Strengthening International Collaboration for Capitalizing on Cost-Effective and Life-Saving Commodities (i4C)

The project "Strengthening International Collaboration for Capitalizing on Cost-Effective and Life-Saving Commodities (i4C)" evaluated eight policy interventions related to prioritizing research funding, incentives to stimulate greater investment, and improving global access to commodities such as medicines and vaccines. i4C is an international consortium of interdisciplinary and innovative researchers with partners from Norway, Canada, South Africa, Tanzania, China, India, Brazil, and agencies such as the World Health Organization, the Coalition for Epidemic Preparedness Innovations (CEPI), the East, Southern, Central Africa Health Community, Fridtjof Nansens Institute, and Access Health International. Our primary research resulted in more than 37 published articles in scientific journals and over 160 dissemination measures for the public. How can international collaboration be strengthened to improve global access to existing life-saving commodities? This question was investigated through primary research related to: institutions, access to medicines, and art as a means to advocate for evidence decision-making. Institutions and international law The consortium investigated the design of institutions, the use of scientific evidence in policymaking and studied the effectiveness of international law as a tool to address global health challenges. Decision makers rely on accurate and impartial scientific advice in decision-making processes. We investigated evidence-informed decision making in the design of scientific advisory committees (SACs), harnessing insights across research disciplines. Six primary studies explored various cases and drew insights from SACs. We conducted an in-depth investigation into the practise of SACs. Key findings identified gaps in the use of SACs and how they can be best designed to increase their effectiveness. International law has been highly regarded as a potential solution to address transnational issues, however our systematic review points to little evidence of their effectiveness, with trade laws being one potential exception. In addition, a quasi-experimental evaluation of the Framework Convention on Tobacco Control (FCTC) found that the FCTC has not accelerated a pre-existing decline in global tobacco consumption. Yet, there is a divergence between HIC accelerating their decrease in consumption and LMIC consuming more tobacco than would have been expected since the adoption of the FCTC. Access to medicines is an issue that was the focus of two sub-projects. Our interest in the role of the state and access to medicines included four primary studies that focused on India, China and east Africa. We found that the implementation of medicines regulatory harmonisation in East Africa has made major progress, but that improvements and additional efforts are needed in order to improve access to quality-assured medicines. Art as a means to advocate for evidence based decision-making Of the eight i4C policy interventions, the interdisciplinary research project and art installation was a radical inquiry for social science research. It was the product of a 3-year collaboration where artistic expression was used to stimulate ideas and provoke questions related to enduring challenges in global vaccination, with a final installation at UNAIDS in May 2017. How can international collaboration best prioritize, finance and incentivize global innovation for life-saving commodities? As with the policy interventions described above. We conducted primary research concerned with investment, decision-making and prioritisation for the research and development of biomedical innovations, namely vaccines for emerging infectious diseases and antibiotics. Several studies used novel economic and decision analysis methodologies to support the prioritization of vaccine development against epidemic infectious diseases (EIDs) in the context of the newly established Coalition for Epidemic Preparedness Innovations (CEPI): An exploratory decision analysis supported CEPI's strategic objective setting and business plan formulation. A cost minimization study generated minimum cost estimates for vaccine development against 11 priority EIDs. A portfolio decision analysis supported the selection of 6 rapid response technology platforms against Disease X. Antimicrobial resistance and the lack of new antibiotics is a critical problem at the highest political levels. Without new antibiotics, it will become increasingly difficult to treat infectious diseases or provide medical treatments that rely upon effective antibiotics. Our recommendations are that a combination of models including grants, pipeline coordinators, market entry rewards and long-term supply continuity models are needed to support a robust and dependable antibiotic pipeline. Greater investment is needed and this investment must be tied to commitments to access and stewardship.

i4C led to fundamental research to address some of the biggest challenges in global health. A globally integrated team, GLOBVAC supported a wide network of researchers across several disciplines, enabling the extension of research methods and evaluation of policy interventions pertinent to multilateral institutions and global fora. Our intention was to examine policy initiatives available to global health policymakers across the four types of global governance arrangements: international rules, international norms and discourses, global market interventions, and access to domestic policy processes. We engaged with decision-makers supporting policymakers to champion evidence-informed initiatives. Our research resulted in more than 35 articles in scientific journals and 130+ public dissemination measures. i4C stimulated interdisciplinary research collaboration continuing to tackle global health governance issues such as epidemic preparedness, AMR, and social determinants of health.

Our main research question is how can international collaboration be strengthened to scale-up cost-effective and life-saving commodities, especially for the world's poorest women and children. We will pursue this question by evaluating eight policy interventions directed at global health governance institutions. Five aim to improve global access to existing, life-saving commodities. These include: 1) evaluating the impact of free trade agreements and regulatory harmonization; 2) examining how emerging economies like Brazil, India and China promote access on the international stage to provide learning for other developing economies; 3) assessing advocacy strategies for promoting evidence-informed policymaking; 4) evaluating existing and new global health governance architecture's contributions to improving access; and 5) considering the role of existing and potentially new international legal mechanisms. Three aim to improve prioritization, financing and incentives for global innovation of new, life-saving commodities. This includes: 6) developing a multi-criteria priority classification model for value-based R&D investments; 7) proposing an R&D investment prioritization framework; and 8) examining global incentives to increase R&D investment in antibiotics. These interventions represent options across all four types of global governance arrangements; international rules (1,5), norms and discourses (2,3), market interventions (6,7), and access to domestic policy processes (4,8). Building on the diverse disciplinary expertise of the research team, each intervention is evaluated using a tailored social science method that is most appropriate, whether that is economic modeling (6-8), interrupted time-series analyses (1,5), interviews and document analyses (1,2,6,7), legal analyses (4,5,8), policy analyses (4,8), political analyses (2,3,8), simulation (7), surveys (1,6) or systematic reviews (5,7).