"Although 'pull' is relatively new to public health, it has a good track record"

Push and Pull
By JAMES SUROWIECKI
Published: December 20, 2004
The New Yorker

This article which appears in the New Yorker, introduces an interesting perspective about introducing vaccines and drugs to developing nations. Many developing nations simply lack the funds needed to buy drugs and vaccines for their people. The average amount of money spent on healthcare in some developing nations is only a few dollars where as in the US it is upwards of $5000 per capita. This huge discrepancy creates another similar problem. New drugs companies take massive risks when it comes to developing new drugs. Investments for such drugs can near a billion dollars and drug producers will target their drugs to the populations that will be most willing to pay high prices. Therefore, there has been a dearth in research and development for diseases afflicting developing nations. Companies realize that their investment, if directed towards solutions for developing nations, may not yield an acceptable return.

The author of this article introduces the concept of incentive and how the UK has promised to buy three hundred million doses of malaria vaccine once proven safe and effective. There are two ways that the governments of western nations entice companies to devote R&D to certain causes. The first method is called “push.” These push mechanisms are how much research has been directed. The government gives direct funding to labs and organizations that are committed to a certain cause. This is quite common and it is how the NIH does most of its funding now. The other approach to promoting research is through “pull” mechanisms. This is the strategy that the UK employed in its blanket claim. Pull mechanisms put the role of competition into the field of the drug companies. This approach seems highly efficient and more beneficial in the long run. It removes government funding of “failed attempts” as is common with push mechanisms.

It seems that world governments and private organizations such as the Bill and Melinda Gates Foundations current tend towards push mechanisms. And even though their contributions to the world of research and the movement to find cures are indispensible, their funding could be better spent by using them as “a carrot on the end of a stick.” By motivating companies to develop vaccines for malaria and other diseases that afflict the developing world, the governments and private organizations are in essence creating competition that will in the end aid the developing nations. This type of funding also removes the favoritism that arises with push mechanisms as politicians fund labs instead of labs directing research.

I think that it is heartening to see governments such as that of the UK taking a step in the right direction to bring funding to where it is most needed and in the manner that is most efficient.