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Since the mid 1990s, global health leaders and funders, such as pharmaceutical companies, have established several innovative public–private partnerships (PPPs), which are explicitly focused on the persistent and unacceptable gap between the need for, and supply of, new tools and drugs with which to fight global infectious 'diseases of poverty'. Separate PPPs now work on malaria drugs, tuberculosis (TB) drugs, malaria vaccines, HIV vaccines, meningitis vaccines, TB diagnostics and microbicides, to name a few examples (see www.ippph.org for further information on these PPPs).

Pulling together the key stakeholders and resources required to launch these initiatives can be celebrated as a real accomplishment. PPPs will only be deemed a successful experiment, however, if and when they develop, and gain approval for, affordable and accessible products for patients in the developing world. Like for-profit start-ups, the quality, credibility, creativity and flexibility of the leadership team will often determine whether individual not-for-profit PPPs succeed or fail. It is crucial to ask, therefore, what kinds of people are needed to champion these initiatives, and where these people might be drawn from.

PPPs are organized as virtual entities — a small, CEO-led team supported by advisory and scientific boards. A key objective is to leverage and retain commitments of skills and resources from both the public and private sectors. The relevant for-profit comparators, from the standpoint of strategy and organization, might be venture capitalist and virtual drug development companies. PPPs are required to conduct due diligence, invest in, manage and support select projects driven by joint corporate and academic teams. They also license-in projects and advance them through contracts with a network of public and private organizations.

Virtual drug development is a challenging and relatively untested model in the for-profit world. At a minimum, when selecting a CEO for a PPP, experience in building entrepreneurial companies as well as core competencies in product discovery, development and delivery would seem crucial. But PPPs face obstacles above and beyond management logistics. PPPs operate in complex terrains serving heterogeneous and sometimes conflicting sets of constituents, as well as facing the inherent challenges of developing and distributing medicines in the developing world. Take, for example, the fact that PPPs need to kill projects 'without guilt' when they fail to meet specific scientific or progress milestones. The effective and productive use of resources must be rewarded, not just the pursuit of projects in and of themselves. But although valued as 'good management' in the for-profit world, the act of killing projects might be associated with organizational 'failure' in the public sector.

There is no one 'right mix' of skills and experience, but whoever the champions in PPPs are, they must be able to effectively sell their mission to, and communicate and work with, large and small pharmaceutical and biotechnology companies, contract research organizations, regulatory authorities in diverse settings, public funders and foundations, global health non-governmental organizations, patient groups, and country governments. Furthermore, getting the 'right mix' might not be a one-off activity. The composition and set of skills in the team will need to change as the pipeline matures, as new types of deals are introduced and as new regulatory issues arise. Although it is difficult to replace 'dedicated people', PPPs need to be prepared to do what is best for the mission; that is, the development of new products.

Again, looking for parallels in the for-profit world, many biotech companies are founded by scientists and academics that have no industry experience. A sign of a 'good company' is one in which the management boards and teams are able to take the decisions to replace leadership as needed. Venture capitalists, for example, will push for the introduction of an operations team at one point to replace or enhance the existing scientific one. Likewise, PPPs must anticipate 'successors' in advance of their talents being needed.

PPPs and biotechnology companies seem to draw from similar 'tight' pools of talent, and so face the challenge of finding and keeping qualified people as CEOs and directors of business development and science. PPPs face additional obstacles. Candidates from industry often perceive the work done in PPPs as advocacy rather than as operations. The politics that surround public health issues might discourage 'business people' from entering and engaging with them. A shift 'up' to a PPP is likely to be considered an interruption to the career path rather than a promotion. At the same time, people with valuable public sector experience might see themselves as 'selling out' to join an initiative that actively seeks to engage (and reward with intellectual property rights and funding) the for-profit private sector to work on global health problems.

An interesting question is whether certain people might be predisposed to want to make a difference as well as make money, suggesting that PPPs are drawing from an even smaller pool than the biotechnology companies. Or perhaps rather than being 'the type' or not, it is possible that people go through cycles in their career and that at certain stages look for something 'more meaningful' than a strict 'for profit' job.

PPP founders, board members and team members must proactively sell their organizations as places for quality people to make a difference, pursue entrepreneurial opportunities and realize social as well as commercial value. The nature of the urgent challenges to be solved and the potential rewards from succeeding in such teams need to be made more transparent and clearly advertised. Millions of lives are at stake.