Breakthroughs Blog: Child health

Tomorrow US policymakers and global health advocates will come together to talk progress made on preventing maternal and child deaths. During the day, the US Agency for International Development (USAID) will host a high-level forum called Acting on the Call: Ending Preventable Child and Maternal Deaths to both celebrate progress and assess the challenges that remain. That evening, the 5th Birthday and Beyond coalition will celebrate America’s leadership and investments worldwide to help children reach their fifth birthday. US investment in R&D has led to new innovations that are saving the lives of mothers and children. Photo: PATH/Teresa Guillien While you’ll probably hear a lot of different facts and figures, one message will be clear—the world has made remarkable progress in preventing the deaths of millions of women and children. In fact, maternal and child deaths have been cut in half in just over two decades. That means that every day this year, 17,000 more children will live and 700 more mothers will survive childbirth than did two decades ago. Central to this progress has been US investment in research and development (R&D) that has led to new medicines and innovative health products that are saving the lives of mothers and children. Globally new vaccines, drugs, diagnostics, and other health innovations have led to 4.2 million fewer child deaths in 2013 compared to 1990, according to a report by the Institute for Health Metrics and Evaluation. Innovations like the polio vaccine, oral rehydration solution to treat diarrhea, and antiretroviral therapies that prevent maternal to child HIV transfer, and others treatments have resulted in incredible gains for maternal and child health.   No country has done more than the United States to help save the lives of the world’s poorest mothers and children. A critical part of the US approach has been our world-leading investment in global health R&D. In fact, the US government is the largest funder of global heath R&D in the world—contributing over 45 percent of total investment. US government investment in global health R&D has led to breakthroughs that have transformed or are poised to transform efforts to reduce maternal and child mortality. Some examples include: The Oxytocin-Uniject™ This is a device filled with oxytocin that helps contract the uterus to reduce post-partum hemorrhage—or excessive bleeding—the leading cause of maternal death worldwide. It is easy to inject and requires little training to administer, so it’s made a dramatic difference in the ability of health workers to administer oxytocin in emergencies or in remote locations outside of traditional hospital facilities. USAID played a crucial role in funding research towards the development of this product. RTS,S malaria vaccine candidate RTS,S is the most clinically-advanced vaccine candidate for malaria—a disease which kills a child every 40 seconds. A recent study showed that infants who receive the RTS, S vaccine had one third fewer cases of both clinical and severe malaria. A vaccine could be an important tool in reducing child sickness and death from malaria. The Department of Defense provided critical funding for the early development and clinical testing of RTS,S. Rotavirus vaccines Rotavirus-induced diarrheal disease kills roughly 435,000 children younger than five each year. Two currently available rotavirus vaccines were introduced in the past two decades, with other vaccines under development showing tremendous progress. The National Institutes of Health developed the first available rotavirus vaccine and has been a financial partner in the development of subsequent vaccines. In addition, the Centers for Disease Control and Prevention also monitors efficacy and safety, and supports clinical trials of rotavirus vaccines. New contraceptive technologies Family planning technologies allow women to space their pregnancies—making it more likely for both the mother and child to survive childbirth. An analysis of 172 countries found that family planning prevented 272,000 maternal deaths in just one year. However, the contraceptive options that exist today don’t always meet the needs of women in developing countries. New vaginal rings are being developed that will be long-lasting and easy for the user to insert and remove without a doctor’s assistance, while new multipurpose prevention technologies combine the delivery of contraceptives with microbicides which reduce the transmission of HIV and other sexually transmitted infections. USAID provides funding towards the development of many of these new contraceptive technologies. While tremendous progress has been made in decreasing maternal and child deaths worldwide thanks in part to new health innovations, each year 6.6 million children still die before their first birthday and 289,000 women still die from pregnancy-related causes. That translates to 18,000 children under the age of five and 800 pregnant women or women in childbirth dying every single day. The United States can and must do more. While the United States should increase access to proven and existing drugs, vaccines, and other health tools for maternal and child health, it is just as critical to develop the next generation of tools to prevent and treat existing and emerging diseases. Sustained and continued investment by the US government in global health R&D is critical to ending maternal and child deaths.

Rachel Wilson is the senior director of policy and advocacy at PATH, a GHTC member. She wrote this guest post in reaction to last week’s conference on child health in Washington, DC. The Child Survival Call to Action that took place last week in Washington, DC, was a unique opportunity for 700 stakeholders working in the government, the private sector, faith-based organizations, and civil society to come together to kick off a long-term, focused effort to save children's lives. While the goal of the Call to Action— to decrease annual preventable childhood deaths to two million by 2035—may seem daunting, we ought to remind ourselves that we already have many of the tools at our disposal to achieve success. Existing health commodities like oral rehydration solution and zinc effectively treat life-threatening dehydration caused by severe diarrhea, one of the leading killers of kids. Insecticide-treated bednets can prevent malaria—another deadly disease for children—and help save half a million lives per year. Solutions like these are simple and affordable, and ought to be expanded so that all children, no matter where they live, can access them. However, to fully answer the call to end preventable child deaths, we also need to determine where there are gaps or where alternatives may need to be added to the portfolio of solutions that are currently available. So, in addition to ensuring access to current interventions, new tools are needed to address the leading killers of kids. To that end, PATH is working in partnership with private-sector partners to develop vaccines to prevent diarrhea, pneumonia, and malaria and better diagnostics to detect diarrhea and malaria. Finally, we are working with our new drug development affiliate OneWorld Health on new formulations for oral rehydration salts and new malaria drugs to treat diarrhea and malaria, respectively. In a similar vein, it is imperative that we invest in innovations that enable us to deliver products—like vaccines—in a safe and cost-effective way. PATH is developing an innovative technique to fully immunize children using less vaccine—a cutting-edge way of spending less money to save more lives. Our new president and CEO, Steve Davis, spoke on a panel around innovation on the second day of the conference where he discussed how collaboration, which the Call to Action exemplifies, is an essential element of innovation. The US Government has been an incredible champion of innovation over the years. According to a recent report put out by the Global Health Technologies Coalition and Policy Cures, the United States is the world’s leader in investments in global health research and development, which have led to some game-changing innovations. These discoveries have contributed to the remarkable progress in the area of child survival. In the last 50 years, child deaths have dropped by 70 percent worldwide, and in the past two decades alone, child deaths have plummeted from 12 million in 1990 to 7.6 million in 2010. This rapid progress is largely due to high-impact solutions, notably new and low-cost vaccines and improved health services. However, without US ingenuity and the foresight to invest in the science that gave rise to these solutions, these gains would have been far less dramatic. The goal of the Call to Action ought to be commended. We have the simple solutions available today to make that happen. And we can save even more lives if we also focus on the health tools and technologies on the horizon. Let’s be sure to answer the call.