Director-General

Dr Margaret Chan speaks about game-changing innovations

Dr Margaret Chan
Director-General of the World Health Organization

Keynote address at the Pacific Health Summit on Game Changers: Affordability and Technologies for Health, session on “Affordable versus cheap: how do we assess value; who should pay?”
London, UK

13 June 2012

Colleagues in public health, ladies and gentlemen,

This is a time of nearly global economic austerity. Spending decisions, also for health development, are being made very carefully, with a strong emphasis on investments that deliver measurable results.

This reality forces an obvious question.

With expectations for health care rising, costs soaring, and budgets shrinking, can the unprecedented momentum for better health that marked the start of this century be maintained?

I see abundant signs that it can. Progress continues, but on a different footing, sometimes on an even surer footing. Much of the answer, I believe, lies in innovation.

We must count on innovation as never before. And I mean the right kind of innovation. Innovation does the most good when it responds to societal needs and not just to the prospects of making a profit.

Last year, a new vaccine, developed in a project coordinated by WHO and PATH, was rolled out in Africa’s notorious meningitis belt.

The project was initiated at the request of African ministers of health. They specified the ideal vaccine, right down to the price: no more than a dollar a dose. As one minister noted, a vaccine that is too expensive for Africa is worse than no vaccine at all.

The international scientific community delivered, in record time, at a cost of only 50 cents per dose. The payback is enormous. A single case of epidemic meningitis can cost a family the equivalent of 3 to 4 months of income.

The vaccine is highly effective and affordable, but by no means cheap. WHO has certified that it meets the highest international standards of quality, efficacy, and safety.

But market forces would never have given Africa the best product that science can offer. All the major vaccine companies were approached, and turned the project down. The Serum Institute in India said yes.

There are some lessons for us here: about unmet needs of the poor, about the value of the right kind of public-private partnership, about South-South collaboration, and about the failure of market forces, acting alone, to solve social problems.

Here is another lesson. Not all innovation needs rocket science. Given the world’s most pressing health problems, the true genius of innovation these days resides in simplicity.

The quest for simplicity and ease of use is not a natural one. Unlike other fields of technical innovation, like computers or mobile phones, advances in medical technology nearly always come with greater complexity and a much higher price. The complexity increases the costs further as highly skilled workers are needed.

At some point we come up against a brick wall, where even the richest countries cannot afford to widely implement the newest interventions. The rise, everywhere, of noncommunicable diseases, with growing numbers of people requiring long-term, sometimes lifelong care, forces us to look at the costs.

Health is benefitting from a new wave of innovation, stimulated in part by commitment to reduce maternal, neonatal, and young child deaths.

The cycle of discovery and invention starts with a diagnosis of the real reasons why women and babies are dying from easily preventable causes. It looks at the realities of a world facing a shortage of more than 4 million doctors, nurses, and other health care staff.

It looks at the places where most preventable deaths occur: the remote rural settings where skilled staff are scarce, facilities are primitive, equipment and essential medicines are missing, electricity is unreliable, and transportation to emergency care simply does not exist.

This is why simplicity and ease of use must be built into the product profile.

Let me give three examples. The first is the Odon device for assisted delivery when labour is obstructed or prolonged: a major cause of maternal deaths.

The device, developed by WHO and now undergoing clinical trials, is inexpensive, ingenious, and so simple it can be used by lower-level staff.

If approved, this will be the first new assistive device since forceps and the vacuum extractor were introduced centuries ago. It will give resource-constrained settings something they badly need: a new life-saving tool.

Also undergoing large clinical trials is a simple paper checklist for safe childbirth. The results of an initial study were published last month. Following introduction of the checklist, adherence to acceptable clinical practices improved by 150%.

No additional resources were invested. Just a simple piece of paper, like pilots use.

Last year, WHO prequalified China’s State Food and Drug Administration. Once individual vaccines are prequalified by WHO, the country’s capacity to produce a large number of vaccines at affordable prices will revolutionize vaccine supplies and their prices.

These are examples of strategic innovation. They are simple and frugal. And they can be game-changers, also in continuing to fuel and sustain the unprecedented momentum for better health.

Thank you.

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