Achieving the Millennium Development Goals: Breaking the Logjam of Innovation
September 4, 2013
In the lead up to the UN General Assembly, the Skoll World Forum partnered with Johnson & Johnson, the United Nations Foundation and the Bill and Melinda Gates Foundation to produce an online debate focused on the last 850 days before the MDGs expire in 2015. We asked some of the world's leading experts what is one thing we must do differently or better to achieve MDGs 4, 5 and/or 6--all focused on improving public health--by the deadline?
Interim Director, Maternal, Newborn, and Child Health, Bill & Melinda Gates Foundation
CEO, Office of the UN Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria
Life-changing innovation sometimes comes in a plain-vanilla package.
Chlorhexidine is a workhorse antiseptic that’s been around since the 1950s. It’s used in more than 60 medical products widely available in drugstores and hospitals across the United States and Europe, from mouthwash to skin products to surgical washes. It’s inexpensive, effective, and safe.
In low-resource countries, it could be a powerful solution to an unacceptable tragedy: the preventable deaths of hundreds of thousands of newborns every year from infection. For about 30 cents a dose, a new formulation of chlorhexidine developed for low-resource settings could be used to prevent infection of newly cut umbilical cords and help save the lives of an estimated 422,000 babies over the next five years.
So what’s stopping us? On the road from development to delivery, innovation can lose its way. Market failures, regulatory and policy roadblocks, and gaps in supply and demand can choke off the flow of ideas and technologies through the development pipeline and put lifesaving solutions out of reach. This is one of our most urgent challenges for the next 850 days and beyond in achieving the Millennium Development Goals: breaking the logjam of innovation.
The pipeline is piled high with game-changing solutions such as chlorhexidine that have gotten stuck in the middle part of the pipeline where new discoveries or new applications of existing interventions can stall and die. Chlorhexidine has a long shelf life, requires no cold chain, and is easy to apply with minimal training and no equipment. Few other interventions have shown such promise for saving newborn lives in so many settings for such a low cost.
Yet chlorhexidine is an overlooked lifesaver. Regulatory hurdles, supply issues, misconceptions about guidelines for umbilical cord care, and a nascent market for the new product formulation all contribute to the product’s limited availability and adoption in developing countries.
Dismantling these barriers requires patient and persistent work. PATH, as secretariat of the Chlorhexidine Working Group, leads an international collaboration of organizations that’s been working since 2007 to promote the use of chlorhexidine for umbilical cord care through advocacy and technical assistance. That work helped lead to a recent decision by the World Health Organization (WHO) to add 7.1% chlorhexidine digluconate to its Model List of Essential Medicines for Children. This is a key step in encouraging its introduction in low-resource settings. PATH is also working to establish manufacturing in African countries to increase the product’s availability at an affordable price.
Global health has too many wallflowers like this, lifesaving solutions that have been sidelined in the development pipeline. Another example is magnesium sulfate. For about $1 a dose, this medicine could save an estimated 55,000 mothers over the next five years from preeclampsia and eclampsia, pregnancy-related conditions that are leading causes of maternal deaths. Confusion among health workers about dosing requirements inhibits routine use. WHO, Merck, PATH, and others are investigating a simplified dosing regimen to make it easier for health workers to administer.
Innovation is more than the act of invention. Truly transformative innovation also must include the everyday business of pushing solutions forward through the barriers that can keep them from achieving impact at scale. The hard work of identifying and developing health solutions, while not complete, has already delivered proven results. The next step will be at least as hard—shattering the walls that stand between these breakthroughs and the people who need them.
This can be painstaking, even tedious work, with payoffs that may not be as tangible as the creation of a new vaccine or the invention of a lifesaving device. It’s fair to say that market development, supply chain improvements, health system strengthening, and demand generation may never be hailed as global health’s “next big thing.”
Yet it is every bit as critical to the goal of saving the lives of women and children. We must cut through the bottlenecks to take innovation to scale, paving the way for the most promising ideas to reach the most vulnerable and disrupt the status quo of poor health and poverty.