Breakthroughs Blog: Polio

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. A landmark study found that men whose HIV infection was fully suppressed by antiretroviral drugs had no chance of infecting their partner—suggesting that if everyone with HIV were fully treated, there would be no further infections. Of the nearly 1,000 male couples across Europe who participated in the study, in which one partner with HIV was receiving treatment to suppress the virus, there were no cases of transmission of the infection to the HIV-negative partner during sex without a condom. According to Professor Alison Rodger, co-leader of the paper published in The Lancet, these findings “provide conclusive evidence for gay men that the risk of HIV transmission with suppressive ART [antiretroviral therapy] is zero” and that the study’s findings “support the message of the international U=U campaign that an undetectable viral load makes HIV untransmittable.” The Global Polio Eradication Initiative (GPEI) unveiled a new five-year strategy on Tuesday, which includes the use of novel oral polio vaccines—several of which are being developed by PATH and its partners—as well as the adoption of smartphone technologies to assist in disease surveillance and faster response. GPEI is also planning to establish a regional hub in Amman, Jordan to allow for easier coordination and increased technical support for polio vaccination programs in Afghanistan and Pakistan, two polio-endemic countries. Additionally, as part of the new strategy, GPEI is expanding its partnership with development institutions such as Gavi, the Vaccine Alliance. These new approaches, among others, will be implemented by GPEI under its new strategy from 2019-2023 in the hopes that this new strategy will be its last, with wild poliovirus successfully eliminated by 2023. The new strategy is currently facing a funding gap of US$3.27 billion, which organizers hope to fill with a pledging conference in November. On Wednesday, the US Food and Drug Administration (FDA) approved the first vaccine against dengue fever. The vaccine, Dengvaxia, has generated much controversy in recent months due to post-marketing research performed by its manufacturer, Sanofi Pasteur, which showed that the vaccine offers protection for people who have already had at least one bout of dengue, but increases the risk of severe infection in children who were dengue-naïve, or never infected when they were vaccinated. The FDA ruled that Dengvaxia can only be administered to individuals between the ages of 9-16 living in parts of the United States where the dengue virus is endemic, and that it can only be given to children and young adults who had one previous laboratory-confirmed case of dengue. Identifying these individuals with prior infection is currently a challenge, because there is no point-of-care diagnostic test available, though Sanofi officials say they have to have one ready for FDA submission by late 2020. Sanofi will earn a priority review voucher (PRV) by bringing Dengvaxia to market. A PRV is an incentive created to encourage pharmaceutical companies to develop drugs and vaccines for neglected diseases and, in exchange, allows a company to expedite the review of another product it wants to bring to market or sell the voucher to another company.

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 Population Council and its partners announced the launch of the first clinical trial to test the safety and efficacy of a male contraceptive gel—an innovation that could advance contraception and bring more equality to the burden of family planning, which is largely borne by women. The gel, known as NES/T, is a novel, reversible contraceptive composed of a progestin hormone used for female contraception and testosterone. The gel is designed to be applied daily and absorbed through the skin on the upper arms and shoulders. The phase 2b trial, sponsored by the National Institutes of Health, will test the product for pregnancy prevention among more than 400 couples. Should NES/T prove effective, it would be the first user-controlled method for contraception for men since the condom. Last Monday, South African drug maker Aspen Pharmacare launched a triple-antiretroviral (ARV) combination tablet for the treatment of HIV in South Africa—a country which accounts for 19 percent of the global burden of people living with HIV and 15 percent of new infections. The new medicine, known as Emdolten, is taken once daily and contains dolutegravir, an antiretroviral medication that counters the drug resistance that often develops with older HIV treatments, along with lamivudine and tenofovir disoproxil fumarate. In May, the South Africa Regulatory Authority and the European Medicines Agency issued a warning advising doctors not to prescribe dolutegravir to women seeking to becoming pregnant following cases of birth defects in a study; however, Aspen Pharmacare stated that using dolutegravir is safe for men, women not of child-bearing age, and child-bearing women using contraceptives, which account for approximately 70 percent of HIV patients. Researchers have developed a way to freeze-dry an inactivated poliovirus vaccine (IPV) so that it can be stored at elevated temperatures, up to 40°C, for four weeks and then dissolved for use without losing its potency—potentially offering a new tool to eradicate the disease. While existing oral vaccines have led to polio’s elimination in many countries, these oral vaccines contain a weakened live virus, which can cause paralysis in rare cases. Thus, there has been push to use IPVs, which contain dead strains of the virus. Although IPVs have already been introduced in many countries, their widespread use is inhibited by their sensitivity to temperatures above and below approximately 4°C (39.2°F).

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A resurrected malaria prevention strategy—seasonal malaria chemoprevention—saved an estimated 40,000 lives in 2015 and 2016, according to new research. The strategy involves giving children a dose of antimalarial drugs monthly during the rainy season—the season with the highest incidence of malaria—to prevent the disease. Researchers and public health professionals were initially skeptical of this technique when applied in real-world settings since it requires thousands of local aid workers to deliver malaria drugs to rural and hard-to-reach areas, but recent results have shown reductions in malaria prevalence similar to those seen in clinical trials in areas deploying the strategy. While historical and recent studies suggest this technique is effective, there are signs this method will only work for a limited time before existing drugs fail because of resistance, meaning alternative solutions must continue to be explored. As the world gets closer to eradicating polio, a funding crisis looms for many countries. Funding for the Global Polio Eradication Initiative is scheduled to be halved in 2019 and expire the following year, except in the most high-risk countries. A reduction in polio funding will leave countries with depleted resources, straining their capacity to vaccinate against other life-threatening diseases and conduct surveillance activities. Today, polio funding supports health workers that also deliver routine immunizations as well as 70 percent of all global funding for surveillance. Also, as polio transmission rates move toward zero, global strategies must be implemented to maintain eradication, including using the safer injectable polio vaccine for up to ten years following eradication, which will be more difficult to achieve if polio resources are strained. At the close of the first Global Ministerial Conference on Ending Tuberculosis, 75 health ministers agreed to take committed action to end tuberculosis (TB)by 2030. Ministers met in Moscow, Russia over two days to discuss and strategize solutions for TB. They concluded with a pledge to take action on four fronts: (1) move to achieve universal health coverage, (2)mobilize domestic and international investments to close gaps in implementation and research, (3) advance research and development for new tools to tackle TB, and (4) build accountability by tracking and reviewing progress in ending TB. Ministers also vowed to take increased action to minimize the risk and spread of antimicrobial resistance.