Combining health and social protection measures to reach the ultra ...

Research resourcesSmall scale businessMultinational not-for-profitSmall and medium Western firms,developing country firms,academics/public45%Within PPPs25%Alone25%TDR**Unable to verify details for three TDR projectsFigure 1: The drug R&D landscape for neglected diseases (Dec 2004): 63 active drug development projectsstudied most closely.)The organizations themselves are private groups not publicprivatepartnerings and are majority funded from privatephilanthropyAlthough they are entirely focused on forwarding the publicinterest in promoting developing country health, as opposedto a private interest in generating profit, and though theyinclude extensive public health expertise on their Boards,Steering Committees and staff, these PPPs are neverthelessnot public entities but are independent private not-for-profitgroups with a public health focus.By accident, rather than design, they are alsopredominantly funded from private philanthropic sources (seeFigure 2).The failure of government donors to step up to the tablemeans that private groups such as The Bill & Melinda GatesFoundation and Médecins Sans Frontières continue to providethe bulk of funding for these PPPs and their activities, and tobe the main auditors of their performance and outputs.The unintended outcome of this situation – and we note* Excludes TDR3% Philanthropic organizations2% Private sector16% Public sector79% UN agenciesFigure 2: Total cumulative PPP funding by type of funder (as of April 2005,including forward funding committed by that date)*that most of these PPPs had hoped for, and sometimesplanned on, having far more substantial government funding– is that, in practice, they are more “private” than “public” inboth their funding, auditing and accountability. This situationhas led to oft-voiced concerns that “Bill Gates is runningworld health”, however both private donors and PPPsthemselves would strongly prefer a healthier public-privatefunding mix, and the greater public responsibility this wouldbring. Nevertheless, until this happens, these PPPs willcontinue to be predominantly privately-funded privateorganizations – they do not stand-in for public participation inthe neglected disease field.PPPs fund academic and developing country R&D activityas well as private industry R&DThese PPPs do not primarily channel public funds to privateindustry activity (often multinational companies), as thebroad brush classical model would suggest. It is not only thatPPP funds largely come from private philanthropic groups, asseen above, but that these funds are distributed to optimalR&D partners in both the public and private sectors and inboth the developed and the developing world.In practice, around one third of PPP R&D grants goto public sector groups (academic drugdevelopment); around one third to private or not-forprofitcompanies, including companies in thedeveloping world and small- to medium-sized drugfirms; and one third to multinational drug companies(see Figure 3).This funding distribution reflects the fact that thesePPPs not only develop promising industry leads butalso work to actively generate new leads, many ofthese from the public academic sector. The role thisplays in translating basic academic research intoapplied research that results in new neglecteddisease compounds is often overlooked.PPPs are not simply funders. They play a centralmanagement role in the R&D process, closely akin tothe role played by Venture Capital (VC) firms ormultinational drug companies in commercial areas.PPPs do not operate as a passive channel of fundsto either their academic or industry partners, i.e. theydo not provide grants in the more “hands off” wayGlobal Forum Update on Research for Health Volume 4 ✜ 141