Turning points for sustainability transitions: Institutional destabilization, public finance and the techno-economic dynamics of decarbonization in South Africa.

Existing socio-technical systems tend to be intransigent to change. Decarbonisation, on the other hand, is an imperative, leading to an obvious conflict between the need for, and highly effective resistance to, change. Moreover, the abandonment of fossil fuel-based technologies in favour of more sustainable alternatives will require substantial reallocation of government's operational expenditure, particularly in countries like South Africa with high per capita greenhouse gas emissions and low per capita income. In this article, it is argued that reallocation will require more than niche experimentation and destabilisation of the present socio-technical regime. Based on a study of South Africa's budget processes, it is concluded that change will only occur when four separate pre-conditions converge, namely a rapidly growing environmental problem capable of leading to civil unrest, a supportive and recently developed policy framework, decreasing techno-economic costs for its solution, and strong political support from an effective ministry or minister. Turning points for transition, although infrequent, can be reached through strategic attention to these pre-conditions. A modified Kingdon multiple streams approach, which introduces the additional dimension of techno-economic feasibility, is proposed as a useful framework for anticipating when and how to act in order to mobilise sufficient public resources for decarbonisation.

An evaluation of South Africa's public-private partnership for the localisation of vaccine research, manufacture and distribution.

BACKGROUND: Public-private partnerships (PPPs), widely used as a means of leveraging the skills, expertise and resources of the private sector to mutual advantage, were similarly adopted by South Africa to support public sector delivery. This study has evaluated one such partnership, namely the Biovac Institute, which was established in 2003 to cover vaccine research and development, manufacturing, and supply. The initiative was highly unusual given that it attempted to combine all three aspects in a single PPP. METHODS: The research has followed a concurrent mixed methods approach. In the quantitative study, data for prices and product volumes were extracted from secondary data sources and used to calculate the economic cost and value-for-money of the PPP. Simultaneously, a qualitative study was undertaken in which a number of key stakeholders were interviewed using a semi-structured questionnaire on their perceptions of the PPP's value. RESULTS: The institute earns a premium on the procurement cost of a broad range of vaccines required by the South African National Department of Health for its immunisation programme, the net value of which was US$85.7 million over the period 2010 to 2014. These funds were used to finance the institute's operations, including vaccine research, distribution and quality control. Capital expenditure to support the establishment of facilities for laboratory testing, packaging and labelling, filling, formulation and, finally, active pharmaceutical ingredient manufacture, approximately US$40 million in total, had to be secured through loans and grants. According to the respondents in the qualitative survey, the principal benefit of the PPP has been the uninterrupted supply of vaccines and the ability to respond quickly to vaccine shortages. The main disadvantages appear to have been a slow and ineffectual establishment of a vaccine manufacturing centre and, initially, a limited ability to negotiate highly competitive vaccine prices. CONCLUSIONS: Overall, it is concluded that a positive value-for-money has been achieved and the institute has been of significant public benefit. Relationships of this nature can be used to achieve public health goals, but need to be realistic about timeframes, costs and the limitations of relational governance in ensuring that complex programmatic outcomes are achieved. It is recommended that a more incremental approach, with clearer contractual goals, penalties and incentives, is adopted in attempting initiatives aimed at the localisation of manufacturing technology by leveraging public procurement.

Determining quantitative targets for public funding of tuberculosis research and development.

South Africa's expenditure on tuberculosis (TB) research and development (R&D) is insignificant relative to both its disease burden and the expenditure of some comparator countries with a minimal TB incidence. In 2010, the country had the second highest TB incidence rate in the world (796 per 100,000 population), and the third highest number of new TB cases (490,000 or 6% of the global total). Although it has a large TB treatment program (about $588 million per year), TB R&D funding is small both in absolute terms and relative to its total R&D expenditure. Given the risk and the high cost associated with drug discovery R&D, such neglect may make strategic sense. However in this analysis it is shown that TB R&D presents a unique opportunity to the national treasuries of all high-burden countries. Using two separate estimation methods (global justice and return on investment), it is concluded that most countries, including South Africa, are under-investing in TB R&D. Specific investment targets for a range of countries, particularly in areas of applied research, are developed. This work supports the outcome of the World Health Organization's Consultative Expert Working Group on Research and Development: Financing and Coordination, which has called for "a process leading to the negotiation of a binding agreement on R&D relevant to the health needs of developing countries".