Examination of Witnesses (Questions 1019
- 1039)
TUESDAY 20 MAY 2008
Dr Iain Gillespie and Dr Benedicte Callan
Q1019 Chairman:
Good morning, Dr Gillespie and Dr Callan. Can I first of all thank
you very much for your time today. As you know, we are a Select
Committee of the House of Lords looking at the question of intergovernmental
organisations and contagious diseases. The main issue is the way
the intergovernmental organisations work together and, of course,
the non-governmental organisations that link in with them. Although
to do that we obviously need to have some sort of knowledge about
those diseases, the main purpose is the interaction between the
non-governmental organisations, intergovernmental organisations
and the value that the British Government gets out of the taxpayers'
money that we put into it. Today's proceedings are being recorded,
but you will have an opportunity to see that before it is published
and to do any corrections of factual matters. If anything occurs
to you after this session that you feel was missed out or needs
to be elaborated, please feel free to contact us and tell us.
Please feel free for either of you to chip in on the questions
as we go along. We want to get as much information as possible,
that is the purpose of this hearing, so do not feel inhibited
in that respect. Perhaps it would be helpful if you could start
by just telling us a little about your two respective roles.
Dr Gillespie: Certainly. I will begin. Good
morning. Thank you very much indeed for making the time to take
oral evidence from us. It is a pleasure to do this in English
as well. From my side it is a strange accent in English and from
Benedicte's side even a more different accent in English. As you
know, the OECD is an economics organisation focused on economic
development and driving globalisation and free trade. Perhaps
I could say something very briefly about how the organisation
approaches its work on health and infectious diseases. In general
there are three areas that we focus on across the OECD. There
is our own area, which is innovation. We come from the Directorate
for Science Technology and Industry. We both sit in a division
called the Biotechnology Division, which is perhaps something
of a misnomer because essentially what this division does is try
to look at how the life sciences can drive growth and transition
structural change through innovation. Other parts of the organisation
with a role are particularly our Development Assistance Committee
which, as you know, is very focused on aid architecture, our Development
Centre which looks at issues such as sustainable financing for
development and, not least, our Health Committee which focuses
on health system performance and health systems efficiency. We
also host a couple of important processes which are not formally
part of the OECD but they address issues around global health.
One is the Africa Partnership Forum, which exists to help OECD
countries engage in the NEPAD Agenda, and the second is the Heiligendamm
process support unit which is a dialogue between the G8 countries
and the so-called O5 countries, which are Brazil, India, China,
South Africa and—
Q1020 Chairman:
Mexico.
Dr Gillespie: Mexico, thank you. The Heiligendamm
process is looking at IP and innovation as one of its lines. That
is where we sit in the organisation. As I say, we come from the
innovation side.
Q1021 Chairman:
Thank you very much indeed. Can I, then, perhaps start by asking
you about this question which has come up a number of times about
the co-ordination between the vertical and the horizontal as it
has been referred to, which I am sure you are familiar with. The
general view, which I know you take from the evidence I have seen
of yours, is that a functioning health system in a country is
absolutely vital. There is a lot of emphasis put on the vertical
treatment of disease, particularly by some of the NGOs. We have
had various arguments put to us saying that these two are not
as contradictory as they seem and, in fact, they are more angles
than horizontal or vertical. I would like your view on that, and
I would like your view particularly on where Noordwijk, if I have
pronounced that correctly, fits in on this. Could you start with
that, both the horizontal and vertical—is that right, is
it a sensible distinction, and how does it fit into the Noordwijk
Agenda?
Dr Gillespie: Let me begin and I will probably
pass for specific comments on Noordwijk to Benedicte. Thinking
about horizontal and vertical approaches, that is a perfectly
reasonable holistic device to look at the various initiatives
that are going on but, for us, there is no right way. The right
way is not horizontal, the right way is not vertical, it has to
be a mixture of both. Where we saw intervention in global health
starting was very much on the so-called vertical axis, although,
in fact, it was only partly a vertical axis; what we saw was a
focus on getting products for AIDS, TB and Malaria to patients.
The focus was, if you like, at the far end of the vertical part
of looking at individual diseases. There was very little work
done on the upstream R&D for any of these diseases. That seems
to us a very reasonable place to have begun but where we are now,
of course, is that we are looking for horizontality across the
entirety of the system, first in functioning healthcare systems
in recipient countries where we have some limited progress still,
secondly in horizontality and systems efficiency, systems complementarity,
across the various vertical initiatives, and, thirdly, around
the innovation system itself, where focus has tended in the last
few years to be on elements of the system, in particular on developing
molecules for particular diseases. We see a more systems-based
approach across the entirety of the innovation cycle in R&D
to be a long-term, much more efficient way. In short, vertical
and horizontal are both required but, in our view, what is really
required is a much more holistic and effective systems approach
to the development of innovation and the delivery of these innovations
in recipient countries. As to Noordwijk, I think that was very
much the starting point for our thinking, but perhaps I can ask
Benedicte to say a little bit more about the specifics.
Dr Callan: Just to add to what Iain was saying,
in Noordwijk, although it was a joint collaboration between those
parts of the OECD that focus on innovation and heath issues and
those parts of the OECD that focus on aid and development assistance,
there was a strong focus on what can be done to change the innovation
system as a whole in order to meet the needs of the developing
world. There was a focus on two complementary sets of issues.
One, what can we do to increase the innovation system efficiency
as a whole, and really there was a tension with some groups saying,
"We have got to focus in on a few diseases", and others
saying that rather we need to look at the set of incentive mechanisms
and infrastructure needs that can lead to a more efficient innovation
system. The second issue that was dealt with in Noordwijk was
how do you build capacity, both in OECD countries for R&D
in this field and capacity in the developing world for R&D.
You are right to say that the OECD focus has been very much more
on this horizontal aspect, and I think that our colleagues in
DCD would agree that their present focus is more on health system
capacity. That said, as you put it earlier, we do not want to
give the impression that the vertical programmes have no value,
they are of great value, and in R&D it is going to be almost
impossible to construct an innovations system where there is not
a disease-by-disease based approach to the improvement of research
and research capacity in those areas. Our focus really was on
the more general innovation system dysfunctions.
Q1022 Chairman:
Thank you. Dr Gillespie, you mentioned that you have looked at
requiring holistic outcome, and one can understand that is an
ideal thing to aim at, but, given the disparities between various
countries on their basic health systems, I suppose the brute question
is: where do you start?
Dr Gillespie: I think the pragmatic answer to
that is that you start from where you are now. We have a whole
range of interventions in place, a whole range of initiatives.
The majority of them, as you said, are vertical, but that does
not mean that efforts cannot be made to make these vertical initiatives
actually stack up together to reduce some of the transaction costs
in delivering the outputs of these systems and try to make the
systems support one another. As you are very well aware, this
is part of the real goal of the Paris Declaration on Aid Effectiveness
on the delivery side. Equally, one wants to provide interventions,
whether it be drugs, vaccines or whatever, into a system which
have some absorptive capacity for these materials. That requires
a more horizontal approach on actually developing healthcare systems.
One size, of course, will not fit all. What Country A requires
will not be what Country B requires. Equally, within the innovation
systems, as Benedicte has said, we see disease-specific innovation,
but at least in the upstream parts of R&D we feel that there
are some structural issues that can be developed which can improve
the efficiency of innovation. You are right, there is no one-size-fits-all
for each of the different countries which have very different
health requirements, but thinking about uniting, if you like,
bringing together, reinforcing, the synergies across these vertical
systems, for us at least is a key element in this notion of horizontality.
Dr Callan: Can I just add to that. Our DAC colleagues
would say one of the most important elements of any programme
that is going to help build health systems and strengthen health
system efficiency is going to be a line-up of country plans. They
would push very strongly for ownership and alignment by recipient
countries of any programme that is designed to help improve their
health systems. That is one of the areas where their position
would be that you really have to start with the recipient countries
and see what they feel their own health system needs are.
Chairman: Thank you. This leads us on
quite neatly to co-ordination, which Lord Howarth will ask about.
Q1023 Lord Howarth of Newport:
Could I ask you about governance, who does what in this already
very complex scene, and what the value is that OECD in particular
adds in a scene where there are already a great many intergovernmental
organisations and groupings of one sort or another, a very crowded
architecture? In your submission you said: "the OECD is well-placed
to play a role in taking action forward ... " with reference
to improving innovation and access to medicines, "not least
since it is able to draw together the key players (governmental,
non-governmental, industry, researchers and civil society) in
developing innovation systems and in delivering innovation".
Two questions arise from that. Do you have the executive power
at OECD to drive this process internationally? And would it not
be the responsibility of the World Health Organisation? Is that
because perhaps it simply has not been very good at it or because
it is not an appropriate role for it?
Dr Gillespie: Let me start off by saying there
can be no doubt as far as any of the OECD countries are concerned
that the intergovernmental organisation, that leads in these areas,
is the World Health Organisation. The issue of innovation in public
health is under discussion now, as we sit here, in the World Health
Assembly in Geneva. We certainly hope, and I think I can speak
not just for the two of us but for all of our colleagues in the
OECD, indeed for all of our member countries, that there will
be an effective resolution coming out of the World Health Assembly
to strengthen WHO's mandate and capacity in looking at innovation
for global health. Let me say that upfront. Secondly, you asked
the question: does the OECD have executive power. The work programme
and the priorities of the OECD are set by our Council, the 30
member countries, through their executive committee. At the moment
they are paused and they have paused following our Noordwijk meeting
waiting for the World Health Assembly to take a decision on where
WHO should be going on the innovation and public health agenda.
It is not for me to say what they will do next, it is for them
to decide what the OECD may do next, but it is very clear that
whatever the OECD does next on the innovation and global health
agenda that will be aimed to complement and support what WHO take
forward coming out of the strategy that we are hoping is adopted
at the World Health Assembly. This is a role that we see the organisation
of the OECD increasingly looking to play, if you like, providing
some of the analytical capability to supplement and support work
that is going on across other parts of the IGO architecture. As
far as the point about the OECD's convening powers, there are
some aspects around innovation that the OECD currently has a longer
track record on and more substantive capacity at present than
the WHO has, and that would be something I would expect our interlocutors
in the WHO to advocate as much as we do. What we see ourselves
doing next, if the OECD Council decides that this is appropriate,
would be to work with the WHO, partly to help them build their
capacity but, frankly, more simply to bring some of the analysis
that we have been doing around innovation efficiency in the delivery
of health technology into their debate. This is something that
we have formulated in a Memorandum of Understanding, a formal
document between WHO and the OECD. We hope that we will continue
to operate that partnership, we will strengthen it in the field
of innovation and health over the coming years.
Q1024 Chairman:
Dr Callan?
Dr Callan: I would just jump in and echo some
of the points, but perhaps give a little bit more detail in the
areas where the OECD has capacity that the WHO may not have worked
quite so much in. First of all, as you mentioned, we have a whole
division that does mapping, measuring and analysis of innovation
systems, how they function, what are the policy tools to spur
innovation, what is the substitutability of these different policy
levers, whether they are complementary. There is a whole range
of work that the OECD has done that is of relevance to this field
of infectious diseases and has not been applied to infectious
diseases but could easily be done if that was something that our
member countries felt was necessary. In the DAC, the issue of
how you align and make more effective overseas development systems
is a big issue. They are taking the issue of global health as
one of their primary areas of concern. The measurement and approved
effectiveness of health systems is something that the community
on health works on in collaboration with the WHO and they share
both their methodologies and the data that they generate. For
some countries this is a very important area; for others, it is
more controversial. On this issue of policy effectiveness and
policy coherence, the OECD has worked very strongly on how you
create coherence between different policy fields in finance, health,
development, science and technology, and how you create a larger
vision of what your overarching policy goals are. Those are specific
areas where the OECD has experience and a secretariat that could
apply its expertise to the issue of global health should countries
feel that was something that was absolutely necessary. More specifically,
and this gets back to the Noordwijk Medicines Agenda, what was
suggested in very politically nuanced terms, because it was a
text that was negotiated amongst a large group of different individuals
and organisations, was the OECD has work on open innovation models,
collaborative mechanisms for IP. Those are things we have been
working on for our own countries and looking at their applicability:
when they are useful and why they are useful. This is something
that has been taken up by the WHO as something that is important
and should be pushed forward. We have experience in why these
models work, why they often are hard to put in place, and that
is something the two organisations need to work together to push
forward. Innovative financing mechanisms for R&D, as I mentioned
earlier, is something that the WHO is interested in and I think
that is what they are going to be pushing forward as the first
elements of work following this WHO resolution if my understanding
is correct. Again, there is an awful lot of work on policy levers
for achieving certain scientific goals or industrial goals. The
OECD has certain capacity where we could collaborate more closely.
I would perhaps mention as a corollary to that these alternative
mechanisms to improve innovations that we have been working on.
There are very specific things where there is possibility for
more collaborative work but there are also some very overarching
large general areas where the OECD perhaps has a history of work
that might be useful.
Q1025 Lord Howarth of Newport:
So the answer to the question as to what value OECD is adding
in this field of international health is that you are analysing
and reporting on such issues as the failure to innovate and on
coherence and collaboration. Is anybody else doing that kind of
work?
Dr Gillespie: On the work looking at collaboration
and development of research networks involving individuals from
the bottom up, at the international level I think it is fair to
say that the OECD maintains, if you like, a substantial lead.
This is an area which WHO, through their Intergovernmental Working
Group on Public Health, Innovation and IPs, has said is important,
but so far they are only beginning to dip their toes in the water.
This focus on how you drive innovation efficiency, whether it
be in health or other areas, is something which the OECD has a
substantial lead in. In fact, this is the core of our new OECD
Innovation Strategy launched by our ministers last year that we
report back to ministers in 2010 on.
Q1026 Lord Howarth of Newport:
So what is the bridge from analysis to action? You report?
Dr Gillespie: Yes.
Q1027 Lord Howarth of Newport:
How are the implications of your reports taken forward? Is there
some mechanism that exists or that you would desire should exist?
Dr Gillespie: It depends very much on the specific
output that we are looking for. Like any other organisation we
have a panoply of tools at our disposal. Sometimes what we will
do is analysis and policy reporting where essentially what we
are looking for are the actors who are involved in the analysis
and reporting. I should just say in parenthesis here that the
actors involved are from member countries, member country governments,
plus from the NGOs, from a number of non-member country governments
and also from the innovative industry. The process of analysis
and development of reports which are agreed by the actors has
an impact on diffusion. What we are essentially trying to do is
move some novel means of thinking. There is an adage in the OECD
that says you can get anything done in the OECD as long as someone
else takes the credit for it!
Q1028 Lord Howarth of Newport:
Should that be the WHO? Is the WHO the lead organisation internationally
for carrying forward the implications of the research that you
carry out?
Dr Gillespie: It is one of the lead organisations.
First of all, I should say there is analysis, but we also have
a number of soft law mechanisms in place, governance frameworks,
that allow or encourage our governments and the private sector
to act in certain ways. Is the WHO the principal customer of analysis
in this area? I would say it is one. The WHO has some executive
power. Some of the recommendations are aimed very much at member
country governments themselves. Some are aimed at the practitioner
at the ground level and that practitioner may be a researcher
in a university, it may be a pharmaceutical company, a biotech
company or a product development partnership. The strength of
the analysis is the fact that we try to internalise in that analysis
all of the different actors and their perspectives, and it is
the bottom-up approach to development of policy directions that
we think is a critical strength of the approach that we bring
to bear.
Q1029 Baroness Hooper:
I suppose that the WHO has the lead in the sense that it is a
truly global organisation in membership terms. I was just wondering
whether the fact that the OECD is an expanding organisation has
any impact on your work. I know Brazil is a recent new member
with a very important and large economy and, of course, you have
a new boss.
Dr Gillespie: Secretary General.
Q1030 Baroness Hooper:
From Mexico. Does that help you with your work in terms of the
follow-up that Lord Howarth has been talking about? I imagine
it does. The second thing, if I may, is that I am a member of
the Parliamentary Assembly of the Council of Europe and we do
an annual report on the OECD which is coming up at the next session
in June and we always try to focus on some health issues and educational
issues as well as the general economic background. Is that helpful
to you? Maybe we could concentrate more in terms of follow-up
on asking questions about what is happening once the analysis
has been done and the follow-up is due to take place.
Dr Gillespie: I think they are both very helpful
questions, if I may say so. We do, indeed, have a relatively new
Secretary-General, Mr Angel Gurria, from Mexico. One of the core
missions that he was elected upon was to make the OECD a more
relevant organisation as a hub of globalisation looking much more
outwards than perhaps we have hitherto. We have entered into discussions
with five member countries to join the organisation and a further
five so-called "enhanced engagement" countries, looking
to build them into the work of the organisation without becoming
full members. These include countries such as Brazil, China, India,
Russia, Indonesia and a number of other key countries. That outward-looking
face of the OECD must be helpful in the interaction with the follow-up
to these kinds of global initiatives. Having said that, for some
time we have had quite a lot of activity with non-member countries.
If we look at the OECD in this area, our members still account
for about 65 per cent of GDP but 90 per cent of global R&D.
One of the real motivating factors for trying to play a role in
this issue around innovation for global health is that most of
the innovation, most of the R&D and most of the spend is in
the OECD countries; so, if you like, we have a special responsibility
for driving innovation to meet the needs of the majority of the
world. That was very much the basis for our debate in Noordwijk.
If you have a chance to look at the agenda, you will see there
was quite a range of very senior players from non-member countries
there as well. As far as the Council of Europe is concerned, by
happenstance tomorrow we have a discussion with the Education
and Science Committee in preparation for the Parliamentary Assembly's
debate. One of the things that we will be raising in that discussion
will be our work on infectious diseases. It will also cover issues
like genetics and genomics, GMOs, human data banks, et cetera.
As far as how useful that debate has been, I think we wait to
see. There is a real opportunity there for us to have more co-ordinated
effort between the two organisations. I am sure that my Secretary-General
will be extremely positive indeed in his engagement with the Parliamentary
Assembly.
Q1031 Lord Desai:
You have already mentioned the Paris Declaration and the five
criteria that you are using. How do you assess donor countries,
whether they are adhering to these five criteria? Secondly, does
this initiative contribute to get donors, people like PEPFAR and
so on, more into line with the way you think things ought to be?
Dr Gillespie: Perhaps I will begin and pass
to Benedicte for more detail. How do we assess? We run surveys
every couple of years—the last survey was in 2006—of
the impact of the Paris Declaration. The report, which is in two
volumes and quite lengthy, was published last year. In very short
terms, there is some progress but much less than we would hope
to see.
Q1032 Lord Desai:
Do you construct an index of effectiveness from the five indicators?
You have got five indicators and you construct an overall index,
do you?
Dr Gillespie: There are five factors and a number
of indicators. Although the factors and the indicators are cross-sectoral,
we also look at the number of sectors, so-called tracer sectors,
and one of the tracer sectors that we are now looking at is the
health sector. That will be one that is focused on particularly
at the third High Level Forum in Accra in September. We have data
from over 100 donors and around 60 recipient countries. Essentially
we do many country reviews of each of the recipient countries,
looking at the five factors and the 12 indicators, and publish
data which looks across and between both donor countries and organisations
and the recipient countries. As I say, in terms of the message
from the last survey, a lot more needs to be done. Benedicte can
perhaps pick up on some of the key messages and I can turn to
the right page in my brief while she speaks. One of the focuses
of the Accra High Level Forum will be about implementation of
the Paris Declaration. In principle, it provides a basis for much
closer integration and alignment of activities, but so far we
would say on progress in some areas in all the 60 recipient countries
there is progress across the donor community but a lot more needs
to be done.
Dr Callan: One of the things that is different
about the Paris Declaration is that it is endorsed by a much larger
group of countries, there was broad consultation on agreeing what
its goals ought to be and it set targets for 2010. There are three
rounds of surveys, one that was done in 2006, one that is being
done right now, 2008, for which they are beginning to get preliminary
data, and there is one that will be done in 2011 to see whether
or not the targets were met. As Iain said, unfortunately the results
so far for 2008 show very limited progress towards some of the
indicators about alignment of aid. One thing to note is that the
survey does not track progress in any one particular sector, so
there is not data that is particular to the health sector, which
is something that I am sure this group in particular would be
interested in seeing. What is important to add to this is that
the DAC participates in discussions with the multilateral donors,
which is the World Bank but also the philanthropists, in discussing
how one is going to monitor progress towards its various goals,
including its health outcome goals. There is an ongoing discussion.
I know last year they met two or three times to discuss using
health as a tracer sector and what indicators they would be looking
towards developing and how they would align their own policies.
There is an attempt to try to bring in other groups.
Q1033 Lord Desai:
They have accepted your indicator methodology, have they? Are
they happy with the methodology?
Dr Callan: I am sorry, I would not be able to
speak to that level of detail. I understand that they are looking
towards developing a common methodology, but I could not say whether
they have accepted or have not when there are still discussions.
Q1034 Chairman:
Before I move on to intellectual property rights and innovation,
can I just ask you this in relation to the answers you have given
so far—and it touches on other views we have heard over
the preceding months? A picture is coming out, of a network of
organisations, NGOs and intergovernmental organisations and so
on, and initially we were perhaps thinking it is very crowded
and there are too many organisations. But the picture that is
emerging is a need to get a clearer view of how they inter-relate
with each other, how the networks evolve and where the WHO sits
in relation to all of that. There is an element of is the WHO
the conductor of an orchestra trying to pull out which bits should
be playing with each other and which bits should not. Does that
sound sensible to you? I have been influenced in my thinking to
some extent by Professor Fidler's evidence to us the other week,
which emphasised the networks analogy.
Dr Gillespie: It is an excellent analogy, it
is one that we have used ourselves and tried to follow-up on after
Noordwijk. The challenge is the network exists but, if you like,
the route through the maze of interactions in the network is poorly
articulated and poorly understood, not least by those actors who
actually form the network. As to whether there is one conductor
or whether there are a number of bandleaders trying to follow
a particular score, that is a question that remains open. Certainly
the functionality of that network and the efficiency of that network,
for us, is the focus of the kind of thinking we in the OECD have
been trying to do, not just in this area but in others too.
Q1035 Chairman:
It is very hard to decide whether or not the networks are working
to best effect and maximising the use of the finances that are
given to them, whether by the UK Government or others, unless
you have someone or some organisation taking a bit of an overall
view. I suppose one tends to jump to the conclusion that that
ought to be the WHO. Is that right or not?
Dr Gillespie: There are a couple of issues here
if we can just slightly unbundle them. The first is the way that
the networks align with themselves, so the bottom-up networking,
the bottom-up system. There is a lot more that could be done there
and there is a great demand from the individual actors, whether
they be PDPs or whatever, to develop a better system. That need
not necessarily be a top-down issue imposed on them. What we need
is space for them to come together to develop these kinds of networks.
The second point is one of assessments of what works and what
does not work. It is certainly very clear to us in all of those
that we have interacted with that we need to be looking at a mix
of different interventions to deliver products for Disease X in
Country Y. What that mix best is in each circumstance is something
which has received scant, if any, attention so far. Which of the
interventions actually make and give best value for money also,
I am sorry to say, has received scant, if any, attention so far.
In mitigation, this is partly because so much of this is so very
new. As to whether WHO should be the orchestrator of this, if
there were to be one orchestrator it would have to be WHO, but
I am not sure whether the one conductor, one orchestrator model
is the right one or not. I am not saying it is not, I simply do
not know.
Q1036 Chairman:
Do you want to add to that?
Dr Callan: I like that analogy very much and
it is a hugely complex and very difficult field. We are struggling
with the question of where the gaps are in the network, where
do they fail and what do they fail to do. There are these multiple
communities of practice. There is an incredible—and in large
part this is thanks to the Bill and Melinda Gates Foundation—renaissance
of ideas and groups that are trying to fill in various different
gaps. Some of it is gaps in funding, some of it is gaps in information
flows. The issue that we are struggling with is that, from a top-down
policy level, we can identify certain things, but what really
needs to happen is for the researchers, the participants in public-private
partnerships, the doctors, to identify for themselves where it
is that the network is failing to make an easy flow from the laboratory
to the patient's bedside of the types of products that are necessary
to reach some of the health outcomes that everybody is hoping
to achieve. It is that identification of the gaps that is necessary.
On top of which, in certain cases we are jumping quickly to conclusions
about what is needed, what are some of the solutions, and for
the most part I do not think we know what the solutions are.
Dr Gillespie: May I just add one thing. We have
a group of new tools coming out now, policy tools if you like,
that we think from what we can see so far could ease some of these
networking problems. The kinds of tools I am speaking about are
means to share intellectual property rights around patent pools
or patent clearing houses, means to ease access to ideas, to molecules
that are partly developed through what we are beginning to see
termed as knowledge markets and, also, much more open innovation
systems where innovators, even some of the very, very large companies
still following a blockbuster model, are looking much more at
going out and exchanging ideas and seeing that there is value
in knowledge transfer across networks which is above and beyond
the proprietary value of the knowledge that they hold. An application
of these kinds of systems into the global network that we see
here in the global health field could help reduce some of these
transaction costs and improve their knowledge flows. We think
this because this is what the actors who are trying to achieve
knowledge say they are looking to have developed.
Chairman: Thank you very much. That moves
on quite neatly to intellectual property rights and innovation
with Lord Avebury.
Q1037 Lord Avebury:
It certainly does lead in to what I was going to ask, which is
about the protection and use of intellectual property rights,
which you say is necessary but not sufficient for stimulating
innovation for neglected and emerging infectious diseases. In
your paper you discuss the complementary reward systems which
have an important role in incentivising R&D for these diseases,
but then you go on to say that further robust analyses are necessary
to decide how these mechanisms can best contribute. You have just
been talking about one or two of them. Is this a matter on which
you are waiting for advice from the World Health Assembly? You
said in answer to a question a few minutes ago that the issue
of innovation was under discussion there. Have they got these
complementary reward systems on the agenda? Do you expect to receive
further advice on the subject after that meeting has been concluded?
Dr Gillespie: Perhaps I could begin by addressing
your specific point about WHO and the World Health Assembly and
then ask Benedicte to say something more about the specifics of
some of the measures we are talking about. What we have seen so
far, as an interested party in the process leading up to the World
Health Assembly, is a draft strategy which is up for debate now.
That draft strategy, if it is adopted, will give us, if you like,
the architecture of what the WHO sees as being their priorities
for the foreseeable period, at least until the next World Health
Assembly a year hence. What we are waiting for is to see which
areas of focus WHO will advance on, which areas of focus WHO will
look to other organisations to work upon, ourselves included perhaps,
and what they will not regard as a priority for them but might
be a priority for us in our own work. Essentially, we are looking
for complementarity with what comes out of the World Health Assembly.
So far, in terms of what we have seen the proposed strategy—and
it will doubtless change over the course of this week—has
some focus on some of the alternative systems, particularly on
so-called prizes for delivery of new molecules. So far it has
had a small amount of attention paid to looking at these collaborative
systems for interchange of intellectual property rights. That
latter area of work, the so-called collaborative mechanisms, pools,
clearing houses, et cetera, is an area of work where the OECD
already has a substantial head of steam looking at these mechanisms
in innovation generally, and global health could be one of them.
As to the variety of specific "push" and "pull"
mechanisms, the complementary systems, perhaps Benedicte could
say a little bit about that.
Dr Callan: Your question is an interesting one
in that it asks, firstly, what are these different mechanisms
and whether we are waiting for a signal from the WHO as to whether
we are going to do work on them. I would first say that the number
of mechanisms that have been proposed to try to accelerate the
development and delivery of new vaccines or therapies for diseases
of the developing world are not dissimilar from mechanisms being
used to develop drugs more generally or that are used to try to
reach other public policy goals in other technology areas. The
way that these are usually distinguished is there is a category
of mechanisms that are "push" mechanisms, which are
essentially feeding the innovation pipeline providing subsidies
to R&D early on, or pull mechanisms that guarantee a market,
guarantee that there is an endpoint.
Q1038 Lord Avebury:
Like the Advance Market Commitment?
Dr Callan: Exactly, like the Advance Market
Commitment, like the prizes, but also things like patent extensions
or patent buy-outs which essentially guarantee that there will
be a larger financial prize at the end if the innovator decides
to invest a certain amount of its R&D into developing new
products. These "push" mechanisms, whether it is funding
for PDPs, whether it is increased funding for infectious diseases,
as the US announced in February of this year, or whether it is
pharmaceutical companies that are saying, "We are going to
invest more in these particular areas", they are things that
the OECD has studied. We have looked at tax credits and what their
impact is on firm behaviour. We have looked at subsidies and what
their impact is on firm behaviour, whether they are substitutes
or complements. These are not things that we are not going to
work on, we are working on them in a number of different areas.
The question is, do we look particularly at what their impact
is going to be on the behaviour of firms who would be willing
to invest in infectious diseases. I think that we should be. There
is an awful lot of interest in what incentivises firms' behaviour
and the OECD is in a good position because it has a good rapport
with the industrial sector as a whole and is in constant dialogue
with them about how policies actually impact their behaviour.
We did some background work on "pull" mechanisms, such
as the Advance Market Commitments and IFF. We have looked at what
these mechanisms are, what their strengths and weaknesses are,
but we have not got to the point that goes beyond what Lord Howarth
was saying, which is analysis. We have not got to the point where
we have had a discussion amongst countries or communities of users
about what kind of policy recommendations or guidelines the OECD
might want to put forward. That is the thing that the OECD may
be waiting for. We are going to continue working on policy incentives
for R&D and what works and what does not work in a variety
of different fields. We will certainly continue working on the
issues that Iain has talked about, which is all the issues about
how you create a smoother knowledge flow of intellectual property,
but the question of whether we particularly look at how this is
going to change behaviour in one very particular field is something
our countries have not come to any decision on.
Q1039 Lord Avebury:
Can I ask, do you think of any particular lessons to be learned
from the one really successful initiative, which is Pneumo-ADIP,
in the case of the Advance Market Commitment? Is that capable
of generalisation or is it a one-off that applies simply to pneumococcal
disease? What similar models can you point to that are developed
at a theoretical stage which remain to be launched in the case
of specific products?
Dr Gillespie: It is a good question
and I wish I had a good answer to it. Unfortunately, we do not,
we simply do not know.
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