Developmental policy is the subject of a specific governmental domain, yet what happens in other domains is often just as relevant. For instance, while developmental aid works in one direction, the effects of agricultural subsidies go in different directions. The problem is known as the challenge to attain policy coherence for development. The Dutch Scientific Council for Government Policy (WRR), in its recent report on the evaluation and revitalization of developmental policy, recommends the search for coherence as one of the two main roads towards improvement (the other one is becoming more specific and professional). Such coherence is not easy in a world full of policy instruments directed at national levels and at very different goals. The problem is one of heterogeneous goals, and also of a lack of effective global governance mechanisms.
In this situation, initiatives of funding, allocating and governing are important, and unavoidably experimental. With regard to genomics, Adèle Langlois evaluated two such experiments a few years ago: the proposal for a Global Genomics Initiative (GGI) of the University of Toronto, and a series of declarations by UNESCO on genomics, genetics and bioethics. In her paper, The governance of genomic information: will it come of age?, she notes that both initiatives, which do not refer to each other, are aimed at more or less the same goals: overcoming global inequalities in health, overcoming the 10/90 gap. The GGI wanted to operate outside of the UN-context because that road was seen as too slow; the GGI was set up as a more heterogeneous network, involving industry, academia, civil society and government. In her evaluation, Langlois skeptically notes that the GGI itself is very slow in coming off the ground. She regrets the lack of synergy; a collaboration between these initiatives could enhance the effectiveness of both, she thinks.
There is more skepticism towards the GGI: its emphasis on genomics as crucial to the future of healthcare is open to the criticism that there are more immediate, poverty-related remedies: clean water, adequate nutrition, sanitation. Langlois mentions this “contested” issue without explicit comment, as a suggestive but unresolved dualism in the heart of the paper. I think that the AWT approach I discussed in recent posts implies a way out of this returning paralysis. If genomics is not set apart, but taken up in a globally oriented general R&D policy, which makes explicit room for the complex multidimensionality of global inequalities, the dualism between the frontiers of science and a broader approach loses its force, at least within the contribution of knowledge. This in turn implies that an independent genomics initiative is not a good idea: genomics needs to be embedded in a more general orientation of science policy. A lesson learned, as I see it.
The phenomenon of overlapping and competing global initiatives continues. In post # 7 I mentioned Thomas Pogge’s Health Impact Fund, which aims to provide incentives for drugs for neglected diseases by rewarding producers for the global health impact of new drugs (which they are to deliver at cost price). Pogge travels around the world to try to interest the wealthy and the powerful and to promote the initiative more generally. He spoke in the Peace Palace in The Hague recently. To the question what he considers as the largest obstacles to the fund he answered that, apart from the short term orientation of states, there are so many initiatives that donors don’t know with which one to go.
A working group of the WHO indeed notes in a report of December 2009 that “more than 90 proposals” for new sources of global financing and/or managing health research are in circulation or have been implemented. The working group distinguishes between financing mechanisms, allocation mechanisms and efficiency proposals and tries to make a first shift, but also adds new promising approaches (including the Health Impact Fund). Clearly, experiments continue, and it is not surprising that the working group recommends a follow up in the form of an in-depth review of proposals. But its recommendation-in-bold refers to an underlying need: the need for public research policy choices all over the world: “build on and promote in countries the adoption of locally relevant public policy choices to bring together the technological capabilities of the public and private actors, in order to generate missing knowledge and create incentive structures to stimulate research and development for appropriate technologies of interest to the developing countries”.
Global goals and global governance instruments are in an interactive and experimental phase.
