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TABLE 1 Lessons Learned

 

Authentic Intersectoral Collaboration

Implementing collaboration between the public and private sectors that goes beyond rhetoric is difficult.

Beginning partnerships early and sustaining them with regular interactions at several institutional levels is at the core of making cross-sectoral collaboration real and useful.

A critical—and informative—test of real collaboration is the sharing of information not customarily shared, for example, product leads in the pipeline, pricing rationales, early data from trials, and ongoing priority-setting processes.

The Product "Life Cycle"

Pharmaceutical research and development are most usefully addressed as a total process that expresses the push-pull dynamic between supply and demand, and offers opportunities for incentives all along the pathway from bench to market.

The market for publicly needed products is not self-evident, so that clear, consistent pictures of public-sector needs, priorities, and policies, as well as potential market sizes and characteristics are essential.

Divergent Sectoral Mandates and Notions of Risk

In the private sector the bottom line is defined by timely financial return. The public sector also needs to take account of competing priorities for resource allocation in terms of public health results.

The cost of pharmaceutical R&D is sizable but its dimensions are poorly understood.

For both sectors, R&D investment decisions derive from interactions among costs, time, and predictability; how those compare across different investment options; and the relative risks they produce.

Public- and private-sector views of risk differ but since both sectors confront it, pooling at least some risks is likely to motivate taking them.

Roles of Advocacy and Public Education

The high value of advocacy and public education in promoting individual disease priorities and catalyzing public awareness is increasingly well appreciated.

However, the public sector and important elements of the nonprofit sector underuse their powers for advocacy for generic public health needs such as vaccines, as well as for needs seen as most important outside national borders.

These lessons, taken together, signal needs for: (1) more information, (2) more predictability; and (3) more sharing of costs and risks, if the requirements for products for emerging infectious diseases are to be satisfied. Looked at systematically across the product cycle, these sort into more specific categories where incentives might be developed to bolster the competitiveness of such public health products in industrial portfolios. Table 2 on the next two pages lays out these categories, highlighting actions expected to be especially critical for advancing the infectious disease enterprise as a whole.

Because a fresh look at the market for these products is believed to be primary for awakening commercial interest, the demand side is presented as leading the



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