Breakthroughs Blog: G20

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. On World Polio Day last week, the World Health Organization officially declared that type three poliovirus has been eradicated—making it the second of the three strains of the virus to be wiped out. Naturally-occurring cases of the last remaining virus strain, type one, are now limited to Afghanistan and Pakistan with a total of just 33 new cases last year. Though much progress has been made toward eradicating this disease, the number of confirmed cases this year has risen to 88 in those two countries as violence and mistrust have hindered vaccination campaigns. Cases caused by the vaccine itself have also thwarted eradication efforts. The National Institutes of Health and the Bill and Melinda Gates Foundation will jointly invest US$200 million over the next four years to develop genetic-based cures for sickle cell disease and HIV. Both partners have vowed that the cures will be both affordable and available in low-resource countries hit hardest by the two diseases, particularly in Africa. This partnership reflects growing concerns that scientific advances such as gene therapies and genome-editing are prohibitively expensive and therefore out of reach to most patients. This collaboration aims to move gene-based therapies into clinical trials in the United States and countries in sub-Saharan Africa within the next seven to ten years and eventually make treatments for sickle cell disease and HIV available in the hardest hit areas. After a two-day meeting in Okayama, Japan, health ministers of the world’s twenty largest economies issued a declaration endorsing the rapid achievement of universal health coverage (UHC), more effective support of healthy ageing, increased attention to health emergencies and their causes, and more forceful action on antimicrobial resistance. The G20 Health Ministers Declaration goes well beyond the general commitments made by G20 leaders to advance global health goals after their two-day meeting back in June. As part of the commitment to UHC, the health ministers recognized the importance of access to medicines and vaccination and reaffirmed pledges to end HIV, tuberculosis, and malaria, among other measures.

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. To help tackle antimicrobial resistance (AMR), the Global Antibiotic Research & Development Partnership (GARDP) announced its new “5 BY 25” strategy to mobilize global stakeholders to raise the €500 million needed to develop five new antibiotic treatments by 2025. According to a GARDP press release, drug-resistant infections cause at least 700,000 deaths per year globally and addressing the growing threat of AMR will be key to achieving universal health coverage and the Sustainable Development Goals. With this new strategy, GARDP aims to develop and make accessible five new treatments that will focus on the priority pathogens identified by the World Health Organization, along with current unmet needs for diseases and key populations. In a promising step towards an HIV and AIDS cure, researchers from Temple University and the University of Nebraska have successfully eliminated HIV from the DNA of infected mice using genome editing technology combined with a slow-release virus suppression drug. Researchers administered a treatment called LASER ART, or long-acting, slow-effective release antiretroviral therapy to suppress HIV cells from replicating in mice engineered to produce human T cells susceptible to the virus. The research team deployed the drug across several weeks to target tissue in the spleen, bone marrow, and brain where latent HIV reservoirs are likely to occur. The researchers then used CRISPR-Cas9, a gene-editing tool, to eliminate the remaining infective cells from the subject’s DNA. By the end of the study, researchers had successfully eliminated HIV from nine out of 23 mice. Researchers are now working on a version of the study with primates. If their methods continue to be successful, clinical trials could follow as soon as next summer. Heads of state from the world’s largest economies committed to advance global health priorities at this year’s G20 Summit in Osaka, Japan. In the G20 Osaka Leaders’ Declaration, they included commitments to move towards universal health coverage by bolstering primary health care and access to medicines, promote healthy aging by preventing noncommunicable diseases, improve emergency preparedness and response, provide support for the countries affected by the current Ebola outbreak, and identify better models for antimicrobial drug research and development. Participants in the summit, described as the “premier forum for international economic cooperation,” includes leaders from 19 countries and the European Union, as well as guest countries and international organizations.

On Saturday, heads of state and government from the world’s leading economies concluded this year’s G20 Summit in Osaka, Japan by issuing a declaration committing to advance global health.Noting that “health is a prerequisite for sustainable and inclusive economic growth,” G20 leaders made a myriad of noteworthy commitments in the G20 Osaka Leaders’ Declaration from advancing universal health coverage (UHC), to controlling noncommunicable and communicable diseases, to tackling health emergencies and antimicrobial resistance (AMR). Recognition of the role of research and new technologies in confronting these challenges was present, but inconsistent.In welcome news, the declaration generally recognized the “importance of science, technology and innovation (STI)” for achieving the Sustainable Development Goals and committed to strengthening health systems to achieve UHC by “promoting public and private sector innovation, such as cost-effective and appropriate digital and other innovative technologies.” GHTC was pleased to see this call out for “affordable” and “appropriate” technologies, which are critical elements for addressing health needs in the world’s poorest places, and that leaders recognized that both the public and private sector have a role to play in accelerating new innovations, such as treatments, vaccines, and diagnostics. But as the declaration delved into particular health challenges, recognition of the importance of research and development (R&D) was somewhat inconsistent.On the positive side, leaders committed to promoting R&D to tackle AMR, noting the ongoing work by the Global AMR R&D Hub, first established under the German G20 presidency to foster international agenda setting and collaboration on research for new antibiotics and treatments. They also called on members and the hub to “analyze push and pull mechanisms to identify best models for AMR R&D.” It is constructive that the G20 committed to moving this agenda forward, as growing drug resistance is complicating the fight against leading global killers, such as malaria, tuberculosis, and HIV and AIDS, which heads of state reaffirmed their commitment to end. A lack of market incentive remains a barrier to spurring new antimicrobial and drug development.AMR is just one emerging threat in our increasingly interconnected world, so we were pleased to see the G20 once again put a spotlight on the importance of improving public health preparedness and the need for sustainable financing mechanisms to prevent and respond to health crises like the current Ebola outbreak in the Democratic Republic of Congo. We were, however, disappointed to see no recognition of the role of R&D and health technologies in enhancing preparedness. Just two years ago, the G20 health ministers, under the German presidency, pledged strong support for collaborative efforts for R&D preparedness, including the Coalition for Epidemic Preparedness Innovations [CEPI] and ongoing work under the World Health Organization’s R&D Blueprint.Despite this criticism, last week’s G20 Summit remains a significant political win for global health advocates—and that’s important to recognize. It was just two years ago that global health, and R&D for global health, featured for the first time ever as part of the G20 leaders’ declaration. With so many pressing global challenges from migration, to climate change, to the impact of disruptive technological innovation, it is promising to see G20 leaders continue to position global health as a priority area for international action and as a critical driver of economic development.In a twist on previous G20 presidencies, last week’s Leaders’ Summit marked a mid-way point in this year’s G20 ministerial process, rather than its usual annual conclusion. With the G20 Health Ministerial Meeting set to take place in October, it is now vital that health ministers build on the positive foundation set at the Leaders’ Summit to put in place more concrete action plans and financial resources to realize the G20’s global health commitments—that rightfully place R&D as a central driver in achieving these goals.

Last week, the Australian government and the Indo-Pacific Centre for Health Security convened practitioners, researchers, educators, and decision-makers across the fields of public health, medicine, veterinary science, agriculture, government, defense, and anthropology for the first Global Health Security Conference in Sydney to examine the progress made to date in strengthening health systems and to identify gaps and opportunities for enhancing the international community’s ability to respond more efficiently and effectively to future health crises.GHTC was on the ground, following the official agenda, participating in side events, and speaking on a panel on innovative game changers to advance prioritization of research and development (R&D) in the Global Health Security Agenda. Here are our three key takeaways from the conversations:1. Innovation recognized as vital to advancing health security.The role of innovation in strengthening health security was highlighted throughout the week, with official sessions and side events showcasing innovative products, partnerships, and research central to advancing global health security.GHTC had a speaking role on a Global Health Security Agenda Consortium panel focused on game changers in global health security and used the opportunity to highlight key innovations that are being used on the front lines in the fight against Ebola in the Democratic Republic of the Congo. The panel hit on key themes that were echoed in other sessions, including the need to build local capacity for deployment of new tools and medicines, enhancing laboratory infrastructure, and strengthening health systems and community response capabilities. Much of the dialogue also centered around the need to engage local stakeholders in the development of innovations, ensuring that tools and technologies are designed and adapted for the local context, and that the deployment of treatment measures for emerging health threats is executed with firm community support to increase the chance of successful implementation.Other speakers throughout the week also highlighted the regulatory and implementation challenges that organizations and countries face when seeking to develop and deploy new tools and innovations and recommended strenghtening global governing structures that could facilitate addressing hurdles around approval timelines and streamline the processes.2. We need a strong focus on financing and sustainability. One core message that was consistent throughout the week was the need for a stronger focus on sustainability. Delegates agreed that states and organizations are too reactive in their mindsets, only responding to the latest outbreak and not taking the necessary preemptive steps, including through R&D, to develop the local, regional, and global capacities that are necessary to effectively combat emerging infectious diseases and other health threats. Ensuring that local infrastructure, laboratory systems, clinical capacity, and overall primary health care services are continually enhanced will allow for a more effective response.  Ebbs and flows in funding for epidemic diseases create additional challenges. The recent Ebola outbreak is a perfect example of how additional public resources can be mobilized to respond to global threats. However, absent a crisis, emergency preparedness and capacity building are often de-prioritized, and the necessary funding needed for additional innovation and product development is often lacking. Delegates called for a more durable approach of creating policies and incentives that catalyze investment for specific diseases, infrastructure, and health workers. Some also suggested looking to multilateral institutions for greater financial support for programmatic activities and creating stronger partnerships with the private sector. As one speaker put it best: “We must marry political capital with money.”3. Multisectoral approach critical to path forward.Are we asking too much of the health sector and not enough of everyone else? In the closing plenary, this question served as a call to action to engage non-traditional stakeholders and relevant decision-makers in other sectors to develop a truly multisectoral approach to strengthen health systems overall and develop the tools and capabilities in-country to detect, diagnose, and treat those threatened by global health threats.Ministers of Health have a difficult case to make when asking for more resources, financial or otherwise. The value of preventive measures is often invisible, since doing it right means there is no outcome. As global health practitioners, advocates, researchers, and decision-makers look for new ways to engage partners in different fora, such as the G20, building linkages to other sectors and government priorities will be key to creating the political buy-in necessary to advance the agenda around global health security.