News

Researchers at the University of Cape Town discovered a compound that blocks the cycle of malaria within the human body, regardless of its drug-resistant status. The compound acts a preventative tool as well as a treatment for those infected with malaria, as it can block transmission and prevent infection. The compound, MMV390048, began phase I clinical trials in 2014, but subsequent data has not yet been published. The drug will enter phase II clinical trials this year in Ethiopia, and it is hoped this drug will be on the market within the next ten. With the world circling in on polio eradication, global public health professionals have run into a major obstacle that makes ridding the disease incredibly complicated: A vaccine shortage. There currently isn’t enough injectable polio vaccine for the world to use, as demand is so high. There isn’t enough of the vaccine in production for each child to receive two shots, which is what researchers suggest to protect against contracting polio. An alternative is the oral polio vaccine, but due to its heightened risk of complications, professionals believe this vaccine will soon be phased out. While polio vaccine manufacturing may be ramped up to treat children in the next few years, it is essential that health care professionals continue to vaccinate children ten years post-eradication to ensure there is no resurgence of the disease. Funders, including the Gates Foundation, are now putting efforts toward the next surge in vaccine demand, and hope to overcome this obstacle to reach global eradication of polio once and for all. An outbreak of Ebola has been confirmed in the Democratic Republic of the Congo (DRC), and health researchers around the globe are working to distribute an experimental vaccine. While the outbreak is contained due to the geographic isolation of the cases, the WHO and Gavi are still working quickly toward an effective and globally approved vaccine that can be used in future outbreaks. The DRC has not requested a vaccine at this point in time, but these organizations are prepping for when the country requests it, or for if the outbreak spreads past the DRC. The vaccine is experimental, and requires special modes of transportation, yet proved incredibly successful during the Ebola outbreak of 2014.

As it does every year, the global health community is preparing for our collective trek to Geneva for the World Health Assembly (WHA) where the World Health Organization’s (WHO) 194 member states and various civil society or multilateral observers will come together to review WHO’s programming over the prior year, sets policy and program priorities for the upcoming one, and approve the budget with which to carry them out. As with most WHAs, there are a number of items related or relevant to research and development (R&D) at this year’s assembly: Director-General elections The highest profile issue on the agenda this year is the selection of the next WHO Director-General (DG) to succeed Margaret Chan. The three candidates still in the running are Dr. Tedros Ghebreyesus (Ethiopia), Dr. David Nabarro (United Kingdom), and Dr. Sania Nishtar (Pakistan). Dr. Ghebreyesus has previously served as Minister of Health and Foreign Affairs for Ethiopia, Dr. Nabarro boasts an extensive track record in the United Nations (UN) and other multilateral organizations, and Dr. Nishtar served as Minister of Health for Pakistan, in addition to founding and leading a successful nonprofit. From an R&D perspective, none of the candidates have direct experience in technology development, but all have indicated in general terms that they would be supportive of R&D. As the chief executive of WHO, the DG sets operational policies and priorities across a variety of programs important to R&D, from the pooled fund and observatory, to ongoing discussions around intellectual property and access to medicines. The influence of the DG is hard to overstate. The race remains very open, and member state delegation contacts have indicated that it is anyone’s race, though this was before news reports emerged containing allegations about Dr. Ghebreyesus’ tenure as Ethiopian Minister of Health. It is unclear to what extent these reports have shifted the race, but GHTC will be on the ground in Geneva providing daily updates as the final days of the campaign unfold and the election occurs on May 23. R&D for potentially epidemic diseases In examining the response to the West Africa Ebola outbreak; ongoing yellow fever and dengue outbreaks; and Zika, WHO recognizes the need for R&D to be a central component of the agency’s strategy to combat potentially epidemic diseases. To that end, WHO has undertaken a number of activities and will be presenting progress to date at WHA. One of the most impactful of these activities is the creation of an R&D blueprint for action to prevent epidemics. The blueprint lays out a number of areas that require global attention to prepare for outbreaks, including product development, as well as social science and epidemiology studies. GHTC is very pleased to see R&D getting its fair share of attention in the context of epidemic preparedness. Without the ability to rapidly develop new tools to address emerging diseases, we will not have the necessary tools in place to prevent or curb an epidemic. Although the blueprint is a step in the right direction, GHTC believes that WHO should also address regulatory guidance and health systems strengthening; new technologies won’t help stop outbreaks if they are held up in regulatory review, nor will it be possible to develop the right tools if health systems are too weak to collect the vital data and samples needed when an outbreak occurs. Antimicrobial resistance Another hot topic over the past year has been the global focus on antimicrobial resistance (AMR) coming out of last year’s UN General Assembly High-Level Meeting on AMR. WHO has been at the forefront of this movement to combat AMR and has committed to supporting countries in developing national action plans to fight AMR, setting up global surveillance systems to track AMR, and helping coordinate across the UN system to ensure a unified UN response. Support for R&D has been a central component in these discussions. GHTC welcomes all of these actions, but notes that WHO and member states have been slow to agree on an AMR stewardship and development framework, which is a vital next step. We will not make progress against AMR without the Framework helping guide investments in R&D, and ensuring that the products developed through that R&D remain effective in use. GHTC will continue pushing for the Framework and for WHO and countries to be held accountable to the promises they made at the UN General Assembly. Consultative Expert Working Group on Research and Development: Financing and Coordination The long-running Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) process continues for this year’s WHA, and the progress update report shows some progress, some treading water, and some disappointment. On a positive note, the WHO R&D Observatory—which will serve as a coordination clearinghouse for information on global health R&D—is moving toward implementation. Once active, the Observatory will be a key tool in helping ensure efficient R&D by facilitating coordination, exposing gaps, and helping researchers prioritize according to need. The second piece of the CEWG’s mandate is standing up a pooled fund to support neglected disease R&D. To be housed at the Special Programme for Research and Training in Tropical Diseases (TDR), the pooled fund would operate in a similar fashion to the Global Fund to Fight AIDS, TB and Malaria, accepting contributions from member states and making grants to research institutions pursuing R&D for neglected diseases that are not commercially viable. While TDR has developed a solid set of terms-of-reference for an expert advisory group to prioritize areas for the fund to focus on, it still has not come to grips with the elephant in the room for any funding mechanism—how they are going to raise the money to support it. Unfortunately, even the current set of demonstration projects to pilot the approach remain underfunded, and it does not appear that most member states or other donors are willing to reach into their pockets for this project. GHTC will continue advocating for them to do so, and for more resources to be made available for R&D in general, but it will be interesting to see the dynamics at this year’s WHA. Closing thoughts Overall, this year’s assembly is likely to be dominated by the DG election, with other topics only attracting attention once this heated content is wrapped up. It is not clear how the three DG candidates will approach R&D should they be elected, so it is very hard to predict what impact the decisions at this year’s WHA will have. Will they chart a direction for the new DG or will WHO’s new leader want to make his or her mark and change course entirely? GHTC will be on the ground providing updates as they happen, as well as the analysis of what they could mean for R&D. Follow us on Twitter at @GHTCoalition for live updates over the course of the week and check back here for a wrap-up blog on outcomes from the 70th WHA later this month.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The US Centers for Disease Control and Prevention (CDC) reported that they expect rates of multidrug resistant tuberculosis (MDR-TB) in Russia, India, South Africa, and the Philippines to rise significantly in the next 25 years. These four countries carry the heaviest burdens of resistant (both drug-resistant and MDR) TB, accounting for 230,000 cases in 2015—nearly 40 percent of cases worldwide. It is predicted that one third of all TB cases in Russia will be drug resistant by the 25-year mark. The CDC suggests that efforts should be taken to prevent the airborne transmission of TB. In addition, CDC notes the need to expand diagnostic capabilities in low- and middle-income countries and access to rapid diagnostics and effective treatments. Zoonotic diseases, or diseases passed from animal to humans, such as Ebola, HIV and AIDS, swine flu, Spanish Influenza, malaria, and the bubonic plague, have been around for hundreds of years. With increased disease surveillance efforts globally, PREDICT, a global surveillance network financed by the US Agency for International Development and other partners, has recognized something important: healthy ecosystems and wildlife leads to less disease, which lowers disease burdens and makes humans safer. In tracking outbreaks like Ebola and swine flu, PREDICT has taken samples from over 55,000 wild animals and have tracked down 815 novel viruses. When ecosystems are damaged and the animals living in those systems are displaced, disease rates are higher. This research suggests that climate conservation can also help prevent pandemics. The United Nations Environment Agency and partners launched a new surveillance platform called the Global Mosquito Alert designed to survey mosquito patterns. Leveraging a global network of scientists and volunteers, the platform will track mosquito populations and disease patterns around the world. The global alert will provide real-time open access data via cloud computing networks, allowing the general population to engage and contribute to documenting and observing the patterns of mosquitoes.