When Leonid Brezhnev and Richard Nixon sat down for their leaders’ summit in Moscow in 1972 it was a crucial point in world history. Both leaders realised that decades of suspicion and hostility between the United States and the USSR had to be overcome to build a better world and to avoid the costs of not working together. It was new territory for both sides and required information exchange and new ways of thinking. It also needed leaders to take risks to open dialogue with the other side who historically had been viewed with wariness and scepticism. Similarly, the dialogue and rapport that developed between Ronald Reagan and Mikhail Gorbachev during the 1980s helped set the scene for subsequent major reductions in nuclear weapons and helped lead to the end of the Cold War.
One gets the sense that when it comes to global health policy we are moving towards some sort of détente – and it is one that is needed. The United Nations Sustainable Development Goals (SDGs) on health agreed by world leaders in 2015 are designed to ensure healthy lives and well-being for all by 2030. They span many areas such as reducing mortality, achieving universal health coverage, supporting the development of new medicine and vaccines, and building health system capacity in countries.
This is an ambitious project. It will require the public, private and community sectors to work together, often in ways that have not been done before. Encouragingly, Director General of the World Health Organization, Dr Tedros, has reiterated that the WHO will work with any partner, public or private, who can improve global health. There are those who have suggested that private sector players like the pharmaceutical industry should be excluded from discussions of global health policy, arguing that it is inappropriate for the private sector to be involved in discussions on public health initiatives. However, this is a naïve view.
The fact is that the private sector is going to be critical to achieving the health SDGs, something recognised in Goal 17 of the SDGs which calls for innovative multi-stakeholder partnerships, including with the private sector. The private sector can bring investment capital, commercial drive, innovation, new solutions and a fresh perspective to global initiatives. When the world leaders signed off on the SDGs in 2015 at the United Nations in New York, they called on the private sector to develop new, innovative solutions to help achieve the SDGs, including health. The pharmaceutical industry is already increasingly partnering with other sectors to improve health outcomes. The count of health partnerships between pharmaceutical companies and other players already stands at almost 350 and growing, so collaboration between the private and public sectors in health initiatives is not new.
There are also already a number of examples where the public, private and civil sectors are working together on common global health initiatives, such as the Medicines Patent Pool, GAVI, the Pandemic Influenza Preparedness Framework, the AMR Alliance and Access Accelerated. While each of these has varying degrees of engagement, collaboration and progress, they all provide a hint of what is possible.
And while these types of initiatives are becoming more common, what is still required is a step change in the dialogue. With a suite of global health goals to be achieved by 2030, collaboration between the public, private and community sectors needs to reach a new level of sophistication, drawing on the different synergies these sectors have to offer. In areas such as achieving vaccination coverage, overcoming anti-microbial resistance or addressing the growing burden of non-communicable diseases, this higher-level collaboration will be critical to success.
But it will not be easy. There is still much misunderstanding between the public, private and community sectors that is affecting the implementation of global health policy. We need to get better at intelligently combining competition and collaboration, as well as developing dialogue between different sectors.
Public sector players, such as political leaders, payer agencies, policy experts, research agencies and regulators will have to continue developing new frames and approaches for working constructively with the private sector. Public sector reform, including the deepening of policy capabilities and professionalism, has been a priority of many countries’ governmental structures. The accelerating changes in the health sector mean that health-focused government agencies will need to embrace these transformational changes in public sector management.
The private sector, including pharmaceutical companies, medical device companies, service companies, insurers and industry associations will have to continue to develop new business models that support collaboration alongside competition. This is similar to a trend seen in other industry sectors where terms such as ‘coopetition’, ‘alliance capitalism’ and the ‘collaborative economy’ have become increasingly common. Think of examples in sectors such as information technology, defence industries and infrastructure development.
Meanwhile, the community sector, including patient groups, healthcare professional groups and activist organisations, will need to get more comfortable working with both the public and private sectors if it wants to be a constructive partner in achieving the health SDG goals.
For some, exploring this new territory will be uncomfortable and challenging. New models and rules of engagement will be different and will overturn previously successful tactics and strategies. Cold War thinking will need to be abandoned. Ultimately, how the different players engage, understand each other and find new ways to work together will determine our success in achieving the global health goals we have set ourselves.
Brendan Shaw is the Principal of Shawview Consulting, having previously held senior positions in international and national pharmaceutical industry associations and public sector positions