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As the 70th session of the World Health Assembly (WHA) winds to a close, memberstate delegates and civil society advocates are collectively taking a moment to catch their breath and reflect on an extremely eventful WHA. In a single week, the World Health Organization (WHO) gained a new Director-General—Dr. Tedros Gehbreyesus of Ethiopia—increased mandatory contributions from member states, and passed a landmark cancer resolution, just to name a few key decisions. In addition to these seismic shifts in the landscape of WHO, health research and development (R&D) was also featured prominently across a number of WHA agenda items, some of which saw highly consequential developments. Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) The long-running CEWG process finally appears to have reached its end. After more than a decade of exploring approaches to support R&D for neglected diseases and actions to stand up a voluntary R&D-pooled fund at WHO, Assistant Director-General (ADG) Marie-Paule Kieny notified the Assembly that no further work would be done on either the pooled fund or the initial round of demonstration projects associated with it. Her comments came at the close of a lengthy session in which both member states and civil society organizations universally echoed the call for more resources to enable the fund and demonstration projects to operate effectively, as well as bemoaning the lack of contributions to date. In justifying the decision to cease work on these projects, ADG Kieny noted that no additional funding has been raised for the fund beyond the US$11 million pledged over three years ago. With that level of funding, the programs were simply not sustainable, she explained. On a positive note, the WHO Global Observatory on Health R&D—which was created to facilitate R&D coordination and guide prioritization—was spared the ax. While resources are not available to expand its database of R&D projects and data immediately, it is now operational and can be expanded at any time, as additional data and funding become available. Access to medicines As expected, the debate around access to medicines continued to rage at this year’s WHA. Although there was not a dedicated agenda item on follow-up to the United Nations Secretary General’s High-Level Panel on Access to Medicines (HLP) report, a number of countries, including Brazil, India, and Argentina, took every opportunity to raise the report in their remarks on other agenda items. In particular, agenda item 13.3 Addressing the Global Shortage of, and Access to, Medicines and Vaccines—which has historically focused more on supply chain issues—saw particularly heated debate, as well as intricate parliamentary maneuvering. India and Brazil led a concerted push, supported by South Africa, for the WHO Secretariat to initiate a consultation process that could result in WHA adopting “consensus language” on access to medicines. A number of European countries pushed back, noting that the WHA agenda item simply contained a report from the Secretariat for the Assembly to note, thus there was no need for consensus language. Implicit in this objection was a concern on the part of countries opposed to recommendations within the HLP report that any opening created to develop new language on access to medicines would invariably result in references to the HLP report. After extensive debate, including the intervention of WHO’s legal counsel, member states reached a compromise whereby the issue of access to medicines would be included on the agenda for January’s WHO Executive Board (EB) meeting, although that item would not specify discussion of the HLP report. South Africa further proposed a standing EB and WHA agenda item on access, which was vetoed by the United States. Beyond parliamentary maneuvering, the debate around access centered on many of the arguments that have become familiar to those following this issue over the years. On one end, civil society activists and some member states called for a wholesale rethink of the ways in which countries provide incentives for innovation, typically through some form of “delinkage,” wherein R&D costs are no longer related to the costs of the final product. At the opposite end of the spectrum, industry representatives and countries with significant pharmaceutical industries argued that intellectual property is not the primary barrier to access and that attention is better focused on supply chains and countries’ lack of domestic financing for health. Concluding thoughts Overall, this WHA featured one of the most packed agendas I have seen since I started tracking WHO. It is promising that, despite all of the competing agenda items, R&D remained a central focus of vigorous discussion and received significant attention. Even beyond the specific policy developments, it is clear that R&D and innovation remains a priority for the global health community.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A recent Congressional hearing on Zika has revealed that there is a lack of consensus regarding the diagnosis and treatment of the virus. Furthermore, only approximately 25 percent of babies born from women who have been exposed to Zika receive the necessary follow-up to evaluate their children for developmental defects. Such follow-up is critical—Zika can cause defects in the infant months after birth. As a result, the impact of Zika may be underestimated, leaving public health professionals uneasy about proposed budget cuts by the Trump Administration, which could exacerbate the treatment and reporting challenges that characterize the current outbreak. Chagas disease, colloquially known as "kissing bug disease," is more deadly than previously thought due to underreporting of the disease. Going undiagnosed while carrying Chagas can elevate the risk of death, primarily due to associated heart problems that will develop over time. Chagas disease initially mimics symptoms of the flu, often causing a misdiagnosis and lack of proper treatment, and it can lie symptomatically dormant for years, silently causing irreparable damage to the heart. There is currently no effective vaccine against the disease. The Democratic Republic of Congo’s (DRC) Ministry of Health has approved the use of an experimental Ebola vaccine to combat the outbreak. The vaccine, though experimental, proved to be highly effective in clinical trials. Details of how the vaccine will be deployed have not been announced yet, but if further cases are confirmed, it will likely be given to contacts and contacts of contacts of those with a confirmed case. So far, there have only been two confirmed cases, but over fifty suspected cases.