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With the global health emergency of the novel coronavirus looming large, last week the global health community gathered in Geneva to kick off the World Health Organization (WHO) Executive Board (EB) meeting. In his opening remarks, WHO Director-General Dr. Tedros Adhanom Ghebreyesus highlighted the agency’s new Science Division and underscored WHO’s commitment to “being at the forefront of science,” signaling the importance of research and development (R&D) to achieve the agency’s goals. GHTC was on the scene following the official agenda and delivering statements. Here are our top three takeaways from this year’s EB:1. Coronavirus and public health emergency preparedness take center stageWith the coronavirus [COVID-19] crisis dominating the attention of the world, the global response to this health emergency was a clear priority for WHO during the EB. Throughout the week, WHO held daily briefings to update member states on the evolving situation and ongoing response efforts. While plenty of the discussions were mired in the ongoing political controversies around travel and trade restrictions, a good portion also encouragingly centered around the need to fast-track the R&D response. Delegates highlighted the development and evaluation of effective diagnostic tests, vaccines, and medicines, as part of the R&D priorities and called for establishing mechanisms that ensure access to these new treatments and technologies for the most vulnerable populations. Data sharing, public-private partnerships, and collaboration were also highlighted as key elements to be strengthened as part of emergency preparedness activities.A global research and innovation forum specifically on the coronavirus was convened by WHO in the days following the EB in line with the WHO R&D Blueprint strategy and preparedness plan to rapidly activate R&D activities during epidemics. Its aim is to fast-track the availability of effective tests, vaccines, and medicines that can be used to save lives and avert large-scale crises.The theme of rapid response capabilities also dovetailed into the dialogue at the EB around the Nagoya Protocol, a legal framework that regulates the sharing of genetic resources across borders to ensure any benefits derived are fairly and equitably shared. China was continuously praised at the EB for its rapid sharing of genetic sequence data on the virus, which has helped accelerate the R&D response. However, this action was not in line with the Protocol, which calls for this type of genetic data sharing to be negotiated individually with each country. In a session on the public health implications of the Nagoya  Protocol, member states called on WHO to continue to gather intelligence and provide a review of the current impact of the Protocol. Several members also highlighted the need for a new international framework to specifically govern pathogen sharing, modeled on the Pandemic Influenza Preparedness (PIP) framework, a non-binding mechanism that seeks to strengthen global influenza surveillance and response systems. WHO Chief Scientist Dr. Soumya Swaminathan promised that her team would continue its efforts to study the issue and hold additional consultations to provide more clarity to all stakeholders.2. R&D features prominently in Global Vaccine Action Plan and Ending TB agendaWith sessions on the Global Vaccine Action Plan, intellectual property, ending tuberculosis (TB), and neglected tropical diseases, it is not surprising that this year’s EB featured an agenda with significant implications for R&D.In particular, the session on ending TB generated critical momentum for R&D, as member states called for increased investment in developing new technologies, including shorter, high-quality treatment regimens and diagnostic tools. The need to enhance data sharing and strengthen enabling environments for R&D was also discussed by country delegates.Member states also unanimously approved two decisions that set the stage for global vaccine policy in the next decade—a draft resolution on “strengthening global immunization efforts to leave no one behind” and the first-ever draft resolution on “eliminating meningitis by 2030”—after reviewing a report prepared by the Director-General on lessons learned from the Global Vaccine Action Plan 2011–2020. Member states were urged to continue working with R&D stakeholders to support immunization supply chain innovations and vaccine administration technologies to increase the efficiency of vaccine delivery. Countries were also encouraged to improve and increase vaccine production capacity and develop new products, services, and practices, including those addressing emerging infectious diseases.3. Civil society engagement at WHO remains strainedCivil society engagement with WHO continues to be a challenging process and this year’s EB strained relations between stakeholders even further. In a surprising move, the EB Chairman, took fairly drastic actions to further curtail civil society participation during the official proceedings. Non-state actors’ (NSAs) statements were reduced to one minute, which has occurred at EB meetings in the past, often as a way to protect time allocated for other agenda items. However, this time, some organizations were also prohibited from delivering statements if they had already made previous interventions during the EB, and the Chair aggressively admonished those who wished to speak on multiple topics.This came amidst the backdrop of a proposal that member states were set to consider that could considerably hamper civil society’s ability to provide input to important fora like the EB and the World Health Assembly (WHA). The proposal called for streamlining the statement process by compelling NSAs to deliver joint interventions, limiting the overall size of civil society delegations, and possibly introducing an altogether new process for dialogue between member states and NSAs at a separate forum. Member states supported the idea of joint statements and a constituency approach, while civil society pushed back against these measures that they believe would restrict meaningful contributions and silence important voices. All stakeholders agreed that the idea of a forum for NSAs required additional dialogue and was too premature for this year’s process. WHO is looking to pilot some of the new procedures, at least in part, during the next WHA, though details are not yet available. With many items still up in the air and further discussion needed to implement and advance programs, the WHA in May promises to be quite the roller-coaster. GHTC will be present and look forward to advancing these conversations with our partners as well as continuing to strategically drive the innovation agenda heading into the Assembly. 

The Global Health Technologies Coalition (GHTC) condemns President Trump’s fiscal year (FY) 2021 budget request seeking deep cuts to global health and medical research programs. The budget proposes a 34 percent cut to global health programs at the US Agency for International Development (USAID) and the State Department, as well as significant cuts to public health and research agencies within the Department of Health and Human Services. If enacted, these reductions would have a disastrous impact on scientific advancements for global health. Cuts could mean fewer breakthrough vaccines, diagnostics, and treatments developed and more lives worldwide at risk of deadly diseases and debilitating conditions.“The Trump administration has once again failed to recognize what Congress has championed across partisan lines for decades: that US investments in global health research are fundamental to America’s global leadership and essential to building a stable, prosperous world where more people survive and thrive and dangerous outbreaks are quickly quashed,” said Jamie Bay Nishi, Director of GHTC. “At a time when our progress in global health is in a fragile state—with biology throwing up new challenges like the rise of drug-resistant HIV and tuberculosis and insecticide-resistant malaria parasites—any cuts to global health research programs put past gains at further risk. Additionally, the budget’s proposed elimination of HIV/AIDS research funding at USAID represents a broken promise by our President who pledged last year to ‘defeat AIDS in America and beyond.’” The Administration’s FY21 budget proposes widespread cuts to programs and funding lines that support research and development (R&D) of new drugs, vaccines, and other technologies to fight neglected diseases and conditions. Examples include the following, which are relative to FY20 enacted levels:Across the board cuts to global health programs at USAID:Elimination of HIV/AIDS funding.22.5 percent cut to Maternal and Child Health.11.3 percent cut to Tuberculosis.8.0 percent cut to Malaria.26.8 percent cut to Neglected Tropical Diseases.61 percent cut to Family Planning and Reproductive Health.6.8 percent cut to the Centers for Disease Control and Prevention (CDC) Center for Global Health.11.6 percent cut to the CDC National Center for Emerging and Zoonotic Infectious Diseases. 7.5 percent cut to the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases.9.0 percent cut to the NIH Fogarty International Center.In the budget request, the President does maintain support for specific programs critical to supporting global health security, including sustaining funding for the Biomedical Advanced Research and Development Authority—which advances medical countermeasures against emerging infectious diseases that pose a risk to Americans—and boosting funding for global health security accounts at USAID and CDC—which support efforts to strengthen health systems of partner nations to better recognize and contain outbreaks. GHTC welcomes this support, which is vital to enhancing global preparedness. However, taken together, the budget fails to recognize the interrelatedness of the persistent and emerging global health challenges we face. And the cuts proposed to biomedical research advanced through programs at NIH, CDC, and USAID would ultimately undermine our efforts to strengthen health systems globally. A life saved from Ebola or the novel coronavirus is not a life saved if it is later lost to tuberculosis or complications during childbirth. And a health system primed and ready to respond to an outbreak can only achieve so much without the right diagnostics to detect, vaccines to prevent, and therapies to treat a deadly disease.For the past three years, Congress has acted in a bipartisan manner to reject the President’s proposed budget cuts to global and medical research. We urge Congress to do so once again and maintain our nation’s strong legacy of humanitarian and scientific leadership in global health R&D.