BOX 3-2 Identifying Promising Interventions
The WHO Commission on Intellectual Property Rights, Innovation and Public Health identified an analytical framework laying out the four interrelated components that together define “the right to health interventions and technologies.” According to this framework, interventions should be available, acceptable, accessible, and of quality, as detailed below.
Available in sufficient quantities. To be available, the right kinds of interventions must exist. If they do not, the principal challenge is to spur innovation to create a product that fills the need. Where a suitable intervention already exists but is unavailable in adequate supply, solutions should be sought through research, such as the creation of a synthetic version of artemisinin, the antimalarial drug, because the natural product is in limited supply. Alternatively, an existing intervention may be suboptimal, such as current tuberculosis treatments that require six months of use and are cumbersome to administer. Then, too, an intervention may require effective procurement of existing products, the financing or subsidizing of production and distribution, or establishing effective delivery infrastructures.
Acceptable, in terms of both their usability and their appropriateness, given cultural and other factors. This requires the right kinds of products, tailored to the specific technical and social needs of the group that will use them. Knowledge is a critical element of creating acceptable interventions, such as knowledge of existing gaps in scientific know-how and clinical outcomes and of behavioral and cultural norms. This sort of knowledge requires its own kind of research and usually relies on epidemiological or social anthropological studies to understand the scale of the impact of a disease on a community or of the means required to achieve uptake of an intervention. Education and health systems research can play an important role.
The lowest possible cost to facilitate access. This requires the financing of research, and the availability of finance often drives the direction of research (HIV/AIDS, for example, has greatly benefited from the active involvement of public sector institutions); affordable pricing of medicines; the financing of procurement that can help to scale up and manufacture new products; and access to existing products.
Effective and of good quality. This requires standards for testing new products, as well as incentives to conduct clinical trials in key populations. Particular ethical and technical challenges need to be resolved for the testing of products on pregnant women and very young children, particularly those who are poor, marginalized, and often most at risk.
SOURCE: Adapted from the Commission on Intellectual Property Rights, Innovation and Public Health, 2006.
