For the present system to work, poor people must be excluded from the innovation, because if they could get access at an affordable price, then affluent people would find ways to buy it cheaply as well - and then the innovator would be poorly rewarded and introductions of new medicines would decline.

There is at the global level a very small number of actors who can meaningfully weigh in on global institutional design, who are able - through powerful governments and most effectively through the government of the United States - to exert substantial influence on international negotiations, which are routinely conducted behind closed doors.

America is run by the rich and powerful in their own interest. To an extent that I think is hard to exaggerate, the intellectuals - academics, journalists and so on - are bought off. And that's a big change that happened in the United States in the last 30 or 40 years.

I see a violation of human rights not in the mere fact that people don't have enough to eat and that they are very vulnerable, but I see it in the fact that the economic institutional order of the world is associated with this very persistent poverty and that different institutional arrangements at the supranational level could stop and even reverse the slide towards ever-greater income disparities.

With the Health Impact Fund, the innovation is paid for separately, through publicly funded health impact rewards, and the product is sold at the cost of production to all. Here, the cruel injustice of preventing the poor from buying at cost - evidenced by today's suppression of the trade in generic versions of patented medicines - would no longer be needed.

Competing companies evolve toward efficiency as the more efficient ones profit and expand while those who fall behind fail. And companies being efficient and profiting under the Health Impact Fund, this is exactly what we want, because the company's profit is directly driven by the health impact its registered products achieve.

We have this highly irrational system of incentivizing innovation for clean and green technologies, where we allow the innovator to have a temporary monopoly and then mark up the price of the product or sell licenses at high prices to those who want to use the kind of product that the innovator has invented. This system is collectively irrational because many people, to avoid the inflated prices of still-patented cleaner and greener technologies, opt for some older technology that is much more polluting.