Breakthroughs Blog: WHO

  The development of new diagnostic, treatment, and prevention products is fundamental to accelerating the decline of the global tuberculosis (TB) burden, panelists from the World Health Organization (WHO), the National Institutes of Health (NIH), and the Bill & Melinda Gates Foundation agreed on during a panel discussion hosted by the Center for Strategic and International Studies (CSIS) on Monday. CSIS panelists say R&D is fundamental to meeting new global TB targets. Photo: PATH/Satvir Malhotra CSIS hosted the panel on the occasion of the release of its summary report Strategic US Leadership – Essential to Address the Global Tuberculosis Pandemic—which examines US approaches to tackling TB both in the United States and abroad. The report concludes that the United States needs to better lead, coordinate, and prioritize its TB efforts, as well as increase fiscal and other resources devoted to the issue. Among its recommendations, the report encourages the United States to create robust, long-term research partnerships with key institutions in select emerging economies to promote the discovery and development of new TB tools. During the panel discussion, Dr. Mario Raviglione—director of the global TB program at WHO—discussed the ambitious TB targets put forward in a World Health Assembly resolution including the goal of achieving 95 percent reduction in TB deaths by 2035. He noted that the model for achieving this target assumes the introduction of new TB diagnostics, medicines, or vaccines and said achieving this target will not be possible without investments in research and development (R&D) that result in the introduction of new interventions. The panelists agreed that while the United States will continue to drive efforts toward the development of new TB tools, middle-income countries and rising economies also have an important role to play as well. Dr. Peter Small—deputy director of the TB program at the Gates Foundation—noted that many of these emerging economies also have high TB disease burdens so they are uniquely positioned to contribute. Dr. Small said he believes that it is important for these nations to increase their R&D capacity and investments in science and that US leadership in fostering R&D capacity within these nations will prove key to the long-term development of more frugal and locally-viable TB products. Dr. Tony Fauci—director of the National Institute of Allergy and Infectious Diseases at NIH—agreed with Dr. Small’s statements regarding the need to forge TB partnerships and collaborations with our emerging economy partners. As an example of successful collaborations, he mentioned the increased use of co-principal investigator projects, where a researcher form the United States and a researcher from a different country collaborate on a research project with each of their home countries providing part of the funding. The panelists discussed not only the need for improved collaboration and coordination with other nations, but also the need for enhanced coordination within the United States. Dr. Fauci said while he believes there should be a concerted, coordinated R&D effort by the US government, it needs to be approached carefully. He said he believes fundamental research at the early stages needs to remain somewhat spontaneous, but that he sees a need for greater coordination downstream. A common theme throughout the discussion was the lack of adequate financial resources to meet the demands of a growing and complicated pandemic. Dr. Fauci mentioned the decreasing purchasing power NIH now as a result of stagnated federal funding over the last few years. He noted that as a result, NIH has less flexibility to jump on promising TB research. Dr. Fauci said he believes our country needs to reevaluate how we think about biomedical innovation and research funding—arguing that the US research budget should not be thought of as discretionary funding, but rather an item that needs to be automatically increased each year like cost of living increases. Panelists were also asked to consider the best arguments to convince US policymakers to increase investment in R&D for TB. Dr. Fauci said advocates should talk about how we live in a global community in which we can’t think of it as “our disease versus their disease”—that the United States has an economic and security interest in tackling TB. He also said the TB community should not see HIV as a source of competition for funding, but rather hold it up as an example of the impact that can be realized as a result of robust investments throughout the development process. Dr. Raviglione agreed, noting that within just a few years of the emergence of the AIDS epidemic, the world had already developed diagnostic tests and a few years later developed antiretroviral treatments. Dr. Raviglione said this is a very visible example of the results that can be achieved for a disease through strong investment in R&D.  

In this guest post, Sarah Alexander—director of external relations for the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS)—writes about the groundswell of momentum surrounding maternal and child health and the role research and development (R&D) can play in helping more babies have a healthy start to life. You may have noticed maternal and child health has been garnering a lot of attention lately. At the Saving Every Woman Every Child Global Summit in Toronto last week, the focus was on ending preventable deaths of mothers and children under 5, and the government of Canada pledged $3.5 billion toward those efforts. The week prior marked the launch of the Every Newborn series in The Lancet, as well as the endorsement of the Every Newborn Action Plan by the World Health Assembly in Geneva. Later this month, the Partnership for Maternal, Newborn & Child Health’s Third Annual Partners’ Forum will be held in Johannesburg. All of these events are building on each other and creating a groundswell that will help forge a blueprint for the post-Millennium Development Goal era.The momentum these efforts have gained is impressive, and great strides have been made in saving the lives of mothers and babies around the world. As the global health community looks toward the next 15 years, we are encouraged that more and more plans are incorporating R&D as pillars of a maternal and newborn health agenda. A focus on R&D will allow researchers to look upstream and investigate new ways of preventing problems from occurring in the first place—exemplifying the maxim that prevention is better than cure.There has been a groundswell of momentum for maternal and child health. There are many opportunities for high-impact R&D as part of the agenda. Photo: PATH/Mike WangAt the GAPPS—an initiative of Seattle Children's—we understand and advocate for all the great work that is being done to treat newborns—especially in low-resource settings—to give them a better chance of survival. With our focus on preterm birth and stillbirth, we envision a scenario where instead of treating infants born prematurely or laying to rest nearly 3 million stillborn babies every year, we could instead identify issues in utero and develop therapies to prevent preterm birth, stillbirth, and other pregnancy complications before they occur.Babies born too soon can face lifelong health complications, including respiratory issues, vision and hearing loss, cerebral palsy, developmental delays, and more. Stillborn babies are often not acknowledged with birth or death certificates, or prioritized in health efforts. While it’s essential that known interventions are scaled up to help save the lives of mothers and newborns, we are glad to see a comprehensive R&D movement picking up steam.There are many opportunities for high-impact R&D in maternal and newborn health. For example, new technologies allow for increased biomarker discovery and therapeutics development, which could allow doctors to screen for and treat conditions in pregnant women and their babies before birth, helping more babies have a healthy start to life.With so much momentum building around maternal and child health, we’re glad to see R&D into prevention is being prioritized so that one day every birth can be a healthy birth.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Kaitlin Christenson, director of the GHTC, summarizes news out of the World Health Assembly (WHA) impacting the global health research and development (R&D) community including debates on the post-Consultative Expert Working Group on Research and Development: Financing and Coordination and post-2015 development agenda, and themes related to regulatory system strengthening, access to essential medicines, and the value of R&D. Renate Baehr—executive director of Deutsche Stiftung Weltbevoelkerung—writes about the next rendition of the European & Developing Countries Clinical Trials Partnership and how its expansion will impact more lives in low- and middle-income countries. She discusses how the program has been broadened to include neglected tropical diseases and how African countries will now fully participate in the group’s governance and decision making. The Canadian government announced it would provide $12 million to Grand Challenges Canada to finance innovations to improve maternal and child health in the developing world. The funding will support 65 projects to be implemented across 25 low-and middle-income countries. The announcement came in advance of the Canadian Prime Minister’s global summit on maternal, newborn, and child health taking place in Toronto from May 28-30. Wired reports on the passage of a resolution at WHA to create a global action plan to tackle the emerging problem of antibiotic resistance that will include exploring technology innovations in diagnostic testing and new drug development. The article notes that some experts believe this will not do enough to stem the problem and are calling for the creation of an intergovernmental body on antibiotic resistance that would be similar to the Intergovernmental Panel on Climate Change.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Yesterday, Senator Patty Murray (D-WA) introduced in the US Senate a significant piece of global health legislation that would strengthen global health research programming within the US Agency for International Development and improve coordination of global health research and development across the US government. The legislation—known as the 21st Century Global Health Technology Act—is companion legislation to the House version of the bill, HR 1515, which was introduced by Representatives Albio Sires (D-NJ) and Mario Diaz-Balart (R-FL) in April 2013. Knight Therapeutics—the developer of a new treatment for the parasitic disease leishmaniasis—is looking to be the first company to auction off the priority review voucher it received from the Food and Drug Administration (FDA). The company received this voucher—which it can redeem to have any drug moved to the front of FDA’s line for product review—following the approval of its leishmaniasis drug Impavido in late March. A Guardian article on the vaccine cold chain discusses the logistical challenges for the global health community in delivering and administering vaccines—which require constant refrigeration for efficacy—in environments with unreliable electricity and infrastructure. It calls for the next generation of vaccines to be developed with the goal of eliminating a burdensome cold chain and notes the success of the MenAfriVac™ vaccine for meningitis which can be used for up to four days outside the cold chain. During the World Health Assembly, UNITAID, the Drugs for Neglected Diseases initiative, and the Medicines Patent Pool launched a new initiative to develop and deliver improved treatments for children suffering from HIV and AIDS. The initiative–known as the Paediatric HIV Treatment Initiative (PHTI)–will focus on three areas: (1) research and development; (2) intellectual property; and (3) market-shaping to ensure availability of treatment regiments for children living with HIV and AIDS. The World Health Organization released a new document on its efforts to find innovative financing for neglected diseases. The documents states there is a $50 million budget line for demonstration projects and the Global Health R&D Observatory over four years, but did not make clear where the observatory would be situated.