malaria significantly.

But basic vaccinations and drugs are still not getting to a majority of people in sub-Saharan Africa and poor nutrition contributes to over half of all deaths associated with infectious diseases in children under five.

The problem is distribution, hampered by poverty, few clinics, bad roads and, above all, bad governance: inept state monopolies, tariffs on medicines, refusing foreign certification and holding back the economic freedoms that would make people better off and therefore healthier.

These facts are well known. If existing drugs, technologies and methods were properly distributed, the benefits for the world’s poorest people would be immense. But the kind of sustained, low-profile effort needed, like the Rotary Club’s worldwide success against polio, brings little reward for politicians whose nearest vista is the next election.

As a result, resources and political attention get shifted away from these bread-and-butter issues towards grandiose schemes. This has the knock-on effect of constantly tying up global health organizations in exploring the very latest novel proposals, while funding for tried and tested approaches gets put on the back burner.

Worse, these superficially attractive big schemes are doomed to failure. It is wishful thinking that the private sector will risk its own capital on developing a vaccine under APC, as it is most unlikely that bureaucrats would have the knowledge of current or future demand, or of development costs, to give the right level of reward to a successful product. But even if a vaccine were invented, how would it ever reach those who need it?

The G8 is not the right place for such schemes. All G8 members apart from Russia are currently running large budget deficits, which push its members into favouring apparently costless but risky strategies over costly things that would definitely help -- like delivering basic vaccinations and medicines.

There is already a wide range of technologies that can have a huge impact on health: as boring and unglamorous as it sounds, the G8 should really be focussing on these basics instead of over-ambitious schemes.