Grab Lunch, Glimpse the Future

New ideas about the development and distribution of medical care, and perhaps a glimpse into the future of global health, will likely emerge through the collaboration of unrelated disciplines, according Adil Najam, director of BU’s Frederick S. Pardee Center for the Study of the Longer-Range Future. Bringing together experts who normally don’t work with one another is the idea behind the center’s new monthly interdisciplinary seminar series Future Challenges, which launches on Monday, March 24, with a lunchtime panel discussion titled Disease and Development.

Najam, the Frederick S. Pardee Professor of Global Public Policy and a College of Arts and Sciences professor of international relations and of geography and environment, will moderate a conversation featuring James McCann, a CAS professor of history, Randall Ellis, a CAS professor of economics, and Gerald Keusch, director of BU’s Global Health Initiative and Medical Campus associate provost for global health, as well as members of the audience. To find out where the economics of global medicine might be heading, BU Today spoke with Ellis, who is president-elect of the American Society of Health Economists.

BU Today: What challenges do developing countries face in providing better health care today?
Ellis: The good news is there’s a lot more financial aid to developing countries than there was 20 years ago. The Gates Foundation alone is spending over $900 million a year on health initiatives. That’s about 10 percent of all health aid internationally. But a growing amount of foreign aid for health programs is program-specific rather than system-wide. This is posing challenges in developing countries when it comes to creating coordinated health-care programs, particularly to cover primary care services. Instead, countries are focusing on specific diseases, like tuberculosis or HIV/AIDS, or on preventing polio and smallpox. We need to help them figure out how to coordinate with these broader programs and how not to fail at providing the basic public health services that have such high value in developing nations, particularly in sub-Saharan Africa.

What impact will booming economies in developing countries have on the distribution of high-quality medical care?
As countries move from low- to middle- or even upper-income levels, there’s a tendency for the health insurance and delivery programs to become extremely uneven and unfair. This is very apparent in South Africa, where there are enormous inequities between households. A few decades ago, these differences were primarily along racial lines. Now they seem to be more socioeconomic, with high- and middle-income households having solid insurance coverage at the same time that low-income households have almost none.

Another challenge will be to prioritize new technologies for countries as they make the transition from low to middle income. There are an awful lot of very expensive forms of treatment being generated in the West, and many of these will not be affordable to all for decades. How are we, as a society, going to prioritize which services are included in the benefits to be covered by social insurance or even private insurance programs? This is, above all, an issue for new pharmaceuticals, which increasingly are costing thousands, even tens of thousands, of dollars in the West. How will these new drugs be affordable? What can be done to promote the use of more cost-effective alternatives? What programs can help encourage international pharmaceutical companies to price recent drugs at affordable levels for developing country’s budgets?

What is the status of intellectual property rights when it comes to pharmaceuticals?
There’s been a strengthening of international patents, so that most countries do adhere to the patent protections of the large pharmaceutical companies. There are a few countries, India and Argentina, I believe, that have somewhat different rules about what is patentable, but they’ve been under a lot of pressure to conform to the international standards. There’s also been a lot of effort, however, to get international drug manufacturers to sell some of their drugs at a greatly discounted price or allow for production of the drugs in other countries.

How is globalization affecting the spread of disease?
Everybody who looks around has noticed that diseases are traveling faster and there are more people crossing boundaries, more airplanes flights, more trade. But also, information about diseases is traveling faster, so we’re much more likely to hear about an infectious disease or a new problem as it emerges. It’s brought awareness to the developed West. Even though we think we can ignore some of these rare or exotic diseases, it’s only a few exposures away from entering the United States or endangering Americans all over the globe. So it’s worthwhile for us to worry about these problems.

What about treatment?
The treatment is challenging in that the U.S. industrial complex focuses on developing technologies and drugs that will be lucrative, especially in the United States. They’ve been less willing to invest in some of the drugs that would be useful in the tropics or in low-income areas of the world — partly because the markup, the extra profits on prices, is much higher in the United States and Europe. Though that’s changing somewhat. Again, the Gates Foundation has funded a lot of research and development on certain kinds of drugs, and there’s a little bit more pressure on these companies to get them to invest in some very specific diseases: river blindness treatment in Africa, for example.

The Pardee Center is interested in the long view, so what trends and issues in the economics of medicine do you see down the road?
I think the growing globalization of trade, of ideas, of technology is one key theme for the future. And perhaps more international agreements by countries to live up to their share of providing international development aid.

The seminar Disease and Development, sponsored by the Frederick S. Pardee Center for the Study of the Longer-Range Future, will be held on Monday, March 24, at the Pardee House, 67 Bay State Rd. Lunch starts at 11:30 a.m., and the panel discussion at noon. The event is cosponsored by Boston University’s Institute for Economic Development, African Studies Center, and Global Health Initiative.

Caleb Daniloff can be reached at cdanilof@bu.edu.