Comparing barriers and enablers of women's health leadership in India with East Africa and North America.

Background: Women are estimated to hold between 70 and 75% of global health positions worldwide yet persistent inequities in power and leadership remain. There is little information on specific enablers and barriers that women working in public health face in India and how those compare with other regions. Methods: We collected and analyzed information from women working in public health in India and East Africa (Kenya, Rwanda, and Uganda) and in global health (Canada and United States), to understand and document the specific enablers and barriers women face in India, compared with other regions. Findings: Several universal themes emerged around factors enabling (mentors, professional networks, leadership based in empathy and team building) or impeding (obvert bias and family responsibilities) women across all contexts. Within this, there are nuances in how women's leadership growth factors and obstacles play out in India differently than in other contexts. Interpretation: There are important similarities in the enablers and barriers faced by women in India and other geographies and important ways these differs in for women in India. By designing programs and policies at institutional levels to address these factors, we can create a professional ecosystem that works for women in health and beyond. Funding: This research was funded by WomenLift Health, which is funded by the Bill and Melinda Gates Foundation. Representatives from WomenLift Health, listed as authors, participated in the conceptualization of the research to define objectives and core questions, provided commentary and revision to improve the manuscript, and supervised the progress of the research.

More Women Must Lead in Global Health: A Focus on Strategies to Empower Women Leaders and Advance Gender Equality.

Despite comprising 70% of the health workforce, women fill only 25% of senior and 5% of top health organization positions. Greater diversity in global health leadership, particularly greater representation of women, is essential to ensure diverse perspectives and ideas inform policies and priorities. Interviews and literature reviews surfaced many of the key challenges that women in global health face at individual, organizational and societal levels. Initiatives working to advance women's leadership are encouraged to consider 5 key priorities that address these challenges.

Modeling the potential impact of emerging innovations on achievement of Sustainable Development Goals related to maternal, newborn, and child health.

BACKGROUND: Innovations that improve the affordability, accessibility, or effectiveness of health care played a major role in the Millennium Development Goal achievements and will be critical for reaching the ambitious new Sustainable Development Goal (SDG) health targets. Mechanisms to identify and prioritize innovations are essential to inform future investment decisions. METHODS: Innovation Countdown 2030 crowdsourced health innovations from around the world and engaged recognized experts to systematically assess their lifesaving potential by 2030. A health impact modeling approach was developed and used to quantify the costs and lives saved for select innovations identified as having great promise for improving maternal, newborn, and child health. RESULTS: Preventive innovations targeting health conditions with a high mortality burden had the greatest impact in regard to the absolute number of estimated lives saved. The largest projected health impact was for a new tool for small-scale water treatment that automatically chlorinates water to a safe concentration without using electricity or moving parts. An estimated 1.5 million deaths from diarrheal disease among children under five could be prevented by 2030 by scaling up use of this technology. Use of chlorhexidine for umbilical cord care was associated with the second highest number of lives saved. CONCLUSIONS: The results show why a systematic modeling approach that can compare and contrast investment opportunities is important for prioritizing global health innovations. Rigorous impact estimates are needed to allocate limited resources toward the innovations with great potential to advance the SDGs.

An updated methodology to review developing-country vaccine manufacturer viability.

In 1997, Milstien, Batson, and Meaney published "A Systematic Method for Evaluating the Potential Viability of Local Vaccine Producers." The paper identified characteristics of successful vaccine manufacturers and developed a viability framework to evaluate their performance. This paper revisits the original study after two decades to determine the ability of the framework to predict manufacturer success. By reconstructing much of the original dataset and conducting in-depth interviews, the authors developed informed views on the continued viability of manufacturers in low- and middle-income country markets. Considering the marked changes in the market and technology landscape since 1997, the authors find the viability framework to be predictive and a useful lens through which to evaluate manufacturer success or failure. Of particular interest is how incumbent and potentially new developing-country vaccine manufacturers enter and sustain production in competitive international markets and how they integrate (or fail to integrate) new technology into the production process. Ultimately, most manufacturers will need to meet global quality standards to be viable. As governments and donors consider investments in vaccine producers, the updated viability factors will be a useful tool in evaluating the prospects of manufacturers over the mid to long term. The paper emphasizes that while up-front investments are important, other critical factors-including investments in a national regulatory authority, manufacturer independence, and ability to adapt and adopt new technology-are necessary to ensure viability.

The GO License: only part of the solution.

The Generic Open (GO) License is a proposal to make patents more accessible for vaccines and drugs in low- and middle-income countries. However, for some health-related products, such as vaccines, intellectual property is frequently not the primary constraint. Technical know-how and assurance of a viable market built on reliable demand at prices that cover costs are the most critical factors for vaccine access. Together with innovative efforts to reduce product development risks and costs and to assure credible markets at profitable prices, the GO License may yet play a role in assuring access for drugs and vaccines for poor countries.

Chapter 26: Innovative financing mechanisms to accelerate the introduction of HPV vaccines in developing countries.

The costs of developing and producing new-generation vaccines have increased compared to many of the older, "traditional" vaccines because of new technologies and regulatory requirements. While the public sector often supports basic research costs, private manufacturers are usually responsible for the investments in product development and production scale-up. When considering investments, firms evaluate the probability of a market. Unfortunately, the developing country vaccine market is small (in revenue terms) and often unpredictable, particularly given inaccurate forecasting in the past. Low-income developing countries expect low prices. Demand (actual decisions to pay for and introduce the vaccine) is almost always lower than need (estimates of requirements to achieve optimal public health outcomes), a distinction that may be even more significant for HPV vaccines given the number of new vaccines against priority diseases that will become available over the coming 5 years. One new mechanism under consideration to address some of these challenges is Advanced Market Commitments (AMCs). By providing an assured price subsidy for developing country purchase of a future vaccine meeting predefined standards, an AMC would provide industry with greater assurances of earning a reasonable return on their investment to serve the poorest developing countries. The AMC mechanism could provide critical motivation for increased industry (private) investment that would otherwise not occur. HPV vaccines are one of six vaccines being considered for a possible AMC pilot.

The problems and promise of vaccine markets in developing countries.

As in the market in North America, major barriers to private investment in the development and production of vaccines exist for markets in developing countries. These include the risks of uncertain funding and demand and the difficulties created by historically low pricing. A number of promising and innovative approaches nonetheless are being explored to increase the incentives and reduce the risks of investing in vaccines for developing countries. These innovations are fueled by the growing recognition of powerful stakeholders that vaccines are a critical technology for ensuring global health.

PneumoADIP: an example of translational research to accelerate pneumococcal vaccination in developing countries.

Historically, the introduction of new vaccines in developing countries has been delayed due to lack of a coordinated effort to address both demand and supply issues. The introduction of vaccines in developing countries has been plagued by a vicious cycle of uncertain demand leading to limited supply, which keeps prices relatively high and, in turn, further increases the uncertainty of demand. The Pneumococcal Vaccines Accelerated Development and Introduction Plan (PneumoADIP) is an innovative approach designed to overcome this vicious cycle and to help assure an affordable, sustainable supply of new pneumococcal vaccines for developing countries. Translational research will play an important role in achieving the goals of PneumoADIP by establishing the burden of pneumococcal disease and the value of pneumococcal vaccines at global and country levels. If successful, PneumoADIP will reduce the uncertainty of demand, allow appropriate planning of supply, and achieve adequate and affordable availability of product for the introduction of pneumococcal vaccines. This model may provide a useful example and valuable lessons for how a successful public-private partnership can improve global health.