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On Saturday, heads of state and government from the world’s leading economies concluded this year’s G20 Summit in Osaka, Japan by issuing a declaration committing to advance global health.Noting that “health is a prerequisite for sustainable and inclusive economic growth,” G20 leaders made a myriad of noteworthy commitments in the G20 Osaka Leaders’ Declaration from advancing universal health coverage (UHC), to controlling noncommunicable and communicable diseases, to tackling health emergencies and antimicrobial resistance (AMR). Recognition of the role of research and new technologies in confronting these challenges was present, but inconsistent.In welcome news, the declaration generally recognized the “importance of science, technology and innovation (STI)” for achieving the Sustainable Development Goals and committed to strengthening health systems to achieve UHC by “promoting public and private sector innovation, such as cost-effective and appropriate digital and other innovative technologies.” GHTC was pleased to see this call out for “affordable” and “appropriate” technologies, which are critical elements for addressing health needs in the world’s poorest places, and that leaders recognized that both the public and private sector have a role to play in accelerating new innovations, such as treatments, vaccines, and diagnostics. But as the declaration delved into particular health challenges, recognition of the importance of research and development (R&D) was somewhat inconsistent.On the positive side, leaders committed to promoting R&D to tackle AMR, noting the ongoing work by the Global AMR R&D Hub, first established under the German G20 presidency to foster international agenda setting and collaboration on research for new antibiotics and treatments. They also called on members and the hub to “analyze push and pull mechanisms to identify best models for AMR R&D.” It is constructive that the G20 committed to moving this agenda forward, as growing drug resistance is complicating the fight against leading global killers, such as malaria, tuberculosis, and HIV and AIDS, which heads of state reaffirmed their commitment to end. A lack of market incentive remains a barrier to spurring new antimicrobial and drug development.AMR is just one emerging threat in our increasingly interconnected world, so we were pleased to see the G20 once again put a spotlight on the importance of improving public health preparedness and the need for sustainable financing mechanisms to prevent and respond to health crises like the current Ebola outbreak in the Democratic Republic of Congo. We were, however, disappointed to see no recognition of the role of R&D and health technologies in enhancing preparedness. Just two years ago, the G20 health ministers, under the German presidency, pledged strong support for collaborative efforts for R&D preparedness, including the Coalition for Epidemic Preparedness Innovations [CEPI] and ongoing work under the World Health Organization’s R&D Blueprint.Despite this criticism, last week’s G20 Summit remains a significant political win for global health advocates—and that’s important to recognize. It was just two years ago that global health, and R&D for global health, featured for the first time ever as part of the G20 leaders’ declaration. With so many pressing global challenges from migration, to climate change, to the impact of disruptive technological innovation, it is promising to see G20 leaders continue to position global health as a priority area for international action and as a critical driver of economic development.In a twist on previous G20 presidencies, last week’s Leaders’ Summit marked a mid-way point in this year’s G20 ministerial process, rather than its usual annual conclusion. With the G20 Health Ministerial Meeting set to take place in October, it is now vital that health ministers build on the positive foundation set at the Leaders’ Summit to put in place more concrete action plans and financial resources to realize the G20’s global health commitments—that rightfully place R&D as a central driver in achieving these goals.

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. The National Institutes of Health has launched a large clinical trial to assess treatments for preventing people at high risk from developing multidrug-resistant tuberculosis (MDR-TB). The study is comparing the safety and efficacy of a newer TB drug delamanid—one of the first drugs available specifically to treat MDR-TB and the first to exist in a child-friendly formulation—with isoniazid, a decades-old drug for TB prevention, in preventing development of active MDR-TB among high-risk individuals exposed to household members with MDR-TB. Study participants are considered at high risk if if they have latent TB infection, suppressed immune systems from HIV or other factors, or are younger than five years old. Study investigators hypothesize that delamanid will be a better prophylactic treatment than isoniazid in reducing the likelihood that at-risk household members of individuals living with MDR-TB will develop active TB. Existing treatments for MDR-TB are often toxic, poorly tolerated, expensive, and aren’t always available. The World Health Organization (WHO) estimated 460,000 people worldwide developed MDR-TB in 2017. According the Access to Medicine Index issued last month, which ranks the world’s 20 largest pharmaceutical companies on their efforts to improve access to medications for the world’s poorest, the industry has made remarkable progress in increasing access to lifesaving medicines, through efforts like drug donation and licensing patents to generic producers. However, according to the report, most of the progress made by the industry is limited to a few companies with their efforts too reliant on donor dollars. GSK has ranked first every year since the rankings began, with its score steadily rising each year. Dr. Jayasree K. Iyer, executive director of the Access to Medicine Foundation which releases the index, stated that two billion people still lack access to the products they need, implying progress on access has just begun. A new, rapid diagnostic test that can detect yaws—a debilitating bacterial disease spread through skin-to-skin contact causing skin lesions and ulcers—may reinvigorate efforts to eradicate the disease which affects thousands of the world’s poorest children. The molecular diagnostic test costs just US$2 and can detect yaws within 30 minutes at point-of-care, eliminating the time-consuming need to transfer disease samples to expensive high-tech labs. Though WHO reported more than 80,000 suspected cases of yaws in 2018, the real number of infections is likely to be much higher. The rapid diagnostic test is one of 30 finalists of the WHO Innovation Challenge and was showcased at the Africa Health Forum earlier this year. The diagnostic has shown “impressive results” in small trials, according to its creator, who is looking to do larger scale testing.

Last week, the Australian government and the Indo-Pacific Centre for Health Security convened practitioners, researchers, educators, and decision-makers across the fields of public health, medicine, veterinary science, agriculture, government, defense, and anthropology for the first Global Health Security Conference in Sydney to examine the progress made to date in strengthening health systems and to identify gaps and opportunities for enhancing the international community’s ability to respond more efficiently and effectively to future health crises.GHTC was on the ground, following the official agenda, participating in side events, and speaking on a panel on innovative game changers to advance prioritization of research and development (R&D) in the Global Health Security Agenda. Here are our three key takeaways from the conversations:1. Innovation recognized as vital to advancing health security.The role of innovation in strengthening health security was highlighted throughout the week, with official sessions and side events showcasing innovative products, partnerships, and research central to advancing global health security.GHTC had a speaking role on a Global Health Security Agenda Consortium panel focused on game changers in global health security and used the opportunity to highlight key innovations that are being used on the front lines in the fight against Ebola in the Democratic Republic of the Congo. The panel hit on key themes that were echoed in other sessions, including the need to build local capacity for deployment of new tools and medicines, enhancing laboratory infrastructure, and strengthening health systems and community response capabilities. Much of the dialogue also centered around the need to engage local stakeholders in the development of innovations, ensuring that tools and technologies are designed and adapted for the local context, and that the deployment of treatment measures for emerging health threats is executed with firm community support to increase the chance of successful implementation.Other speakers throughout the week also highlighted the regulatory and implementation challenges that organizations and countries face when seeking to develop and deploy new tools and innovations and recommended strenghtening global governing structures that could facilitate addressing hurdles around approval timelines and streamline the processes.2. We need a strong focus on financing and sustainability. One core message that was consistent throughout the week was the need for a stronger focus on sustainability. Delegates agreed that states and organizations are too reactive in their mindsets, only responding to the latest outbreak and not taking the necessary preemptive steps, including through R&D, to develop the local, regional, and global capacities that are necessary to effectively combat emerging infectious diseases and other health threats. Ensuring that local infrastructure, laboratory systems, clinical capacity, and overall primary health care services are continually enhanced will allow for a more effective response.  Ebbs and flows in funding for epidemic diseases create additional challenges. The recent Ebola outbreak is a perfect example of how additional public resources can be mobilized to respond to global threats. However, absent a crisis, emergency preparedness and capacity building are often de-prioritized, and the necessary funding needed for additional innovation and product development is often lacking. Delegates called for a more durable approach of creating policies and incentives that catalyze investment for specific diseases, infrastructure, and health workers. Some also suggested looking to multilateral institutions for greater financial support for programmatic activities and creating stronger partnerships with the private sector. As one speaker put it best: “We must marry political capital with money.”3. Multisectoral approach critical to path forward.Are we asking too much of the health sector and not enough of everyone else? In the closing plenary, this question served as a call to action to engage non-traditional stakeholders and relevant decision-makers in other sectors to develop a truly multisectoral approach to strengthen health systems overall and develop the tools and capabilities in-country to detect, diagnose, and treat those threatened by global health threats.Ministers of Health have a difficult case to make when asking for more resources, financial or otherwise. The value of preventive measures is often invisible, since doing it right means there is no outcome. As global health practitioners, advocates, researchers, and decision-makers look for new ways to engage partners in different fora, such as the G20, building linkages to other sectors and government priorities will be key to creating the political buy-in necessary to advance the agenda around global health security.