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February 19, 2007

The Keys to Successful Global Health Policy

Advance Market Commitment Pilot Latest Policy to Improve Global Health

View lecture by Ruth Levine 

What are the key ingredients to developing a successful global health policy? Ruth Levine, director of programs and a senior fellow at the Center for Global Development in Washington, D.C., addressed the question at a talk held at Johns Hopkins Bloomberg School of Public Health on February 9.

A successful large-scale health policy requires sufficient sums of money that is predictably available over a long period of time, Levine explained. In addition to money, successful programs require political leadership on a national and international level. New technology or new application of existing technology in an effective distribution system is needed, as well as a technical consensus on the solutions. Finally, successful policies require good management and evaluation of programs on the ground.

“What does it take for donors to succeed in turning what they have, which is money, into health? That’s the big question on the table in my view,” said Levine, a graduate of the School whose book, “Millions Saved: Proven Successes in Global Health,” examined many recent public health successes—from the prevention and treatment of river blindness with ivermectin to the elimination of polio in the America’s to the fortification of staple foods with iodine and other micronutrients. “Throwing money at the problem, however you define the problem, is a really great idea, if and only if we can figure out what’s needed to make sure that the new moneys in global health are actually effective in achieving changes in health conditions.” The process of developing policy, she added, requires collaboration among the fields of science, economics and politics.

Since 2000, Levine said governments and philanthropists have committed more money to global health, with the emergence of programs like the Bill & Melinda Gates Foundation, the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative. However, about 70 percent of new spending is focused on purchasing drugs and products, up from about 25 percent in previous years. Much of the new money is also earmarked for specific diseases. “In economic jargon, the pie is bigger and it’s cut differently,” said Levine.

Donors, as Levine explained, typically fund projects on the “basis of effort” rather than on the “basis of results.” In other words, donors often pay for the work that they hope will achieve a result, rather than for the outcome itself. Levine noted that most research and development of new drugs is funded on the basis of effort.

“When you pay on the basis of results a few things have to happen. First you have to be clear on the result that you want to be achieving and it has to have a result that is measurable. Those who are getting the money as incentive have the power to make decisions or influence the decisions that lead to the results,” Levine explained. “One of the things required for new donor moneys to turn into health is for donors to shift somewhat—but not completely—from paying for effort to paying for results or at least paying attention to results.”

As an example, Levine cited the February 9 decision by Italy, the United Kingdom, Canada, Russia, Norway, as well as the Bill & Melinda Gates Foundation to commit $1.5 billion towards funding the pilot Advance Market Commitment for pneumococcal vaccines. The Advance Market Commitment, developed by Harvard economist Michael Kremer and which Levine helped refine, is designed to create an incentive (or market) for manufacturers to make vaccines for diseases affecting developing countries. Donors agree to commit money towards a vaccine at a set price, if and when they are developed, to be paid per person immunized. The Advance Market Commitment will begin with pneumococcal vaccine, which already exists and is proven to be effective. In the future, Advance Market Commitments could be used to spur development of vaccines for malaria or other diseases that are not prevalent in developed countries.

Levine credited colleagues at the Bloomberg School of Public Health for their role in making the pneumococcal vaccine Advance Market Commitment pilot a reality, particularly Orin Levine, PhD, associate professor in theDepartment of International Health and director of the PneumoADIP (Pneumococcal vaccine Accelerated Development and Introduction Plan). “Orin Levine and his team in the PneumoADIP program here were phenomenally instrumental in helping with the design of the pneumo pilot,” said Levine, no relation to Orin Levine.

Levine’s talk was the first in the Global Health Leaders Forum, sponsored by the Johns Hopkins Center for Global Health and the Bloomberg School’s Department of International Health. Tashi Yomada, MD, president of the Bill & Melinda Gates Foundation, spoke on February 21.--Tim Parsons