Public, Private and Philanthropy - Global Health GPF April 13

William F0ege, Bill and Melinda Gates Foundation
Liza Kimbo, Sustainable Healthcare Foundation
Richard Feachem, Global Fund for AIDS, Tuberculosis and Malaria
Peter Piot,UNAIDS
Alice Albright, GAVI

A fabulous panel of public, private and hybrid entities providing health care in developing countries - finally a discussion of ALL 3 sectors need to (and can and are) working together. Finally - a recognition that it is cross-sector effort.

Inspiration from Liza Kimbo:
Sustainable HealthCare Foundation runs micro-franchised nurse-run health clinics in rural Kenya. It is a functioning, profitable mix of private business structure and NGO trustworthiness that also receives public money. Nurses make 10x living wage in their own communities. Supplements public health clinics, which can not be fully funded by government and has resulted in nurse surplus.

Lessons from Peter Piot
1. Capacity and management skills from business matter
2. Local ownership is key
3. Coordination is critical
4. Bring unit costs down (esp. anti-retrovirals in AIDS)

Peter Piot: What should we have done differently?

  1. We waited too long. If we had funds for AIDS 15 years ago that we have today we would not have 65 million people living with HIV and ruined entire economies. Costs of Inaction are phenomenal
  2. We have neglected ownership and demand side
  3. We have neglected coordination
  4. We focused too much on raising money and not enough on delivering the goods
  5. We have focused on short-term impact and not long term view
AIDS has demonstrated that coordinated global health interventions are possible.

Alice Albright, GAVI
Vaccines can save lives for less than 30$ per child. GAVI focuses on distributing vaccines to 70 poorest countries in the world. Trying to reach 80% of children in 90% of districts in those countries. Performance based funder - countries develop proposals and both GAVI and nations monitor performance

About 90% of R &D money goes to 10% of disease prevention; 90% of fatal diseases don't fall into that pool.

Business model
GAVI tries to build a 360 degree funding base - raise money from every possible source. Make as much of it as possible long term and unearmarked. ($3.5 BN raised)
In turn, makes long term commitments to countries
Signal willingness to pharmaceutical companies that they will buy the vaccines - GAVI will buy available and future vaccines - a "pull" on commercial R & D. Bring more companies into the industry and lower prices.
Just beginning to work with countries to rehabilitate their health infrastructure so vaccines can be delivered.

$4BN raised for International Finance Facility for Immunization
  1. Launched last Fall
  2. 20 year, legally binding commitments of 7 (soon to be 8) donor governments
  3. Taken these promises to Bond market and borrowed against them - $4BN
Advanced Market Commitment Program
  1. Addresses challenge of how long it takes to get vaccines to market, especially at market rates that poorest countries can afford
  2. Trying to change the rate at which the price curve changes
  3. Contractual mechanism by which group of funders "tops up the price" of R & D for vaccines and pharma companies agree to bring price down faster
  4. Five governments plus Gates Foundation have committed to $1.5 BN
  5. Focusing on a vaccine for pneumoccocal disease

Have prevented 2.3 million early deaths so far, have immunized 28 million people with DPT and 140 million people with other disease vaccinations.

GAVI Failures
  1. Is GAVI too process-oriented? too many controls, too many steps to getting the money out the door faster
  2. Don't get too into the weeds of institutional differences between us (organizations and governments and sectors)

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