With donor fund levels sinking in the midst of a global fiscal crisis, multilateral institutions are finally having to face an issue they have avoided for years: prioritizing time, people and resources to tackle a few health challenges rather than many. The UN Millennium Development Goals — now more than halfway toward a target completion date of 2015 — are widely viewed as a failure in terms of creating the necessary framework to define roles and channel program implementation around agreed outcomes.
The solution is supposedly to be found in building a new global, multi-party initiative to treat and cure non-communicable diseases, which due to the epidemiological transition are now the leading causes of mortality and morbidity in most countries — including a majority of the developing world. Thus, all eyes are on a major UN-hosted conference on non-communicable diseases on September 19-20 in New York to be attended by heads of state, finance and health ministers from 190 countries. The extent of industry involvement is still unclear, but the tone set to date is such that it is likely to represent a lost opportunity for cooperation with Big Pharma: the developing country bloc is insisting that the focus of discussion be on access, technology transfer and IP issues rather than science and the development of new treatments.
The impasse is reflective of a much larger problem affecting the global health community: poor governance. Recent reports have rattled donors by documenting extensive overlap in activities, the disruptive impact of a spike in AIDS program funding on other health care interventions, corruption in the distribution of resources, and the negative impact of foreign assistance in general on development and economic growth in poor countries.
“Governance in the multilateral institution community is a closed shop,“ former UNAIDS Program Director Peter Piot told Pharm Exec. “Given the realities of the economic system, little practical can be accomplished without direct participation by the private sector in addressing key global health challenges, but in many cases industry is simply shut out.” He noted that existing fora like the WHO’s annual World Health Assembly [WHA} are “so out of touch with reality to the point that they are more likely to retard progress rather than advance it.”
Look for a slow but growing movement by outsiders to reform these large institutional stakeholders – or defund them. NGOs like the Gates Foundation are already filling the space with resources that far exceed the pinched coffers of governments.