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In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week.  The dapivirine ring—a monthly vaginal ring that releases the antiretroviral dapivirine (ARV)—was shown to be effective in girls younger than 18 in a phase 2a clinical trials. Developers of the product are currently seeking approval for the ring’s use in women ages 18–45, but health professionals want to expand the targeted age group to teenagers ages 15–17. Researchers conducted this initial trial on female teenagers in the United States and found positive results. Not only was the tool safe and effective in delivering ARVs into the females’ bloodstreams, it was also deemed easy to use and enjoyable to use by over 90 percent of participants. Next steps include conducting a study on teenage girls in Africa. The National Institute of Allergy and Infectious Diseases (NIAID) and Janssen Pharmaceutical Companies, a subsidiary of Johnson & Johnson, partnered to create an HIV vaccine candidate to protect against multiple strains of HIV at once. Scientists used a mosaic technique—patching together several strains of HIV and looping them together into one vaccine—and initial studies suggest this vaccine is promising. Participants in an early study handled the vaccine well, and blood results suggested the participants had an adequate immune response to the vaccine. While these results are promising, NIAID stressed that these are preliminary results and more testing is necessary. This marks the fifth time an HIV vaccine has reached clinical trials in humans. Three of these approaches were abandoned because of low efficacy in later trials, while the other trial remains ongoing. As the fight against HIV and AIDS continues, there is still much to be done. Health professionals fear a second HIV and AIDS pandemic as HIV drug resistance rises, manufacturing capability is maxed out, and funding from major donors falls. It is expected that 54 million individuals globally will be living with HIV by 2030, requiring a massive supply of front-line medicines and second-line therapies for the estimated 10 percent of cases where HIV is resistant to front-line treatment. Sites responsible for manufacturing and producing front-line HIV medications have limited ability to expand further, and expanding production sites to endemic areas of Africa is limited due to inadequate infrastructure. Finally, funding sources are becoming increasingly more scarce. As the White House focuses capital on domestic issues and donor funding decreases, researchers fear the lack of funding necessary to conduct important HIV and AIDS research in the future.

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.