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A crisp chill hung in the air one early morning last week as members of the GHTC team stepped up the stairs adjoining the newly refurbished Apple Carnegie Library in Washington, DC, to pose for a photo with more than one hundred fellow research and development (R&D) advocates from across the country. GHTC was joining these representatives from more than 350 organizations as part of the Rally for Medical Research. Later that day, we would all descend upon Capitol Hill to implore lawmakers to increase funding for the National Institutes of Health (NIH). For GHTC, increasing the NIH budget is a clear priority to improve global health—but our team was also at the Rally on another mission: to show that global health and domestic health R&D advocates can and should work together to achieve our shared goals.The Rally for Medical Research was launched in 2013 with a speech given from atop those same stairs. That year, NIH funding was at risk of sweeping budget cuts. But in every year since the launch of the Rally, with health R&D advocates, patients, and scientists coming to Washington to advocate collectively for investments in NIH, the agency’s budget has grown. In fact, over the last six years, the NIH budget has increased by more than one-third—showing dramatic growth after a decade of stagnation. This year, advocates requested an increase of at least another US$2.5 billion, which would bring total NIH funding to $41.6 billion.On the steps of the Carnegie Library, GHTC stood side by side with advocates who were patients, caregivers, and researchers. Almost every advocate there was focused on a health priority affecting Americans, and so that morning, we were unsure how our globally focused message would land. But we planned to stick with our conviction: that domestic health R&D and global health R&D should and do share many of the same priorities.And for the rest of the day, we marched around Capitol Hill and made that argument to anyone who would listen.The first and most intuitive point we would make is that NIH-funded research for American health also benefits global health. You can often trace the streams of new domestic and global health technologies to the same wellspring of basic research. For example, in the 1980s when little was known about HIV and AIDS, the NIH was at the forefront of uncovering its basic biology. Later NIH research helped kickstart many of the technologies now used around the world for HIV and AIDS treatment and prevention. With advancements in R&D tools and strategies—such as artificial intelligence and the repurposing of drugs already approved by the US Food and Drug Administration (FDA)—it will only become easier to find global health applications from domestically-focused R&D.But the flow of R&D from the United States to the rest of the world is only part of the story. At the Rally, we tried to share a more nuanced narrative, explaining that the reverse is also true: when the United States invests directly in R&D for global health aims, that research often returns to benefit Americans. For instance, pre-exposure prophylaxis, or PrEP, is now commonly prescribed to prevent HIV infections for at-risk Americans and is a key part of the newly announced strategy to end HIV in the United States over the next decade. Many lawmakers may not realize, however, that PrEP was developed through clinical trials conducted mostly in low- and middle-income countries.Likewise, clinical trials for tuberculosis (TB) are often done abroad because they are difficult to conduct in the United States, where the patient population is small and dispersed. Pretomanid, a new antibiotic, is being called a game-changer for the treatment of highly drug-resistant TB. Its recent FDA approval as part of a combination treatment regimen was based on results from a clinical trial in South Africa and Tanzania. Now, in addition to treating patients around the world, the drug will be used in the United States to treat patients suffering from this deadly and most difficult to treat form of TB.And this unsung story extends to non-communicable diseases (NCDs). Research on NCDs abroad has led to insights on the NCD burdens we face at home. For example, hypertension research with African populations has helped illuminate how hypertension in African American populations is largely driven by social and not genetic risk factors. Another example is in the treatment of lupus, a painful autoimmune disease that affects up to 1.5 million Americans. It happens that some of the most effective treatments for lupus are anti-malarial drugs.The histories of both domestic and global health R&D are filled with examples of discoveries and technologies that start down one road and turn down another. It’s increasingly clear, however, that the R&D landscape is changing, and these roads will need to merge into a multilane highway of science and discovery. In the domestic health lane, the increasing number, novelty, and ambit of infectious and vector-borne disease outbreaks are driving investment in global health security and vector-borne disease research; in the global health lane, the increasing burden of NCDs in low- and middle-income countries is adding to the call for universal health coverage.Throughout the Rally for Medical Research, in four meetings with congressional staff and two meetings directly with members of Congress, we repeated these points alongside patients, family members, and friends who had direct experiences with pediatric cancers, rare diseases, and other devastating conditions. No facts or figures are as compelling as hearing the voice of someone who has direct experience with a condition, and so we were worried whether our talking points about R&D for diseases many Americans have never seen firsthand would sway congressional staff, members of Congress, and our fellow advocates—but every person listened. By the end of the day, we could tell the other advocates thought our stories strengthened, rather than detracted from, our shared advocacy message about the need for more investment in NIH. When our group finished the last meeting on our original schedule, a few other advocates approached GHTC and asked if we would be willing to participate in one more after-hours meeting with another member of Congress—and of course, we stepped up to join them.Too often in global health we cubbyhole ourselves and miss opportunities to work with our domestically focused advocacy counterparts who share our same fundamental goal: to improve human health and well-being. Many of these opportunities offer mutual benefit—and combined, our arguments are stronger. In the future, the GHTC US advocacy and policy team will continue to look for moments when we can stand with our fellow domestic R&D advocates as we did on that brisk morning. Like in R&D, the best progress often comes from working together.

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.Scientists from Target Malaria, a research consortium backed by the Bill and Melinda Gates Foundation, have for the first time outside of the lab released genetically sterilized mosquitoes in Burkina Faso to combat malaria. Using a technique known as a gene drive, scientists injected male mosquito embryos with an enzyme that sterilizes them, with the goal of reducing the mosquito population over time. Target Malaria is also developing an enzyme to prevent male mosquitoes from passing on X chromosomes, which results in all male offspring, thereby reducing malaria transmission since female mosquitoes are the ones that primarily bite and transmit disease. Researchers continue to push for new approaches to combat malaria, which killed more than 400,000 people in Africa in 2017. Progress against the disease is stalling, according to the World Health Organization (WHO). Biotech company Themis has raised US$44 million to develop its chikungunya vaccine through a phase 3 trial and move the lead candidate from its immuno-oncology research and development (R&D) program into humans. Themis filed an IPO to raise the funds last year but held off due to “adverse market conditions,” leaving the company to consider other options to fund further development. Last month, Merck invested $200 million in Themis for vaccine R&D, indicating Themis had lined up private financing to fund further development. The phase 3 trial is due to start in the coming months, enroll thousands of participants, and deliver data around the middle of next year. Themis is considering taking the vaccine to market itself. The US Food and Drug Administration (FDA) has accepted an application for approval of Merck’s Ebola vaccine, V920, also known as rVSV∆G-ZEBOV-GP. The vaccine is eligible for priority review and Merck will learn of the FDA’s decision by March 14. If the vaccine receives FDA approval, Merck would become the first company to receive clearance to sell a vaccine against the virus in the United States. In addition to its FDA filing, Merck has had an application for approval in Europe accepted for review earlier this year and has also applied for WHO prequalification status. V920 has been used on an investigational basis during the current Ebola outbreak in the Democratic Republic of the Congo, with only 71 cases among the 93,965 at-risk people who received the vaccine, according to WHO.

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. On Friday, Kenya became the third African country—following Malawi and Ghana— to introduce the world’s only licensed malaria vaccine. Health authorities are administering the vaccine to young children in rural areas where transmission rates are high. The aim is to reach approximately 360,000 children per year across the three countries in which the vaccine is being rolled out. Although the vaccine only protects about one-third of children who are immunized, those who are vaccinated are likely to have less severe cases of malaria. The vaccine—developed by GlaxoSmithKline, PATH, and partners—is the first and only vaccine to significantly reduce malaria in children, according to the World Health Organization. Malaria kills approximately 435,000 people every year, the majority of whom are children under five years of age in Africa. For the first time, researchers have used CRISPR gene-editing technology to try to treat a person infected with HIV. Scientists in China used CRISPR to engineer human stem cells to mimic a rare form of natural immunity against the HIV virus and transplanted them into a man with HIV and blood cancer. Though many of the cells survived in the man’s body for more than a year without causing detectable side effects, the number of cells was not high enough to significantly reduce the amount of HIV in his blood. While this research was a mixed success, scientists say it serves as proof of concept that CRISPR can be used to edit human stem cells that can be implanted safely in a patient. Researchers at the University of Alberta have developed a user-friendly, affordable, one-step test to diagnose dengue—a mosquito-borne disease that infects nearly 400 million people per year and causes flu-like symptoms. Unlike many traditional diagnostic tests for dengue which, in order to produce a precise diagnosis, require expensive equipment, multiple steps, and advanced training to operate, this test only requires a small blood or plasma sample and a portable tester that produces results in about two hours. As this new dengue test requires cold chemicals, the researchers are now exploring the use of vacuum-drying to create a powder that could withstand the heat in tropical climates where dengue is endemic. Additional research is required for field trials.

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. Human clinical trials are being planned to evaluate whether Ivermectin, a drug used to treat parasitic diseases like river blindness and elephantiasis, could become a new drug to combat malaria. Earlier this year, clinical trials conducted in Burkina Faso using Ivermectin for conditions unrelated to malaria found that it reduced malaria transmission by making the blood of people who were repeatedly vaccinated lethal to mosquitoes. Studies have also found that Ivermectin can kill plasmodium falciparum, the malaria parasite carried by mosquitoes, when administered to humans. The US Centers for Disease Control and Prevention, in collaboration with the Kenya Medical Research Institute (Kemri) and other global health partners, will perform the upcoming trials. Kemri and its partners say they hope this breakthrough could lead to the development of a new class of antimalarials in less than two years. Researchers have devised and tested a new mobile program which encourages tuberculosis (TB) patients to adhere to their treatment regimen. Compliance is a challenge with TB because treatment typically lasts for at least six months and involves multiple daily pills that can cause side effects such as nausea, fever, rashes, and stomach pain. The program, Keheala, texts patients to remind them to take their pills daily and asks them to actively verify that they have done so. Patients are ranked and told where they stand in an “adherence contest” against other patients. If patients do not verify that they have taken their pills, they receive more texts, calls, and finally a clinic is alerted. In the trial conducted, only four percent of patients in the Keheala program had bad outcomes, while 13 percent of those in the control group did. Based on these results, the US Agency for International Development will fund an expansion of this trial. Adherence to medications is crucial in treating TB, as those who miss too many pills often develop drug-resistant strains. As a result of the dengue outbreak sweeping across Bangladesh, the World Health Organization and the International Atomic Energy Agency have agreed to trial an innovative technique, known as the sterile insect technique (SIT), which uses radiation to sterilize male mosquitoes. Once sterilized, the male mosquitoes are released into the wild to mate with female mosquitoes, who then do no reproduce—reducing the mosquito population over time. SIT has been used successfully in parts of Africa to eradicate the tsetse fly which transmits sleeping sickness. Experts believe irradiating insects is better than other ways of controlling the mosquito population as it does not involve introducing non-native species or risk mosquitoes developing resistance to insecticides. The first group of sterilized mosquitoes will be released into the wild in Bangladesh in 2021-22.