Challenges and a path forward

For the HIF to become a reality, it will need to be studied, challenged, We need help from a wide range of stakeholders – innovative companies, governments, insurance companies, epidemiologists, NGOs, lawyers, economists, doctors, and many others too – to push forward with the ideas presented here and to strengthen the proposal. In other words, the HIF needs your help. We therefore encourage you to contact us at if you have comments or ideas on this proposal.

Second, the clear direction forward for the present is testing the HIF approach at a small scale. There is a lot to study before the HIF is ready to implement. In particular, it makes sense to see how pharmaceutical companies will respond to the pay-for-performance mechanism built into the HIF. This aspect of the HIF can be tested on a manageable scale. A pilot would involve a company dropping the price in one market for a patented drug, and being paid a separate performance-based incentive bonus based on measured health benefits. For example, such a pilot might reward a company based on the serotype coverage in a region of a particular vaccine, recognizing that higher coverage implies greater effectiveness. Each product has at least some components of its effects that are measurable in a reasonable time period.

Third, it is necessary that governments – supported by their citizens and with the collaboration of pharmaceutical firms – begin making commitments to support the HIF, once they are satisfied of the merits of the proposal. We hope to convince governments, one by one, to commit to supporting the HIF financially if enough other countries do so as well.

The Health Impact Fund is a fair and cost-effective way of stimulating research and development of high-impact pharmaceuticals. It would make advanced medicines available to all at competitive prices, while at the same time offering ample rewards for innovators.