Chelsea Clinton, PhD, Vice Chair, Clinton Foundation; Vice Chair, Clinton Health Access Initiative
Moderator: Deena Shakir, General Partner, Lux Capital; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2023 - Global Health: The Power Of Public–Private Partnerships 

Conferences

Chelsea Clinton, PhD, Vice Chair, Clinton Foundation; Vice Chair, Clinton Health Access Initiative
Moderator: Deena Shakir, General Partner, Lux Capital

Global Health: The Power Of Public–Private Partnerships

Well, hello everyone. It's so nice to see all of you. We, we've already started the countdown clock. We've only got 14 minutes and I have so much, I want to talk to you about Chelsea. So we're going to go ahead and dive right in and because of the limited time, start thinking about the questions you have. I'm hopeful, we'll get to at least one, maybe two. And there is somebody going around with a microphone who will come to you and will call on you once I get to ask a few of mine. So without further ado Chelsea Clinton, I want to ask you about the Clinton Health Access initiative also known as over the last two decades, Chai has negotiated over 100 and 40 global deals to lower the price of health products by 50 to 90% which is absolutely phenomenal. Can you share a bit more about Chai's origins and its approach to creating these types of partnership models to reduce health care costs? Yeah. Thank you so much, Dina and I wanna thank uh fortune um for inviting me and particularly giving me the chance to talk about uh public, private partnerships. Uh I also want to thank everyone here um at the Ritz Del Rey for keeping me hydrated and caffeinated. Um And I do know that uh these events are always real team effort. So just thank you to everyone I've met and everyone that I haven't met uh for bringing us here together today. Um So the genesis of chai really was in the HIV AIDS equity crisis, you know, more than 20 years ago where people living in places, you know, like Los Angeles at the beginning of the 21st century, were able to access uh largely anti retroviral drugs that were turning aids into certain desinence into a chronic disease. And my father and Nelson Mandela decided to work together kind of in their post presidential lives to try to help ensure that more people in more places could access these life saving medicines in 2001, the average price per person per year of a R V s in the global South was just over $10,000. Fast forward to today. It's about $60.21 million of the 29 million people who access antiretrovirals every day. Um, adults and kids alike access those medicines through agreements that the Clinton Foundation helped negotiate. But, oh, gosh, thank you. This is great. I feel like you all should travel with me all the time. I get like audible woos and applause. Um And I'm really proud of that market shaping work of of shifting um the power of the market to change a high price, low volume dynamic into a high volume, low price one now has characterized so much of our work. And so we've applied that same approach to the pneumococcal vaccine, the rotavirus vaccine injectable, long lasting reversible contraceptives point of care, diagnostics. We're now spending a lot of time in hepatitis in trying to increase access to medical oxygen and and so much else that we so often, I think um maybe don't take for granted but are not cognitive of what we have access to here in the United States to try to ensure that anyone anywhere has access to life saving medicines and commodities. And the last thing I'll say is a new effort that we're a part of is the new initiative launched by the World Health Organization last week to try to catch kids up on their routine immunization in 2021 alone, more than 25 million kids under the age of one missed at least one routine immunization. And so we're working with W H O and the Gates Foundation and others uh to hopefully have the largest kind of childhood immunization effort ever over the next 18 months to catch as many kids up as possible. Um because no one should die of polio or measles or pneumonia, including in this country where we also need people to be vaccinating their kids. Absolutely. Such incredibly important and impactful work. And you know, the topic of our panel today is public private partnerships and it's particularly meaningful for me because 13 years ago, I happened to be working with your mother at the State Department when she created the Office of Public Private Partnerships. Uh, so much has happened in those 13 years, including a pandemic. And I'd love to hear a little bit more about what the role of public and private partnerships is today in the context of global health and health care more broadly. Oh, goodness. Well, I think we have to continue to build on kind of what we know works and certainly, um you know, it is so much of our market shaping work and we also try to support our partners who are doing um work uh in kind of innovative delivery models and thinking about the work that partners in health and others are doing in Liberia and Sierra Leone to try to increase health care, workforce capacity and with innovating training modules to train front line nurses to be able to provide basic psychiatry kind of screening and care that's not in our bally or area of expertise. But hopefully, as those models prove themselves or iterate to prove themselves, we can help and try to bring them to scale. I do think though, you know, when you ask about the role of public private partnerships kind of after the last few years, I think we spend so much time, understandably focused on the M R N A vaccines and technologies. I spend a lot of time thinking about um the really uh unfortunate to try to use a not too judgmental word, um kind of rise in not only kind of vaccine hesitancy and questioning, but outright kind of rejection of vaccines and of kind of science and the scientific kind of process and also too often on our scientists, our epidemiologists, our frontline health care workers. And so I do think we need to have a much more robust conversation and sense of urgency because I think we are less prepared today than we were arguably in January of 2020. Partly because of the kind of um lack of trust and confidence in uh in not only our scientists um but in, in science itself, um and certainly in the public health professionals. And so I think we need kind of the public sector to hopefully stop doing things like stripping away public health emergency powers from state public health agencies. But we also need the private sector to help candidly like do a better job of helping explain kind of the science that you are already commercializing and bringing to market, but also what you're working on and and help us kind of in the broader conversation, not be uncomfortable with the discomfort of uncertainty. And so I do think we need really good ideas for how best to do that because we all deserve to hopefully not be as unprepared as I worry, we are at the moment. Well, speaking of good ideas, one of the many hats that you wear is also as an investor and we're actually co invested in a company called Summer Health uh in the pediatric Space. And you've also invested in women's health, which is an area that I'm also very passionate about. Can you talk about the role of technology and innovation in these topics specifically around maternal health where this country is in a maternal health crisis, particularly among uh underserved populations of black people. Absolutely. So I'm originally from the state of Arkansas which uh has the iom um kind of a place at the moment of having the worst maternal health outcomes in the country. Um Now, some of this is probably what you're all kind of thinking of lack of prenatal care, kind of insufficient access to not only prenatal care but maternal health care and um kind of post natal care. That's absolutely true. It also though is kind of a place where we see so many of our inequities uh coalescing in really tragic ways. So a rise of opioid use disorder deaths in expecting a new moms, a huge spike in death by suicide in expectant and new moms in Arkansas. Not surprisingly, the number one leading cause of those deaths by suicides are with a firearm. And so we do see in Arkansas kind of all of these painful um kind of intersections of the failure to adequately protect kind of public or patient health and particularly our most vulnerable are black and brown expected in new moms. And so, you know, something that I am a huge believer in and I'm so happy to be able to manifest that kind of belief, you know, as an investor and an advocate is in having more midwife centered and O B G Y N supported care. We have not only reams of data over the last years and decades, but arguably, you know, far longer of how important kind of midwife centered and empowered care is. And so I'm so proud to be able to partner with a company that we've invested in Medora to bring that first to New York City. And then hopefully, you know, more broadly across the city and around the country and know there are many people in this room, you know, who are similarly working to kind of provide more women, more kind of continuous kind of high quality kind of access to care while they're pregnant, while they're giving birth and postpartum, you know, up to a year or longer, depending on how long they're breastfeeding or what sort of support those new moms need. That's good for those moms. That's also, of course, good for us as a country, not only kind of on an ethical or moral basis, although I would posit that should be sufficient, but also certainly on an economic basis given we know how much lost productivity there is uh for mothers who are not sufficiently supported, kind of in being their full selves. Absolutely. And not to pull a Rihanna in case anyone was wondering, I'm also expecting a baby soon. So very much appreciate all the innovation you have. You are bedazzled. You can, you are be we're gonna turn it into the audience for one question. So I think we've got a paddle somewhere right there who she's going to call on someone for their, for? My favorite color is blue. Great. Thank you. Um My name is Raj A, I'm a, a past surgeon and I'm just starting a company in the obesity and metabolic health space. And um Chelsea, you, you paying something in me, you said the cost of the antiretrovirals went down from $10,000 to $60. We know the obesity crisis is massive by 2035 4 billion people in this country will be sorry in the world will be suffering from obesity. That's about half the population. It's due to cost $4.3 trillion right? Which is about 3% of the global GDP. We've tried exercise lifestyle, let's move sugar taxes, all this kind of stuff. Medications are really taking a hit now. So how do you think we um manage this global crisis? Yeah, I think um such an important question and I think too, um, this is a question that affects not only those of us in this room. But, but more broadly, I mean, you know, for close to a decade now, uh the Joint Chiefs of staff have said that obesity, uh the obesity crisis in our country is a national security issue. You know, we have many um local fire departments and police departments that are not able to recruit kind of sufficient numbers because of a lack of kind of overall kind of health and fitness levels, you mentioned kind of the coming cost, but we, we see very much those costs here today already, not only kind of health care costs but also in loss of productivity. Um I would though, uh respectfully take a slight um kind of contention though, with you said, we've tried a lot of things. We haven't really tried any of those things at scale and in coordination and fewer than 10% of American kids in public elementary and middle schools have daily pe classes. We actually, we're talking about public private partnerships. If this is something that you all care about, put pressure on your kind of uh local school boards and depending on kind of what school district you live in and where the sources of funds are coming, kind of on your city council, on your state governments that they're title one schools and what the federal government is specifically allocating funds for. Then we tried sugar taxes. We haven't really, I mean, like Philadelphia is the only major city in our country that has a real soda tax. Um I know there is a big movement to try to put pressure on E BT and snap benefits. I don't support that because I'm deeply uncomfortable with telling people already living on the margins that um they should not have access to kind of the full choices of people not living on the margins. But I do think there needs to be a more concerted effort to try all of this in concert for kids, adolescents, you know, young adults and adults and you would know better than I, we also know different interventions are more likely to work um with greater effectiveness in those areas. And also absolutely. Um we need to be looking globally in the same way we did and continue to do with our market shaping work on kind of what will the generic sorry to the pharma companies in the room? But like what are the generic versions? What are the input costs? How quickly can this be manufactured? Can those be manufactured in a globally um purposely globally diverse way in the way that we've seen with antiretrovirals? Um antibiotics and increasingly vaccines can be manufactured in Latin America, in Asia, in South Africa, and East Africa, in West Africa, in Eastern Europe, you know, and elsewhere. Um And then how do we build on the pre-existing supply chains um to help ensure that the people who could benefit from, from medicines as part of a larger set of interventions have access to them. And of course, then having enough health care professionals who actually are there to deliver those and then assess the ongoing impact. And now Dana is cutting me off. I'm getting all right. Well, thank you so much Chelsea. There's so much more we could talk about, but really thanks to everyone. Thank you. Thank you.