International Financial Support Research Articles

Prevention of mother-to-child transmission of syphilis and HIV in China: What drives political prioritization and what can this tell us about promoting dual elimination?

ObjectiveThe present study aims to identify reasons behind the lower political priority of mother-to-child transmission (MTCT) of syphilis compared with HIV, despite the former presenting a much larger and growing burden than the latter, in China, over the 20years prior to 2010. MethodsWe undertook a comparative policy analysis, based on informant interviews and documentation review of control of MTCT of syphilis and HIV, as well as nonparticipant observation of relevant meetings/trainings to investigate agenda-setting prior to 2010. ResultsWe identified several factors contributing to the lower priority accorded to MTCT of syphilis: relative neglect at a global level, dearth of international financial and technical support, poorly unified national policy community with weak accountability mechanisms, insufficient understanding of the epidemic and policy options, and a prevailing negative framing of syphilis that resulted in significant stigmatization. ConclusionA dual elimination goal will only be reached when prioritization of MTCT of syphilis is enhanced in both the international and national agendas.

Perspective of CO2 capture & storage (CCS) development in Vietnam: Results from expert interviews

This paper summarizes expert opinions regarding crucial factors that may influence Vietnam’s future use of carbon capture and storage (CCS) based on face-to-face interviews in December 2013 with 16 CCS-related experts from the Vietnamese government, research institutes, universities and the energy industrial sector. This study finds that financial incentives and climate policy are the most important factors for the development of CCS technologies in Vietnam in the next two decades. Financial incentives involve direct subsidies from the government, such as tax exemptions for land use and the importation of CCS-related equipment. In addition, all the experts agree that international financial support is important to initiate a large deployment of CCS technologies in Vietnam by implementing demonstrative/pilot projects to prove CCS’s working efficiency.

Drug Control in Afghanistan: Culture, Politics, and Power during the 1958 Prohibition of Opium in Badakhshan

This article explores the process leading to the Afghan government's decision to implement a prohibition and eradication of opium in the northeastern province of Badakhshan. It explores why Daud chose Badakhshan, the impact of the opium ban on the people of Badakhshan and the future of opium production and trade, as well as the evolution of drug control in Afghanistan under the Musahiban dynasty. Ultimately, the ban was launched because it allowed Daud to garner international praise and financial support, while enforcing eradication in an area inhabited by ethnic minorities ensured that the Afghan government's coercive strategy would not generate resistance from rural Pashtun tribes historically opposed to these types of state intervention.

Congolese Elections 2011: Mostly a Problem of Global Governance and Negative 'Soft Power', not Resources

When Congolese President Joseph Kabila was inaugurated for a second term on 20 December 2011 the fallout from the 28 November elections in the Democratic Republic of the Congo (DRC) was 'situation normal: continued instability'. After Kabila's main opponent, Etienne Tshisekedi, 'swore himself in' on 23 December (Tshisekedi website), there were two men claiming to be president and several other candidates demanding a new ballot. The 2006 elections, the DRC's first since the Global and Inclusive Agreement (Dialogue Inter-Congolais 2002), were shambolic, but clearly legitimate (UN 2007, Carter Center 2006a, b, c). This was partly due to the fact that the United Nations Organization Mission in the Democratic Republic of the Congo (Monuc) had a stronger presence than its successor, the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (Monusco). There was also more international attention in 2006, including an EU rapid reaction force. However, many of the issues in the 2011 election - violence, logistical problems and irregularities - were present in the previous one (see, eg, UN 2006; Carter Center 2006a, b, c). There was possibly as much international financial and logistical support as there had been in 2006. There were fewer international observers but more local ones. The main differences relate to context, the structure of international assistance and the lack of a second presidential round. The crisis had been years in the making. More important than diminished engagement in the mechanics of the election was the international community's sham attention to governance in sub-Saharan Africa and the culture of impunity it has encouraged. The West, unlike China, has failed to appreciate the strategic importance of the DRC. By encouraging regional dictators instead of enthusiastically supporting the rule of law early and often, it tacitly encouraged bad behaviour.

The Scientific Field During Argentina’s Latest Military Dictatorship (1976–1983): Contraction of Public Universities and Expansion of the National Council for Scientific and Technological Research (CONICET)

This study looks at some of the traits that characterized Argentina’s scientific and university policies under the military regime that spanned from 1976 through 1983. To this end, it delves into a rarely explored empirical observation: financial resource transfers from national universities to the National Scientific and Technological Research Council (CONICET, for its Spanish acronym) during that period. The intention is to show how, by reallocating funds geared to Science and Technology, CONICET was made to expand and decentralize to the detriment of universities. This was the primary tool used by the military regime to thwart higher education’s research development, bolstering research efforts at other realms. Thus, CONICET grew in budget, number of researchers, and staff size, creating new research institutes, while national universities struggled with reduced funding and were forced to shut down their institutes and programs. As a result, CONICET virtually concentrated all scientific research, foregoing the knowledge accumulated at universities, which drove a wedge between both institutions. This military approach to science and technology policy-making is discussed, bearing in mind the notion of dependence—both in terms of the state’s intervention in the inner workings of the scientific-university field as well as regarding the role played by international financial support in scientific research development.

La gestion forestière communautaire comme source de revenus locaux : deux études de cas en Amazonie brésilienne

La gestion forestière communautaire (Gfc) apparaît comme une des voies permettant de protéger les forêts, tout en générant des revenus directs pour les petits propriétaires forestiers. Depuis le milieu des années 1990, les projets de ce type se multiplient en Amazonie brésilienne. Cependant, la plupart se heurtent à de nombreuses difficultés malgré des financements publics conséquents. Deux de ces projets, mis en oeuvre dans l'État du Pará (dans l'Est de l'Amazonie), ont fait l'objet d'analyses entre 2008 et 2010 qui visent à mettre en lumière les principaux obstacles s'opposant à leur viabilité financière sur le long terme et à déterminer les revenus de l'exploitation forestière réellement perçus par la communauté. Le premier obstacle majeur à la réussite des projets de gestion forestière communautaire est la lourdeur du processus réglementaire : il faut actuellement deux ans pour aboutir à l'approbation d'un plan de gestion. De plus, l'élaboration et la mise en oeuvre d'un tel plan de gestion est un processus onéreux. Aucun des plans de gestion analysés n'aurait réussi sans le soutien financier externe d'agences nationales ou internationales et sans assistance technique. D'autre part, dans le contexte actuel du marché amazonien, le bois n'apporte que des revenus directs limités pour les petits exploitants, alors même que leurs terres sont forestières à 80 %. L'accès aux marchés est très incertain et les groupes de petits exploitants ont beaucoup de mal à vendre leur bois à des prix rémunérateurs. Des garanties publiques assurant un prix rémunérateur minimum pour le bois issu de projets de gestion forestière communautaire, sont sans doute nécessaires pour qu'ils deviennent une source réelle de revenus pour les petits exploitants amazoniens.

Rising Food Prices and Their Implications for Education in Africa

Using cross sectional data of Sub-Saharan African countries from 2006-2009, this paper studies the relationship between food crisis, and child education outcomes. Although the study finds a significant and negative direct impact of food crisis on primary completion rates in the region, the same cannot be said for primary enrolment rate, and gender disparities. Even the highest food inflation countries have achieved a slowly progress in primary enrolment in the food crisis period. The results show that children enter schools, but parents may find it so costly to send them, and never complete the primary level. The paper also finds that other factors such as per capita income, student expenditure, and government expenditure can be helpful in explaining the child education outcomes in the region. At the same time, our findings are sobering: In sub-Saharan African countries, international educational goals are unlikely to be reached by 2015, and poor child education outcomes are frequently widespread, in the context of tight government budgets, there is an urgent increase in international financial support needed to help the region to attain quantum and quality of human capital.

Why Pursue Negotiations with the Taliban ?

Despite the unprecedented international financial aid and military support to the government of Afghanistan, the scaled-up military presence of the United States and the variety of US and ISAF (International Security Assistance Force) tactics used in the ongoing effort to defeat the resistance and establish peace, security and the rule of law, the situation in Afghanistan has deteriorated. The resistance has grown, war and insurgency in Afghanistan have intensified, and the Taliban have expanded their activities, becoming a countrywide movement with territory gained in the north and west. Conversely, the United States is facing great economic challenges both at home and abroad, and there is pressure from Congress and the American public on President Barak Obama to bring American men and women deployed in Afghanistan back home.

The Evolution of Stakeholder Perceptions of Deploying CCS Technologies in China: Survey Results from Three Stakeholder Consultations in 2006, 2009 and 2012

We examine the evolution of Chinese stakeholder views on CCS over the past six years. The first major survey conducted in 2006 sought to understand views on deploying CCS technologies in China. In 2009, a second survey had the primary goal of understanding stakeholder perceptions of technology choice and financing issues for the first large-scale CCS demonstration projects in China. The latest consultation in 2012, building on previous surveys, investigates stakeholder perceptions as well as behavioural issues affecting preferences. In total, over 350 stakeholders were consulted from 2006 to 2012. Climate change is found to have risen dramatically as a priority for all stakeholders. The potential of CCS is more widely acknowledged, but more so by industry and less among government officials. Knowledge of CCS has also increased substantially. Post-combustion technologies are increasingly viewed as the preferred capture technology and some form of utilization, increasingly enhanced oil recovery, is preferred for CO2 storage. Aside for concern over CO2 storage risk, which remained high, attention moved from a focus on third party exposure (e.g. health and safety risks) to direct risks (e.g. the cost of CO2 capture). The expectation of international financial support for demonstrating CCS in China had shifted over time and has gradually diminished.

Technical Progress as a Solution for Romania and Greece to Face the Global Crisis’ Problems and the Bad Forecasts

1. Introduction Greece and Romania have a common historic, cultural and economic destiny. This is why both countries have to face to a complicated challenge nowadays. The global crisis forced both countries to adopt severe austerity measures in order to obtain the economic survive. Greece and Romania asked for the international financial institutes' support and started to implement painful economic reforms which attract the hostility of the civil society. On short and medium term will be not much financial possibilities to support a big recovery of the jobs, industries and welfare. This is why an alternative possibility would be the efficient use of the technical progress. We talk about human capital and technical support of it, because both countries have enough average and high skill labour, which is able to support the economic recovery. The technical progress in economy represents a dynamic complex process which introduces the latest techniques and scientific research's results on capital and labour, in order to increase productivity, output and economic efficiency. An important element of the economic development is the optimal dimension and the efficient use of the demo-economic resources. As a result of the obsolete and relative labour decrease in economy related to the demographic trend, the training and the human capital become essential to a modern economy. In order to analyse the economic development in Romania and Greece under the technical progress impact, a production function will be used. This production function is based on two control parameters and one behaviour parameter. Cobb and Douglas used the production functions for the first time in 1928. During the 50s-70s, there were a lot of theoretical debates on this kind of function. The greatest problems were focused on aggregate production functions, even that the microeconomic production functions were put under scrutiny, as well. The debate in this field started criticizing the way the factor input, capital, was measured and how the notion of factor proportions had distracted economists. (2) Other specialists succeeded to make the production function more realistic by adding in natural resources. (3) Other specialist criticised Solow and Stieglitz's approach which was considered a trick against the laws of thermodynamics. (4) Neither Solow nor Stiglitz addressed his criticism, despite an invitation to do so in the September 1997 issue of the journal Ecological Economics? (5) An interesting retrospective of the production function approach evolution was made in 2003. (6) The same historical approach was made by in 2007, as well. (7) In the same period, the analysis concerned production functions and was robust with respect to increases in the number of independent variables and to alternative functional forms. (8) On the other hand, the meta-production function was presented as best-practice production function. (9) The paper takes a supplementary step under production function approach, in order to use this type of function to quantify the technical progress on economic development and to realise a pertinent comparative analysis between Greece and Romania. 2. Methods This proposal is a model based on a production function. In order to apply this theoretical approach to the macroeconomic evolution, a Cobb-Douglas function is used as follows: Y = A[L.sup.a][K.sup.b], in which: A: technical parameter, A L: labour; K: fixed capital; a: parameter proportional to relative labour productivity; b: parameter proportional to fixed capital efficiency. Both labour productivity and fixed capital efficiency are under the impact of the technical progress. This technical progress in the economy is quantified by the growth of the labour knowledge ([alpha]) and the growth of fixed capital use degree ([beta]). …

Estimates of incremental investment for and cost of mitigation measures in developing countries

Keeping the global temperature increase below 2°C will require concerted mitigation action by both developed and developing countries. In the UN Framework Convention, the Kyoto Protocol and the Copenhagen Accord, developed countries have an obligation to provide finance for mitigation measures in developing countries. Estimates of incremental investment and incremental costs for mitigation action in developing countries are reviewed. These estimates cover developing countries as a group, individual countries and specific sectors. Many mitigation measures are more capital-intensive but have lower operating costs than the technologies they replace, so the incremental investment exceeds the incremental cost. There is no agreed basis for determining how much international financial support should be provided for mitigation measures in developing countries. Although the amount of international funding needed cannot be determined from the available analyses, it is likely to lie between the estimates of incremental cost and the incremental investment. The few estimates of incremental mitigation costs available suggest that these costs will rise substantially over the next two decades and exceed US$100 billion by 2030. The promises to increase international climate funding significantly over the next decade are encouraging, but it is not yet possible to determine whether the promised funding will be sufficient.

Some Lessons for the Future from the Global Malaria Eradication Programme (1955–1969)

Encouraged by the early success of using dichloro-diphenyl-trichloroethane (DDT) against malaria, the World Health Organization (WHO) embarked on the Global Malaria Eradication Program (GMEP) in 1955. Fourteen years later, the campaign was discontinued when it was recognised that eradication was not achievable with the available means in many areas, although the long-term goal remained unchanged. During the GMEP, malaria was permanently eliminated from many regions. In other areas, however, substantial gains were lost in resurgences, sometimes of epidemic proportions. During the 1970s and 1980s, because of economic and financial crises, international support for malaria control declined rapidly, but in the past decade, following increasing demands from endemic countries and promising results from scaling up of control activities, interest in malaria elimination and the long-term goal of eradication has received international political and financial support. In 2007, there was a renewed call for malaria eradication and a consultative process to define a research and development agenda for malaria eradication (malERA) was established. Lessons learned from the GMEP (1955-1969) highlight the fact that no single strategy can be applicable everywhere and that a long-term commitment with a flexible strategy that includes community involvement, integration with health systems, and the development of agile surveillance systems is needed.

The Copenhagen Accord: abatement costs and carbon prices resulting from the submissions

As part of the Copenhagen Accord, individual countries have submitted greenhouse gas reduction proposals for the year 2020. This paper analyses the implications for emission reductions, the carbon price, and abatement costs of these submissions. The submissions of the Annex I (industrialised) countries are estimated to lead to a total reduction target of 12–18% below 1990 levels. The submissions of the seven major emerging economies are estimated to lead to an 11–14% reduction below baseline emissions, depending on international (financial) support. Global abatement costs in 2020 are estimated at about USD 60–100 billion, assuming that at least two-thirds of Annex I emission reduction targets need to be achieved domestically. The largest share of these costs are incurred by Annex I countries, although the costs as share of GDP are similar for Annex I as a group and the seven emerging economies as a group, even when assuming substantial international transfers from Annex I countries to the emerging economies to finance their abatement costs. If the restriction of achieving two-thirds of the emission reduction target domestically is abandoned, it would more than double the international carbon price and at the same time reduce global abatement costs by almost 25%.

Vietnam's Palliative Care Initiative: Successes and Challenges in the First Five Years

In 2005, Vietnam's Ministry of Health (MoH) launched a palliative care initiative that uses the World Health Organization (WHO) public health strategy for national palliative care program development. With international financial and technical support, the initiative has made significant early progress. A rapid situation analysis in 2005 led to national Guidelines on Palliative Care in 2006, radically improved opioid prescribing regulations in 2008, the training of more than 400 physicians in palliative care by early 2010 using three curricula written especially for Vietnam, and the initiation of palliative care services in some hospitals and in the community. Yet, access to palliative care services remains very limited. Many challenges must be overcome to reach the goal of access for all to essential palliative care services that are integrated into the systems of cancer care, HIV/AIDS care, and primary care. Going forward, crucial aspects of the initiative will be continued commitment to palliative care by the MoH, careful planning and targeted funding that address each part of the WHO public health strategy, ongoing expert technical support, and collaboration among international technical and financial supporters.

Health systems financing and the path to universal coverage

Donor commitments to health have increased more than fourfold since the Millennium Declaration was signed in September 2000, reaching more than US$ 20 billion in 2008.1 Despite this, progress towards some of the health Millennium Development Goals (MDGs) has been disappointing in many settings.2 The simple act of raising more international funds cannot, by itself, achieve the Goals if the health system is too weak to support the rapid scale-up of service coverage.3 Where there are insufficient health workers and health facilities, or where people can’t obtain health care because they cannot afford to pay, supporting actions are needed. Domestic health financing systems must be robust enough to attain and sustain increased coverage. Financing for universal coverage is based on two interlinked foundations. The first is to ensure that financial barriers do not prevent people from using the services they need – prevention, promotion, treatment and rehabilitation. The second is to ensure that they do not suffer financial hardship because they have to pay for these services.4 Health services cost money and someone has to pay. Even with the recent increase in external funds for health in low-income countries, these countries still have to find almost 75% of their health funding in domestic sources. The way that countries raise those funds is critical. Direct payments required when people obtain care (e.g. user charges) prevent many people from seeking care in the first place, and may result in financial catastrophe, even impoverishment, for many.5 Improving universal coverage requires systems that raise the bulk of funds through forms of prepayment (e.g. taxes and/or insurance), and then pool these funds to spread the financial risk of illness across the population. They require health financing systems with inbuilt incentives to ensure that these funds are used efficiently and equitably. The World Health Organization’s next world health report will be on health financing and will argue that almost every country, rich and poor, can improve service coverage or financial risk protection by addressing one or more of the core tasks of a financing system – raising sufficient funds, pooling these funds to spread financial risks and spending wisely. The Bulletin of the World Health Organization has been running a series of news stories since December 2009, showing how health financing systems affect people’s lives. Reports have been published in the following order from Spain,6 China,7 Thailand,8 the Republic of Korea,9 Switzerland,10 Nigeria11 and, in this issue, the United States of America.12 In addition, some of the issues that policy-makers inevitably face as they develop their health financing systems are highlighted in perspectives published this month. In terms of raising more funds, Fryatt & Mills13 outline the main achievements of the high-level Taskforce on Innovative International Financing for Health Systems. They claim that it has helped maintain momentum for increased international financial support for health in low-income countries at a time of the financial crisis. In response, McCoy & Brikci14 argue that the Taskforce report was disappointing. It gave only lukewarm support to a financial transactions levy, an option targeting the banking sector, while supporting consumer taxes affecting the poorer population groups. The focus on innovative financing could also backfire by encouraging countries to renege on their commitments to provide official development assistance – in fact only a few of them have kept their international promises to date. Yates15 focuses on how funds for health are raised and makes a case for abolishing user fees, starting with services for women and children. On the other hand, Jowett & Danielyan16 claim that the debate about user-charges is not so straightforward. For example, Armenia has developed an official fee schedule for health services as a way of countering unofficial or under-the-table payments. Finally, Leatherman & Dunford17 report that microfinance increasingly provides relatively poor people, often women, with income-earning opportunities and suggests that it might also help people to access health services where they must pay for them. Many countries are very close to universal coverage and others are making good progress. The Bulletin’s articles on this topic raise fundamental questions that must be considered when thinking about how best to develop and adapt national health financing systems for universal coverage.

Structuring International Financial Support for Climate Change Mitigation in Developing Countries

In the Copenhagen Accord of December 2009, developed countries agreed to provide start-up finance for adaptation in developing countries and expressed the ambition to scale this up to $100 billion per year by 2020. The financial mechanisms to deliver this support have to be tailored to country and sector specific needs so as to enable domestic policy processes and self sustaining business models, and to limit policy risk exposure for investors while complying with budgetary constraints in OECD countries. This paper structures the available financial mechanisms according to the needs they can address, and reports on experience with their application in bilateral and multilateral settings.

When to start antiretroviral therapy in resource-limited settings: a human rights analysis.

BackgroundRecent evidence from developed and developing countries shows clear clinical and public health benefit to starting antiretroviral therapy (ART) earlier. While discussions about when to start ART have often focused on the clinical risks and benefits, the main issue is one of fair limit-setting. We applied a human rights framework to assess a policy of early treatment initiation according to the following criteria: public-health purpose; likely effectiveness; specificity; human rights burdens and benefits; potential for less restrictive approaches; and fair administration.DiscussionAccording to our analysis, a policy of earlier ART initiation would better serve both public health and human rights objectives. We highlight a number of policy approaches that could be taken to help meet this aim, including increased international financial support, alternative models of care, and policies to secure the most affordable sources of appropriate antiretroviral drugs.SummaryWidespread implementation of earlier ART initiation is challenging in resource-limited settings. Nevertheless, rationing of essential medicines is a restriction of human rights, and the principle of least restriction serves to focus attention on alternative measures such as adapting health service models to increase capacity, decreasing costs, and seeking additional international funding. Progressive realisation using well-defined steps will be necessary to allow for a phased implementation as part of a framework of short-term targets towards nationwide policy adoption, and will require international technical and financial support.

Climate Change Adaptation, Development, and International Financial Support: Lessons from EU Pre-Accession and Solidarity Funds

Funding adaptation requires adequate governance and there are different ways to organise and channel the funds to where it is most efficient and most necessary. This paper investigates this issue and studies the practical implementation of a development under conditionality, namely adaptation-development, and its requirement in terms of financing architecture. To contribute to this research, it looks at similar problems that have been met in the past, namely the European funding programs for Eastern Europe countries that were candidates to adhesion, and European internal structural and cohesion funds. These funding examples provide a pertinent analogy for the adaptation problem, and most issues in adaptation finance have also been met in these funds (difficulty to define and measure additionality and incremental cost, concept fuzziness, need for leverage and mainstreaming, ownership and sovereignty issues). Publicly available documents from the European Commission and the European Court of Auditors are reviewed, providing interesting insights into possible implementation of adaptation finance. These insights can be summarized into seven main lessons: (1) “black-spot” programs are less flexible but more efficient than “concept-based” programs; (2) a multi-scale and multi-step approach can minimize sovereignty and ownership issue, and facilitate capacity building; (3) private funding leverage is a myth, and funding based on the “additional cost” is highly inefficient; (4) non substitutability among objectives and regions is necessary; (5) sub-national eligibility criteria are a viable solution; (6) institutional capacity matter: low-capacity countries should focus on capacity building and “black-spot” strategies; higher-capacity countries can follow a concept-based approach; and (7) the EU should use its own experience to promote its views of adaptation funds.

China's wind industry: policy lessons for domestic government interventions and international support

The dynamics of the development of China's wind power industry were investigated from a dual perspective of domestic government interventions and international support. The progress of China's wind power industry is largely attributed both to the effective implementation of a bundle of domestic public policies (such as the wind power concession programme, mandatory renewable power market share, power surcharge for renewables, and tax relief) and international support (in the forms of technology transfer, CDM and public finance support). Wind power has great potential for mitigating China's future CO2 emissions. However, resource uncertainty, technology risk, and market uncertainty will need to be addressed in order to translate the potential into market reality. Enhancing domestic technology R&D support, increasing the level of the power surcharge for renewables, international support (e.g. CDM), and improving technology transfer will assist in minimizing these uncertainties and risks. Policy relevance: International technological cooperation is illustrated in terms of how domestic policy and international support interact through constructive domestic policies, private-sector joint ventures, and international capacity building and financial support. The definition of a new objective for future policy (large-scale penetration of wind in the Chinese power system) allows for the identification of future priorities for technology cooperation. Large amounts of intermittent generation require new technologies and practices for grid operation and management, and better adaptation of turbine design to domestic materials and local conditions. Win—win options exist, but need to be supported by capacity building and frameworks that balance incentives for international technology companies against Chinese concerns over dependence on imported technology and high licensing fees.

Immunologie der Tuberkulose und Entwicklungsstand neuer Impfstoffe

Even 125 year after the discovery of Mycobacterium tuberculosis as the aetiological agent of tuberculosis by Robert Koch, tuberculosis is still a global health emergency according to WHO. The high infection rate with M. tuberculosis that persists in the human host until a weakened host immune system allows a reactivation and complicated and expensive antituberculous chemotherapy urgently demand the development of new vaccines. Increasing numbers of multidrug-resistant tuberculosis, especially in the successor states of the former Soviet Union and China, further complicate an efficient tuberculosis control. For decades, there was no new release of an antituberculous drug to efficiently fight tuberculosis. Hence, also drug development has to keep up with the development of resistance by the pathogen. The following review describes the immune response to M. tuberculosis infection and the deduction of strategies for novel vaccines. Thanks to international financial support, several new vaccine candidates are already in the pipeline and close to clinical testing phases.