Harpal Dhillon, PhD
Advisor on Governance and Systems Design
Preservation · Capability · Custodianship
Modern systems rarely fail because they lack innovation. They fail because the capabilities they depend on are treated as background conditions until they begin to degrade. Health systems produce the outcomes they are designed to produce. I work on the design.
My work sits at the intersection of governance, systemic risk, and the preservation of critical capabilities, with a particular focus on problems where degradation is slow, distributed, and difficult to reverse, yet becomes politically visible only after substantial capability has already been lost.
I arrived at this question through more than twenty years working across pharmaceutical strategy, regulatory affairs, medical governance, and health systems in multiple therapeutic areas and geographies. Across these settings, I repeatedly encountered the same underlying challenge: what appear to be technical, clinical, or commercial failures are often failures of governance, incentives, and institutional design.
Antimicrobial resistance serves as the primary reference case. Novel antibiotics function as strategic reserves yet are governed as commercial products. Market reform, pull incentives, and stewardship programmes each address real problems, but none of them were designed to govern a strategic reserve, and no institution currently possesses the mandate to preserve antibiotic effectiveness across time. I have described this as custodian failure: the absence of institutions whose primary mandate is the preservation of critical capabilities. The governance challenge is not institutional scarcity but mandate assignment. The institution that would address it, holding authority comparable to a central bank in finance or the International Atomic Energy Agency in nuclear governance, does not yet exist.
My current working papers develop this argument through the framework of [Reserve Governance] , exploring how societies preserve critical capabilities before crisis becomes visible and what forms of governance are required when conventional market and policy mechanisms prove inadequate.
Advisory
I advise organisations navigating complex questions of governance, systemic risk, and institutional design, and welcome conversations with executives, policymakers, researchers, and funders working on resilience, governance, global health, and the preservation of critical capabilities.
Writing
Background
Independent researcher and advisor. Contributing Expert, GARDP. Formerly Chair of the Expert Antimicrobial Group, Royal Pharmaceutical Society. Contributor, DRIVE-AB global antibiotic valuation consortium.
