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Strong Medicine : Creating Incentives for Pharmaceutical Research on Neglected Diseases - Michael Kremer

Strong Medicine

Creating Incentives for Pharmaceutical Research on Neglected Diseases

Hardcover Published: 27th September 2004
ISBN: 9780691121130
Number Of Pages: 152

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Millions of people in the third world die from diseases that are rare in the first world--diseases like malaria, tuberculosis, and schistosomiasis. AIDS, which is now usually treated in rich countries, still ravages the world's poor. Vaccines offer the best hope for controlling these diseases and could dramatically improve health in poor countries. But developers have little incentive to undertake the costly and risky research needed to develop vaccines. This is partly because the potential consumers are poor, but also because governments drive down prices.

In "Strong Medicine," Michael Kremer and Rachel Glennerster offer an innovative yet simple solution to this worldwide problem: "Pull" programs to stimulate research. Here's how such programs would work. Funding agencies would commit to purchase viable vaccines if and when they were developed. This would create the incentives for vaccine developers to produce usable products for these neglected diseases. Private firms, rather than funding agencies, would pick which research strategies to pursue. After purchasing the vaccine, funders could distribute it at little or no cost to the afflicted countries.

"Strong Medicine" details just how these legally binding commitments would work. Ultimately, if no vaccines were developed, such a commitment would cost nothing. But if vaccines were developed, the program would save millions of lives and would be among the world's most cost-effective health interventions.

Industry Reviews

Winner of the 2004 Award for Best Professional/Scholarly Book in Medical Science, Association of American Publishers "This book should interest anyone involved in international public health, politics and economics. It is a valuable effort to find a practical solution to a major problem."--Pierre Chirac, Nature

Forewordp. ix
Acknowledgmentsp. xiii
Introductionp. 1
Health in Low-Income Countriesp. 6
The Disease Environment in Low-Income Countriesp. 6
Weak Health-Care Infrastructurep. 7
Malaria, Tuberculosis, and HIV/AIDSp. 11
The Impact of Cheap, Simple Technologiesp. 20
The Paucity of Private R&D Targeted to the Needs of Low-Income Countriesp. 25
The Extent of R&D Targeted to Low-Income Countriesp. 25
The Scientific Potential for New Vaccinesp. 27
Market and Government Failuresp. 29
Why Target Foreign Assistance to Vaccine R&D?p. 30
The Patent Tradeoffp. 33
Low-Income Countries and Intellectual Propertyp. 36
Social versus Private Return: Some Quantitative Estimatesp. 40
The Role of Public Purchasesp. 42
The Role of Push PRogramsp. 45
Meningococcal Meningitis: An Example of a Successful Push Programp. 46
A Cautionary Tale: The USAID Malaria Vaccine Programp. 47
Incentives under Push Programsp. 49
The Potential Role of Pull Programsp. 55
The Effect of Market Size on Innovationp. 55
The Impact of Financial Incentive Programsp. 56
Examples of Pull Programs Stimulating Researchp. 59
Advantages and Limitations of Pull Programsp. 63
Pull Programs: A Menup. 68
Commitments to Finance Purchase of Products and Patentsp. 68
Patent Extensions on Other Pharmaceuticals as Compensation for Vaccine Developmentp. 70
Best-Entry Tournamentsp. 72
Expanding the Market for Existing Vaccines and Drugsp. 73
Determining Eligibilityp. 76
Basic Technical Requirementsp. 76
Independent Adjudication Committeep. 78
Market-Test Requirementp. 81
Exit Clausesp. 84
How Much Should We Promise to Pay for a Vaccine?p. 86
What Market Size Is Needed to Spur Research?p. 86
Cost-Effectiveness: What Is a Vaccine Worth?p. 90
How Should Payment be Structured?p. 97
Paying for Multiple Vaccines and Market Exclusivityp. 100
Bonus Payments Based on Product Qualityp. 103
Increasing the Promised Price over Timep. 105
Avoiding Windfallsp. 106
Industry Consultationsp. 107
Scope of the Commitmentp. 109
What Diseases to Cover?p. 109
Vaccines, Drugs, and Other Technologiesp. 109
Incentives for Agricultural R&Dp. 112
Moving Forward With Vaccine Commitmentsp. 115
Making a Commitment Legally Bindingp. 116
The Politics of Creating Markets for Vaccines and Drugsp. 118
Potential Sponsors of New Markets for Vaccines and Drugsp. 119
Referencesp. 127
Indexp. 145
Table of Contents provided by Publisher. All Rights Reserved.

ISBN: 9780691121130
ISBN-10: 0691121133
Audience: Tertiary; University or College
Format: Hardcover
Language: English
Number Of Pages: 152
Published: 27th September 2004
Publisher: Princeton University Press
Country of Publication: US
Dimensions (cm): 23.5 x 15.2  x 1.91
Weight (kg): 0.43