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Health ministers of the G20 nations, representing the world’s leading economies, met earlier this month in Mar del Plata, Argentina to chart a course of action on global health for the upcoming year. Under the leadership of Argentina, the meeting and its resulting outcome declaration focused on four themes: antimicrobial resistance (AMR), malnutrition and child obesity, health systems strengthening, and public health preparedness. While the language that found its way into the final declaration is worthy of note and analysis, so too are the items left on the cutting room floor. GHTC was pleased to see health ministers recognize the critical role of research and development (R&D) in combating AMR but was also disappointed to see further commitments on health R&D absent from the declaration. Here we take a closer look at the good, the bad, and the unknown for global health R&D under the G20. The Good Following the precedent set last year under the German presidency, G20 health ministers reaffirmed their commitment to tackling AMR, emphasizing the role of new technologies in confronting this challenge. Importantly, the health ministers encouraged investment in R&D across a range of interventions—including antimicrobials, diagnostics, and vaccines—while “promoting affordable and equitable access to all individuals in need.” Although this inclusion of language on access is not surprising, the framing of R&D in a broad sense is quite positive given the dire need for treatment-supporting technologies that are relevant to low- and middle-income country (LMIC) settings. Ministers also welcomed the work of product development partnerships (PDPs), including the Global Antibiotic Research and Development Partnership and TB Alliance. This call out of PDPs is important because it serves both as a validation of the PDP model and demonstrates that there are ways to support innovation while also working to ensure equitable access, concepts frequently seen as being in tension. GHTC was also pleased to see the declaration define AMR broadly and note its “growing threat among…fungal infections and drug-resistant HIV, malaria and tuberculosis.” While in wealthy countries concerns around AMR primarily center on “superbugs” and facility-acquired infections, the inclusion of health issues predominantly impacting LMICs is a long-overdue acknowledgment of the dangers of AMR in low-resource settings. It was also positive to see health ministers voice support for the 2017 commitment by G20 leaders to “further examine practical market incentives” to encourage stakeholders, including industry, to develop new antimicrobials. One of the key dynamics at play in the global health R&D ecosystem is the reality that there are a number of regions, diseases, and technologies for which there are not functioning commercial markets and as a result people do not have access to the health tools they need. New policies or incentives to help address these market barriers, while ensuring health equity, have the potential to dramatically accelerate progress towards universal access. It is positive that the G20 has committed to moving this agenda forward. While GHTC was pleased to see the G20 continue to shine a spotlight on the role of R&D in addressing AMR, we were disappointed to see the G20 fail to acknowledge the importance of R&D in improving epidemic preparedness—particularly given that under the German presidency, the G20 pledged strong support for collaborative research initiatives, including the World Health Organization R&D Blueprint and the Coalition for Epidemic Preparedness Innovation. The Bad Unfortunately, the declaration takes a narrow approach to improving our ability to prevent, detect, and respond to outbreaks, focusing solely on health system strengthening. It is clear that being better prepared requires having both strong health systems in place and the right technologies on hand to prevent an outbreak from becoming a deadly crisis. We saw with the 2014-2015 Ebola epidemic, the 2015-2016 Zika epidemic, and the recent outbreaks of Nipah virus how the lack of available interventions like vaccines and diagnostics hampered response efforts. These crises have taught us that when it comes to fighting outbreaks, health system strengthening and R&D must go hand in hand. Given the important signaling power of the G20 forum to its members and to the world, it is disappointing to see the G20, under the Argentinian presidency, take such a limited view of health security that fails to include research and product development. We hope future presidencies will take a more comprehensive view. The known and unknown While the G20 Leaders’ Summit will not take place until November, with this declaration, we now know what they will say on health. As such, our attention as advocates now turns to the next holder of the G20 Presidency, Japan, and prognosticating how the G20 will choose to prioritize global health under its presidency.  Given that Japan has a long-documented history of prioritizing universal health coverage, as well as supporting global health R&D, we can be cautiously optimistic that the positive statements under Argentina will be expanded upon, and that we will see a more holistic view of the importance of innovation and R&D in global health at this time next year.   Photo credits: PATH/Georgina Goodwin, G20.

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. Major funders are betting that a new online platform for genetic sequencing will help health workers worldwide more easily identify mysterious infections and track disease outbreaks. The platform, IDseq, seeks to make metagenomics sequencing—the analysis of genetic material and the matching of those readouts to databases of known microbes—, which can be expensive and technically demanding, more accessible and affordable, particularly in low-resource settings. Free and based in the cloud, IDseq allows researchers to upload patient data, which is then “crunched” against existing databases, to determine what infection a patient has. The Chan Zuckerberg Initiative is supporting the platform’s development, and the Bill & Melinda Gates Foundation announced last week a new training program to support clinicians around the world in using the platform. In an early stage trial, a combination of two broadly neutralizing antibodies (bNAbs)—proteins that can bind to different strains of HIV and prevent the virus from entering human cells—suppressed blood levels of HIV for months after treatment in some people. Participants received up to three infusions of bNAbs over a six-week period with their viral load monitored every one to two weeks. Though further testing and refinement is required, long-acting bNAbs combinations may eventually become an alternative to daily anti-HIV drugs. Researchers hope to test whether engineering the antibodies to last longer in the blood can improve viral suppression and explore new combinations with additional antibodies or other drugs. The Global Antibiotic Research & Development Partnership (GARDP) and Novartis are joining forces to reduce child deaths from antimicrobial resistance (AMR) by accelerating the development of generic antibiotic treatments for children. The strategic partnership will focus on: 1) enhancing the availability of generic antibiotics and increasing access for children in low- and middle-income countries, 2) developing heat-stable pediatric formulations, and 3) leveraging the knowledge and shared expertise of both partners. The partnership between GARDP and Novartis is a response to the World Health Organization’s call for affordable, improved, and adapted antibiotics for this vulnerable population, for which treatment options are limited.

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. In a new report, researchers at the Johns Hopkins Center for Health Security highlight 15 promising technologies that could help make the world better equipped to fight emerging infectious disease (EID) outbreaks and prevent such outbreaks from becoming catastrophic events. The list includes innovative solutions from vaccines that spread through populations like viruses to 3D printed drugs. The 15 technologies identified in the report fall under five broad categories—disease detection and surveillance, diagnostics, manufacture of pharmaceuticals, administration of vaccines and drugs, and medical care—and range in use from the early detection of an EID, to preventing its spread, and through to the care of patients. Notably, researchers looked for innovations that could be used in developing countries where EID outbreaks “hit first and hit hardest,” according to Dr. Crystal Watson, lead author of the report.  A novel synthetic DNA vaccine candidate against Ebola, which targets the virus’ surface, offered complete protection from the Zaire strain of the Ebola virus in preclinical research. Importantly, the vaccine candidate also demonstrated durability, showing strong immune responses one year after the last dose—a particularly challenging area for Ebola vaccines. Compared to traditional vaccine approaches that involve injection into muscle, synthetic non-viral–based DNA vaccines can be administered directly into the skin, resulting in consistent, potent, and rapid immunity. The antibody levels resulting from this vaccine candidate were equal to or higher than those for other vaccines currently being evaluated in the clinic at the Wistar Institute Vaccine & Immunotherapy Center, where the research was conducted. One researcher noted the success of an intradermal, low-dose regimen as encouraging in the pursuit to create safe and effective vaccines that are optimized for high-risk areas. A new type of malaria vaccine, known as a transmission-blocking vaccine (TBV), which aims to prevent mosquitoes from becoming infected by malaria parasites when feeding on infected humans, could one day become part of a suite of tools used to combat malaria. While traditionally scientists have focused on developing vaccines that prevent malaria infection from developing after a person is bitten with a parasite-carrying mosquito, a TBV works differently. A TBV signals the human body to begin making anti-malaria antibodies that will be passed to the mosquito when it bites the immunized person, disrupting the transmission cycle between mosquitoes and humans. While a TBV would not directly prevent an immunized person from getting infected, it would reduce the likelihood of people in that community becoming infected. A research team supported by the PATH Malaria Vaccine Initiative, the University of Buffalo and others have shown that the TBV approach could be effective. The researchers found that antibodies from a protein called Pfs25 effectively blocked the development of malaria-causing parasites in the gut of mosquitoes in animal studies.

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. Rotasiil, a first-of-its-kind thermostable vaccine to prevent rotavirus—the most common cause of severe diarrheal disease in children worldwide—has achieved prequalification from the World Health Organization. This status will allow United Nations agencies and other organizations to procure the vaccine at low-cost for use in low- and middle- income countries. Developed by the Serum Institute of India with clinical trial and licensure support from PATH, Rotasiil is an oral vaccine administered to infants in a three-dose course, which does not require refrigeration—making it easily distributable in places where power shortages and failures can disrupt the cold chain necessary to keep traditional vaccines viable. Rotasiil is the fourth rotavirus vaccine on the market, and the second developed by an Indian organization. Japanese company Kansai Plascon has launched the world’s first mosquito repellent paint in Zambia. The paint technology, which has shown to be safe in humans, disrupts the nervous system of a mosquito upon contact, reducing its ability to remain on walls where the paint has been applied. “The knock-down effect lasts for up to two years, offering lasting protection from malaria infection and other mosquito-borne diseases,” Kansai said. Mosquito repellent paint offers a new tool in the arsenal to fight malaria—one of the world’s deadliest diseases—alongside other anti-malarial measures such as bednets, prophylactics, and insecticide spraying. The Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Defense Advanced Research Projects Agency (DARPA) has launched a new partnership to strengthen the health security of the United States by focusing on the research, development, and deployment of medical countermeasures and advanced technologies to combat these threats. ASPR and DARPA will focus on two initial areas of collaboration—bacterial pathogens to combat microbial threats and the discovery of molecular biomarkers. ASPR’s Biomedical Advanced Research and Development Authority (BARDA) and DARPA will conduct preclinical and clinical trials of a new type of therapeutic for antibiotic resistant bacteria with an aim to develop a product that mitigates the effects of multidrug-resistant infections. BARDA and DARPA will also focus on discovering and validating biomarkers—which define a person’s exposure to a virus before the person shows symptoms of infection—and developing tests that can identify infected patients quickly to help contain disease outbreaks. Through the partnership, ASPR and DARPA will increase collaboration and share data—maximizing the impact and investment of both agencies.