Co-authored with Dr. Adel Mahmoud
Why is it that we can buy Coca-Cola beverages virtually anywhere, when basic health products like oral rehydration therapy or condoms are unavailable in many of those same places? As discussed in a recent Princeton Seminar on Global Health, the answer to this question and others may lie in applying the relevant expertise of the private sector to new health initiatives through public-private partnerships for the improvement of global health. Although global health was historically dominated by UN agencies and bilateral organizations, new partnerships with the private sector have emerged since the 1990s. For example, today the U.S. Agency for International Development (USAID) alone has formed nearly 700 public-private partnerships, demonstrating a remarkable increase from around 50 public-private partnerships existing in the 1980s. In part, global health's private sector revolution has been spurred by advances in science and technology as well as the realization that previous "magic bullet" interventions are insufficient to address the broad determinants of health.
With an evident link between a country's GDP and its overall health status, the private sector has a stake in global health improvements. From a macroeconomic perspective, a corporation's investment in the well-being of its consumers has long-term benefits for its economic development through the creation of new markets and the availability of additional human resources. Although short-term pressures from investors may conflict directly with a corporation's decision to allocate resources towards long-term societal improvement, experience shows that there is long-term value in investments that create benefits for both companies and the societies in which they operate.
Beyond corporate responsibility, the private sector can contribute to global health with its resources, expertise, and innovation. Knowledge of product delivery, research and development, and manufacturing and supply can be translated to global health interventions. Particularly in the realm of pharmaceuticals and vaccines, corporations are needed to create products that enhance global health, and public-private partnerships can be utilized to distribute those commodities and improve access for millions. For example, through its Mectizan Donation Program, Merck & Co., Inc., has donated more than 1 billion treatments of Mectizan for the control and eventual elimination of river blindness to regions in need. By partnering with the WHO, World Bank, ministries of health, and various NGOs, the Mectizan Donation Program demonstrates the potential for a public-private partnership to combat disease and make significant health improvements. Further, global health actors in the public sector can leverage the expertise of corporations to fill in their own gaps. For instance, the public sector can make improvements in access to health products by examining the supply chain and distribution networks of the private sector and devising ways to apply those same systems to the delivery of medical commodities.
Despite the potential for a win-win situation, the involvement of the private sector inevitably alters the landscape of global health and brings its own host of uncertainties. The private sector itself is heterogeneous and includes its own global health actors ranging from the Global Alliance for Vaccines and Immunization (GAVI) and the Global Fund to Fight AIDS, TB and Malaria (where the private sector sits on the board with other partners) and the Bill & Melinda Gates Foundation, to the individual private practices of physicians, pharmacies, and clinics in developing countries and emerging markets. With such complexity, are all partners equally influential in public-private partnerships? And who holds the private sector accountable? Further, could the potential resources of new partnerships go to waste due to a lack of adequate governance, financial architecture, and coordination between the public and private sectors of global health? With the historical distrust and skepticism of private sector involvement from some in the public sector and civil society, the progress of public-private partnerships will rely on discovering common ground and working together to answer these questions in specific circumstances. As a growing number of examples clearly demonstrate, the private sector has a major role to play in achieving an important and positive impact on global health.
Adel A. F. Mahmoud, MD, PhD, is a professor at the Woodrow Wilson School of Public and International Affairs and the Department of Molecular Biology at Princeton University. He has recently retired as President of Merck Vaccines and member of Management Committee of Merck & Company, Inc.