Walk the Talk

The USAID, our country’s primary agency for doing good works around the world (about $47 billion worth in FY2012, USAID Fact Sheet), has jumped on the “let’s help young people create solutions to the world’s problems” bandwagon with a new program, the Higher Education Solutions Network (HESN).  I heard about HESN recently since the USAID sent a serious chunk of change ($25 million) to my alma mater, MIT (specifically the D-Lab), in November to lead a group of six other institutions of higher learning over the next five years in a program that is “intended to fight poverty by developing and evaluating useful technologies for communities around the globe” (MIT News).   While I think the intention behind the HENS is good and I can’t complain about more money being available to people who may start technology-based companies for global health, I always wonder how effective these programs are first, in developing technology (or more importantly, making products) and second, in making a difference in the lives of the intended beneficiaries.  As regular readers of my posts know (cf., “Singin’ Be-BOP”), my skepticism results from observations that:

  • the academic world is awash in technological fixes for many problems of poverty (e.g., Global Health and Innovation Conference 2013)
  • there is little empirical research to support the idea that university-originated technologies decrease poverty (I’d be happy to be corrected especially by a study from MIT’s  Poverty Action Lab); and
  • turning university-originated technology into products, especially products meant for needs and markets in the developing world, is very difficult and requires more than talking and grants.

So what specifically will the USAID-funded MIT program do?  One half of the funding is for an International Development Innovation Network (IDIN) which “will create eight innovation hubs and venture accelerators worldwide that will support and connect promising technologies and innovators to the resources and training necessary to bring solutions to the populations that need them most” (IDIN).   As I understand it, this Network will be an amplification of the International Development Design Summits which the D-Lab has organized outside the US since 2007 to create a “user-based community of active, creative designers [who] can invent, innovate and inspire each other to create new technologies” (IDDS).  I understand the inspiration part but did not find any stats on what happened to the new technologies created by IDDS participants.  The IDIN will be more directed toward venture acceleration and providing “resources,” but I could not find any specifics on how this will be accomplished.  In my experience as mentor in MIT’s Venture Mentoring Service and elsewhere, venture founders benefit from advice and connections from sector-specific, former entrepreneurs and, not surprisingly, money from interested and involved investors.  The other half of the funding will go into the Comprehensive Initiative for Technology Evaluation (CITE) which will evaluate technologies (or products? a big difference) along the three axes of:  suitability (is the product needed by the intended user and will it work as intended); scalability (can the product be used widely); and sustainability (can the product be provided over the long term) (CITE and MIT News).  While it makes sense to standardize the way in which technologies and potential products for poverty alleviation are evaluated and certainly in the interests of USAID to do so, since it or its subcontractors may be buying those products, I would think that CITE will be just confirming what the inventor(s) should have done in the first place, i.e., figure out if the technology/product is needed and how to distribute it to those who need it.  The best test of a product, of course, is the marketplace, and two notable attempts to create an on-line marketplace for technologies for the developing world is Kopernik that, although inefficient since it is donation-based, lists dozens of products (Kopernik), and Maternova, for birth-related products (Maternova).  Perhaps, CITE could start by performing the equivalent of Consumers’ Report evaluations on these products.

As I noted first in a post in 2010 (“USAID and Innovation”), the USAID under its new director Rajiv Shah is promoting innovation in technology and policy for international development and clearly the HESN and the new MIT programs are extending that effort into the universities.  However, as I noted my review of the USAID participation in the grant-giving Savings Lives at Birth program (“USAID Rhetoric or Reality”), the USAID needs to employ the several well-recognized means of venture initiation and support like experienced advisers and engaged investors (unlike those giving “no-stings-attached” grants).  The main USAID program for funding non-/low-/for-profit start-ups is its Development Innovation Ventures program (DIV), which I’ve mentioned before (“MONGO Bingo”).  It now has a nice portfolio of 28 “ventures,” and it will be interesting to see how USAID tracks the success (and expected failure) of these, learns from the effort, and improves the DIV program.  Of course, as I wrote in “USAID Rhetoric or Reality”, USAID should also be learning from successful venture acceleration programs like the MassChallenge, which has turned about $2 million in funding each the last three years into $365 million invested by others in new ventures (MC).  Perhaps, the D-Lab and its fellow institutions could figure out away to sponsor its IDIN and CITE “graduates” to apply to and attend MassChallenge or a similar venture acceleration program.  I think it could be done for under $500K per year, or way less than the portion of the grant going into institutional overhead.


It’s NIGH Time

Last week, the Global Health Technologies Coalition (GHTC), a Gates Foundation-funded “advocacy” organization based in Washington, DC, added to the pile of reports on the US government global health policy by releasing “Saving Lives and Creating Impact” (GHTC report).  The GHTC represents a group of 40 nonprofit organizations “working to increase awareness of the urgent need for technologies [i.e., products such as therapeutics, vaccines, and diagnostics] that save lives in the developing world.”  This is a worthy goal but I can’t help but wonder about the effectiveness of an organization that purports to advocate for more products for improving health in the developing world and for “incentives to encourage private sector investment” in creating those products, but has no private sector (for-profit) members or advisors (Members and Steering Committee).  Unfortunately, the authors of the report start with two premises from the conventional wisdom of the non-profit global health advocacy field:

-“the US government has long played a [meaningful, substantial, important?] role” in the development of new global health products; and

-there is “insufficient commercial market to attract private industry” to develop global health products.

So, not surprisingly, they arrive at the conclusion that the solution is for the US government to do more of what’s it is doing now, especially in funding non-profits like academic researchers, non-profit product development groups (PDPs), and advocacy groups.  I read the report and came to a different conclusion.

To their credit, the authors do a good job in gathering together all the bits of the wide-ranging US government’s global health technology development effort.  Many agencies are involved in some way (hey, it’s the government where coordination and cooperation are not rewarded), primarily, USAID, FDA, DoD, CDC, and NIH.  Of the approximately $1.6 billion spent annually on global health research and development, the majority is doled out the by NIH (87%) and is spent at the early stages of development (66% preclinical and 20% on clinical) and mostly on the big three global diseases (HIV/AIDS at 57%, tuberculosis, 12%, and malaria, 10%), leaving 21% for the remaining twenty or so neglected (hence the name) and noncommunicable diseases.  The authors also do a good job in providing details on the sponsorship of the development of 43 products applied to global health between 2000 and 2010 (Table 1), and I counted US government involvement of any type in 24 (56%).  In the report’s text, four products are highlighted to demonstrate the importance of the governments role:  a vaccine for meningitis, a diagnostic system for finding drug-resistant TB infections, next generation HIV preventatives (microbicides), and improved TB drugs.

Since I wrote posts on the first two products, I think I am reasonably well-informed about their development, and, unlike the authors, my take is the that government role, while important (all help is important), was an participant, not as a leader or a catalyst.  Specifically, in the development of the meningitis vaccine (called MengAfrVax), FDA licensed a method of conjugating or attaching the basic parts of the vaccine together to the vaccine developers (the Meningitis Vaccine Project led by the non-profit, PATH) and transferred the technology to the manufacturer, the for-profit Serum Institute of India who committed to a low-priced final product (Watch Out Big Pharma? 12/16/10).  This was helpful, but the FDA expertise is regulation, not manufacturing, and the technology may have been available elsewhere.  I wrote about the TB diagnostic system in three posts (ReDux 1/6/11, ReDux Part II 1/13/11, TB Dx:  Getting There 3/1/12) and noted that the NIAID was involved by funding a university team that discovered the markers of drug resistance (in this case, DNA sequences), but the core of the product was the diagnostic platform developed by the company, Cepheid.

While the report’s authors mention the involvement of for-profits (companies) in product development, they don’t note the extent of involvement, which is greater than the US government’s (I counted 39 products or 84% of the total in Table 1) or attempt to figure out why in these cases, there was no “market failure.”  The authors also mention two programs in which the government can and does directly fund product development with companies, the Small Business Innovation and Research or SBIR program and the Cooperative Research and Development Agreement or CRADA program), but state, without support, the lack of company involvement is due to a lack of incentives and that SBIRs are “poorly suited” to stimulate company participation.  Interestingly, the authors mention that 40% of all SBIRs result in products, leading me to wonder if the percentage of SBIR awards leading to global health products is higher or lower.  I gave my opinion on the role of SBIRs in global health product development in one of my earliest posts (SBIR Drop in the Bucket 11/5/09) and argued that the government is not using this effective tool enough and that the funding can fill an important gap in supporting prototype development.  Maybe the authors may have benefited from more research on and input from the private sector.  Also interesting is their mention that there are more than 360 global health products in development and US government involvement in about half; I would have appreciated the same analysis they applied to existing products to these pre-products.

The report’s authors conclude with several recommendations that the US government:

  • maintain or increase its funding of global health technology development [why not redirect, especially away from the already well-funded diseases of the wealthy and away from basic research and toward organizations that are product-oriented?];
  • focus on more translating research into products [like on product development, testing, and maybe also manufacturing and distribution]; and
  • increase funding of the PDPs [some do a good job and others don’t, see posts Too Big To Flail 1/5/12 and Commercialization a Going Concern 5/27/10]; and
  • as a bone to the for-profits, “review programs that support industry translation  for their suitability for companies working on global health products” [why didn’t the authors review these programs themselves?].

My recommendation is that the GHTC advocate for the formation of a National Institute for Global Health (NIGH) funded by a proportional re-allocation of the funding of the other NIHs.  The NIGH will also have a healthy SBIR program (about 50% rather than the standard 2% of its budget) and will take the lead in “guiding” other government agencies involved in global health technology development toward supporting more product development.  I also recommend that the GHTC get more input from those who developing global health products and putting them into commerce where they are accessible to the people who may benefit from them.

USAID Rhetoric or Reality

I was not able to attend the Partnering for Global Health Forum on June 27, the third in a series organized by Bio Ventures for Global Health (BVGH) and held in conjunction with the big biotech-fest, BIO 2011, in Washington, DC.  The Forum has a laudable aim (“creating new market-based solutions that speed the development of drugs, vaccines, and diagnostics for the world’s poorest,” BVGH What We Do), but after attending previous two meetings,  I noted room for improvement (my postings of 5/6/10 and 5/11/11).  To catch up, I have been viewing the video archive of the meeting , thanks to BVGH ( PGH Webcast Recordings), and started with the pre-lunch remarks by Dr. Rajiv Shah, the relatively new administrator of the USAID,  due in part to the major role the USAID has in implementing the US global health-related projects (budgeted at about $10 billion in 2010-11), and in part because he seems like the right person given his background and statements, for example, to get the USAID “to focus our efforts on facilitating a continuum of invention and innovation from bench to bush” (Barmes Lecture 2011).

Last year in my posting of 4/1/10 (and reprise posting of 6/2/11), I reviewed a speech Dr. Shah gave at a Life Science Innovation meeting in which he implied that the USAID would be promoting innovation and global health product development.  I recommended the agency do so by putting out requests for proposals (RFPs) for applicants (especially companies) to develop and  deliver needed products with an attached advance purchase commitment, specifying desired performance, quantity and price.  In this way, the USAID, as a buyer of global health products, would create financial incentives, an attractive market for prospective suppliers.  So I was disappointed in his remarks at the Forum in that he was addressing an audience that included representatives of biotech, diagnostic, and medical device companies looking for funding or investment for global health products, but made no mention of the role of companies in his agency’s global health mission.  The closest he came was to say that the USAID wants to “build markets” and “accelerate the introduction of new technologies,” but was shy on specifics.

Dr. Shah did mention specifically one program sponsored by the USAID, Saving Lives at Birth:  A Grand Challenge for Development (SLB), which has as one of its three goals the promotion of the development of new technologies (the others are finding ”new approaches to provide high-quality care at the time of birth” and “empowering and engaging pregnant women and their families”).  Maternal health is a major need (and a Millennium Development Goal) and that need has inspired many new, but apparently mostly uncommercialized, technologies (e.g., there are about 120 listed in the Innovation Index maintained by the company, Maternova, MN Index).  So how does the SLB intend promote the invention of new technology or better yet apply those that exist?  Apparently, the most ineffective way:  a grants program that gives money away to those who have a good grant-writing staff.

The SLB has some good aspects:  a fast turn-around time between application and award (4-5 months), a substantial amount of money to work with ($16.25 million in 2011-12, USAID RFA), longer term commitment (5 years and a total of $50 million (SLB Press Release), and at least the intent to fund the commercialization (use) of products, i.e., projects involving the “transition to scale of integrated innovations” (SLB Grants).  Not-so-good aspects are:

  • three (rather than one) overarching goals;
  • five international sponsors who may not be on the same page all the time;
  • limits to the amounts awarded to “seed” project (no more than $250K) and “transition” projects ($2 million);
  • review of applications by staff unfamiliar with the innovation process (the reviewers are not identified);
  • no intent to encourage grantees to coordinate their projects, when justified; and
  • no statement about performance measurements (maybe this is in the application).

An alternative to the grant approach is the model adapted from the venture capital industry by venture acceleration “contests,” for example, the Mass Challenge (MC).  Applicants, typically young people who have caught the entrepreneurial bug, pitch their start-ups to a experienced and skeptical business-types with the awards being a mix of money, incubation space, coaching, and professional services.  Successful “pitchers” are those with unique ideas, a shot at customers (someone who thinks their product or service has value), and a realistic plan (time and money) for execution.  The aim is not necessarily to create new companies, although that does happen, but to invest in people who want to innovate, that is, create something that has value (products, services) from nothing.  Unfortunately, the cash involved is enough to give the venture founders some momentum but is not sufficient as seed capital.

If Dr. Shah really wants to figure out how to accelerate technology development for global health, he needs to hang out more with entrepreneurs and founders and mangers of small companies.  After his remarks, one questioner asked what his agency could do to bridge the valley of death- the critical period when a small company is trying to get sufficient proof of the value of their core technology and/or its first customers- and his response was that he was trying to make the USAID easier to work with and to increase “deal flow” which will help companies with products to sell but not those with products in development.  In his Barmes Lecture on Global Health earlier this year, Dr. Shah said:  “We will develop at USAID a center of excellence to accelerate product development and field introduction, bringing in industry experts and academic fellows to inform our thinking and investing seed capital in promising ideas wherever they’re found. … There’s been a huge amount of progress in the last decade in the knowledge of how to aggressively scale new interventions and technologies and we want to capture and harness that.  We will work with firms to make sure their biomedical products can reach the poorest people in the poorest countries. And we will leverage our commodity procurement systems to prioritize buying new technologies so that we can get volumes up and prices down in more creative and innovative ways.”  Got it; when?

USAID and Innovation Reprise

I noted that Dr. Rajiv Shah, USAID’s administrator, will be a panelist at the upcoming Partnering for Global Health Forum to be held June 27 2011, in Washington, DC, (PGH program) and was reminded of my post of 4/10/10:

The recent Life Science Innovation Northwest conference (held March 16-17 in Seattle, Innovation NW) had a prominent yet unusual luncheon keynote speaker.  It was Dr. Rajiv Shah, the new administrator of the US Agency for International Development which is better know for its role in international aid rather than innovation in biotech.  Dr. Shah has substantial credentials for his new position and has ties to the Seattle area; he has an MD from the University of Pennsylvania and served as Chief Scientist at the  Department of Agriculture and as deputy director of policy and finance for the Gates Foundation’s Global Health Program (Shah Bio).  Although I was unable to find a text or video version of his talk, I saw he was interviewed by Luke Timmerman, national biotechnology editor for Xcomony, one of the best sources for news on emerging technology-based companies in the US (Xconomy).  In response to being asked what he saw was the USAID’s role in promoting Gates-type private-pubic partnerships and getting innovations in drugs, diagnostics, and vaccines  “out in the field and actually helping people in poor countries,” Dr. Shah said:  “We make a significant amount of direct investment in research and product development.”  And then he clarified his statement (a bit):  “We buy a lot of health commodities for low-income communities and low-income countries. They range from contraceptive commodities to malaria drugs to vaccines for children. That significant purchasing power could be used to create financial incentives for more technology development.”  (Shah Interview)

As a part-time advisor to several startups in global health that are scrounging about for funding, the first comment caught my attention.  First, I noted that USAID is not one of the agencies that have strong research programs and are subject to the Small Business Innovation and Research (SBIR) set aside, not that the SBIR program has had any role in promoting global health (GH) product development to date.  As I noted in my posting of November 5, 2009, only $15 million of the NIH’s annual $700 million SBIR funding goes into global health-related R and D.  Next I went to Grants.gov (Grants.gov), the website that lists recently posted grant opportunities for the entire government.  There are 104 USAID-sponsored RFAs (requests for applications) listed, covering a range of topics from implementation of good government practices to delivery of HIV/AIDs care, but none were specifically for technology development nor did the few I looked at in detail include such funding.  The RFAs are in keeping with the USAID’s mission of aid delivery and the standard government practice of hiring contractors to put our billions to work.   I note that, in the interview, Dr. Shah stated that one of his agency’s goals is to improve the contracting process by emphasizing monitoring results and involving more NGOs and non-profits organizations, which, to my thinking, would be a revolution in international aid.

Next, I checked the USAID website and found that the primary global health group is the Bureau of Global Health (Bureau of Global Health) which was funded at $4.15 billion in fiscal year 2007 (update needed, please).  The Bureau seems also be the key department for implementing the Global Health Initiative as announced by President Obama last May (GHI Statement).  The resulting headline was widespread and welcome (“$63 billion over 6 years”), but details were lacking.  Presumably the Bureau’s guidance for spending its share ($10 billion in FY 2010?) is provided by the Implementation of the Global Health Initiative Consultation Document (GHI Document), which, again, has no mention of product R and D support.  I found a similar story at the website for the Bureau’s Neglected Tropical Disease Initiative (NTD Initiative) which lists as its goals: monitoring and evaluation for integrated control programs; drug supply and delivery; operational research for improving implementation of mass drug administration; and selecting countries for inclusion in the Initiative.  No R and D support is mentioned, not even a listing of their current contractors (NTDI Contracts).

Clearly, Dr. Shah is interested in a role for the USAID in promoting innovation, and perhaps has a task force working on the specifics.  As he mentioned, as a buyer of global health products, USAID can create financial incentives, but only if the specifications for the needed products and the demand (quantity and price) are clear (and attractive) to prospective suppliers.  Rather than RFAs, the Agency could put out requests for proposals (RFPs) specifically aimed at developing the needed products with an attached advance purchase commitment (like the AMCs for vaccine used by GAVI which Dr. Shah worked on while at the Gates).  Clearly most of the Agency’s annual funding must be applied to purchasing and deploying current products to address the immense current need, but some portion could be used for stimulating the development of the next generation of products.  As an example, currently USAID is looking for two contractors to help them spend $450 million dollars in TB care over the next 5 years (TB Care RFA).  The RFA mentions the lack of useful (rapid and low-cost) diagnostics for HIV, TB, and MDR TB but not from where these products will come; at least the contractors could be required to purchase such products, should they be available, at some specific amount or percentage of diagnostics purchases.  This type of RFP could be done for a number of needed products; Dr. Shah alluded to publishing some kind of needs list to stimulate product development in the interview (“We’ll publish a focused, prioritized list of what the challenges are out there”).  I hope it appears soon with product specifications and terms for AMCs.  [Note:  the contract was awarded to multiple contractors in October 2010; none have experience in technology development and it is not mentioned in the objectives, USAID TB CARE.]

In addition, the USAID clearly knows a lot about the environments in which the next generation products will be used (and perhaps has a role in creating them), has relationships with the recipient countries’ governments which regulate and register new products, and knows the methods and costs of product delivery.  All of this experience and knowledge should be useful to companies seeking to enter the global health market and could be shared.  The USAID already has a large archive of documents resulting from their work (USAID Documents), perhaps it could be the basis for the Agency’s outreach effort to biotech companies interested in global health.


Last week, the team at the Center for Global Health R and D Policy Assessment (CGHRDPA), a subsidiary of the Results for Development Institute (R4D) released another “consultation draft” on R and D policy for global health, this one entitled “Can a R&D Tax Credit Expand Investment in Product Development for Global Health?” (Tax Credit Assessment).  And although I am banging the same drum again, I’m offering a review.  My first quibble is that the author should be explicit about the difference between research and development, drop references to a “research gap” (page 3), and focus, as the draft’s title states, on the role of tax credits in product development for global health.  Hence, in the section on governmental polices aimed at “R&D” (starting on page 4), the author (Aarthi Rao) should distinguish the extent to which the policies are intended, and actually do, increase research or development or both.  Clearly, the grand-daddy of US research tax credit programs, dating from 1981 and described on page 5, is called the “Research and Experimentation” credit for a reason and, as it applies to pharmaceutical product development, is aimed at and limited to, preclinical research not development.

My next quibble is that the author is takes a side trip into the economics of R and D policy (page 7) without identifying the role of tax credits vs. other fiscal incentives.  I’m sure there are thousands of papers on this topic (e.g., those listed in Table 2), but I’d like to know which are relevant to stimulating product development.  Also I’d like to know which support the statement that “Firms are unlikely to use the standard industry R&D credit for goods with little to no market value unless a credit is large enough to make these products profitable.”  It seems to me that no amount of credit will make a product profitable; the question what level of tax credit is needed to yield a favorable return on R and D expenditures for the company not a single product.  I also think that the next section, starting on page 8 and describing a tax credit proposed by Genzyme that was the basis of a bill, HR 3156, in 2009, should follow the later description of existing tax credit programs for several reasons.  HR 3156 was proposed, not passed, likely reflects the best of current policies (one would hope), and may be a good case study of the current politics around federal policies aimed at non-clinical neglected disease research.  Also it would be interesting to know more about Genzyme’s objectives, for example, for limiting the credit to preclinical research (so companies would not to be pressured to doing the more expensive clinical research?), since the tax credit incentive will need to align with the beneficiaries’ (companies’) objectives to be used.

On pages 9-13 the author summarizes well four existing R and D tax credit programs and their utility:

  • the Research and Experimentation Tax Credit: “mixed value … due to its design” but moreover not relevant to most biotech/pharma companies (see below);
  • the Orphan Drug Credit:  “hailed as successful” and the author notes the need for a constituency for advocating;
  • the UK’s Vaccine Research Relief Programme:  not enough data to assess outcomes and utilization is low; and
  • last year’s Qualifying Therapeutic Discovery Research Project Tax Credit (TDP):  deserves a stronger review by the author since it was wildly popular.

The TCP was a refundable credit (essentially a grant for companies without tax liabilities) for small companies (fewer than 250 employees) and applied to a wide range of potential products.  It was reviewed and managed by the IRS so the application process was more about accounting than good science, but a survey by BIO, the biotech industry trade group, found (not surprisingly) that the TDP created jobs, advanced research, and kept companies in the US (BIO TDP survey).  It’s worth noting that since the money was capped ($1 billion) and the applicants many (5600), the average award was small ($250K) and most went to a “popular” disease target, cancer (26%), although infectious disease projects got a decent 12%.

My last criticism, as I have noted on the previous draft reports by Center, is the lack of input from the biotech/pharma industry.  The discussion of potential participation in a global health tax credit program on page 14 reflects this.  It seems to me that the reason big pharma is not interested in tax credits is that the credits are not relevant to their economics.  The top ten pharma companies spent about $67 billion on R and D in 2010 (Fierce Biotech article), a big number of which about half is spent on development, but have tax liability lower than the nominal 35% due to lots loopholes (the average may be as low as 5.6% according to Baker NYT editorial).  Huge expenses and low taxes do not a credit make.  For biotechs without profits, a nonrefundable credit is useless (unless made transferable), but a refundable (grant-equivalent) credit is helpful (c.f., the TDP).  For the mid-tier companies, a tax credit may be attractive but there are more attractive options, such as large infusions of nondilutive funding for small-market, but innovative, new products, e.g., Vertex receiving $75 million from the Cystic Fibrosis Foundation for treatments for the US’s 30,000 CF patients (Xconomy article).  As for other disincentives whose explication may benefit from an industry perspective, the author states “Firms may be unwilling to use a credit that requires them to share intellectual property as they may seek to maintain the exclusive rights to their intellectual property to reap profits” (page 14).  This may be the case, but how companies may be interested in sharing IP should be explored.  I noted the author lists five industry people from three companies as being consulted for this draft.

The author describes several specific design elements for a tax credit (pages 16-17) which is helpful but, without comparison to other alternatives, not useful.  For example, it is stated but not supported that “Direct funding to companies’ global health programs or their affiliated non‐profit research institutes could be as or more effective with less uncertainty about whether the program will be used or not” (page 17).  I think so but such a policy would open a big can of worms.  Clearly another draft is needed. On pages 18-19, the author lists five outstanding questions, three of which require a better understanding of the markets and business, so I hope more industry-types are consulted.  As for this draft, I agree with the author on what needs to be done:  “To better understand the potential of tax credits for serving these smaller markets [really big but low-margin markets], more research would have to be done to illuminate which products for global health have potentially profitable markets and to decipher whether firms have an interest in pursuing them.”  If the Center needs my help, they know where to reach me.

News Flash from Puzzler Tower

As Ray Magliozzi, our former mechanic and co-host of Car Talk (NPR People) notes around this time of year, the Puzzler is on vacation.  And, so I am, at least this week, but not wishing to disappoint my devoted readers (all three of you), I offer a short list of sites that I think are interesting to those poking about in global heath, as I do.

In my meanderings while looking for financing for global health start-ups, I found a rare blog about developing diagnostics for the rest of the world, called Testing the Test:  Diagnostics for the Other 90% (Testing the Test).  It’s well-written and has a strong mix of business and technical points.  The author, “toppavak,” is Pavik Shah, who, according to his LinkedIn profile is currently a Ph.D. candidate in engineering at the University of North Carolina, Chapel Hill (P Shah).  He notes that one of his passions is to apply his engineering knowledge to developing “appropriate and cost-effective technologies in developing world health care,” specifically diagnostics.  Unfortunately, he hasn’t posted since August 2009.  Deep into his thesis work?

On Toppavak’s blog is a link to the blog of another UNC student, Namen Shah, who is in an MD/PhD program and aiming to become an infectious disease epidemiologist.  He calls his blog “Topnaman Malaria Blog” (Topnaman), the name derived in some way from a brand of ramen noodles.  Mr. Shah is the recent recipient of a Soros fellowship (UNC PR) and evidently has started a social venture incubator called Veer Labs, LLC (VeerLabs).  I hope to explore this topic in an other posting.  Tip o’ the hat to both these outstanding futurists.

Coming soon to the student-oriented, social entrepreneurship space in the fall is the MIT Global Challenge, an extension of the MIT Public Service Center’s IDEAs competition.  Since its starting in 2001, IDEAs has been focused on students (IDEAs); the Global Challenge aims to bring in MIT’s international alumni base (MIT PSC) to form up teams and generate potentially innovative solutions, a great idea given MIT’s graduates enthusiasm for entrepreneurship and reality, at least in my biased view.  From what I have seen of the beta site, I think the GC team is off to a good start.

Speaking of things MITish,  Global Health Ecosystem @ MIT (GH at MIT) is a compilation of the many threads of global health interest at MIT.  While the site needs some curation to weed out some dead links (don’t we all), it has a useful “Targets” tab to link to other MIT resources from basic science to venturing for students interested in global health.  It also could be better integrated with the Institute’s International Development Network (IDN) and be less academic (i.e., more connected to reality).  It’s chief academician is Dr. Anjali Sastry (A Sastry).

Finally, in the “thoughtful analysis of US global health policy” column is the Kaiser Family Foundation’s site, GH Policy at KFF.  In my humble opinion, the policy analysts there do an excellent job of sifting through the vast US government sand pile to collate, summarize, and analyze the many aspects, financial, legal, and political, of our country’s ever-evolving global health effort.  And sometimes with diagrams for the more visually-oriented.

Happy Fourth.

Moving Along Smartly

I’ve observed that we in the US are gifted with an extensive global health industry composed of advocacy groups, policy think tanks, academic institutes, and non-governmental organizations/contractors.  I’ve also noticed that several of these groups in the past year have weighed in on what the US government should being doing (a change of administration helped, I guess).  Examples are:

-The U.S. Commitment to Global Health:  Recommendations for the New Administration, Institute of Medicine, May 2009 (IOM Report);

-The U.S. Government’s Global Health Policy Architecture:  Structure, Programs, and Funding, Kaiser Foundation,  April 2009 (Kaiser Report);

-The Future of Global Health:  Ingredients for a Bold & Effective U.S. Initiative, the Global Health Initiative, October 2009 (GHI Press Release); and most recently

-The Report of the CSIS Commission on Smart Global Health Policy, Center for Strategic and International Studies (CSIS), March 2010 (Smart Report).

I was pleased to learn more about the CSIS report first hand when three members of the Smart Commission as well as several notables from the New England global health community presented the report’s key recommendations and took questions at Boston University this past Monday (the Commission will present at several other locations this year; see Smart Global Health).

The Commission’s recommendations may be boiled down to two points:  give global health policy and action higher priority (in part by appointing a senior State department czar) and spend more money (primarily through advocacy groups, policy think tanks, academic institutes, and NGO contractors).  Their recommendations were not much different from those of the other reports, leaving me wondering what new findings the 25 commissioners found while holding two all-day meetings, making “numerous conference calls and expert consultations,” and visiting Kenya.  There is no reference in the report to what they thought about duplicating the efforts of the other advocacy groups or how they were funded.  The Commission did add a new slant to their deliberative process in that they solicited public input:  “With the help of the staff of Blue State Digital, we created an interactive Web site, www. smartglobalhealth.org, which allowed us to exchange ideas with thousands of people who proposed questions for deliberation, anecdotes and photos from the field, and most importantly, fresh, critical insights.”  It’s a great idea, to involve us nonprofessionals, but I did not see a description of how the input was/will be considered and incorporated (I’ll submit and see what happens).  I also noted that one of the commissioners is a founding partner of Blue State Digital, so perhaps it is not surprising Commission decided to seek web-based input using this company’s help (was it free?).  I also noted that the Commission concluded, as most of the professional global health industry has, there is little role for companies or market-based solutions in the government’s global health program.  On page 11, the authors recommend the “U.S. government can more systematically tap the special competencies of the U.S. private sector to strengthen the performance of U.S. global health programs,” so use companies as contractors but don’t use or learn from their abilities to invent and deliver products and services at affordable prices.

I followed up on a few of the points made by the presenters at Monday’s forum:.

Gerry Keusch, a professor of international health at BU (who I have met with about BU’s global health initiative) (Keusch Bio), mentioned the extensive involvement of our local biotech and pharma companies in global health but other than two representatives (from Genzyme and Novartis), I didn’t see other companies represented at this meeting.  Maybe New England would benefit from a regional association to bring together our academic, political, and corporate global health interests.

Peter Lamptey, a Commissioner and president at Family Health International (Lamptey Bio), summarized the Commission’s recommendations using the word, investment, many times but it seems to me that investments are made with an expectation of results and with a means of holding those who are receiving the investment accountable for achieving those results.  The report states that someone needs to create a “new evaluation framework” needed to measure results and verify progress, and I’m hoping the Commission follows through and undertakes a comparative study of evaluation methods, at least.

Jim Geraghty, senior vice president at Genzyme, said that global health is “central” to Genzyme, and but did not mention specifics.  On  their corporate website I found only one document, the 2006 Philanthropy Overview (2006 Overview), that briefly mentions their global health efforts.

Michael Capuano, one of our state’s congresspersons (Capuano), is know as a direct speaker and stated the audience should not expect leadership in global health (or anything else) from their elected representatives and said that, off the island of Massachusetts, many people don’t see a reason to spend money on improving other people’s health when they don’t have insurance themselves.  But is it really an either-or situation?  I can think of lots of ways to redirect current Federal dollars to pay for the Commission’s recommendations.  As for leadership, if he needs a staffer who can provide him advice on what “following” he needs to do in global health, I’m available.

Joel Lamstein, a founder and president of John Snow International, a government- and foundation-supported consulting firm (JSI) said that the implementation of change is often ignored in policy and is under-funded in practice, but, surprisingly, did not comment on the Commission’s approach to implementation, which seems more of the same with its mixed results at best.  As an example of the implementation challenge, he mentioned that JSI has been working on improving maternal and child health in Nepal for 20 years.  According to USAID (e.g., USAID Nepal), the country’s maternal and child health has improved (but is still too low) and improvement has been slowed by an insurgency (also noted by Joel).  I wondered what JSI has learned about implementation after 20 years there and if they could share it (and what their overhead rates were).

Next week:  BIO 2010 and the Partnering for Global Health Forum.