Breakthroughs Blog: WHO

Last week’s World Health Organization (WHO) Executive Board (EB) meeting featured a packed agenda covering diverse topics ranging from WHO’s overall plan of work for 2019-2023 to the global burden of snakebite envenoming—as well as some unexpected chicken dancing by delegates. Given that the EB sets the agenda for May’s World Health Assembly (WHA), the inclusion of an agenda item on access to medicines and WHO’s plan on intellectual property (IP) indicates that we can expect a contentious few months leading to the WHA. Here is how debates on these agenda items shook out:Access to medicines For the third consecutive year, the EB addressed the issue of access to medicines and health technologies—a topic that has received much attention in recent years and sparked strong, diverse opinions from member states on how best to address. Last year at the WHA, member states reached a compromise to allow consideration of the findings of the United Nations Secretary-General’s High-Level Panel on Access to Medicines (HLP) at this year’s EB. For the meeting, the Secretariat produced a comprehensive report mapping out WHO’s current activities against the specific HLP recommendations. Though a number of countries objected to this approach on the grounds that it implicitly endorsed the findings of the HLP report, there was broad consensus in the room that access to medicines is a global problem that requires WHO action and that the agency could not afford to delay any longer.As a result, the EB agreed on a decision point calling for WHO to develop a “roadmap report” outlining WHO’s work plans on access as part of the process of finalizing the overall 2019-2023 plan of work. This report will be submitted to the 2019 WHA.Intellectual property Speakers at the EB, 2018 (Photo: GHTC/Matt Robinson) While the access to medicines agenda item reached a consensus decision more quickly than expected, the debate on IP raged over multiple days during both formal and informal sessions at the EB. The debate ultimately boils down to a divergence between high-income countries—countries with significant pharmaceutical industries—and low- and middle-income countries on whether WHO is an appropriate forum to address IP. Those against WHO taking an active role on IP (including the United States and Japan) argue that the World Trade Organization and the World Intellectual Property Organization are the appropriate forums. On the other side, a coalition of countries led by Brazil and India argue that IP in medicines is a unique category and that international policy must be set with a health perspective first. As the global normative organization for health, WHO is thus the appropriate venue to address IP.After many days of closed-door negotiations, the board ultimately decided to move forward with a consensus resolution text. It called for member states to implement recommendations from the new WHO report on IP and public health as appropriate for their national contexts and to continue further discussions and for the Director-General to begin implementing the recommendations and submit a progress report to WHA in 2020. Notably, the following provisions were stripped out of the resolution, including calls for member states to:1. Promote transparency and understanding of research and development costs2. Identify essential products at risk of shortages and take measures to prevent stock outs3. Commit to dedicating at least .01 percent of gross domestic product to basic and applied research relevant to developing countriesGHTC will continue tracking these issues over the coming months heading into WHA, and we look forward to what will be a spirited meeting in May!

  2018 is shaping up to be another important year for US policy related to global health and medical research. As Congress returns for a busy work session and the White House continues to roll out policy reforms, here are the top five issues GHTC will be following in 2018: 1. US funding for global health R&D President Trump’s fiscal year 2018 (FY18) budget proposal called for dramatic cuts to global health, medical research, and public health accounts across the National Institutes of Health, US Centers for Disease Control and Prevention, US Agency for International Development (USAID), and the Department of State. While legislators pushed back sharply on these proposed cuts, Congress has not yet passed final FY18 spending bills. This means that we still do not have a final picture of what US government funding for global health and medical research will look like for this year. As Congress tries to navigate budget caps and other pressures that may constrain overall government spending, GHTC will continue to advocate for strong, stable public funding for critical global health and medical research programs. We’re also looking ahead to the fiscal year 2019 (FY19) budget and appropriations process, and bracing for a proposal from President Trump that may include even more significant spending cuts than those proposed in FY18. Despite verbal acknowledgement from the Trump Administration that US global health and medical research programs remain critically important, as the Administration continues plans to streamline government activities and reign-in spending, we do not expect to see prioritization of these issues reflected in Administration-driven spending proposals. GHTC will closely monitor FY19 proposals in the coming months and continue to engage with Congress, who ultimately sets government spending levels. 2. USAID and State Department reorganization As part of the Trump Administration’s plans to streamline and reshape the federal government, it has announced plans to reorganize the State Department and USAID. USAID plays an important role in global health research and development (R&D), supporting late-stage clinical research and implementation research as well as operating Grand Challenges to identify and advance promising health innovations from around the world. USAID and the State Department submitted reorganization plans to the White House Office of Management and Budget on September 15, 2017, but details of those plans have not yet been made public and further information remains scarce. GHTC will continue to monitor evolving plans and policy and strongly advocate for continued leadership of USAID in global health innovation. 3. BARDA reauthorization The Pandemic and All-Hazards Preparedness Act (PAHPA), which authorizes the Biomedical Advanced Research and Development Authority (BARDA), is due for reauthorization this year by Congress. In recent years, BARDA has played an increasingly important role in the advanced development of medical countermeasures for emerging infectious diseases, like Ebola and Zika, and antimicrobial resistance. Reauthorization presents a potential opportunity to bolster BARDA’s role in the global health R&D space. GHTC will monitor the PAHPA reauthorization process and work with Congress to support a strengthened role for BARDA in the emerging infectious disease space. 4. Global health security GHTC is also watching US efforts to promote global health security, including continued support for the Global Health Security Agenda (GHSA)—an international partnership launched in 2014 to help countries strengthen their ability to respond to health threats. The United States is now funding GHSA through the one-time emergency Ebola supplemental funding, which expires in FY19, so future financing for the program remains uncertain. Without renewed commitment and financial support for global health security activities, the United States will have to pull back critical disease detection, prevention, and response operations around the world. GHTC will also work to include R&D in global health security policy decision-making. During the two most recent global disease epidemics, Ebola and Zika, a lack of proactive, sustainable funding for R&D meant that United States and the world did not have the drugs, diagnostics, and other tools needed to contain these diseases. Despite this, GHSA in its current form lacks any prioritization or commitment to R&D to detect, prevent, and respond to global epidemics. As domestic and global discussions on global health security continue, GHTC will advocate for R&D as a critical component of epidemic preparedness and response. 5. US engagement with key multilateral bodies Multilateral organizations and partnerships are vital mechanisms to help advance a healthier and more secure world. In our modern and increasingly globalized world, new, emerging, or long-standing health challenges, which do not respect borders, cannot be tackled by individual countries alone. Strong US leadership and funding for organizations like the United Nations (UN), the World Health Organization, and the Global Fund to Fight AIDS, Tuberculosis and Malaria are key to advancing global health and ensuring that these organizations function effectively in support of US priorities. Despite several senior Trump Administration officials expressing support for strong multilateral engagement, the United States’ role in pushing for a recent $285 million cut to the UN’s overall budget appears more indicative of how the United States can be expected to engage in the near future. While it is currently unclear exactly how these cuts will be implemented across the various UN health-related programs, GHTC anticipates significant impact on the various UN technical agencies’ ability to support global health, including R&D. GHTC is committed to leading strong, coordinated action to advance US leadership in global health R&D in 2018 and beyond. The United States has long been a leader in global health, development, and medical research, and we look forward to sustaining and bolstering this legacy in the years ahead.  

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. In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Australian scientists solved a mystery about how malaria-causing parasites infect the human body, making a key discovery that could pave the way toward an effective vaccine for the disease. Researchers found that one of the malaria-causing parasites, P.vivax, infects humans by latching onto a protein that carries iron to young red blood cells. In response, researchers created antibodies designed to block this from taking place, thus halting the infection process. Future research on the antibodies’ effectiveness is needed, but researchers remain optimistic the discovery will lead to a potential vaccine candidate for P.vivax, though it could be another decade before clinical trials begin. In December, the World Health Organization (WHO) prequalified the first infant-safe typhoid vaccine—Typbar TCV—for global use. The move comes after years of research, including a high-profile “challenge trial” involving volunteers swallowing the live virus, which found the vaccine was 87 percent effective in preventing infection. This approval by WHO allows donors, including United Nations agencies, to purchase Typbar TCV—which is now priced atUS$1.50 a dose and could drop to $1.00 if donors order more than 100 million doses—for use in low-resource countries. Global use of the vaccine should help curb the use of antibiotics for treatment, mitigating the increasing threat of antibiotic-resistant typhoid. Vitamin C may shorten tuberculosis (TB) treatment time by killing more bacteria, according to a new study in Antimicrobial Agents and Chemotherapy. Researchers at Albert Einstein College of Medicine accidentally discovered that antioxidants, like vitamin C, stopped TB bacteria in test tubes from becoming “persisters”—or TB bacteria that become dormant during treatment and eventually cause reinfection. To test this discovery further, researchers conducted a mice study and found promising results: The mice given vitamin C in concurrence with TB drugs had ten times fewer bacteria in their lungs than the mice not given vitamin C. While human studies are necessary to confirm effectiveness, researchers agree that coupling TB drugs with vitamin C is a safe, accessible, and inexpensive choice.

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. In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A new, rapid diagnostic tool designed to detect Ebola in low-resource settings—EbolaCheck—is heading into its first field trial. Like other Ebola diagnostics, it works by detecting viral genetic material in blood, but it also has several characteristics that make it innovative and easy to deploy in the field: It is mobile; inexpensive, costing ten times less; rapid, taking as little as 70 minutes; needs minimal power to operate, and can be administered by staff with little training.The first field trial is scheduled to launch in rural areas of Brazil in January 2018, with an intent to study potential deployment challenges like temperature, humidity, and operating procedure. A group of Ugandan millennials designed a low-cost, reusable malaria diagnostic tool—Matibabu—capable of quickly detecting malaria without drawing blood. Matibabu beams a red laser on an individual’s finger, detecting changes in shape, color, and concentration of red blood cells, all of which are affected by the presence of the malaria-causing parasite. Matibabu can diagnose malaria in only two minutes (compared to 30 minutes or more for a blood test) with an 80 percent success rate, though the developers noted some patient skepticism due to the simplicity and uniqueness of the test. Matibabu has already generated strong interest among the global community: The designers won the 2013 United Nations Women’s Empowerment award and are shortlisted for the Royal Academy of Engineering’s Africa prize for engineering innovation, with an award of £25,000. If the developers win, they plan to use the funds to begin clinical trials and work to increase the accuracy of the tool. Through gene therapy, researchers at UCLA engineered blood-forming stem cells in animals to produce chimeric antigen receptor (CAR) molecules that create T-cells capable of recognizing and destroying HIV-infected cells. These engineered cells persisted in destroying infected cells for more than two years after the initial edit, offering hope as a method to create long-term HIV immunity. While these findings are preliminary and the sample size is small, they are the first to show that this method of gene editing works in creating targeted immune cells that can mature and become functional throughout the body. This method of gene editing, coupled with other effective treatments like antiretroviral therapy, may pave the way for safe and lifelong HIV immunity.