From the Tower to the Hill: Moving Ideas and Research Into the Policy Realm

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From the Tower to the HillMoving Ideas and
Research Into the Policy Realm

• Andy Burness
• Burness Communications
• Presentation at
• The Centre for Intellectual Property Policy,
  McGill University
• Conference on Biotechnology and Intellectual
  Property Reinventing the Commons
• September 26, 2005

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PROPOSALA partnership between researchers and
policymakers
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PURPOSETo translate knowledge from the tower
to the hill, from academia to the public square
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THE PROVERBIAL QUESTIONIf a tree falls in the
forest, and no one knows that it fell, did it
really fall at all?
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For the researcher, what good is knowledge if
its closely held by fellow technicians?For the
policymaker, good decisions require information,
and information withheld, or research withheld,
is no information at all.
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What is Research Withheld?

• Research restricted to technical journals
• Research filled with jargon
• Research poorly or tediously presented
• Research that takes too long to read
• Research that leads to no clear recommendations
  or has no apparent relevance to policy

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The Jargon Game
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Whats in it for the Researcher?

• The opportunity to inform the policy process
  maybe influence it
• The freedom to share knowledge with the public
  through their governments
• The knowledge that whats learned from
  researchers can genuinely improve quality of life

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Whats in it for the Policymaker?

• New information to inform sound decisions and the
  best possible policy
• Outside, impartial expertise free of politics
• Technical expertise likely greater than that
  which can be found within government

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How can a Research/Government Partnership Work in
Practice?

• PATH Malaria Vaccine Initiative
• Agricultural Research
• Beef and the Brazilian Rainforest
• Cash and Counseling Empowering disabled people
  on Medicaid

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PATH Malaria Vaccine Initiative
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In search of a malaria vaccineyesterdays pipe
dream, todays legitimate hope
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Fast facts

• 3,000 children will die today from malaria, most
  in Sub-Saharan Africa
• Malaria is estimated to cost Africa 12 billion
  annually in GDP
• Silent Tsunami

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RTS,S Pediatric Clinical Trial

• A public-private partnership of the PATH Malaria
  Vaccine Initiative, GlaxoSmithKline Biologicals,
  the Hospital Clinic of the University of
  Barcelona, and the Manhiça Health Research
  Centre, supported by the Bill Melinda Gates
  Foundation

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• Phase 2b Six-month study, 2000 children,
• age 1-4 in Mozambique
• Efficacy against clinical malaria attacks was 30
• Efficacy against severe disease was 58

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 Efficacy of the RTS,S/AS02A vaccine against
Plasmodium falciparum infection and disease in
young African children randomised controlled
trial.Alonso PL, Sacarlal J, Aponte JJ, Leach
A, Macete E, Milman J, Mandomando I, Spiessens B,
Guinovart C, Espasa M, Bassat Q, Aide P,
Ofori-Anyinam O, Navia MM, Corachan S, Ceuppens
M, Dubois MC, Demoitie MA, Dubovsky F, Menendez
C, Tornieporth N, Ballou WR, Thompson R, Cohen
J.Centre de Salut Internacional, Hospital
Clinic/IDIBAPS, Universitat de Barcelona,
Barcelona, Spain. palonso_at_clinic.ub.esBACKGROUND
Development of an effective malaria vaccine
could greatly contribute to disease control.
RTS,S/AS02A is a pre-erythrocytic vaccine
candidate based on Plasmodium falciparum
circumsporozoite surface antigen. We aimed to
assess vaccine efficacy, immunogenicity, and
safety in young African children. METHODS We did
a double-blind, phase IIb, randomised controlled
trial in Mozambique in 2022 children aged 1-4
years. The study included two cohorts of children
living in two separate areas which underwent
different follow-up schemes. Participants were
randomly allocated three doses of either
RTS,S/AS02A candidate malaria vaccine or control
vaccines. The primary endpoint, determined in
cohort 1 (n1605), was time to first clinical
episode of P falciparum malaria (axillary
temperature gt or 37.5 degrees C and P falciparum
asexual parasitaemia gt2500 per microL) over a
6-month surveillance period. Efficacy for
prevention of new infections was determined in
cohort 2 (n417). Analysis was per protocol.
FINDINGS 115 children in cohort 1 and 50 in
cohort 2 did not receive all three doses and were
excluded from the per-protocol analysis. Vaccine
efficacy for the first clinical episodes was
29.9 (95 CI 11.0-44.8 p0.004). At the end of
the 6-month observation period, prevalence of P
falciparum infection was 37 lower in the
RTS,S/AS02A group compared with the control group
(11.9 vs 18.9 p0.0003). Vaccine efficacy for
severe malaria was 57.7 (95 CI 16.2-80.6
p0.019). In cohort 2, vaccine efficacy for
extending time to first infection was 45.0
(31.4-55.9 plt0.0001). INTERPRETATION The
RTS,S/AS02A vaccine was safe, well tolerated, and
immunogenic. Our results show development of an
effective vaccine against malaria is feasible.
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Coverage in two dozen countries in 21 languages

• Bahasa Indonesia, Chinese, Czech, Danish, Dutch,
  English, Estonian

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A billboard in London
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Melinda Moree, Director, The PATH Malaria Vaccine
Initiativein Congressional testimony

• To do a Phase III clinical trial costs about
  ten times as much as it costs to do a phase I
  clinical trial. (In the past), it was the science
  that was the greatest impediment, and today, I
  would say that it really is the money.

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Gordon Brown, British Chancellor of the Exchequer

• The recent breakthrough is a revolution in our
  time. We need to ensure that the vaccine goes
  into commercial production and is available at
  affordable prices. The British government,
  working with other governments, is ready to enter
  into agreements to purchase these vaccines in
  advance, to ensure a secure market, and that
  vaccines are available more cheaply.

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Agricultural Research Beef and the Brazilian
Rainforest

• Center for International Forestry Research (CIFOR)

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For further information, contact (U.S.) Coimbra
Sirica 1 631 757 4027 Amy Ekola Dye 1 202 427
8246 Ellen Wilson 1 301 652 1558 (Indonesia)
Greg Clough, CIFOR 62 251 622 622/Mobile 62 812
864 6613 EMBARGOED FOR RELEASE Friday, 2 April
2004 World Appetite for Beef Making Mincemeat
Out of Brazilian Rainforest According to Report
from Major International Forest Research
Center Free of Mad Cow and Foot-and-Mouth,
Amazonian Cattle Find Favor Abroad Study Says
Dramatic Growth in Exports Primary Culprit in
Huge Rainforest Losses in Brazil BOGOR,
INDONESIA (2 April 2004) -- Brazils spectacular
and growing success as a prime exporter of
beefvolume of exports abroad have increased more
than fivefold in the last six yearsis
responsible for much of the recent spike in the
destruction of the Amazon rainforest, according
to a study released today by one of the worlds
leading forestry research organizations. In a
report summarizing their work, the researchers
demonstrate a strong link between the dramatic
deforestation rates, which the Brazilian
government is expected to announce shortly, and
the growth in exports that have caused a massive
surge in the Brazilian Amazons cattle
populationfrom 26 million head in 1990 to 57
million in 2002. The report, Hamburger
Connection Fuels Amazon Destructionissued by the
Center for International Forestry Research
(CIFOR), a Future Harvest Center based in Bogor,
Indonesiasuggests that the jump in the worldwide
demand for Brazilian beef has been brought on by
several factors, among them concerns regarding
the threat of mad cow disease in several other
cattle-producing countries.
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The Amazon The price of success
April 17th 2004 SÃO PAULO Does Brazil have to
choose between economic growth and preserving the
endangered Amazon?
The main driver of deforestation, according to a
new report by the Centre for International
Forestry Research (CIFOR), is a recent surge in
exports of beef. A sharp devaluation of the real
has made exports more competitive. Meanwhile, the
number of Brazilian states declared free of
foot-and-mouth disease has increased the mad-cow
scourge, which put some consumers off British and
American steaks, has been avoided. Hence,
measured by volume, since 1997 Brazil's beef
exports have jumped more than five-fold. Many of
the extra cows are grazing on land that was once
rainforestoften illegally occupied rather than
bought. Some pasture land is later used to grow
soya, another commodity with a voracious
international
DURING the 1970s and 1980s, when Brazilian
governments were determined to colonise the
country's last frontier, they pumped subsidies
into the Amazonian interior. Today, the forces
driving deforestation in Brazil are different
where once the logging and farming that eroded
the forest served mainly the domestic market, it
is now the demands of consumers in Europe and
Asia that are drivingand acceleratingthe de-
Last week, Brazil's government disclosed that
23,750 sq km (9,170 sq miles) of Amazon forest
were felled in the year beginning August 2002,
the second-worst on record. Yet this bad
environmental news is linked directly to some of
the best news for the economy in years Brazil's
extraordinary performance as an exporter of
commodities. Does the country have to choose
between the forest and foreign exchange?
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Cattle seen as growing threat to Amazon
Driven by worlddemand, Brazils herd has
doubled Land mass the sizeof Haiti was lost
toranching in 2001-2 AXEL BUGGEREUTERS NEWS
AGENCY
The report, "Hamburger connection Fuels Amazon
Destruction," by the Indonesia-based Center for
International Forestry Research was released as
environmentalists feared the latest Amazon
destruction rates could be the highest ever.The
deforestation rate in the world's largest jungle
jumped 40 per cent in the 12 months to the middle
of 2002 and the authors of the report along with
other environmentalists are bracing for figures
for the subsequent year which could be yet
higher. The latest data should be released in
coming weeks. At around 9,840 square miles, the
deforestation figure for 2001-2002 was the second
highest on
Booming Brazilian beef exports could be the main
culprit behind a sharp rise in deforestation of
the Amazon jungle as cattle farmers cut deeper
into the forests, a leading research institute
says.
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POLICY OUTCOME

• Subsequent to media coverage, World Bank
  announces four-year, 1.2 billion loan to Brazil
  to protect the rainforest

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Empowering disabled people on Medicaid
Cash and Counseling

• To educate policy makers about consumer
  direction as an option for improving quality of
  life

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Cash Counseling Demonstration Overview

• Demonstration States
• Arkansas, Florida, New Jersey
• Study Populations
• Adults with disabilities (Ages 18-64)
• Elders (Ages 65)
• Florida only Children with developmental
  disabilities

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Basic Model for Cash Counseling

• Step 1 Consumers receive traditional assessment
  and care plan
• Step 2 A dollar value is assigned to that care
  plan
• Step 3 Consumers receive enough information to
  make unbiased personal choice between managing
  individualized budget or receiving traditional
  agency-delivered services

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Policy Implications

• Can increase access to care
• Greatly improves quality of life (all ages)
• Caregivers also benefit greatly
• Medicaid costs increased from 3-14, but would be
  about the same if comparable services were
  offered under the traditional plan

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Original and Expansion Cash Counseling States
POLICY IMPACT
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Common Elements of Effective Advocacy

• Clear and consistent message
• Clear desired action

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Waging and Winning the War of
IdeasResearch and producing policy papers is
not where our job is. The effort is wasted if it
fails to reach those of influence, those who
decide or implement policy, the lawmakers and
regulators. Waging and winning involves
commitment, talent, creativity and patience,
because there is a new battle every day, and we
are here for the long haul.-- Edwin Feulner
The Heritage Foundation