Q&A: Health systems innovation with Gill Samuels
Gill Samuels is chair of the foundation council of the Global Forum for Health Research. A neuropharmacologist by training, she is former head of science policy and scientific affairs at the European division of Pfizer Inc.
As the architecture of global health research becomes more complex and focus increasingly moves from biomedical to health systems research, she believes we need a global health research and innovation system (GHRIS) — an approach that addresses both biomedical and health systems research (see Health innovation requires a systems approach).
SciDev.Net caught up with her at the Global Forum for Health Research 2009 in Havana, Cuba, to hear about why we need such an approach.
Why do we need a global health research and innovation system?
Health is an international language, just as science is. The challenges are transnational. For example, with regards to non-communicable diseases, developing countries are having epidemics of exactly the same diseases that affect the North. And then there's climate change and communicable disease.
This innovation system is not constraining — it is a system to enable and to help us learn from each other. I believe that by working with other countries on problems that unite us all, it will move forward cooperation in a number of areas.
When did the shift from biomedical to health systems research start to happen?
About three years ago we started to realise that technical innovation was insufficient. We were not hitting the milestones for the Millennium Development Goals because the infrastructure wasn't there. One had to look at the health systems — not just health delivery but how you do innovation overall — because it was clear that was where the focus should be if technical innovation was to bear fruit.
Could a GHRIS foster integration of funding for health systems and for health programmes?
Funding is an interesting area because the way in which you decide what to fund can cause huge bureaucratic challenges, which are the enemy of innovation. We have to look very hard at how funding policy and practice can enable — rather than disenable — innovation.
What do you think about mechanisms proposed to boost research and development for neglected diseases, such as patent pools or prize funds?
We are fortunate to have an intellectual property system — despite its downsides.
Establishing other sufficiently robust systems is difficult. For example if you look at technical innovation for new pharmaceuticals, we are talking about 10–15 years of financial support.
You haven't finished when you register a new medicine. The only time you can even half-claim that you have finished is when you get the medicine to patients in a sustainable supply. So it's not just a case of "let's fund this lab project".
How can Cuba, which has been successful in developing its health system, transfer their technological knowhow to other developing countries?
Sometimes it's not the detail of a programme that matters, it's the inspiration that comes from a different model.
The Cuban model undoubtedly has at its roots the political values of social solidarity, which has allowed it to deliver extraordinary health outcomes with relatively small investments.
Given the escalation now in terms of healthcare investment now in the North, I look forward to continuing the discussions that have started here in Cuba.
I'm also delighted that we have been able to come to Cuba and see it in practice because reading about it is one thing but experiencing it is something totally different.