What other criteria are there to rank funding mechanisms upon, apart from access and innovation?

We propose to use the criteria of access and innovation to evaluate possible funding mechanisms. Several other factors for assessing funding mechanisms have been proposed, many of which fall within the remit of either access or innovation such as health impact/public health impact, delinking, dissemination and innovation incentive.

See also the funding mechanisms document in answer to this question.

We propose to use the criteria of access and innovation to evaluate possible funding mechanisms:

Access: To what extent does a funding mechanism increase access to medicines?
Innovation: To what extent does a funding mechanism incentivise innovation based on health impact?

Several other factors for assessing funding mechanisms have been proposed.

Some of these criteria fall within the remit of either access of innovation:

Health impact/public health impact.¹ Health impact is ultimately why access and innovation matter, and can be taken roughly as the combined outcome of those criteria.
Intellectual property.² This criterion was explicitly defined as the extent to which intellectual property arrangements stimulated innovation and enhanced access, so seems comprehensively covered by those two criteria.
Delinking.³ While not commensurable with either access or innovation, delinking like intellectual property regulation is only valuable in relation to access and innovation. It therefore seems dominated as a factor.
Dissemination incentive.⁴ Incentives for distribution are a part of the access criteria: if there is little incentive to disseminate, access will be reduced and vice versa.
Innovation incentives.⁵ This overlaps perfectly with the innovation criterion.
Predictability and flexibility of resource for recipients.⁶ This can be considered as a part of the extent to which innovation is incentivised: if resources are unpredictable and inflexible, they will provide less of an incentive.
Strength of incentives.⁷ This is straightforwardly a part of the innovation criterion.

Other criteria do not fall within this remit, but are being treated in this project as part of a separate workstream:

Political feasibility.⁸ Political feasibility is an important characteristic of a potential funding mechanism, which we are working on through our stakeholder and communications work.

Further proposed criteria are not covered by access or innovation, but seem peripheral:

Capacity building:⁹ Capacity building may be an independently important issue in terms of the structuring of scientific research and access to knowledge. It might create a more sustainable or richer research environment. While this means that capacity building is potentially valuable in relation to health impact, it seems that the problem is tangential to R&D funding mechanisms.
Quantity of additional resource.¹⁰ This issue does not seem salient enough to be considered as a separate criteria: in a theoretical sense, the level of resourcing can just be increased or decreased to the desired amount. In a political sense this is obviously not true - but this can be considered both under ‘political feasibility’ and under ‘financial feasibility’.

There are also other proposed criteria which merit further investigation, as they are neither encompassed by access or innovation, nor peripheral to our project:

Costs. Hoffman and So used the criterion ‘financial implications’ to refer principally to the administrative costs of a mechanism.¹¹ Hecht, Palriwala and Wilson also used costs (financial and political) as a criteria.¹² The CEWG report also used efficiency/cost-effectiveness and financial feasibility as a criterion.¹³ Stiglitz considered both transaction costs, risks in terms of litigation, and the extent to which selection was market-based, all of which could be seen as part of the cost of a mechanism.¹⁴ Another issue which can be considered as an element of the cost of a mechanism is the efficiency of the mechanism in terms of who pays for innovation: Stiglitz considers the funding of R&D as tax-like, and then asks how efficient the system is. The patent system is an inefficient tax, as consumers pay for it regardless of financial ability, and also it fund R&D ex post when it is at its most expensive. Grants are an efficient tax system, as the money for them is collected in an (ideally) fair way by the government from taxpayers, and then disbursed ex ante, when research is at its cheapest.
It seems clear that access and innovation come at a price and that there is therefore a trade-off between costs and our criteria which needs to be taken into account.
Technical feasibility.¹⁵ Whether or not a mechanism actually functions in a theoretical sense is a separate question to whether it improves access or incentivises innovation, although it is a prerequisite for the expectation of either actually occurring. There are many facets to technical feasibility, including governance and accountability¹⁶ and the sustainability of resource generation.¹⁷

Renwick, Brogan and Mossialos also present criteria for ranking funding mechanisms, but the criteria are specific to the antibiotic context.¹⁸

Bibliography

Hecht, Robert, Paul Wilson, and Amrita Palriwala. “Improving Health R&d Financing for Developing Countries: A Menu of Innovative Policy Options.” Health Affairs (Project Hope) 28, no. 4 (2009): 974–85. doi:10.1377/hlthaff.28.4.974.

Hoffman, Steven J., and Karen So. “Assessing 15 Proposals for Promoting Innovation and Access to Medicines Globally.” Annals of Global Health, Tropical Medicine in the Era of Global Connectivity, 80, no. 6 (2014): 432–43. doi:10.1016/j.aogh.2015.02.004.

Stiglitz, Joseph E. “Economic Foundations of Intellectual Property Rights.” Duke Law Journal 57, no. 6 (2008): 1693–1724. doi:10.²³⁰⁷⁄_40040630.

“Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination.” Report of the Consultative Expert Working Group on Research and Development: Financing and Coordination. World Health Organisation, 2012. http://apps.who.int/iris/bitstream/10665/254706/1/9789241503457-eng.pdf?ua=1.

Renwick, Matthew, David M. Brogan, and Elias Mossialos. “A Systematic Review and Critical Assessment of Incentive Strategies for Discovery and Development of Novel Antibiotics,” 2015. http://eprints.lse.ac.uk/64852/1/Mossialos_systematic_review_and_critical_assessment1.pdf.

Hoffman and So, “Assessing 15 Proposals for Promoting Innovation and Access to Medicines Globally”, p. 433; “Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination”, pp. 48-49. ^[return]
“Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination”, pp. 48-49. ^[return]
“Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination”, pp. 48-49. ^[return]
Stiglitz, “Economic Foundations of Intellectual Property Rights”, p. 1722. ^[return]
Stiglitz, “Economic Foundations of Intellectual Property Rights”, p. 1722. ^[return]
Hecht, Wilson, and Palriwala, “Improving Health R&d Financing for Developing Countries”, p. 981. ^[return]
Hecht, Wilson, and Palriwala, “Improving Health R&d Financing for Developing Countries”, p. 981. ^[return]
Hoffman and So, “Assessing 15 Proposals for Promoting Innovation and Access to Medicines Globally”, p. 433. ^[return]
“Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination”, pp. 48-49. ^[return]
Hecht, Wilson, and Palriwala, “Improving Health R&d Financing for Developing Countries”, p. 981. ^[return]
Hoffman and So, “Assessing 15 Proposals for Promoting Innovation and Access to Medicines Globally”, p. 433. ^[return]
Hecht, Wilson, and Palriwala, “Improving Health R&d Financing for Developing Countries”, p. 981. ^[return]
“Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination”, pp. 48-49. ^[return]
Stiglitz, “Economic Foundations of Intellectual Property Rights”, p. 1722. ^[return]
“Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination”, pp. 48-49. ^[return]
“Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination”, pp. 48-49. ^[return]
Hecht, Wilson, and Palriwala, “Improving Health R&d Financing for Developing Countries”, p. 981. ^[return]
Renwick, Brogan, and Mossialos, “A Systematic Review and Critical Assessment of Incentive Strategies for Discovery and Development of Novel Antibiotics”, pp. 8-11. ^[return]