I moderated a meeting this morning in which one participant advised the rest to “kill early, kill decisively and kill often”. You will be relieved to hear that the subject was public-private partnerships for global health. Wanjiku Kamau was talking about research programmes to find health interventions that benefit people in low-resource parts of the world. She was recommending a quick end for product research that it is not delivering.

 

Forty or so people gathered from government, foundations, the pharmaceutical industry, not-for-profit health product developers and civil society. They were all sure that major change would affect the governments and foundations which fund research on vaccines, medicines, devices and diagnostics and the partnerships which use this funding to take these interventions from an idea to a product.

For public and foundation funders, there have always been trade-offs: research takes a long time (often longer than anyone thought it would) but it’s difficult to acknowledge to bosses — or, certainly, politicians — that results may not be visible for fifteen or twenty years. One participant said it was always a balancing act between risk, time and cost. To try not to lose their balance, funders impose targets, value for money measures and lots of milestones.

As funders exert more and more control over their money, it becomes difficult for their partners to follow Wanjiku’s advice on deadly force: the money has been given for a specific programme — often a programme to develop one intervention. It can be tough to acknowledge that you have hit a dead end if being honest leads to being out of work. Success, though, depends on being able rapidly to follow the right leads and divert resources away from those that no longer look promising.

There are different pressures on the product developers: early optimism and determination has often given way to a recognition of difficulties and subtleties. The first product development partnerships may have thought they could dissolve within a decade; now they are worrying about retirement plans and graduate recruitment. Even if research delivers as expected, products have to be licensed, paid for, distributed and used. Something that seemed like a great idea in a boardroom on the East Coast of the US may not meet real needs in Africa or Asia. Or, it may never be sufficiently consumer -friendly or affordable to reach those who do need it. Maybe there ought to be new kinds of partnerships and collaborations to get expertise throughout this long chain from concept to clinic?

It has taken fifteen years for the not-for-profits to realise that medical research is difficult said an industry participant. In any case, said another, this is what pharmaceuticals companies do: identify a gap in the marketplace, manage a portfolio of products that might one day fit into the gap, develop one or more, register them and then sell them. A not-for-profit developer suggested that industry had not shown that it could do any of this well in developing and emerging markets or that it could do it cost-effectively. The exchange pointed to a recurring theme: it is no longer easy to draw a clear line between “for profit” and “not for profit developers”. Few products can make it from lab bench to the poorest communities on altruism alone. The not-for-profits need industry skills and experience and industry can use money from governments or foundations to develop products that could not otherwise command pharma resources or attention.

I was lucky to have had a great panel (Dr Sue Kinn from DfID, Dr Anurag Mairal from PATH and Jon Pender from GSK joined Wanjiku) and a lot of very thoughtful, frank and engaged participants in the discussion. It was a fascinating morning. PATH, which convened the meeting, will come up with a full report to add to their own recent report on PPPs.

These reflections are my own and may not be shared by the organisers or any other participants in the meeting