April 16, 2011

YAIA: Yet Another Index Acronym

Filed under: intellectual property — Tags: , , — ghtech @ 3:30 pm

I visited a link today from the Center for Global Development’s Amanda Glassman about a panel struck to discuss vaccine funding for the GAVI Alliance. Amanda’s presentation focused on which of the G-20 countries were paying their “fair share” toward funding GAVI given that herd immunity from vaccines is a global good. Her first attempt to quantify which countries were paying into GAVI appropriately was to compare the percentage of GAVI’s funding by country to that country’s contribution to global GDP. Using this analysis indicated that the UK was paying way more than their fair share, whereas the US was paying way less. Given the Jenny McCarthy debacle recently in the US regarding vaccinations as well as the protracted economic downturn, this may not be surprising. In her post, Amanda suggested that perhaps a more sophisticated analysis would be to create a GAVI funding index in analogy to CGD’s Commitment to Development Index. This led me to learn more about this index.

At first glance, this index suffers from the same downfall as other indices – that is, it’s an index, which necessitates decisions about scaling, standard deviation, weighting, etc. The full scoop on CGD’s answer to these questions is found here. Once the waves of index ennui washed over me and dissipated, I began to look at some of the salient features of this particular index. Interestingly, the index quantifies not just spending, but contributions to global development in other areas as well. I focused on technology contribution, since that is my main interest. Wanna guess who came out on top in terms of technology contributions to global development last year? Portugal! South Korea was 3rd, Japan was 4th, and the US was 13th. One of the reasons is because of changes made to the index since last year:

“The intellectual property rights (IPR) section of the technology component gained two new indicators: one on whether countries allow patent applications to be challenged before they are officially approved, which discourages companies for claiming ownership of ideas already in the public domain; and one on whether patent exceptions are provided for research purposes, increasing access to such innovations in developing countries.”[1]

This bumped Portugal way up above where it was last year. But even still, looking at the 2009 numbers yielded the top five technology contributors as: Spain, South Korea, Japan, France, and Canada, which contained some surprises for me. Funding for technology development counts in the index, as does virtually every component of intellectual property rights and protection law for that country. The US ranks low because of its rather draconian patent law. It will be interesting to track this index over time to see if some of the interesting IP developments in the US and Canada affect their rankings over time. In the meantime, I feel the need to make an index to rank all of the global health indices out there. Perhaps there’s a support group for that.

March 31, 2011

Mesofinance in the developed world

Filed under: economics — Tags: , , , — ghtech @ 10:23 am

So, I was perusing Kiva.org the other day, as I frequently do, and lo and behold, there was a loan going to a person from the US. Kiva, as many readers of this blog will know, is a microfinance organization that purports to give small loans directly to individuals. The microfinance concept is a growing one in global health and international development, and Kiva is one of the major players partly because it allows you, the individual lender, to see a picture of the person you are loaning to (although the debate about Kiva rages on, see here). Most of the loans go to people in places that you might expect (sub-Saharan Africa, war-torn Afghanistan/Pakistan, parts of Central America, etc.) But the US? Surely the per capita income here is too high regardless of the circumstances to warrant microfinance. It seems like it just wouldn’t cover the costs. $250 USD goes a long way in Africa, but does not go a long way in the US. The loan to the American I saw was for $5,625. Thus this is more mesofinance than microfinance. This is especially true given that the average Kiva loan is currently $318 per borrower.

So, my initial reaction was that this was (a) silly, because it wouldn’t work, and (b) criminal, because it was diverting funds from people in places that really needed it. Has Kiva experienced mission creep? But then I began to think more critically about the issue, and decided to do some more digging. Was my assumption that the per capita income in the US was too large a valid one? After all, there are rich people and poor people everywhere, and the US certainly runs the gamut in terms of extreme poverty and extreme wealth. Kiva claims to check these loan requests carefully before putting them on the site, so there must have been a reason this loan made it.

The critical thing to realize here is that the per capita income for the entire country is the average (arithmetic mean) of all incomes from all earners. But, if you look at the variance, the story is very different. Figure 1 shows that while the top US earners have increased their incomes dramatically over the past 20 years, the lowest earners have barely made any progress at all.

US income distribution 1947-2010

Figure 1.  US income distribution, 1947-2010.  Source:  US Bureau of Labor Statistics

While all the lines on the graph have positive slope (explaining the rise in the mean per capita income), someone in the bottom 5% of earners will be having a progressively harder time surviving as time goes on. As another comparison, if we look at the rise in per capita income for the bottom 20% of earners compared to the rise in cost of living measured using the consumer price index, we see more clearly the suffering that is increasingly taking place. The annual wage for someone in the bottom 20% of earners has increased 41% (in 2007 dollars) compared to a 1000% increase in the CPI over that same period (Figure 2).

US Consumer Price Index 1947-2010

Figure 2.  US Consumer Price Index (CPI), 1947-2010.  Source:  US Bureau of Labor Statistics

So, now I think very differently about this loan. My home country is not immune from extreme poverty and Kiva is right to raise money for loans to the people in the US. One concern I have is that people will give differently to fund loans in the US (or Canada, or elsewhere in the developed world) compared to developing countries. I must say, I don’t see evidence of that yet, but this is also the first loan I’ve seen going to someone in the US, so perhaps time will tell.

March 18, 2011

Access Success: Getting health technologies to those who need them

Filed under: diagnostics,intellectual property — Tags: — ghtech @ 2:32 pm
ghtech.org is proud to announce the first in a series of guest posts to the blog. Today’s post is written by Dr. Rebecca Goulding, a researcher working at the University of British Columbia in the area of intellectual property for neglected diseases. You can read her full bio at the end of the post. Look for more posts from global health leaders in the coming weeks.

by Dr. Rebecca Goulding

Given that fact that you are reading this blog, you probably already know that cheap, robust, field-appropriate health technologies that can give rapid feedback about disease states are greatly needed to improve health outcomes in developing countries. I’m not talking about CT or MRI scanners, or complex diagnostic devices that you might see at a local city hospital – but relatively simple and robust tools that can be used in a range of remote, resource-constrained areas. Examples include: risk-assessment for pre-eclampsia during child-birth, detection of infectious diseases and their drug resistant sub-types (in patients, animal hosts and the general environment), and communication devices that help community health workers and patients to interpret diagnoses or to adhere to treatment regimens. Inventing such a technology is only the first step in a long and winding road to getting it to people in need. Researchers who envisage the whole pathway – from conception of an idea through to real-world implementation – have a greater chance of achieving “access success”.

As a hypothetical exercise let’s say you are a UBC graduate student or professor with a great idea for a new Chagas disease diagnostic test that is much better than existing tools: it is tough, easy to use, gives rapid results, and best of all, it would be cheap to make. This has the potential to be a key piece of technology that could help clinicians and public health experts to decide who to treat and how to control the spread of this deadly parasitic disease. Funding from the CIHR or the NIH may help you to figure out the test’s sensitivity and specificity in the lab. It might also be possible to get funding to gather field data, for example to test whether the technology will work well under field-conditions in Bolivia, one of the countries with the highest prevalence of the disease. But what are the next steps that must be taken before this test starts being used on a much broader scale?

The process of developing your health technology into a tool that has significant impact will require significant funding. What usually happens at universities is that inventions like diagnostic tests (equipment and method) are patented. The patented invention is then often licensed, sometimes exclusively, to a third party wishing to develop the invention in exchange for a royalty payment to the inventor and the university. Any company thinking about investing the capital (often very substantial amounts of money!) to develop your diagnostic technology is likely to want you to have a strong intellectual property (IP) position (i.e. strong patent(s) protection). However, it is important to get the balance right: enough IP protection to be able to incentivize investment in development, and not too much so that others are not entirely shut out from innovating in the area.

Here exists an important stage in your products pathway to access success: will there be any interested parties willing to invest the money to develop your Chagas disease diagnostic test? There are two distinct markets for Chagas disease diagnostics: a) in developed countries (e.g. Latin American immigrant populations in California) and b) in middle-income countries (e.g. Brazil, Peru, Bolivia). Therefore it is possible that a small biotechnology company may be interested to license the IP to develop a product – but only if they can be sure to achieve a return on their investment. Some larger companies may also be willing to invest in such a project as part of their social corporate responsibility, but will still want to avoid making a loss. A product development partnership (PDP, also known as public private partnership), which funds and manages the development of technologies for neglected diseases, may also be interested in your technology. PDPs do not do in-house R&D, but instead fund development partners who do. Alternatively, it may be possible to start up your own spin-off company, by licensing the technology to a spin-off from UBC, and by securing funding for product development from other private, government or philanthropic sources.

For argument’s sake, imagine that a company is interested in licensing your Chagas disease diagnostic. What kind of things must you consider before licensing negotiations begin?

University technology transfer offices deal with the negotiations for the licensing of IP to third parties. The issue of improving access to university-discovered technologies in developing countries is increasingly on their radar, thanks to organizations such as the Bill and Melinda Gates Foundation and Universities Allied for Essential Medicines (UAEM). For example, in 2007, after discussions with UAEM and others, UBC announced it was adopting global access principles that aim to improve global economic and social impacts of UBC’s innovations and guarantee technology access to these technologies for the world’s poor. There is a range of global access licensing strategies that could potentially be used to negotiate a balanced deal that creates incentives for the company and at the same time ensures access to technologies for the people who need them the most. These include limiting field of use, including geographical restrictions, requiring at-cost production of the technology in developing countries and limiting royalty payments in exchange for other terms that promote access. While UBC and other universities are clearly on board with improving technology access, much depends on how amenable the licensee is to such concessions.

Universities may have better access success if they license such technologies to relevant PDPs who themselves have an access mandate at the very core of their business model. These PDPs have a mandate to ensure the availability and affordability of technologies and medicines, and also their adoption in developing countries (the AAA mandate). PDPs have significant funding at their disposal for product development and access to partner companies who may make in-kind contributions. Thus they have the leverage to make significant demands when negotiating licensing deals with universities and other IP holders. PDPs typically want a royalty-free exclusive license for the IP (at least for the neglected disease field of use in question), from the IP holder, which also allows them the freedom to manufacture the products in any country, presumably by any manufacturer they choose. As long as universities (and the inventor – that’s you!) are comfortable to give up the technology for free to a PDP, then this might be the most straightforward way of ensuring access success.

There are an increasing number of innovative licensing deals being made between universities and licensees – and it seems there is increasing receptivity for the goals of access. I believe it is important for university researchers at the forefront of health technology innovation, to think through what an “access success” strategy would look like, and that this needs to happen before they get to the boardroom of the licensing office to negotiate.

Dr. Rebecca Goulding is currently working as a consultant on the potential of alternative intellectual property, regulatory and financial innovation strategies to promote biomedical innovation for neglected diseases.  She has worked as a postdoctoral fellow at ISIS at the Sauder School of Business (2009-2010) and with the Intellectual Property Policy and Research Group (IPPRG) at the W. Maurice Young Centre for Applied Ethics (2008-2009), where she worked on alternative intellectual property regimes and upstream genomic research. Rebecca completed her BSc in genetics and MSc in hematology/oncology at the University of Dublin, Trinity College.  She continued her graduate studies at the Terry Fox Laboratory, BC Cancer Research Centre, finishing her PhD in genetics at University of British Columbia in 2008.  For her thesis, Rebecca studied Ras protein signaling pathways in lymphocytes and the molecular genetics of leukemia development. During the last years of her PhD, she became involved with a student group called Universities Allied for Essential Medicines (UAEM), which inspired her interest in global health research, particularly in the area of neglected disease drug research.

February 18, 2011

Changes afoot

Filed under: Uncategorized — ghtech @ 2:10 pm

Hi everyone,

I know I haven’t posted in a while, and there is a good reason.  I will be leaving my position at UBC and returning to the United States (Seattle area) by the end of this academic term.  Naturally, this sort of life change brings with it a lot of turmoil and the blog has suffered.  The good news is that I am transitioning more fully to a career in global health, which will allow me to turn this site into what I think it can be.

I will be engaging a number of opportunities in global health in the hear future, starting with the Global Health Innovations conference at Yale in April, hosted by Unite for Sight.  If you will be attending this conference, let me know, as I would like to meet you.

In the near future (March), you can expect some blog contributions from leaders in global health diagnostics as well as global health technology licensing and the issues around this, so stay tuned through this upcoming period and you will be rewarded!

Eric

February 1, 2011

International surgery organizations

Filed under: Uncategorized — Tags: , — ghtech @ 1:39 pm

I have started volunteering as a web developer for a nonprofit organization here in Vancouver called the Canadian Network for International Surgery (CNIS). CNIS provides surgical and obstetrical training in low-income countries. They have grown from a group of three local surgeons to the largest international surgical training organization in the world, with twenty centres in eight African countries. Dr. Taylor, one of the founders of CNIS, was recently awarded the Order of Canada for his contributions to global health. I encourage you to check out this fine organization and donate if you like.

Also of note is the group called Global Partners in Anesthesia and Surgery (GPAS), whose mission is to develop and implement strategies to reduce the global burden of surgical disease and to improve the quality of perioperative care in the developing world. GPAS is holding the second annual Conference on Surgery and Anesthesia in Uganda here in Vancouver on April 2.

Finally, there is a good list of global health surgery organizations here if you are interested in learning more (slightly out of date). Organizations specializing in fistulas, cataracts, cleft lip/palettes, and more are present. GiveWell ranked ReSurge International (formerly Interplast) as their top charity in this 2008 list due to transparency and impact.

January 16, 2011

Helminth sequencing continues

Filed under: science — Tags: — ghtech @ 12:18 am

I hope you have not eaten recently – today’s post is gross.  Fair warning.

Helminth infections are one of the greatest detractors to global health.  It is estimated that millions upon millions of people are infected by helminths every year (see Figure 1).  Helminths comprise several classes of parasitic worms, including those that cause schistosomiasis, elephantiasis, river blindness, and others.  Some of these helminth infections are known to be easily treatable, but many others are not.  As a result, DNA sequencing efforts for several species of helminth are ramping up or underway already.

helminth prevalence

Figure 1. Prevalence of helminths infections world-wide. Taken from Disease Control Priorities in Developing Countries | Peter J. Hotez, Donald A. P. Bundy, Kathleen Beegle, and others

One of the better-known parasitic worm infections is guinea worm disease, or dracunculiasis (Figure 2).  Unlike other global health phenomena, the best treatment for this disease is abstinence:  simply don’t get it.

Guinea worm disease photo

Figure 2. Guinea worm emerging from an infected person’s foot.

Infection results from drinking contaminated water, and filters are now widely available at feasible price points so that most people can screen out the larvae that cause the disease.  The other major advantage here is that there is no environmental reservoir, meaning that the parasite has to pass through human hosts every year to survive.  Therefore, if infection of all humans can be avoided, the disease can be completely eradicated.  For many other helminth species, however, there are environmental reservoirs for the parasites, necessitating the development of screening, diagnosis, and treatment tools to combat infection.  Here, DNA sequencing can play a role.

The first helminth species to be fully sequenced was Brugia malayi, the species that causes elephantiasis (see Figure 3).  Other genomes are currently in the assembly stage, like Onchocerca volvulus, which causes river blindness.  Finally, there are several species currently being sequenced, including Schistosoma mansoni, the causative parasite of schistosomiasis.

Elephantiasis photo

Figure 3. “Bellevue Venus” Oscar G. Mason’s portrait of a woman with elephantiasis. Taken from wikipedia.org.

As sequencing technology continues to improve, the speed with which these species may be sequenced will also increase, meaning we will soon have lots of genomic information to mine regarding how best to detect and treat these devastating diseases.

January 14, 2011

Healthier global health

Filed under: Uncategorized — ghtech @ 11:43 am

With the start of 2011 upon us, many people have resolved to be healthier this year. Luckily, you can both make yourself healthier as well as others at the same time. Simply participate in one of fundraiser rides/walks/runs in your area. Perhaps Vancouver is particularly well-suited to this, what with its mild year-round temperatures and wonderful summer weather, but I know of events all across Canada that are wonderful to participate in. As a public service, therefore, I list below the different “healthy global health” events in British Columbia this coming year. Some are easy to do, others more difficult, so I list them all now in case you need time to prepare! Some of these are also held in other provinces and countries – these are marked with an asterisk.

February:

6: Vancouver Sustainability Run

March:

6: Vancouver Sustainability Run

April:

9: Vancouver Sustainability Run

May:

7: Walk of Life for Cardiac Health, Kelowna, BC *
8: Vancouver Sustainability Run
29: Run for Water 2011, Abbotsford, BC (5K,10K, half marathon, marathon)
30: World Partnership Walk, Aga Khan Foundation *

June:

5: Vancouver Sustainability Run
5: CBI Hustle for Hunger, Nanaimo, BC (6K or 10K) *
18: The Ride to Conquer Cancer BC (Vancouver to Seattle) *
26: Run to End Poverty Vancouver, Engineers without Borders (half-marathon) *

July:

9: Underwear Affair, BC Cancer Foundation (run 10K, run or walk 5K) (this one has a rocking after-party!)

September:

19: Terry Fox Run (5K or 10K run/walk) *

October:

3: Run for the Cure Vancouver (1 or 5 km, run or walk) *

November:

7: Vancouver Sustainability Run

January 5, 2011

Higher prices for drug development

Filed under: Uncategorized — Tags: , , — ghtech @ 11:31 am

As a follow-up to my previous post on the high costs of developing new drugs and vaccines for diseases impacting global health, a new Tufts Center for the Study of Drug Development (CSDD) outlook report states that the average cost of developing a new drug has risen to $1.3B. An excerpt from the press release announcing the report states:

Actions that will help improve R&D productivity, according to Tufts CSDD, include greater reliance on translational science to help identify the right disease targets for new molecules; greater use of partnering with external service providers to share risks, reduce cycle times, lower costs, and improve resource management; and greater use of sophisticated portfolio management techniques.”

The full report is available for purchase at http://csdd.tufts.edu/reports.

December 31, 2010

Happy 2011 everyone!

Filed under: Uncategorized — ghtech @ 11:02 pm

This is a note to let everyone know that posts here will now appear on the Global Health Technologies Facebook fan page!  You can access it by going here:

2011 Global Health Resolutions

Filed under: Uncategorized — Tags: , — ghtech @ 12:19 pm

Today is the last day to make New Year’s Resolutions (on the western calendar, anyway), and so I thought I’d make a list of what I think the humans on Planet Earth should try to accomplish in global health this year.  I welcome your inputs on this as well.  Just add them in the comments section below.

1.  “Eliminate” polio.

This one has been on everyone’s list for many years now, but we are closer than ever.  This is, of course, subject to the realization that most diseases for which there are vaccines are rarely completely eliminated, but let’s get as close as we can.

2.  Cut meningitis infection in Africa by 75%.

I think with the new vaccine approved by the WHO recently and now available in Niger, Burkina Faso, and Mali, we are closer than ever to removing this scourge from the lives of children the world over.

3.  Continue advances in diagnosing and treating TB using DOTS.

DOTS is a remarkable success story in many countries, but not in all.  We need to find ways to make TB treatment more uniform and successful across the world.  Recently-approved rapid diagnostics for TB will help.

4.  Drive advances in helminth diagnosis and research.

Helminths are a bane on the human population and have been for centuries, if not always.  There is relatively little work in this area, yet the effects of helminth infection, particularly in children, are huge.  More work clearly needs to be done.  I personally resolve to look at the feasibility of molecular diagnostics for helminth infection using some of the work we are doing in malaria diagnosis in our lab.

5.  Continue work in malaria diagnosis and treatment.

Here, there is also progress we can build on.  A new vaccine is almost available, although it has critically low effectiveness.  There are also new diagnostics being developed that may eliminate the cold-chain  required to store and transport current tests.

6.  Continue work in treating and preventing HIV/AIDS.

As the major killer world-wide, we need as much effort here to continue as possible.  The knock-on effects of treating HIV/AIDS are definitely worth the effort.

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