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1. Estimating Canada’s Return on Investment from an Ambitious Program to Incentivize New Antibiotics

Author:
Rachel Silverman and Adrian Towse
Publication Date:
12-2022
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
Anti-microbial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure those same drugs, driving “anti-microbial resistance,” or AMR. Already, drug-resistant infections kill an estimated 5,400 Canadian citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. To address this growing crisis and solve market failures that prevent the development of new antibiotics, the Government of Canada is considering a new program that would provide minimum guaranteed revenue to the successful developers of new antibiotics. In this note, we present the results of a modelling exercise to estimate the likely return on investment (ROI) from such a program, assuming it is paired with complementary and proportionate efforts from Canada’s G7 partners. The results are necessarily imprecise due to several uncertain parameters, but nevertheless provide evidence of a very high expected ROI that is robust to different inputs and assumptions.
Topic:
Health, Science and Technology, Investment, and Medicine
Political Geography:
Canada and North America

2. Operation Warp Speed, Encore: A Case for US Leadership to Drive Market-Based Global Health Innovation

Author:
Rachel Silverman
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
he experience of the COVID-19 pandemic—both in the US and around the world—has helped highlight the potential feasibility and importance of biomedical R&D for global health and welfare. In the midst of a very large, focused expansion of public expenditure for R&D on COVID-19—both direct (e.g. supporting trials) and indirect (e.g. promised revenue via advanced purchase agreements)—dramatic and rapid advancements in biomedical science took place, with very large commensurate social and health benefits. Drawing from this experience and momentum, this paper argues that the US should deepen its engagement and ambition in global health R&D to drive other similarly transformative improvements in global health outcomes and security—protecting American citizens from global health threats while also helping save and improve lives and livelihoods around the world. To provide illustrative evidence about the potential of such investment, it lays out three indicative case studies where US government investment, at least partially in the form of a pull mechanism, could help incentivize and drive high-value innovation: for new antimicrobials; a rapid, low-cost TB test; and for next-generation, accessible whole genome sequencing. Using clear and generally conservative assumptions, the case studies describe how such biomedical innovation could generate large returns on investment—in two of three cases exclusively from the perspective of US domestic welfare—while also saving and improving lives around the world. It concludes with a discussion of implications for research funders, emphasizing the need for large R&D investments to tackle commensurately large global health threats.
Topic:
Science and Technology, Hegemony, Leadership, Innovation, and COVID-19
Political Geography:
North America and United States of America

3. An Ambitious USG Advanced Commitment for Subscription-Based Purchasing of Novel Antimicrobials and Its Expected Return on Investment

Author:
Rachel Silverman and Adrian Towse
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Antimicrobial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure to those same drugs, driving “antimicrobial resistance,” or AMR. Already, drug-resistant infections kill an estimated 35,000 Americans and 1.27 million global citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. However, the R&D pipeline for new antimicrobials remains sparse, constrained by an array of market failures that prevent private companies from capturing a sufficient private return on investment (ROI) despite the very high social value of new antimicrobials. Widespread recognition of these market failures among experts and policymakers has driven a search for creative solutions, and generated enthusiasm for the use of pull mechanisms which could help incentivize antibiotic development. One particularly promising pull approach—so-called “subscription models”—would offer guaranteed annual payments to successful antibiotic developers delinked from sales volumes. A subscription approach is included in the pending PASTEUR Act, which is legislation introduced by lawmakers in the US House of Representatives and Senate and endorsed in President Biden’s 2023 budget request. In this paper, we consider the expected return on investment for such a program—that is, an ambitious new program to incentivize antibiotic development via a US government subscription-based pull mechanism (though not necessarily the PASTEUR Act, per se). We construct an illustrative subscription program from first principles, with parameters drawn (where possible) from the literature and some simplifying and deliberately conservative assumptions about program design and remuneration. We model the 10- and 30-year costs and benefits of such an initiative, both from the US domestic perspective and from a global welfare perspective. We find that the program is likely to generate a very high social ROI in both the short and long-term. From the US domestic perspective—considering both the value of averted death/disease and associated hospital costs—ROI is calculated at 6:1 over a 10-year time horizon and 28:1 over a 30-year time horizon. From the global perspective—exclusively considering the health value of DALYs (Disability Adjusted Life Years) averted—ROI grows to 27:1 over a 10-year time horizon and 125:1 over the full 30-year program duration. Sensitivity analysis suggests that the overall high returns are robust under a wide variety of alternative assumptions and scenarios. Based on these high social returns, we encourage the US Congress to urgently finance and authorize a subscription program for new antimicrobials, with particularly consideration for the PASTEUR Act.
Topic:
Health, Science and Technology, Innovation, and Medicine
Political Geography:
North America and United States of America

4. Pathways for Labor Migration from Northern Central America: Five Difficult but Necessary Proposals

Author:
Michael A. Clemens
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Very few labor-based pathways for regular migration are available for people in Northern Central America, often called the “Northern Triangle” of Guatemala, Honduras, and El Salvador. This paper briefly summarizes the state of labor-based migration channels in the region. It then argues that extending those channels is a necessary complement to asylum reform even for the goal of humanitarian protection. It concludes by arguing that five recommendations for long-term reform, though difficult, are needed to unleash the maximum shared benefit of these pathways.
Topic:
Migration, Labor Issues, Asylum, and Immigration Policy
Political Geography:
Central America, North America, Honduras, Guatemala, and El Salvador

5. Healthier Firms for a Stronger Recovery: Policies to Support Business and Jobs in Latin America and the Caribbean

Author:
Andrew Powell and Liliana Rojas-Suarez
Publication Date:
08-2022
Content Type:
Special Report
Institution:
Center for Global Development
Abstract:
This report—the product of a joint working group convened by the Center for Global Development and the Inter-American Development Bank—focuses on firms and labor markets in Latin America and the Caribbean during the COVID-19 crisis and the highly uncertain recovery phase now underway. The ongoing Russian war in Ukraine, volatility in international financial markets, and fears of global stagflation (low growth and high inflation) combine with the impacts of the pandemic to make the economic environment particularly challenging. Through a balance sheet analysis, the report describes how larger firms have navigated the crisis by cutting back on vari­able costs and investment. It also focuses on small and medi­um-size enterprises (SMEs), which appear to have suffered more in terms of closures and restrictions on credit access. The impacts on labor markets were unprecedented, with steep falls in employment and participation rates. A key question is whether the reallocation of resources, favor­ing firms in sectors that were hit less hard and able to take advantage of digital technologies, will persist. Key dangers are that informality is higher than ever, that productive resources remain trapped in small and less productive or ultimately unviable enterprises, and that firms are not rebuilding their capital stocks quickly. Drawing on an analysis of firms and labor markets, the report provides a set of recommendations for policymakers in the region and suggestions for international financial institutions to assist productive firms to invest, support the growth of new firms, and enhance labor market performance.
Topic:
Development, Economics, Finance, and Banking
Political Geography:
South America, Latin America, Caribbean, and North America

6. Mainstreaming Evidence Use through Locally Led Development: Recommendations for USAID

Author:
Janeen Madan Keller, Amanda Glassman, Julia Kaufman, and Ruth Levine
Publication Date:
07-2022
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
ince the 2006 release of the CGD report When Will We Ever Learn? Improving Lives Through Impact Evaluation, there have been nearly two decades of progress in generating and using evidence for public policy decisions and development programs. There has been a steady increase in the number of impact evaluations—a rigorous approach that establishes the attributable net impact of a project or program. Their ability to assess attribution makes impact evaluations uniquely well suited for decision making. Nevertheless, the COVID-19 pandemic put a spotlight on an unfinished agenda and underscored the need for high-quality, timely, and context-specific evidence. Across sectors, decision makers in governments, aid agencies, multilateral organizations, and NGOs have not yet fully harnessed the value of evidence for better public policies. Numerous challenges limit evidence use. On the demand side, impact evaluations may lack relevance to policy decisions and fail to respond to decision makers’ priorities, timelines, and questions. On the supply side, decision makers often lack institutional incentives and funding to generate and act on relevant evidence. Current funding models compound these challenges by contributing to misaligned incentives between policymaker needs and academic researchers. In response to these challenges, CGD launched the Working Group on New Evidence Tools for Policy Impact to develop a renewed agenda for the next generation of investments in impact evaluation and related evidence systems to enhance their value for real-world decision making. The group brought together policymakers and experts to review the progress and obstacles to the use and utility of evidence for global development. Its final report highlights how far the field has come in addressing critiques about the scale, generalizability, and policy utility of impact evaluation, and offers recommendations to the development community on “what and how to fund to deliver on the promise of impact evaluation and bolster the broader evidence ecosystem.” The working group proposes five ways to improve impact evaluation funding and practice: (1) design evaluations that start from the policy question and decision space; (2) harness technology for timely, lower-cost evidence; (3) advance locally grounded evidence-to-policy partnerships; (4) enact new incentives and structures to strengthen evidence use; and (5) invest in evidence leaders and communities. This brief details how USAID can mainstream evidence use across the agency. It is based on working group discussions, numerous consultations with experts including current and former USAID staff, and background research over the course of the project.
Topic:
Development, Local, USAID, and Foreign Assistance
Political Geography:
North America, Global Focus, and United States of America

7. ABCs of the IFIs: Understanding IDA20

Author:
Jocilyn Estes and Erin Collinson
Publication Date:
04-2022
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
With the COVID-19 pandemic hitting government balance sheets especially hard in low-income countries, the World Bank’s shareholders—including the United States—agreed to an advance replenishment of its grant and low-interest loan window, the International Development Association (IDA). By holding a pledging session one year early, donors sought to ensure IDA, which serves the world’s poorest countries, would have the resources to provide financing where it was needed most. In December 2021, following the final meeting of the 20th replenishment of IDA (IDA20), the World Bank announced a $93 billion replenishment package, leveraging $23.5 billion in contributions from 48 high- and middle-income countries. The United States reclaimed its position as IDA’s top donor, pledging $3.5 billion over three years to support pandemic response and an economic rebound in the world’s poorest countries. The United States has long had a vested interest in the World Bank, and in IDA in particular, working to ensure it is well run and resourced appropriately, and that its policy agenda reflects US interests. The US Congress plays a pivotal role in overseeing US engagement with the institution—managed by the Treasury Department—and providing funding to enable the US to meet its commitments. Due to the acceleration of IDA19, the US has two IDA installments due this year. The president’s fiscal year 2023 (FY23) budget request includes funding for a final payment to deliver on its IDA19 commitment and a partial first installment toward the latest US pledge to IDA.
Topic:
Development, Multilateralism, Sustainability, and Banking
Political Geography:
North America and United States of America

8. Recommendations for US-Africa Space Cooperation and Development

Author:
Rose Croshier
Publication Date:
03-2022
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
The United States, a leader in space exploration and innovation, has a unique opportunity to establish enduring diplomatic, commercial, and security ties with African nations through space cooperation—with the potential to yield substantial development benefits. The U.S. space sector is robust, an area of comparative strength vis-à-vis Europe, Russia, and China. By driving space cooperation, the U.S. can reinforce the rules-based order as articulated in international agreements like the Artemis Accords. Expanded space capabilities can also support the achievement of several of the UN Sustainable Development Goals, which range from improving data-driven governance to closing the global digital gap. U.S. policymakers have an opportunity to implement a collaborative approach with emerging African space actors both to grow a peaceful and law-abiding community in space and to benefit from Africa's contributions to the global space ecosystem. Space capability can also serve a crucial infrastructure role, yielding similar benefits to “traditional” infrastructure—including facilitating access to 5G connectivity through low orbit satellites and addressing clean water and food security needs through remote sensing and satellite communications.
Topic:
Development, International Cooperation, Space, and Territory
Political Geography:
Africa, North America, and United States of America

9. Greening the US Sovereign Bond Guarantee Program: A Proposal to Boost Climate-Directed Sovereign Finance in Developing Countries

Author:
Scott Morris, Rowan Rockafellow, and Alan Cameron
Publication Date:
02-2022
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Sovereign bond guarantees (SBGs) are an effective but underutilized instrument available to the US government in support of developing country partners. By protecting bond purchasers in the event of a foreign issuer country’s default, SBGs substantially reduce borrowing costs for developing country governments. In this CGD policy paper, we estimate the costs and benefits of historical US sovereign bond guarantees in order to model the use of SBGs for climate finance purposes. We demonstrate that the US government-provided SBG has the effect of conferring the US government’s cost of borrowing on the partner government. On that basis, it represents substantial savings for these countries. Based on this analysis, we propose a $20 billion “Green” SBG program aimed at financing climate change mitigation efforts in 28 emerging market economies. We estimate that the US government could support $20 billion in bond issuances through a subsidy outlay of $2 billion, resulting in a 22 percent reduction in borrowing cost of the target countries, which represents $4 billion in budgetary saving for their governments. We propose that the subsidy appropriations in support of the guarantees be retained and recycled within the Green SBG program, which would substantially improve the financial leverage of the program over time. We also suggest that the program could be used for climate adaptation purposes by targeting a different group of developing countries
Topic:
Climate Change, Development, Finance, Sustainability, and Green Transition
Political Geography:
North America and United States of America

10. Addressing the “Root Causes” of Irregular Migration from Central America: An Evidence Agenda for USAID

Author:
Sarah Rose, Reva Resstack, Helen Dempster, Elisa Cascardi, and Jeremy Weinstein
Publication Date:
12-2021
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In recent decades, the number of people migrating irregularly from the three Northern Triangle countries of Central America—El Salvador, Guatemala, and Honduras—has been increasing, putting pressure on the Biden-Harris administration to address the root causes of irregular migration and deliver “results.” Evidence suggests that these countries are undergoing a demographic and economic transition, hence emigration pressure will likely remain for the coming decades. Yet there is much an entity like USAID, the United States’ largest development agency, can do to moderate the short-run drivers of irregular migration such as violence, climate shocks, lack of economic opportunity, and inaccessibility of legal migration pathways. In this policy paper, we outline the available evidence within these areas that is directly pertinent to irregular migration and identify key evidence gaps to be filled by future research and evaluation. We conclude by outlining five recommendations for how USAID can ensure its work is evidence-based and contributes to new learning, supporting policymakers in this field for decades to come.
Topic:
Development, Immigrants, USAID, Influence, and Migrants
Political Geography:
Central America, North America, Honduras, Guatemala, El Salvador, and United States of America

11. Strengthening the Global Care Economy: A Roadmap for the Biden-Harris Administration

Author:
Megan O'Donnell, Mayra Buvinic, and Shelby Bourgault
Publication Date:
10-2021
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
In calling for large-scale investment in the United States’ care economy, the Biden-Harris administration has taken an unprecedented step in recognizing and addressing the constraints that American families, and particularly women, face in juggling paid and unpaid work within their own country. The administration now has an opportunity to translate its positioning of care as essential infrastructure within the US context into a complementary foreign and international development policy agenda. This can be done through (1) supporting existing global partnerships aimed at enabling families’ access to quality, affordable care services, and (2) complementing existing efforts through a US government-led initiative dedicated to strengthening the global care economy.
Topic:
Economics, International Cooperation, Hegemony, and Discrimination
Political Geography:
North America and United States of America

12. Enabling US Government Participation in Pull Mechanisms for Social Impact Innovation: A Survey of Federal Authorities, Budgetary Barriers, and Potential Solutions

Author:
Steven Kosiak and Rachel Silverman
Publication Date:
08-2021
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
United States government support for scientific and technological research and development (R&D)—across sectors including but not limited to energy, agriculture, and health—has the potential to save lives, reduce global poverty, and help address the most pressing global challenges. Traditionally, the US government has funded most R&D via grants and contracts (“push” funding), directly subsidizing and defraying the up-front R&D costs. An alternative approach—“pull” funding—would use the promise of future sales and/or other revenue to indirectly justify up-front expenditures in R&D, thereby “pulling” innovations to market. Despite several theoretical and practical advantages of “pull” funding, US government use of this approach has thus far been limited, in part due to regulatory and legal barriers. Yet across the entirety of the US government, there are nonetheless creative and interesting approaches to support innovation which include pull elements. To help the US government make broader use of pull approaches, this policy paper surveys the ways in which US government authorities, budgetary rules, and procurement approaches either facilitate or constrain use of pull mechanisms to support R&D. It specifically focused on the budgetary “scoring” issues that can affect, and sometimes hinder, the use of such mechanisms. It concludes with a discussion of potential legislative changes and workarounds to budgetary scoring challenges that might facilitate expanded use of these mechanisms.
Topic:
Governance, Budget, Innovation, and Research and Development
Political Geography:
North America and United States of America

13. Exploring How the US International Development Finance Corporation Can Support Health Sector Investments: Is the Glass Half Full or Half Empty?

Author:
Julia Kaufman, Janeen Madan Keller, and Rachel Silverman
Publication Date:
07-2021
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Health sector investments present an opportunity for the US International Development Finance Corporation (DFC), under the Biden-Harris administration, to demonstrate meaningful global leadership and refocus on its development mandate, driving broader health benefits and contributing to global economic recovery. DFC’s early days have been defined by a mixed record, notably in the health sector. Still, in the context of the pandemic’s health and economic impacts, the agency is well positioned to help strengthen pandemic preparedness and expand equitable access to health products and innovation in low- and middle-income countries. Through investments to build private sector manufacturing and delivery capacity, DFC can help stem and reverse these losses and insure against future health crises. This policy paper explores how DFC can strategically invest in health while balancing sometimes competing policy imperatives related to health equity, commercial viability, and foreign policy interests. We first provide an overview of the development finance landscape in the health sector and select DFC health-focused investments to date. We then suggest three high-impact engagement opportunities in the health sector for DFC to consider, including building regional manufacturing hubs for health supplies; providing R&D incentives for biotechnology; and supporting robust supply chains for health-adjacent services and delivery models. Lastly, we outline key principles to guide future DFC health sector investments, such as compatibility with long-term universal health coverage goals, a learning agenda for development effectiveness, and health-specific considerations for additionality and co-financing.
Topic:
Development, Health, Finance, and Investment
Political Geography:
North America and United States of America

14. A Decision Tree for Digital Payment Services: The Case of Mexico

Author:
Ivonne Acevedo and Miguel Szekely
Publication Date:
07-2021
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper explores the reasons why digital payment services in Mexico are used to a much lower extent than would be expected considering the country’s level of development and the authorities’ efforts to expand these types of services during the past two decades. The paper applies the analytical framework proposed by Claessens and Rojas-Suarez (2020), which consists of identifying the binding constraints preventing an increase in the usage of digital payment services, among a set of alternative explanations. The methodology starts by evaluating the price and usage of digital payment services to discover whether constraints may be on the supply side, the demand side, or both. The main findings suggest that the crucial binding constraints on the expansion of digital payment services in Mexico are mainly on the supply side of the decision tree. Indeed, we identify the regulatory framework seems to be a binding constraint, since it creates an unlevel playing field among the providers of digital payment services. Current regulation could also be a constraint on increasing the provision of digital financial infrastructure, particularly for expanding cash-in and cash-out access points in rural areas. Thus, relaxing the regulatory constraint could enable the expansion of digital payment services. In addition, there is evidence suggesting that a coordination failure, reflected in a strong preference for transacting in cash, might be a binding constraint in the country. Perceived low or nonexistent benefits from using digital payment services could be the source of the coordination failure, since it prevents the formation of a critical mass of users, which in turn discourages suppliers from offering these services.
Topic:
Economics, Finance, Services, and Digitalization
Political Geography:
North America and Mexico

15. A Review of the 2X Women’s Initiative: Recommendations for the Biden-Harris Administration

Author:
Megan O'Donnell and Jocilyn Estes
Publication Date:
04-2021
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Amidst an economic crisis disproportionately impacting women in low- and middle income countries, the US International Development Finance Corporation (DFC) is well positioned to prioritize the promotion of gender equality through its investment portfolio and in turn contribute to an inclusive recovery. This policy paper reviews the extent to which DFC (and its predecessor, OPIC) have focused on the promotion of women’s economic empowerment and broader gender equality to date, particularly through the 2X Women’s Initiative. Using project data from the DFC project database and mobile application, as well as consultations with the DFC 2X team, we compile all 2X projects and analyze key trends across sector, geography, financial tool and intermediary. The paper also reviews the initiative’s contributions to accelerated momentum in gender lens investing across development finance institutions through the 2X Challenge. After highlighting strengths of DFC’s gender lens investing approach, as well as gaps and areas of opportunity, we make recommendations for how DFC under the Biden-Harris administration can both build on DFC’s early progress to improve gender integration in external lending, technical assistance, advisory services, and its internal policies and practices – as well as increase the ambition of its gender targets and its focus on transparency and results.
Topic:
Governance, Women, Leadership, and Gender
Political Geography:
North America and United States of America