Investing in Health Innovation: A Cornerstone to Achieving Global Health Convergence

In December 2013, the Commission on Investing in Health—a group of 25 economists and global health experts chaired by former United States Treasury Secretary Lawrence Summers and health economist Dean Jamison—published its report, called “Global Health 2035” [1]. The report set out an ambitious investment framework for achieving what the authors called a “grand convergence in global health” by 2035. They defined grand convergence as a reduction in avertable infectious, maternal, and child deaths to universally low levels—the kind of levels seen today in the world’s best-performing middle-income countries, such as Chile, China, Costa Rica, and Cuba (conveniently labeled “the 4C countries”). Modeling by the Commission suggested that convergence within a generation could be achieved by aggressively scaling up health tools (e.g., medicines, vaccines, and diagnostics) and strengthening health systems to deliver these tools. But the report came to an important conclusion: The world cannot reach convergence with today’s tools alone. Tomorrow’s tools will also be needed. The Commission researchers first modeled the health impact of building robust health delivery systems and scaling up today’s medicines, vaccines, diagnostic tests, and other health technologies to extremely high coverage levels, such that around 90%–95% of those who need them are receiving them [1]. Even under these optimistic conditions, the modeling showed that low-income countries would reach about two-thirds of the way to convergence by 2035 [1]. The remaining gap could be closed only through the discovery, development, and delivery of new health technologies. Empirical research has shown that countries that adopt such innovations see acceleration in their health progress [1,2]. These “rapid adopters” achieve an additional decrease in their under-five mortality rate of about 2% per year, compared with countries that do not take up these technologies [2]. In the second step of the Commission’s modeling, the impact of new technologies was included—i.e., an additional 2% per year decline in mortality rates was applied. Only with this “accelerator” effect was convergence achieved. What are the most important innovation priorities for closing the convergence gap? Which tools in the pipeline appear to have the most potential as “game changers”? These questions are at the heart of a special collection of nine articles, called “Grand Convergence: Aligning Technologies and Realities in Global Health,” being published today across three PLOS journals: PLOS Biology, PLOS Medicine, and PLOS Neglected Tropical Diseases. Over the last 18 months, we have had the privilege of acting as Collection Coordinators, choosing the topics and authors and shaping the overall collection structure (we played no role in mediating the peer review or in editorial decision-making—as always, these were the sole responsibility of the editors of the three journals). In commissioning the collection, we aimed to focus on five conditions that disproportionately affect the world’s poorest people: HIV/AIDS, tuberculosis (TB), malaria, maternal and child mortality, and neglected tropical diseases. While noncommunicable diseases are not a focus of this collection, the take-home messages of the collection on the importance of investing in innovation apply equally to these diseases. We reached out to a diverse group of authors from low-, middle-, and high-income countries, many of whom are directing global disease control campaigns or major international research efforts. Many of the articles in the collection are analyses of potential “game-changing” technologies. We also included provocative pieces that lay out compelling ideas for the kinds of innovation that will be needed in the scale-up and delivery of health tools and services and in the very ways in which we fund and organize health research and development (R&D) worldwide. When we consider all of the articles as a whole, we see three dominant cross-cutting themes.