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This fall has brought a flurry of global forums, political negotiations, and shifting priorities that will shape the global health agenda through the end of the year and into the next. Across these discussions, one message has become increasingly clear: the global health architecture is changing, but the need for new and better health technologies has not diminished. If anything, the pressures facing health systems, the emergence of new infectious disease threats, and persistent gaps in access make sustained investment in research and innovation more important than ever. GHTC had the privilege to participate in a season of global forums, from the United Nations (UN) high-level meeting (HLM) on pandemic prevention, preparedness and response (PPPR) in New York City, New York to the World Health Summit (WHS) in Berlin, Germany. As we reflect on our takeaways and next steps from these forums, we see both opportunities and risks. There is considerable momentum to rethink how global health institutions operate, how resources are mobilized, and how countries shape their own health priorities while preserving the scientific expertise, partnerships, and predictable financing needed to develop and deliver lifesaving innovations.  UNGA and the unfinished business of PPPR Three years ago, UN member states gathered in New York for the PPPR HLM, amid a profound sense of global urgency emerging from the COVID-19 pandemic. This September, member states returned to the issue against a more complicated geopolitical backdrop, with renewed attention to pandemic preparedness alongside persistent disagreements over equity, intellectual property, and international cooperation, echoed in other ongoing processes forging pandemic priorities.  After months of negotiations, member states were unable to reach consensus on the PPPR political declaration ahead of September’s HLM, and the text was referred to the broader UN assembly this month, where it was subsequently adopted. Though there were some initial snags in its adoption, the declaration reaffirms the importance of international cooperation and advances several priorities for health innovation, including sustained investment in research and development, stronger public-private partnerships, and expanded regional manufacturing capacity. Together, these commitments reflect a comprehensive vision of preparedness that seeks to pair innovation with the manufacturing and partnerships needed to bring new tools to scale.These negotiations also highlight a challenge that extends beyond the political declaration: how to translate commitments on pandemic preparedness into the practical capabilities countries need to detect and respond to emerging threats. During HLM week, GHTC and Adjuvant Capital hosted a roundtable discussion with US Department of State Bureau of Global Health Security and Diplomacy and multilateral stakeholders examining lessons from Ebola, including the critical role of diagnostics, surveillance, and innovation in strengthening outbreak response. The multifaceted dialogue reinforced that preparedness is not simply a question of having the right technologies available; countries also need the systems, partnerships, and sustained resources to deploy those technologies effectively. Investments in R&D, surveillance, regulatory capacity, and access must therefore be understood as interconnected components of preparedness, rather than competing priorities.Topline takeaway: This fall’s PPPR discussions showed that broad support for pandemic preparedness can coexist with deep disagreements over international cooperation, making both sustained investment in vaccines, diagnostics and therapeutics and workable mechanisms for research coordination and equitable access all the more critical. The measure of progress will not be the strength of the next declaration, but whether countries are better equipped to detect, prevent, and respond to the next outbreak.  WHS and the innovation agenda The global health community gathered again in Berlin in October for WHS. Against a backdrop of evolving global health priorities, momentum for change, and pressure on traditional financing models, the summit offered a chance to consider how innovation can strengthen health systems, address persistent gaps in access, and support resilience in the face of emerging challenges.For GHTC, a particularly valuable discussion centered on the role of product development partnerships (PDPs) in advancing health innovations for diseases and populations too often overlooked by traditional commercial markets. GHTC co-moderated a session convened by Medicines for Malaria Venture, bringing together perspectives from PDPs and their partners on the evolving challenges of developing and delivering new health technologies. The discussion highlighted both the value of the PDP model and the pressures facing these partnerships as the global health financing landscape changes. PDPs have demonstrated what is possible when scientific expertise, public and philanthropic investment, and cross-sector partnerships are brought together around shared health priorities. Yet developing a new medicine, vaccine, or diagnostic is a long-term undertaking. Unpredictable financing can disrupt research pipelines, weaken scientific partnerships, and jeopardize years of progress.This concern extended well beyond the PDP discussion. Across conversations with funders, financing partners, and GHTC members, a recurring theme at the summit was the need for greater consistency and predictability in global health financing. While there is understandable interest in pursuing new financing models and greater efficiency, innovation cannot be sustained through short-term funding cycles alone. Predictable investment is essential to maintaining the research infrastructure, scientific talent, and partnerships that make progress possible.  Innovation remains central to the global health agenda, but the changing financing landscape also raises difficult questions about who will support research for diseases and health needs that remain underserved by commercial markets. As traditional donors reconsider their commitments to global health assistance and countries face competing demands on limited resources, there is a risk that important research priorities will be deprioritized precisely when sustained investment is needed most. New financing approaches are welcome, but they must complement rather than simply replace the long-term public and philanthropic commitments that have historically made much of this research possible.Topline takeaway: Innovation remains central to the global health agenda, but translating scientific advances into meaningful health outcomes requires more than promising technologies. Sustainable financing, effective partnerships, supportive policy environments, and equitable access must remain part of the conversation. For GHTC and its members, WHS reinforced the importance of connecting R&D priorities with the broader systems and policies needed to bring innovations to the people who need them. Looking ahead: Keeping innovation central The implications of this fall’s global forums will extend well beyond the declarations adopted and discussions held. Several interconnected processes, including ongoing negotiations on the Pathogen Access and Benefit-Sharing annex to the Pandemic Agreement, the Accra Reset, and Lusaka Agenda, will help shape how global health institutions operate, how research is funded, and how countries participate in developing and accessing new technologies. As these reform efforts advance, it will be important to ensure that research and innovation are not overlooked in discussions that often focus primarily on health financing and service delivery. These evolving mechanisms are also starting to take shape as the World Health Organization prepares to elect a new Director-General, one who will face consequential questions about which technical capacities to preserve, where to focus investment, and how to maintain the expertise and global coordination that underpin innovation and access. As these conversations continue, several priorities stand out. Global health institutions must become more effective and responsive without sacrificing the scientific and technical capacities that underpin progress. Financing reforms must recognize that research and innovation require long-term, predictable investment. And efforts to strengthen country ownership must create meaningful opportunities for countries to shape research agendas, build scientific capacity, and benefit from the innovations they help advance. Perhaps most importantly, global health R&D cannot be treated as a secondary consideration in debates about governance and financing. New vaccines, diagnostics, medicines, and other health technologies are essential to achieving the very goals these reforms are intended to advance. For our coalition, the task ahead is to work with our members and partners to ensure that innovation remains central to these discussions, that commitments are translated into practical action, and that the global health ecosystem emerging from this period of change is better equipped to deliver for the people and communities it serves.

The Coalition for Epidemic Preparedness Innovations (CEPI) has launched a critical Phase 2/3 clinical trial to evaluate vaccine candidates for the Bundibugyo strain of Ebolavirus, which is responsible for the current outbreak in the Democratic Republic of the Congo and currently has no approved vaccine. The trial will assess the safety, immune response, and efficacy of multiple vaccine candidates in parallel, beginning with Merck’s Ervebo, which is approved for Ebola Zaire, with two Bundibugyo-specific candidates from Moderna and the University of Oxford/Serum Institute of India expected to enter the trial shortly. The organizers hope the trial will help curb transmission and save lives during the current outbreak, while strengthening preparedness for future outbreaks. Weill Cornell Medicine recently announced that it has received a four-year, $8.2 million grant from the National Institute of Child Health and Human Development at the US National Institutes of Health to further development of an experimental on-demand male contraceptive pill that temporarily renders sperm immobile. There is an urgent global need for new contraceptive options for men beyond condoms and vasectomy to enable men to share contraceptive and family planning responsibilities more equally with female partners and reduce the burden that has historically fallen on women. The researchers will now work toward advancing the technology into a Phase 1 trial, developing an oral formulation, setting manufacturing protocols, and establishing safety. A new study from a team of international researchers evaluating experimental methods to improve mRNA vaccine delivery identified a promising needle-free vaccination method, which could offer a new delivery method for mRNA technology, which is continuing to show promise across a range of health areas, as well as reduce unwanted inflammation. The method, which combines a high-pressure liquid jet that delivers mRNA alongside two substances that strengthen the immune response, was able to protect against the viruses that cause COVID-19 and flu in mice. The researchers will now evaluate the method in larger animals and, if it continues to prove successful, in human trials. 

A new study sheds light on the findings of a recent trial evaluating the ability of a laboratory-made broadly neutralizing antibody (bnAb) to prevent HIV infection, pointing to approaches that could lead to more successful future antibodies and vaccines. bnAbs are naturally occurring antibodies that can neutralize multiple strains of HIV; they are considered a promising approach in HIV prevention research. A large, multicountry clinical trial evaluating a laboratory-made bnAb found that it did not significantly reduce overall HIV infections, although it showed some ability to reduce infections caused by highly sensitive strains. In the new study, researchers examined what happened in the participants who received the bnAb, discovering that there were extended periods of time when their antibody levels were too low to block less-sensitive strains of the virus. The study results suggest that more potent antibody concentrations and combinations of antibodies that attack the virus in different ways could have more success.An international research team has identified a crucial compound in the saliva of virus-carrying mosquitoes that could lead to a new prevention strategy for multiple mosquito-borne viruses. The researchers found that when mosquitoes infected with two orthoflaviviruses, West Nile virus and Zika virus, bite, their saliva contains not only the virus but also a viral compound that promotes infection by inhibiting the body’s initial immune response that is triggered when a virus enters the skin. The findings suggest that this viral compound could be shared among other orthoflaviviruses as well and could be a promising target for a preventive vaccine against multiple viruses from this group. The researchers have developed a vaccine targeting the compound that is now being optimized for clinical evaluation. New research from scientists in the United Kingdom highlights a new mechanism that a dangerous fungus uses to evade antifungal treatments. Candida auris is a priority pathogen that has caused outbreaks globally over the past two decades and can be highly fatal for vulnerable hospitalized patients. Current antifungal drugs work by targeting fungal cell walls, hindering the fungi from expanding. The researchers found that one way C. auris eluded treatment was by creating multiple versions of its entire genome, including a wide range of mutations in a specific gene that plays a key role in cell wall integrity. These findings point to new pathways for developing next-generation antifungals and combination antifungal regimens.

A study from the University of California, San Francisco found that a new long-acting HIV combination treatment could provide an alternative, more accessible option for some people with HIV. Long-acting treatment options can provide a simpler, more convenient alternative to daily pills for people living with HIV, but the only approved long-acting combination includes rilpivirine, which is not available in low- and middle-income countries, and the virus has been known to develop resistance to it and similar drugs. The new combination under study replaces rilpivirine with lenacapavir, which uses a different mechanism to target the virus. In the study, all participants achieved and maintained control of the virus. Additional clinical trials are planned to evaluate the approach more comprehensively, but, in the meantime, these findings could help guide care.  A team of researchers at the Massachusetts Institute of Technology has found a way to keep mRNA vaccines stable at higher temperatures, which could drastically lower costs and improve access to the technology in low-resource settings around the world. mRNA vaccines must be kept at extremely cold temperatures during transport and storage, requiring high costs and continuous monitoring. The researchers adjusted the formulation of the tiny particles that carry the mRNA, making them more resistant to heat. The vaccines the team produced can be stored at room temperature for up to a year or at nearly 100 degrees Fahrenheit for two months. Even after storage, the shots elicited equivalent immune responses in mice to the original formulations.The Medical Research Council/Uganda Virus Research Institute and the London School of Hygiene and Tropical Medicine have launched a Phase 1 clinical trial in Uganda evaluating the safety and immune response of a vaccine candidate for Bundibugyo, the severe strain of Ebolavirus behind the ongoing outbreak in the Democratic Republic of the Congo for which there are currently no licensed vaccines. Conducted in partnership with the Oxford Vaccine Group and Pandemic Science Institute at the University of Oxford, the trial builds on an ongoing Phase 1 trial of the same candidate in the United Kingdom. Both trials are funded by the Coalition for Epidemic Preparedness Innovations (CEPI). The candidate, ChAdOx BDBV, was developed by scientists at the University of Oxford and uses the same platform as the Oxford/AstraZeneca COVID-19 vaccine.