{"id":81,"date":"2010-08-05T08:45:19","date_gmt":"2010-08-05T13:45:19","guid":{"rendered":"http:\/\/carleton.ca\/criticalconversation\/?page_id=81"},"modified":"2012-05-04T11:16:47","modified_gmt":"2012-05-04T15:16:47","slug":"innovations-in-public-private-partnerships-related-to-hivaids","status":"publish","type":"page","link":"https:\/\/carleton.ca\/criticalconversation\/critical-conversations\/hiv-aids\/innovations-in-public-private-partnerships-related-to-hivaids\/","title":{"rendered":"Event Summary"},"content":{"rendered":"

Innovations in Public-Private Partnerships Related to HIV\/AIDS<\/strong>
\nThursday November 1, 2007:<\/strong><\/p>\n

Summary<\/strong><\/p>\n

On November 1, 2007 Carleton\u2019s School of Public Policy and Administration, in collaboration with the Canadian International Development Agency (CIDA), the Public Health Agency of Canada (PHAC) and the Wellesley Institute hosted a critical conversation on HIV\/AIDS, as part of the Carleton\u2019s Critical Conversations series. The discussion drew both Canadian and international participants from the public, private, academic, and non-profit sectors to share their expertise in the innovative approaches to public-private partnerships (PPSs) specific to HIVAIDS.\u00a0 This report highlights some of the main conclusions made by the leading specialists from CIDA, PHAC, Bill and Melinda Gates Foundation, International AIDS Vaccine Initiative (IAVI), PneumoAdip, GAVI Alliance, Industry Canada, the Philanthropic Foundation of Canada, as well as Johns Hopkins and Carleton Universities.<\/p>\n

One of the overwhelming themes was the possibility of the PPP\u2019s achievement of a greater combined good resulting from the combination of each sector\u2019s cultures and expertise.\u00a0 The advantage of the PPP could be in the fact that generally the public sector has the desire to pursue the public good, while the private sector seeks to maximize benefits with minimum resources and the philanthropic foundations bring flexibility, quicker decision making and fewer accountability-related restrictions. With the mix of the strength of each sector, the partnerships could maximize benefits with minimum resources. It was established that there is a need for a model whereby the AIDS epidemic is addressed with the support and conviction of the public and philanthropic sectors but with the private sector mentality of efficiency.<\/p>\n

Among the critical success factors for sustainability in public private partnerships were: an understanding of each partner\u2019s needs, expectations and organizational procedures; a communication network for all partners; harnessing of the energy of different sectors; return on investment; transparency and establishment of trust and mutual interest; setting of clear outcomes; agreement on the overall goal; access to information and, shared governance.<\/p>\n

Although there are a number of successful PPPs, they still face some challenges. For example, vaccines do not necessarily reach those most in need due to market failures, regulatory shortcomings and partnerships that fail to address everyone\u2019s best interests.\u00a0 The participants identified best practices to overcoming these obstacles. \u00a0In terms of vaccine development and production, among the recommendations were finding the \u201csweet spot\u201d where the interests of the developing countries, vaccine makers, and international organizations converge. In addition, strategies to make a business\/investment case appeal to industry were suggested, such as: calculation of the cost of inaction and establishment of a counterfactual, explicit expression of ambitions and the means of result measurement, maintenance of long-term political will and sustenance of efforts, identification of key stakeholders and the building of momentum.<\/p>\n

In conclusion, the PPPs are an enormous opportunity to win the global fight against HIV\/AIDS, provided each player follows the best practices and becomes part of the value chain.\u00a0 To learn about the discussion in more detail, please see below:<\/p>\n

Detailed Conversation<\/strong><\/p>\n

Dr. Ernest Loevinsohn<\/strong>, Director General, CIDA, reminded the assembly that AIDS is the fourth largest cause of death worldwide. He shared the Canadian Government\u2019s approach to tackling HIV\/AIDS as rights-based, focusing on the needs of the growing number of women and children affected by the epidemic. Dr. Loevinsohn pointed out that it takes ample resources to implement the rights of the most vulnerable, and accordingly, he made the link between the public and private sectors and discussed whether the latter\u2019s massive resources can help accomplish the goals of the former in the fight against the disease.<\/p>\n

Dr. Loevinsohn posed a few critical questions from the perspective of the public sector when joining a PPP:<\/p>\n

\n
    \n
  • When should the public sector engage with the private sector?<\/li>\n
  • When the resources of the public sector are simply not enough?<\/li>\n
  • How can a fair process be ensured when the public sector engages with the private (i.e. can\u2019t play favorites)? Which private sector company gets the money?<\/li>\n<\/ul>\n<\/div>\n

    Dr. Loevinsohn also posed a few questions from the perspective of the private sector when joining a PPP.<\/p>\n

    \n
      \n
    • Is this going to be profitable?<\/li>\n
    • Is it going to effect long term profitability\/market share?<\/li>\n
    • Does this look good for corporate social responsibility?<\/li>\n
    • How does this affect the company morale?<\/li>\n<\/ul>\n<\/div>\n

      Dr. Loevinsohn concluded that the advantage of the PPP could be in the fact that the public sector has the desire to pursue the public good, and the private sector, to maximize the benefit with minimum resources. With the mix of the cultures of the two sectors, the partnerships could maximize benefit with minimum resources.<\/p>\n

      Dr. Jose Esparza<\/strong>, a Senior Advisor on HIV Vaccines for the Bill and Melinda Gates Foundation (BMGF) began by giving a brief overview of the Foundation.\u00a0 He highlighted their focus on education and health- acknowledging that science and technology have the potential to improve people’s lives, and that the Foundation strives to deliver results to the disproportionably impacted developing countries.\u00a0 The core value of the Bill and Melinda Gates Foundation is: \u201call lives, no matter where they are being led, have equal value.\u201d<\/p>\n

      The Bill and Melinda Gates Foundation funds the Collaboration for AIDS Vaccine Discovery (CAVD), which is an international network of eleven Vaccine Discovery Consortia (VDCs) and five Central Service Facilities (CSFs). CAVD grants target a strategic gap in HIV vaccine development: translation\/maturation phase. In addition, the Foundation formalized a Memorandum of Understanding with the Government of Canada, collaborating for the Canadian HIV Vaccine Initiative (CHVI).\u00a0 Their HIV\/AIDS vaccines program bases its global access strategy on a thorough understanding of the market. There are major scientific and organizational challenges with HIV vaccine development, so the Global HIV Vaccine Enterprise seeks a greater strategic focus, increased resources and greater collaboration. Dr. Esparza\u2019s work focuses on prevention, although it also supports some treatment initiatives.\u00a0 Dr. Esparza stated that in his opinion the success of PPPs depends in large part on one\u2019s understanding of the linkages between profitability and sustainability.\u00a0 As a concluding remark, Dr. Esparza noted, \u201cthe development of an HIV vaccine represents one of the most difficult challenges that modern bio-medical science is confronting.\u201d<\/p>\n

      John McGoldrick, <\/strong>Senior Vice President, International AIDS Vaccine Initiative (IAVI) started his presentation by stating that \u201cwe can save many lives, and we have an obligation to save as many lives as we can; it has become obvious that we are not going to treat our way out of this epidemic in the developing world.\u201d Dr. McGoldrick believes that the one thing that can stop the epidemic is a vaccine. The critical question is \u201cwhen\u201d?
      \nIn terms of public-private partnerships, Dr. McGoldrick remarked first that pure market forces are not enough to generate the vaccine.\u00a0 Second, that there is a need for a different model involving public and philanthropic support with a private sector mentality and lastly, that all partners must maximize results and minimize resources.<\/p>\n

      Mr. McGoldrick concluded by discussing how IAVI is a PPP that focuses on the HIV vaccine with a concentration on the developing world.\u00a0 IAVI is distinctive, if not unique, for its focus on a vaccine. Canada has been visionary in many regards with respect to AIDS epidemic and is one of a dozen countries supporting IAVI, along with organizations like Bill and Melinda Gates Foundation. Early on, Canada stepped forward, and a recent two-year grant for IAVI from Canada has been a good shot of life blood in the arm for which IAVI is very grateful.<\/p>\n

      Question and Answer Period<\/strong><\/p>\n

      Following Dr. McGoldrick\u2019s speech, Carleton\u2019s Dr. Jackson acted as moderator during a brief open discussion involving the presenters, discussants and other conference participants.\u00a0 The opening question was \u201cwhat are the criteria for successful sustainability for PPPs and AIDS?\u00a0 Dr. Esparza responded by listing money, return for investments and the need to harness the energy of different sectors as key ingredients to successful sustainability.\u00a0 He also stated that if members do not understand the needs and expectations of one partner than the partnership will fail.\u00a0 According to Dr. Exparza, approximately 60% of partnerships in the private sector fail; which is a very high percentage and studies indicate they usually fail in the implementation phase.\u00a0 Dr. McGoldrick also responded to the question by listing trust, transparency, openness, clarity and straight talk as essential to successfully sustaining public-private partnerships with respect to HIV\/AIDS.<\/p>\n

      The discussion then moved on to the question of: what is the added value of the private sector when it comes to a public good like the HIV vaccine?\u00a0 Dr. Esparza responded by saying that the HIV vaccine is an example of market failure.\u00a0 Due to fact that the private sector is not really interested, the public sector must exert an enormous effort to create scientific innovation and attempt to create the vaccine.\u00a0 However, the government does not really possess the scientific knowledge and expertise to create this vaccine, and so it is very unlikely that the vaccine would ever be created from a purely public sector effort.\u00a0 Dr. McGoldrick expanded on Dr. Esparza\u2019s comments by stating that the talents of the public sector are not complete for this vaccine task.\u00a0 In fact, according to Dr. McGoldrick the private sector\u2019s skill set is not complete for the HIV vaccine task either because they lack on the purpose\/motivation front.<\/p>\n

      Dr. Orin Levine<\/strong> began by giving a brief overview of PneumoADIP. He mentioned that pneumonia is responsible for more deaths than people realize, and it is on par with HIV\/AIDS, malaria and tuberculosis as a cause of death. In addition, pneumonia has doubled in concert with AIDS explosion, and it often kills or is spread after an influenza epidemic.\u00a0 However, there is hope, and it lies mainly in the success of the pneumococcoal vaccine.\u00a0 However, there are a number of challenges. Although the World Health Organization (WHO) recommended that the pneumococcoal vaccine be introduced in every country, it still hard to get the vaccine out.\u00a0 One would think that these vaccines would be flooding into Africa but they are not. Industry didn\u2019t see a demand in developing countries, even though people in developing countries are most at risk. Consequently, the industry limited its production to supply wealthy countries, and a limited supply means high prices. Now, the developing countries are beginning to express their demand for pneumo-caucal vaccines and this is key. It is just as much work to deliver the vaccine as it is to create it.<\/p>\n

      Dr. Levine shared successful strategies of PneumoADIP and suggested concrete steps in establishing lasting PPPs in the vaccination industry.\u00a0 Specifically, he opined there is a need to find the \u201csweet spot\u201d where interests of the big three (developing countries, vaccine makers and international organizations) converge.\u00a0 In addition, it is necessary to make a business or investment case to appeal to industry.\u00a0 He argued that the successful PneumoADIP approach is organized around three areas of activity: establishing value, communicating value and delivering value.\u00a0 Dr. Levine concluded his presentation with four key principles to follow in respect to PPPs: calculate the cost of inaction and establish a counterfactual, make your ambitions explicit, understand the needs of stakeholders and find a solution space and establish yourselves as a continuous value chain aimed at realizing the ambitions expressed.<\/p>\n

      Dr. Kumar<\/strong> opened by giving a brief presentation on GAVI.\u00a0 GAVI is a unique public-private partnership that brings together all major stakeholders in the field of immunization.\u00a0 The GAVI board has representation from WB, WHO, UNICEF, donor and recipient governments, industry and civil society.\u00a0 GAVI\u2019s mission is to save children and protect people\u2019s health through immunization in poor countries.\u00a0 Dr. Kumar then discussed a common complaint about GAVI- that it was too ad hoc.\u00a0 Going forward, she said that GAVI would like to make a priority list so that countries can pick the vaccines they need most off an established list.\u00a0 Dr. Kumar also touched on accelerated development plans, the introduction of new vaccines (i.e. impact assessments), emerging civil-society partnerships and the program-level principles of the private sector.\u00a0 Increasingly, vaccines purchased by UNICEF are manufactured in the developing world and so recently there has been a dramatic increase in the immunization.\u00a0 She said that there is a high return from immunization (18%) because of economies of scale and supply and demand forces and long-term investment strategies must be prioritized.<\/p>\n

      Question and Answer Period<\/strong><\/p>\n

      Another open discussion period followed Dr. Levine and Dr. Kumar\u2019s speeches.\u00a0 This discussion focused on the question of how to avoid blockages like the ones that are being seen with the delivery of the HPV vaccine?\u00a0 It is suggested that looking at the rollout of the HPV vaccine as a case study could be quite valuable as it has many issues similar to that of the potential HIV\/AIDS vaccine.\u00a0 Government, specifically PHAC and CIDA, understand that these \u201csofter\u201d issues- of how to reduce blockages and regulatory issues- are important but are not sure how to facilitate eliminating them.<\/p>\n

      Dr. Keough<\/strong> began his lecture with a discussion of the fact that PPP\u2019s usually require an extensive front-end investment from the public sector and then the private sector takes over.\u00a0 This investment progresses over four stages, specifically: discovery, development, production and marketing.\u00a0 Dr. Keough specified that a public good PPP- driven model will always involve a continuous investment by the public sector because the private sector shareholder is usually unwilling to assume the risk at the end section of the project and so public sector must always step in and remain strongly involved until the end of the project.\u00a0 He also emphasized that it is important to find the investment or business \u201cspace\u201d where all partners are comfortable- where everyone wins.\u00a0 When the interests of the pubic and the private sector intersect, it results in a more effective PPP.\u00a0 While it often takes more energy to have an effective PPP the output will be higher and could potentially be higher than just the sum of the shareholder\u2019s outputs.\u00a0 For HIV\/AIDS-specific public-private partnerships it is necessary to provide a platform for training in public health administration for the developing countries to set up new alliances.\u00a0 According to Dr. Keough, this will allow the public sector to gain new customers new alliances and new facilities.\u00a0 Dr. Keough concluded by stating that the main barriers to effective PPP\u2019s are: control, culture, comfort, risk tolerance and legal or regulatory issues.<\/p>\n

      Hilary Pearson<\/strong> began by discussing the large cultural divide between the sectors (public, private, philanthropic).\u00a0 In Canada, there are very few PPP initiatives, and none on the scale of the Bill and Melinda Gates Foundation.\u00a0 In Quebec there is the Chagnon Foundation (at $1.5 billion) and many other smaller organizations.\u00a0 Foundations have advantages of flexibility, speed in decision-making, high risk tolerance, willingness to admit failure, more patience than government and more freedom from overly-restrictive accountability measures.\u00a0 Ms. Pearson ended her presentation by referring to some lessons drawn from a recent German conference which listed the following as crucial factors for successful PPPs, specifically: clarity of objectives, support from political decision-makers, communication network for all partners, understanding of cultural differences.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Innovations in Public-Private Partnerships Related to HIV\/AIDS Thursday November 1, 2007: Summary On November 1, 2007 Carleton\u2019s School of Public Policy and Administration, in collaboration with the Canadian International Development Agency (CIDA), the Public Health Agency of Canada (PHAC) and the Wellesley Institute hosted a critical conversation on HIV\/AIDS, as part of the Carleton\u2019s Critical […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":17,"menu_order":0,"comment_status":"open","ping_status":"open","template":"pg-full.php","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","_mi_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":"","_links_to":"","_links_to_target":""},"yoast_head":"\nEvent Summary - 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