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This fall, the global health community gathered against a backdrop of change. Shifts in global funding, visible pullbacks from multilateralism, and an evolving global development architecture are reshaping how actors engage and advocate on the world stage.For the Global Health Technologies Coalition (GHTC)—and for many others—this moment has prompted reflection on how we show up in global forums and what it means to engage meaningfully amid transition. Following a busy season of high-level gatherings, we’ve taken time to reflect on what these moments revealed—both in the lead-up and in the conversations that followed—and how they are shaping our thinking about GHTC’s role and path forward in these spaces. Reconnecting at UNGA80 In the run-up to this year’s 80th United Nations General Assembly (UNGA80), there was an unusual air of hesitation across the global health community. Typically, mid-August brings a flurry of coordination calls and side event planning, but this year, the energy felt uncertain. For GHTC, our initial hesitation to participate stemmed from UNGA’s focus on noncommunicable diseases (NCDs), an area outside our traditional advocacy repertoire. However, we also had questions about which of our partners would be in New York City this year and what our role could or should be in the tumultuous year we have all had. Yet, as it goes, we and other organizations confirmed our plans to attend UNGA, and soon, the familiar rhythm of civil society’s presence in New York began to take shape.  In New York, GHTC and the Global Health Council (GHC), with STUF United Fund, cohosted an event on innovation, security, and equity in a changing global landscape, which brought together policymakers, funders, and implementers to examine how global health can stay resilient amid geopolitical uncertainty. The discussion was lively and focused on the technical aspects of innovation, security, and equity, but afterwards participants commented not on those technical matters, but on our authentic and pragmatic approach and tone with which we addressed these topics. Audience members remarked that the discussion was one of the most genuine moments of the week. For GHTC, moderating this dialogue reinforced the need for global health advocates to bridge communities and connect innovators, funders, and policymakers around a shared vision for equitable access. It also reminded us that the credibility of civil society depends on showing up authentically, especially in moments of uncertainty or disagreement.  One striking development at UNGA this year came during the High-Level Meeting on NCDs, where the United States laid out objections to the political declaration and voted against it, taking consensus for the resolution off the table. While this move was not unexpected given the US government’s posture toward multilateralism this year, it was still a sobering moment. Secretary of Health and Human Services Robert F. Kennedy has made NCD prevention a national priority under his leadership at the department, yet his sharp criticism of the declaration underscored the United States’ continued reluctance to advance these goals through global cooperation. Women’s health as a catalyst for R&D transformation  As the global health community’s focus shifted from New York to Berlin, Germany for the World Health Summit (WHS), many of the same themes carried forward—innovation, equity, and the importance of collaboration amid shifting global priorities. After UNGA80, we saw how essential it was for civil society's voices to remain present and aligned in global conversations, and we viewed WHS as an opportunity to do just that. For us, a standout moment in Berlin was our participation in the Gates Foundation’s Women’s Health Innovation Equity Forum—a convening of global leaders, innovators, and funders dedicated to advancing accountability and progress in women’s health research and development (R&D).  What stood out the most at this forum was the shared understanding that women’s health R&D can be a testing ground for how we build a more equitable and collaborative innovation system overall. Conversations at the forum went beyond individual products or technologies to look at the broader ecosystem: how research can better reflect women’s lived experiences, how artificial intelligence and digital tools can be designed to avoid bias, and how we can create inclusive pathways from discovery to delivery. The call was not just to innovate for women but to innovate with women, by centering their voices, co-designing solutions that fit their realities, and ensuring that they are represented as leaders, scientists, and decision-makers throughout the R&D process. These ideas align with GHTC’s work to strengthen the global health innovation ecosystem. Our goal is to help make equitable, inclusive, and well-resourced innovation systems the rule, rather than the exception.  Reimagining the global health architectureOver the past several months, we've participated in a number of conversations, meetings, and working sessions aimed at reimagining how the global health architecture can be rebuilt stronger and more resiliently in the years ahead. One gathering, hosted by the Wellcome Trust just after WHS, brought a new focus and sense of shared purpose to this discussion, convening partners from across North America and Europe to explore the future of global health amid ongoing change and reform. This initial session focused on North American and European partners, with additional regional discussions planned to ensure perspectives from low- and middle-income countries and other stakeholders are fully represented as the series continues. The gathering brought together an extraordinary mix of leaders—funders, policymakers, researchers, and advocates—who are committed to reimagining how the global health ecosystem advances innovation and equity. Our discussions explored how the next generation of global health architecture could deliver faster, more inclusive, and stronger regional capabilities for research and manufacturing and more sustainable financing that bridges discovery and delivery. It was both humbling and energizing to be part of such a thoughtful, solutions-oriented dialogue at a moment when the global community is being called to reexamine what collective action really looks like.  For GHTC, these reflections really brought home why our coalition’s work matters. The conversations highlighted how innovation, access, and financing are all part of the same continuum, which is exactly what GHTC has been advocating for as we work to strengthen R&D systems, regulatory pathways, and product access. What struck us the most was the shared understanding that reforming global health innovation is not only a technical or financial issue but also a matter of trust, shared power, and accountability. We left the meeting encouraged and inspired, knowing that voices like ours, grounded in evidence, partnership, and advocacy, have an important role to play in shaping a more connected, inclusive, and resilient global health ecosystem. In Berlin, we also had the chance to join our partners, including the Medicines for Malaria Venture (MMV), Impact Global Health, and others, at events highlighting innovation and equitable access on the margins of the WHS. Finally, to close out our continued engagement with the civil society arm of the G20, we supported our partners—including the South African Health Technologies Advocacy Coalition, Resilience Action Network Africa, MMV, Better Health Solutions, and others—in hosting a side event on science, research, and innovation on the sidelines of the G20 Social Summit. This event highlighted the value of meaningful partnerships and global collaboration, reinforcing the importance of civil society's voices in shaping health innovation and research agendas worldwide. Looking aheadAs this season of global convenings draws to a close, GHTC is taking stock. We are reexamining our multilateral priorities and exploring how to continue showing up—strategically, collaboratively, and boldly—in spaces that are themselves evolving. We extend deep thanks to our partners—GHC, MMV, Impact Global Health, the South African Health Technologies Advocacy Coalition, Resilience Action Network Africa, Better Health Solutions, and many others—for the coordination and collaboration that made this season so meaningful. Even during a period of change, these gatherings reaffirmed that innovation, solidarity, and shared purpose remain at the heart of progress in global health. 

A Phase 1 randomized controlled trial found that a single dose of the ChAdox1 Rift Valley fever (RVF) vaccine was safe, tolerable, and elicited a strong immune response in 30 adults in Uganda, where RVF—a neglected, mosquito-borne disease that is considered a significant public health threat and a priority for vaccine development—is endemic. The trial was led by researchers at the Uganda Research Institute and the London School of Hygiene and Tropical Medicine Research Unit in Uganda and provides the first evidence supporting the vaccine from a trial in an endemic setting. While the vaccine could potentially be transformative for RVF prevention, further research is needed that follows participants for a longer period and includes a larger group of participants, including children, pregnant women, and immunocompromised people. Last week at the American Society of Tropical Medicine and Hygiene annual meeting, Medicines for Malaria Venture and Novartis shared the results of a Phase 3 study testing a new malaria treatment, known as GanLum, finding that the treatment was highly effective at treating malaria, including drug-resistant cases, and could also block disease transmission. GanLum was found to be 99.2 percent effective in curing patients, more effective than standard artemisinin-based combination therapies, the gold-standard malaria treatment introduced more than 20 years ago, whose use has been undermined since the emergence of partial resistance. The developers say that, pending regulatory approval, the new treatment could be rolled out within the next few years. South African pharmaceutical company Biovac is launching trials of a cholera vaccine, which, if it proves successful, could become the first vaccine developed from start to finish on the African continent. Africa faces the brunt of the global cholera burden but is almost entirely reliant on vaccines made internationally, which has become increasingly challenging in recent years as cases have risen sharply around the world and vaccine stocks have diminished. The African Union has committed to increasing the proportion of routine vaccines used in Africa that are manufactured on the continent from just 1 percent now to 60 percent over the next 15 years, an effort triggered by the access challenges African countries faced during the COVID-19 pandemic. 

The World Health Organization's (WHO's) TB Vaccine Accelerator Council recently published a new report calling for action to ensure equitable access to future tuberculosis (TB) vaccines currently in the pipeline. While the only licensed vaccine for TB is 100 years old and has limited effectiveness in adolescents and adults, as of September, there are 16 candidate vaccines in clinical development, six of which are in Phase 3 trials. WHO estimates that a vaccine for adolescents and adults that is at least 50 percent effective could avert up to 76 million TB cases and 8.5 million deaths over 25 years. However, as the report claims, global demand could far exceed supply in the initial years after a vaccine is approved because there is no designated funding for such a rollout in low- and middle-income countries most affected by TB, which are already facing significant funding shortfalls. In anticipation of these potential bottlenecks and barriers to access, the report identifies six solutions to encourage countries with a high burden of TB, manufacturers, and other funders and stakeholders to start preparing now for the rollout to ensure future vaccines can reach people who need them faster. In a Phase 1 randomized controlled trial, an experimental intranasal vaccine against multiple H5N1 avian flu strains generated a broad immune response, demonstrating the potential of such a vaccine to play a major role in preparing for outbreaks of emerging viruses with evolving strains, as H5N1 continues its worrying spread. The University of Maryland research team tested the vaccine against a placebo in 40 adults between 18 and 45, finding that the vaccine was safe, well-tolerated, and stimulated immunity at various doses. One group received a vaccine dose combined with an adjuvant, an ingredient used to trigger a stronger immune response, and their immune systems were better able to neutralize infected cells for longer, suggesting that the use of an adjuvant could be a promising approach that might allow for lower doses, which could stretch limited vaccine supplies in the event of an outbreak. Last week, IAVI published new findings from the first-in-human Phase 1 clinical trial of its Lassa virus vaccine candidate, which show that one dose of the vaccine triggers robust and long-lasting immunity and is safe. There are no vaccines or treatments currently licensed against the dangerous illness, which causes thousands of deaths in endemic West Africa and has been designated as a priority pathogen with pandemic potential. The trial enrolled 114 volunteers in Liberia and the United States. The candidate, now undergoing a Phase 2a trial in West Africa, is currently the most advanced Lassa fever vaccine candidate in the pipeline and uses the same platform as Merck’s single-dose Ebolavirus vaccine, which is approved in more than a dozen countries. 

The Global Health Technologies Coalition (GHTC) welcomes the strong research and development (R&D) focus in South Africa’s draft health ministerial declaration, which recognizes the vital role of science and innovation in strengthening health systems, advancing equitable access to medical countermeasures, and supporting sustainable economic growth. However, much of the R&D language in the text lacks clear commitments, specific targets, or actionable measures needed to translate these ambitions into tangible outcomes.We commend the draft declaration’s explicit call to “foster scientific collaboration to accelerate the development of safe and effective vaccines, therapeutics, and diagnostics” and to “develop resilient and sustainable health R&D ecosystems.” The emphasis on building regional manufacturing capacity, reinforcing supply chains, and investing in a skilled health workforce reflects a welcome commitment to a more distributed and equitable innovation ecosystem capable of responding rapidly to future outbreaks. We also welcome the declaration’s endorsement of sustained domestic investment lines for R&D to promote self-reliant science ecosystems.We applaud the recognition that “international collaboration and efforts to accelerate end-to-end development of therapeutics” are vital to address persistent gaps across the R&D pipeline, including through partnerships between research institutions in low- and middle-income and high-income countries. Specifically, the draft’s focus on strengthening regional science hubs and building “transparent, inclusive, and responsive science advisory mechanisms” echo GHTC’s long-standing advocacy for collaborative and equitable R&D models that leverage regional expertise and ensure innovations are designed for—and accessible to—all populations.GHTC also notes South Africa’s elevation of antimicrobial resistance (AMR) in its health agenda. This inclusion in the ministerial text reflects a growing recognition of the threat of AMR and the need for novel health technologies to address it, marking an important step forward during South Africa’s presidency.While this robust language across the document reflects the progress our community has made in ensuring R&D is recognized as a key pillar of health progress, we are disappointed to see that G20 leaders failed to rally around a clear set of commitments or targets and failed to build on deliverables promised by South Africa’s original health agenda.For example, while advocates have praised South Africa’s efforts this year to mobilize a coalition for the development of therapeutics, the text lacks the operational details needed to establish the group. It also omits reference to South Africa’s proposed Commission on Science and Innovation for Health and Economic Growth, underscoring the gap between the ambitions that had been outlined and the tangible outcomes that were delivered through this year’s G20 process.The draft only briefly touches on the Coalition for Local and Regional Production, Innovation, and Equitable Access that emerged from Brazil’s G20 presidency last year. While this was an exciting R&D development to stem from the G20, momentum to carry it forward continues to stall.Finally, while the text underscores the importance of long-term investments in R&D and domestic resource mobilization, it falls short of offering concrete funding targets or commitments, highlighting a lack of political will among leaders to advance new investments.As the G20 finalizes the declaration, we call on health ministers to not only preserve the R&D language in the text but to strengthen it with concrete, actionable measures that advance innovation, ensuring that the G20 remains a forum where global health, particularly lifesaving R&D, remains a top priority.