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On July 8, G20 leaders committedto work together to combat the rise of antimicrobial resistance (AMR) and potentially pandemic diseases. This includes efforts to foster research and development (R&D) through cooperative initiatives, including a new collaboration hub for AMR R&D. This is a welcomed step forward by G20 leaders, and marks the first time R&D for global health has been featured as part of the G20 declaration. The inclusion of R&D commitments came about as the result of a sustained advocacy campaign by GHTC and our partners, including open letters, calls to action, a roundtable expert discussion event, and direct outreach to policymakers. Why does the G20 matter? The G20 is a leading forum for international coordination on a range of global challenges impacting economic growth and development. In representing the world’s 20 largest economies, it represents nearly two-thirds of the global population. While many world leaders have expressed concerns about global health crises and the rise of AMR, there was no certainty global health—much less health R&D—would be prioritized among tough debates on other pressing global challenges—including climate change, trade, the Syrian conflict, and migration. What was the win for health R&D? In its declaration, the G20 recognized the critical role of R&D in improving pandemic preparedness, tackling priority pathogens, and combatting AMR. It also pledged support for coordinated research initiatives, including existing structures like the World Health Organization (WHO) R&D Blueprint and the Coalition for Epidemic Preparedness Innovation—focused on preventing epidemics—as well as called for a new “R&D Collaboration Hub” for AMR research. The G20 declaration represents a statement of political will to move those initiatives forward, which is an exciting achievement for the global health R&D community. Firstly, support for WHO’s R&D Blueprint is a very welcomed development. The Blueprint lays out a global strategy to ensure the world is prepared to rapidly mobilize R&D activities and resources in response to an outbreak. The goal is to ensure that necessary technologies are available sooner to save lives and avert a large-scale crisis. In the wake of the West African Ebola outbreak—and as the world faces other threats like Zika—ensuring R&D resources and structures are in place to respond to outbreaks quickly is common sense, and GHTC welcomes the G20’s commitment to supporting it. Secondly, in calling for an international collaboration hub for AMR R&D, the G20 takes work that has been stalled by WHO and moves it in a more ambitious direction. As an outcome of the long-running Consultative Expert Working Group on R&D: Financing and Coordination process, WHO established a Global Observatory on Health R&Dto facilitate R&D coordination and prioritization. However, at the last World Health Assembly, WHO announced it will not proceed any further in expanding the observatory without additional funding. With G20 leaders not only committing to R&D coordination and collaboration—which is the goal of the observatory—but also committing to a concrete mechanism and fostering support for that mechanism, they have embraced the goals of the observatory as they relate to AMR. Showing the clear impact that this type of collaborative mechanism has in one area of R&D will greatly strengthen the drive for a global mechanism. That is a very exciting prospect for the continuation of this important work. Why is R&D a priority for the G20 now? Health crises are not simply a challenge for low- and middle-income countries: They increasingly affect the world’s leading economies as well. The rise of AMR not only heightens the threat of untreatable malaria in Africa, but also impacts hospital patients in Europe who could face incurable infections following surgeries. Given that the next disease outbreak could be a single plane flight away from becoming a global pandemic, R&D is vital to ensure we have the tools to respond quickly in all countries. It’s estimated that large-scale disease pandemics could cost the global economy more than US$60 billion per year, while an R&D investment of $1 billion per years could deliver the tools needed to protect against outbreaks. What’s next? Overall, although the G20 focused on R&D through the lenses of AMR and health security—which addresses only a portion of the health challenges for which new tools are needed—the declaration is a very good sign that the global health R&D community is making an effective argument about the need for health R&D to be viewed as a critical aspect of broader global discussions on development, trade, economic growth, and security. It is now imperative that G20 leaders follow through on commitments made at the summit and turn words in a declaration into concrete action, marshaling new resources and stronger incentive, and financing mechanisms to spur critically-needed R&D to unlock the cures and treatments of tomorrow.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The World Health Organization (WHO) and UNICEF have reported nearly 1 in 10 children did not receive any immunizations in 2016. This includes immunizations for diphtheria-tetanus-pertussis (DTP). WHO and UNICEF reported that the global immunization rate for the full round of the DTP vaccine is only 86 percent, falling short of the 90 percent goal of global immunization. Furthermore, in 2016, eight countries had DTP immunization rates of less than 50 percent. Estimates by WHO and UNICEF suggest that 10 million more children in 64 countries need to be vaccinated every year in order to achieve the 90 percent goal. This highlights the need to bring vaccines to low-resource settings that have been chronically affected by low immunization rates. A new study published in Proceedings of the National Academy of Sciences highlights a new diagnostic tool that performed well in distinguishing Zika from other flaviviruses, including dengue. UC Berkeley and Humabs BioMed partnered to create a low-cost, easy-to-use diagnostic tool to specifically test for the Zika virus. Researchers found this tool was capable of distinguishing between Zika and other flaviviruses, as well as distinguishing current and past Zika infections in patients. The tool had 91.8 percent sensitivity—the ability to correctly identify those with the disease—and 95.9 percent specificity—the ability to correctly identify those without the disease. This tool could be used in Zika- and dengue-endemic areas, assisting in diagnostic processes and subsequent treatment, especially among populations adversely affected by Zika, like pregnant women. For the first time in history, more than half of all HIV-infected individuals are receiving treatment. In 2016, it was estimated that 19.5 million individuals were receiving HIV treatment, with a total of 36.7 million people infected with HIV. These estimates are both increases from the estimated 17.1 million treated and 36.1 infected in 2015. Further, AIDS-related deaths have decreased by more than half since 2005. Though these rates are promising in the fight against the global epidemic, the United Nations (UN) acknowledges that there is much left to do in the fight against HIV and AIDS, particularly in the context of less stable health systems in resource poor settings.