Q&A | Published:

Straight talk with... Amanda Glassman

Nature Medicine volume 17, page 1534 (2011) | Download Citation

Abstract

Since its launch in 2001, the Center for Global Development (CGD) has been instrumental in convening working groups and issuing reports that shape the agenda for a range of topics that affect global poverty and people of the developing world. At the helm of its global health effort is Amanda Glassman. As the daughter of US Foreign Service diplomats, Glassman was exposed to disparities in public health in developing countries from a very young age. So it was a no-brainer for Glassman that she would devote her career to tackling those inequalities. She has spent the last two decades at places like the US Agency for International Development, the Inter-American Development Bank and the Brookings Institution. Last year, she joined CGD as the director of its global health policy division.   One idea that the $10-million-a-year, Washington, DC–based think tank has championed with some success is what's known as an advance market commitment (AMC), a financial instrument that incentivizes vaccine development for diseases primarily affecting low-income countries. It's for this influence that the center, which is mainly funded by governments and philanthropic entities, was ranked the fifteenth most important US think tank by Foreign Policy magazine in 2008. In recognition of CGD's ten-year anniversary last month, Elie Dolgin spoke to Glassman about how the think tank turns its words into actions.

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What makes the CGD different from other global health–focused nonprofits?

The CGD is not only focusing on aid, although aid is obviously one important piece of the puzzle. But we're also looking at correcting collective action failures, how well global institutions are doing at solving global problems and at key issues that cut across multiple stakeholders in the system. We bring an economics and financing lens to global health issues that is unique.

How independent are your analyses?

No more than 20% of our funding comes from any one source, and many times we're able to speak or write about issues that no vested interest in the field will do. As an example, my colleague [CGD senior fellow] Mead Over has written a lot about allocating money for AIDS control so that new infections are minimized, rather than doing some of what the community has done so far, such as allocating funds for unproven interventions like abstinence education or failing to adequately finance very cost-effective prevention interventions like voluntary male circumcision. Mead wrote a piece that was not popular among existing funders or advocates at the time but that increasingly represents a viable strategy that will be adopted, because now funds are falling and people have to focus on using what's available for better impact.

Can you point to a specific example where the CGD has had a major impact in the arena of global health?

The advance market commitment was a big one. It was a $1.5 billion pilot program—led by the GAVI Alliance and financed by the Bill & Melinda Gates Foundation and the G8—that really set off from a working group that was run here at CGD. We looked at the lack of incentives to bring vaccines for diseases that primarily affect the poor in developing countries to market, and basically said: “Well, what if we make a market for these vaccines? At the end of the day, how does that change the incentive to get these candidate vaccines through stage 3 clinical trials and into production?” That idea was picked up by GAVI and tested for the pneumococcal vaccine, and, in December 2010, GAVI delivered the first AMC-funded pneumo vaccine to children in Nicaragua. Eleven low-income countries have introduced the vaccine this year. GAVI estimates that 650,000 child deaths will be averted by 2015 as the result of these efforts.

In October, the CGD released a report calling for better systems to support the costs and regulatory oversight of running clinical trials in developing countries. How do you help implement this strategy?

The New Partnership for Africa's Development [NEPAD], an economic organization attached to the African Union, is interested in serving as the host for a regional regulatory pathway that will oversee clinical trials. What we'd like to see next is that some money that the Gates Foundation gave to the World Bank goes to NEPAD to be able to implement this strategy. We'll also want to see funders of clinical trials use that regional pathway to register their clinical trials. And then we would hope to evaluate how well the regulatory pathway is really working. An idea is just an idea, but at implementation it might obviously look different.

How long does implementation of CGD recommendations generally take?

It took a year to run the working group on clinical trials, and, ideally, we want to see significant progress by next year. Either people are going take this seriously and move on it or they're not. Sometimes an idea's time hasn't come, and then we wait two or three years more. For the advanced market commitment, it took four years from the time the working group first met to the AMC being approved for funding at a G8 conference, and then it was another two years before it actually was able to fund the pneumococcal vaccine. It takes its time, but, all along, the idea is that we continue to monitor what's happening and continue to provide advice and assistance if it's needed.

What's your next big initiative?

Next year, we'll be looking at improving value for money among the global health funders. As you know, health aid will likely stagnate over the coming years, so we'll be looking at how global health funders can achieve more impact with the dollars spent.

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DOI

https://doi.org/10.1038/nm1211-1534

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