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The following statement focuses on the 150th World Health Organization Executive Board meeting agenda item 11: “Immunization Agenda 2030.”Many recent scientific and multilateral agency reports and publications suggest that overall, immunization took a step backward in the past two years. Despite the tireless efforts of countless immunization program staff and health workers to ensure the availability of vaccination services, vaccination coverage globally fell for the first time in a decade. The COVID-19 pandemic has overwhelmed immunization infrastructure and workforce, impacted the global supply chain, increased the incidence of antimicrobial resistance (AMR), and derailed gains made in immunization campaigns around the world. Immunization is a pillar of people-centered primary health care, and we urge the World Health Organization (WHO) and member states to strengthen vaccine-related research and innovation with the most vulnerable populations in mind. GHTC calls on WHO and member states to: Accelerate and expand the COVAX facility research and development agenda to advance next-generation COVID-19 vaccines, including “variant-proof” COVID-19 vaccines and shots that could provide wide protection against coronaviruses, vaccines with optimized dosing, and vaccines more suitable for delivery in low-resource settings. World leaders must also do everything in their power to correct the shameful lack of equitable access to these lifesaving tools. Focus on the full spectrum of innovations that support immunization programs. The near term will inevitably be dominated by a continuing focus on COVID-19 vaccine rollouts. Nevertheless, it is vital that these activities are also leveraged to strengthen vaccine manufacturing capacities, storage, administration, and co-administration with other health interventions as well as novel service delivery, including focused “test & vaccinate” strategies as recently recommended by the Gavi board.Align immunization efforts with those to combat AMR. As highlighted by the recent research study published in The Lancet, drug-resistant bacteria kill 1.27 million people a year, the great majority of them in low- and middle-income countries. Children under 5 are particularly vulnerable. These shocking numbers require dramatic commitment against AMR, well above what has been funded thus far. Development of new vaccines could substantially reduce the burden of disease, especially for children under 5 in low-income settings. Support implementation research and the development of formal feedback loops to monitor follow-up of recommendations made by groups such as the Strategic Advisory Group of Experts on Immunization and regional immunization technical advisory groups. 

The following statement focuses on the 150th World Health Organization Executive Board meeting agenda item 10: “Road map for neglected tropical diseases 2021–2030.”Neglected tropical diseases (NTDs) are inextricably linked to poverty and inequality. These diseases exact a heavy toll, causing chronic illness, severe disfigurement, blindness, and death. More than 1.5 billion people are estimated to require interventions against NTDs each year with many existing tools inadequate to effectively screen and treat populations in low-income and low-resource settings. Increased attention in recent years has brought new resources to the fight against NTDs and fueled research breakthroughs. Yet, very significant gaps remain in the arsenal of tools needed to control and eliminate these diseases, underscoring the need for research and development (R&D) of new tools. COVID-19 has also significantly disrupted interventions and activities across the entire spectrum of research and essential health services for NTDs. Leaders must demonstrate greater urgency to ensure that the progress made over the past decade is not reversed due to challenges caused by the pandemic.Therefore, GHTC calls on the World Health Organization (WHO) and member states to:Address the current diagnostic gaps for NTDs. The Diagnostic Technical Advisory Group for Neglected Tropical Diseases recently published a number of target product profiles, and more guidance and support from WHO will be necessary to spur the development of new diagnostic tools. We urge WHO and member states to work together to explore regulatory and manufacturing pathways to facilitate prequalification and regulatory approval of in-vitro diagnostics. Support programs that help catalyze innovation and build capacity to develop new drugs, vaccines, and other health technologies, and urge WHO to facilitate greater coordination across the full scope of diseases. Accelerated programmatic action could advance scientific understanding for developing new tools, improving strategies, and strengthening service delivery. We urge member states to fill key gaps by investing in R&D for new and improved treatments and prevention tools, including therapies designed for children and shorter, simplified regimens with fewer side effects.

The following statement focuses on the 150th World Health Organization Executive Board meeting agenda item 9: “Global strategy for tuberculosis research and innovation.” Progress toward tuberculosis milestones and targets has been hit hard by the COVID-19 pandemic. In 2020 alone, deaths from tuberculosis increased from 1.4 million to 1.5 million globally, far fewer people were diagnosed and treated for tuberculosis, and spending on essential tuberculosis services and research failed to increase in line with existing and new needs. This poses a risk to the achievement of the targets set in the political declaration of treating 40 million people diagnosed with tuberculosis and providing tuberculosis preventive treatment to 30 million people by 2022. To reverse the impact of the pandemic, avert preventable deaths, and put the world on track to end tuberculosis, essential tuberculosis services must be restored as a matter of urgency, and more domestic and international resources need to be mobilized. It is also critical that the development and uptake of new technologies is part of that investment. The Treatment Action Group reported tuberculosis research and development investment of US$915 million in 2020, far below the 2018 UN high-level meeting target of at least US$2 billion per year. Annual funding for tuberculosis research needs to more than double to reach the global target.Therefore, GHTC calls on the World Health Organization (WHO) and member states to:Substantially increase investments in tuberculosis research to drive technological breakthroughs and the rapid uptake of innovations. Member states must mobilize domestic resources, foster public–private partnerships, and incentivize the responsible and well-regulated engagement of pharmaceutical companies, biotechnology firms, and other health product developers to expand the pipeline of new and equitably accessible tuberculosis tools, especially true point-of-care molecular diagnostics, new antibiotic regimens, and vaccines. While the specific call for member states to meet their tuberculosis research funding fair share targets is most welcome, much work remains to make these targets a reality.Address the unmet needs in translational research for tuberculosis. The pandemic has demonstrated that rapid sharing of data helps accelerate research and discovery. Some countries have already made strides by using common protocols coordinated through the Regional Prospective Observational Research for Tuberculosis (RePORT) network, and contributed data and biospecimens to the platform. Member states should double down and push for additional coordination and collaboration through these platforms. Address the drug-resistant tuberculosis crisis and close persistent gaps in diagnosis and treatment access and care. WHO and member states should work to ensure that the process for including new technologies to fight drug-resistant tuberculosis on the essential medicines and diagnostic lists and other guidelines is streamlined. WHO must continue to support the implementation of the global strategy for tuberculosis, including through the Special Programme for Research and Training in Tropical Diseases to provide crucial capacity-building and implementation research support to countries.

Many experts have speculated that 2022 could bring the end of this acute stage of the COVID-19 pandemic. But if this proves true, what our new normal will be, and whether we’ll be better prepared for future crises, will depend on the decisions that our policymakers make in the months ahead. As 2022 begins, here are some of the top policy issues GHTC will be tracking.1. Will we achieve targets to vaccinate the world and what curveballs will COVID-19 still throw our way?What trajectory the pandemic will take in 2022 will depend in significant part on how successful efforts are to vaccinate the world. Last year, world leaders coalesced around a goal of vaccinating at least 70 percent of the world’s population by mid-2022, with an interim goal of vaccinating at least 40 percent of people in each country by the end of 2021. But a number of cascading challenges—from unexpected manufacturing disruptions with key suppliers to surging demand for booster shots in wealthy nations—slowed global efforts. As the year drew to a close, more than 90 countries missed the interim target, with many of the poorest nations in sub-Saharan Africa stuck at single digit vaccination rates. In a glimmer of positive news, the COVAX global vaccine facility delivered a record number of vaccine doses in December, hopefully setting a positive trend for the months ahead. Yet it remains clear there is much lost ground to make up as the year kicks off. Reaching the 70 percent target will require a significant influx of resources to boost manufacturing and overcome on-the-ground delivery and administration challenges, as well as continue research to respond to variants and deliver second generation vaccines better suited for distribution in low-resource settings. While leaders of the world’s richest nations have pledged their support for this global goal, few additional commitments of resources have materialized and nearly three-quarters of promised dose donations have yet to be shipped as of December. GHTC will be watching closely in 2022—particularly as President Joe Biden is expected to host a follow-up COVID-19 summit in March—to see whether the world embraces new urgency and accountability to close these gaps. As we’ve seen with the delta and omicron variants, COVID-19 could also still throw some unexpected curveballs our way that could upend existing efforts. 2. Will reams of recommendations turn into meaningful multilateral reforms?One might call 2021 the year of recommendations as several eminent groups, including the Global Preparedness Monitoring Board, the Independent Panel for Pandemic Preparedness and Response, and the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response, issued reports recommending actions to reduce the world’s vulnerability to pandemic threats. This included several significant proposed reforms to the existing multilateral architecture, including establishing a new Global Health Threats Council to elevate preparedness to the highest level of political leadership, creating a new financial intermediary fund or financing facility at the World Bank to support countries in strengthening their preparedness capacity and to finance surge response during a crisis, making permanent a structure like the Access to COVID-19 Tools Accelerator (ACT-A) to support end-to-end product development for epidemic threats, and advancing a pandemic treaty or framework convention on health preparedness to reform or build upon existing International Health Regulations. Now it remains to be seen whether 2022 will turn into a year of action to make these reforms a reality. GHTC has long advocated that research and development (R&D) is an essential pillar of health preparedness. As these discussions advance, we will be monitoring closely to see how ACT-A evolves and pushing for any such international agreement or financial fund to support countries in strengthening their research and manufacturing capacity.3. Will the US COVID-19 spending spigot still flow in 2022?During the first year of the pandemic, policymakers in Congress seemed willing to throw unlimited money at the problem, passing a series of huge emergency spending bills to finance response efforts and cushion the pandemic’s reverberating economic impacts in the United States—though money for the international response was slower to arrive and lower than advocates and experts recommended. Now that we’re nearly two years into this crisis, many are asking whether Congress has hit pandemic spending fatigue or whether the spigot will still flow. The last major emergency supplemental funding package—the American Rescue Plan Act (ARPA)—was signed in March 2021, more than ten months ago. But the need for additional resources seems as acute as ever as 2022 begins. On the domestic front, omicron is overwhelming US hospital systems and fueling increased demand for tests and boosters, while on the global front, reports are the US Agency for International Development (USAID) is fast running out of resources, as it has already spent or earmarked most of the money it received through ARPA to support global vaccination and response efforts—just as a significant influx of vaccine doses are finally arriving in partner countries and the international response is entering its most operationally intensive phase yet.Political observers are now watching closely whether Congress will put together a new emergency funding package, possibly pairing it with the regular fiscal year (FY) 2022 spending bills that it must pass before the continuing resolution now funding the government expires on February 18. As these talks advance, global health advocates are pushing for any such package to include substantial resources to replenish the coffers of USAID, the State Department, and the Centers for Disease Control and Prevention (CDC) to lead the international response.4. How exactly will the United States build back better for global health innovation?While congressional policymakers spent 2021 largely in emergency response mode, as the new year begins, many are looking to the future of how we can strengthen US agency programs for health preparedness, as well as build upon the research successes and gaps illuminated by COVID-19. Several pieces of legislation are expected to advance this year, which could significantly transform our health innovation infrastructure.For example, the Senate Health, Education, Labor and Pensions Committee is formulating a new pandemic preparedness bill that will look at retooling and refining the capabilities of several Health and Human Services agencies, potentially including the Biomedical Advanced Research and Development Authority (BARDA). This federal agency, which is responsible for developing medical countermeasures against health threats, went from obscurity to a household name during the pandemic as it was entrusted with an influx of emergency funding more than 40 times its annual appropriated levels to advance COVID-19 vaccines, treatments, and tests. GHTC has long advocated for Congress to provide dedicated funding for BARDA to grow its R&D activities for naturally occurring health threats, including emerging infectious diseases (EIDs), antimicrobial resistance, and pandemic influenza. Much of the agency’s work on EIDs has been funded via unsustainable “boom and bust” cycles of emergency funding appropriated only after a crisis has begun. This pandemic preparedness legislation opens fresh opportunity for Congress to authorize such a permanent funding line to fuel sustainable, proactive preparedness research.Additionally, Representatives Diana DeGette (D-CO) and Fred Upton (R-MI) are advancing bipartisan legislation dubbed Cures 2.0, a follow-up to their 2016 21st Century Cures Act, which among other things would authorize a new Advanced Research Projects Agency for Health (ARPA-H). Modeled after the Defense Advanced Research Projects Agency, this new federal agency would seek to speed the development of medical innovations by funding high-risk, high-reward projects not likely to be advanced by traditional commercial research activities. Given this goal, the agency’s work could encompass research on poverty-related and neglected diseases, a recognized area of market failure. But at the moment, ARPA-H is more of rough concept than a fleshed-out proposal. As Cures 2.0 advances, much will need to be worked out as to what the agency’s research scope will actually include; whether it will be housed within the National Institutes of Health as President Biden has proposed or as a separate entity as some stakeholders have advocated for; and how much money congressional appropriators will be willing to pony up for this new unproven agency.Alongside these legislative efforts, GHTC has also recently unveiled a proposal for the creation of a new catalytic fund at USAID to drive global health innovation, called the Supporting Innovative Global Health Technologies (SIGHT) Fund. Such a fund would allow USAID to supercharge its existing work to advance inclusive innovations for low-resource settings, as well as reverse a declining trend in the agency’s spending on R&D as a proportion of its global health budget. As the year continues, GHTC will seek to advance this proposal with policymakers in Congress and the agency.5. Will calls to decolonize global health be codified into policy and practice?Calls to decolonize global health gained steam last year as the world bore witness to the gross inequities in access to COVID-19 vaccines and other tools between rich and poor nations, and here in the United States, the Black Lives Matter movement forced Americans to reckon with our nation’s history of racism past and present. While many leaders in the global health and development field now recognize the need to correct long-standing power imbalances rooted in the colonial era, individual organizations—from nongovernmental organizations to international institutions to development agencies—are grappling with how to translate this goal into policy and practice. Here in the United States, new USAID Administrator Samantha Power, in one of her first public addresses in November, laid out her vision for a new era of “inclusive development” at USAID. This included targets to direct at least a quarter of USAID funding to local partners within the next four years and by the end of the decade to have 50 percent of USAID programming have in place “local communities in the lead” who are responsible for codesigning, implementing, and evaluating programs. As 2022 continues, the global health community will be watching closely how Administrator Power’s vision leads to concrete changes in programs and practices at the agency.6. Will funding for other global health areas grow to match evolving needs?Much has been documented about how the COVID-19 pandemic has set back progress in other areas of global health, from disrupting routine immunization programs and reliable access to HIV and tuberculosis drugs to increasing the cost and complications of conducting research and clinical trials. The common refrain from health practitioners is that more resources are needed not just to respond directly to COVID-19, but to shore up other vital global health programs to protect fragile progress. Here in the United States, we’ll be watching whether congressional appropriators take this need to heart in 2022 as they finalize FY 2022 spending bills and begin work on FY 2023. Outside of programs focused on health security, most global health-related funding lines at the CDC, State Department, and USAID have been flat-funded in recent years, in practice decreasing their purchasing power as COVID-19 has only increased the cost of doing business. As every country worldwide is feeling the weight of the latest omicron-fueled surge, the first few days of 2022 have unfortunately felt much like “2020, two.” But as the year continues, it is our hope the pandemic will turn a corner and that policymakers will embrace lessons learned from this crisis to ultimately usher in a healthier, safer, and more equitable world for all.