Academic journal article Bulletin of the World Health Organization

Public-Private Partnerships for Health: Their Main Targets, Their Diversity, and Their Future Directions

Academic journal article Bulletin of the World Health Organization

Public-Private Partnerships for Health: Their Main Targets, Their Diversity, and Their Future Directions

Article excerpt

Voir page 719 le resume en francais. En la pagina 720 figura un resumen en espanol.

Introduction

The disparities in health between rich and poor populations are, in a significant measure, attributable to a lack of access to drugs and vaccines as well as to differences in the geographical distributions of certain disease agents and sanitation. Historically, drugs and vaccines have become available through an informal division of responsibilities between public entities and private companies, all undertaking activities in accordance with their mandates or motivations. This division of labour constitutes a poorly defined partnership in which the outcomes desired by different parties have never been explicitly negotiated. In the more economically advanced countries it is generally regarded as reasonably successful, having led to the availability of a broad range of effective drugs and vaccines. However, this kind of system is not particularly responsive to the specific health needs of the world's poorest populations.

Substantial differences in health status have probably always existed between rich and poor populations and have certainly been documented for decades. Improved comparative data are now reinforcing the long-standing humanitarian and ethical concerns about inequalities in access to health products, health services, and resource allocation. Trends in increased travel, global awareness, information flow, and commerce -- collectively termed globalization -- have raised the level of interest about the possible causes and consequences of the uneven distribution of disease, particularly of emerging infections. As a result, increasing attention is being directed at the need to reduce global disparities in health.

Globalization has been accompanied by a reassessment of the strengths and limitations of public/governmental, private/commercial, and civil society institutions in grappling with world problems. Particularly in the health arena it seems to be recognized that intractable problems require not just better coordination of traditional roles but also new ways of working together in order to achieve a synergistic combination of the strengths, resources, and expertise of the different sectors.

With the aim of stimulating discussion on the most effective types of future action this paper presents a preliminary examination of experience in public-private partnerships. The focus is on partnerships between international or governmental agencies on the one hand and commercial pharmaceutical companies on the other. Most of these partnerships also include civil society bodies, e.g. nongovernmental organizations. Simple donations of funds or products by pharmaceutical companies, while potentially useful, are not considered here, nor is general corporate philanthropy.

Disparity in health between rich and poor

The health disparity between rich and poor countries results in average life spans of 77 and 52 years respectively (1). Deaths attributable to infectious diseases (Table 1) contribute most to the disparity. Deaths associated with diarrhoea and respiratory infection are rare in industrialized countries but are the major killers of children in developing countries. Diseases that do not occur in industrialized countries, e.g. malaria and schistosomiasis, or ones that are comparatively rare in these countries, e.g. tuberculosis and HIV/AIDS, impose a heavy burden on both adults and children in developing countries. The burden of morbidity from a number of untreated, debilitating but rarely fatal diseases in developing countries, including sexually transmitted infections, has a substantial impact on productivity.

Table 1. Deaths from infectious diseases
worldwide, 1998(a)

Causes(b)                               Deaths

No satisfactory vaccine available when data compiled

AIDS                             2 285 000 (27.47)(c)
Tuberculosis                     1 498 000 (18. … 
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