#HealthPolicyValentines for global health research

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email.  The second-largest Ebola outbreak in history—which has infected 3,500 people and killed 2,250 in the Democratic Republic of Congo (DRC) since August 2018—is down to its last chain of transmission despite ongoing violence that has hampered response efforts. The waning of the Ebola outbreak comes as the outbreak of the novel coronavirus, COVID-19, has captured global attention and potentially funding as well. According to a World Health Organization (WHO) spokeswoman, “Funding needs [for the Ebola response] have not as yet been fully met, and currently there is a risk there will not be funding for WHO activities beyond February.” Despite the waning of Ebola cases in DRC, last Wednesday, an independent committee that advises WHO unanimously agreed the Ebola outbreak continues to be a public health emergency—a designation recently extended to the COVID-19 outbreak. Though WHO and others have worked tirelessly to contain Ebola, the region’s health system remains weak and the likelihood of future outbreaks is high. The experimental antiviral drug remdesivir successfully prevented disease in rhesus macaques infected with Middle East respiratory syndrome coronavirus (MERS-CoV), according to a study performed by the US National Institutes of Health and supported by the Biomedical Advanced Research and Development Authority. Remdesivir both prevented disease when administered before infection and improved the condition of the macaques when given after the animals already were infected. MERS-CoV is closely related to COVID-19, which emerged in Wuhan, China in December of last year and has grown to be a public health emergency. The promising results of this study support the case for additional clinical trials of remdesivir for MERS-CoV and COVID-19. Gilead Sciences developed remdesivir and collaborated in the research. On Monday, February 10, President Trump released his proposed budget for fiscal year 2021, which seeks deep cuts of US$3 billion to global health funding. The proposed cuts include a 34 percent reduction to global health programs at the State Department and US Agency for International Development (USAID) and a seven percent cut in funding to the Centers for Disease Control and Prevention (CDC)’s Center for Global Health. President Trump’s budget also proposed a 58 percent reduction in funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria and a 50 percent cut in funding to WHO. Despite these widespread proposed cuts, the budget did include some boosts in funding—a $50 million increase for CDC’s global health security activities and $15 million for USAID’s Global Health Security programs. President Trump’s budget has been condemned by public health experts and many lawmakers, who have spoken out against the cuts which are unlikely to go into effect.

With the global health emergency of the novel coronavirus looming large, last week the global health community gathered in Geneva to kick off the World Health Organization (WHO) Executive Board (EB) meeting. In his opening remarks, WHO Director-General Dr. Tedros Adhanom Ghebreyesus highlighted the agency’s new Science Division and underscored WHO’s commitment to “being at the forefront of science,” signaling the importance of research and development (R&D) to achieve the agency’s goals. GHTC was on the scene following the official agenda and delivering statements. Here are our top three takeaways from this year’s EB:1. Coronavirus and public health emergency preparedness take center stageWith the coronavirus [COVID-19] crisis dominating the attention of the world, the global response to this health emergency was a clear priority for WHO during the EB. Throughout the week, WHO held daily briefings to update member states on the evolving situation and ongoing response efforts. While plenty of the discussions were mired in the ongoing political controversies around travel and trade restrictions, a good portion also encouragingly centered around the need to fast-track the R&D response. Delegates highlighted the development and evaluation of effective diagnostic tests, vaccines, and medicines, as part of the R&D priorities and called for establishing mechanisms that ensure access to these new treatments and technologies for the most vulnerable populations. Data sharing, public-private partnerships, and collaboration were also highlighted as key elements to be strengthened as part of emergency preparedness activities.A global research and innovation forum specifically on the coronavirus was convened by WHO in the days following the EB in line with the WHO R&D Blueprint strategy and preparedness plan to rapidly activate R&D activities during epidemics. Its aim is to fast-track the availability of effective tests, vaccines, and medicines that can be used to save lives and avert large-scale crises.The theme of rapid response capabilities also dovetailed into the dialogue at the EB around the Nagoya Protocol, a legal framework that regulates the sharing of genetic resources across borders to ensure any benefits derived are fairly and equitably shared. China was continuously praised at the EB for its rapid sharing of genetic sequence data on the virus, which has helped accelerate the R&D response. However, this action was not in line with the Protocol, which calls for this type of genetic data sharing to be negotiated individually with each country. In a session on the public health implications of the Nagoya  Protocol, member states called on WHO to continue to gather intelligence and provide a review of the current impact of the Protocol. Several members also highlighted the need for a new international framework to specifically govern pathogen sharing, modeled on the Pandemic Influenza Preparedness (PIP) framework, a non-binding mechanism that seeks to strengthen global influenza surveillance and response systems. WHO Chief Scientist Dr. Soumya Swaminathan promised that her team would continue its efforts to study the issue and hold additional consultations to provide more clarity to all stakeholders.2. R&D features prominently in Global Vaccine Action Plan and Ending TB agendaWith sessions on the Global Vaccine Action Plan, intellectual property, ending tuberculosis (TB), and neglected tropical diseases, it is not surprising that this year’s EB featured an agenda with significant implications for R&D.In particular, the session on ending TB generated critical momentum for R&D, as member states called for increased investment in developing new technologies, including shorter, high-quality treatment regimens and diagnostic tools. The need to enhance data sharing and strengthen enabling environments for R&D was also discussed by country delegates.Member states also unanimously approved two decisions that set the stage for global vaccine policy in the next decade—a draft resolution on “strengthening global immunization efforts to leave no one behind” and the first-ever draft resolution on “eliminating meningitis by 2030”—after reviewing a report prepared by the Director-General on lessons learned from the Global Vaccine Action Plan 2011–2020. Member states were urged to continue working with R&D stakeholders to support immunization supply chain innovations and vaccine administration technologies to increase the efficiency of vaccine delivery. Countries were also encouraged to improve and increase vaccine production capacity and develop new products, services, and practices, including those addressing emerging infectious diseases.3. Civil society engagement at WHO remains strainedCivil society engagement with WHO continues to be a challenging process and this year’s EB strained relations between stakeholders even further. In a surprising move, the EB Chairman, took fairly drastic actions to further curtail civil society participation during the official proceedings. Non-state actors’ (NSAs) statements were reduced to one minute, which has occurred at EB meetings in the past, often as a way to protect time allocated for other agenda items. However, this time, some organizations were also prohibited from delivering statements if they had already made previous interventions during the EB, and the Chair aggressively admonished those who wished to speak on multiple topics.This came amidst the backdrop of a proposal that member states were set to consider that could considerably hamper civil society’s ability to provide input to important fora like the EB and the World Health Assembly (WHA). The proposal called for streamlining the statement process by compelling NSAs to deliver joint interventions, limiting the overall size of civil society delegations, and possibly introducing an altogether new process for dialogue between member states and NSAs at a separate forum. Member states supported the idea of joint statements and a constituency approach, while civil society pushed back against these measures that they believe would restrict meaningful contributions and silence important voices. All stakeholders agreed that the idea of a forum for NSAs required additional dialogue and was too premature for this year’s process. WHO is looking to pilot some of the new procedures, at least in part, during the next WHA, though details are not yet available. With many items still up in the air and further discussion needed to implement and advance programs, the WHA in May promises to be quite the roller-coaster. GHTC will be present and look forward to advancing these conversations with our partners as well as continuing to strategically drive the innovation agenda heading into the Assembly.