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

The 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.