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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. An English springer spaniel has been trained to sniff out Clostridium difficile, a drug-resistant bacterium that infects nearly half a million Americans and costs the US health system an estimated US$1 billion annually. The two-year-old pup—Angus—was tapped for the job after Teresa Zurberg, who normally trains dogs to sniff out bombs and drugs, almost lost her life to C. difficile. Zurberg’s husband, a nurse, had read about a now-retired beagle in the Netherlands that had been trained to smell the bacteria on patients, and the couple approached the local health authorities, suggesting their new pup would be a prime candidate for such a job. Now, after extensive training, Angus is an official employee of Vancouver General Hospital, where he moves from room to room, searching for traces of the bacteria, which are then destroyed using ultraviolet light. As nearly two-thirds of C. difficile cases are acquired in hospitals, dogs like Angus could have a significant impact in not just detecting, but preventing, new cases of C. difficile. Launched last week at the World Economic Forum in Davos, the Coalition for Epidemic Preparedness Innovations (CEPI) seeks to develop vaccines against the diseases most likely to cause the next major pandemic. The coalition was established by the governments of Norway, Japan, and Germany in partnership with philanthropic organizations the Wellcome Trust and the Bill & Melinda Gates Foundation. Collectively, these partners have pledged US$460 million to the initiative, half of what is needed for CEPI’s first five years of operation. During its initial phase, CEPI will focus on advancing two experimental vaccines for each of the three viruses that have been identified by the World Health Organization as leading contenders for the next major pandemic: Lassa fever, Middle East respiratory syndrome (MERS), and Nipah virus. Carbapenem-resistant Enterobacteriaceae (CREs), a class of deadly, drug-resistant bugs that have been deemed “nightmare bacteria” by the director of the Centers for Disease Control and Prevention may be more prevalent and virulent than previously realized. These bacteria often contain specific genes that enable them to evade different types of antibiotics, including carbapenems, potent drugs that are often reserved as the last line of treatment against drug-resistant infections. To better understand their evolution and spread, researchers at Harvard University and the Massachusetts Institute of Technology sequenced the genomes of 263 CREs, collected from patients at four hospitals. The results revealed that carbapenem resistance is emerging across diverse types of bacteria and that the genes that confer resistance can be transferred between distinct bacterial families. Even more alarming: some CREs don’t have any of the known resistance genes, meaning that there are either more, unidentified resistance genes than we are aware of or that CREs have developed other ways to resist antibiotics. The study also indicates that CREs can be carried and transmitted asymptomatically, making surveillance of these dangerous infections all the more difficult.

The annual cycle of World Health Organization (WHO) governance meetings continues, with many WHO member states and advocates convening in Geneva this week for the 140th WHO Executive Board (EB) meeting where they will shape the agenda and resolutions for May’s World Health Assembly (WHA). The agenda is extensive, and covers everything from narrowing the field of WHO Director-General (DG) candidates to a short list in preparation for a vote at WHA, to addressing routine administrative matters. In discussions with other stakeholders and member states, the agenda items receiving the most attention are those on WHO reform and the DG election. But there are also two key resolutions that will directly impact global health research and development (R&D): Follow-up to the Consultative Expert Working Group on R&D: Financing and Coordination (CEWG) The long-running CEWG process continues soldiering forward from its inception in a movement to create a treaty to fund R&D for neglected diseases and conditions in the early 2000s. After many years of negotiations, in 2015, WHA approved five “demonstration projects” designed to test the feasibility of establishing a multilateral pooled fund to finance R&D, as well as the establishment of an R&D observatory to identify areas of unmet R&D need and inform the priorities of such a fund. In 2016, a sixth demonstration project was added, though these projects have yet to be fully funded and face a shortfall of roughly US$73 million to complete their programs. The policies currently on the table this governance cycle are approval of a plan to operationalize the global health R&D observatory, as well as solicitation of member state guidance into developing the principles that will guide a pooled fund for R&D. The observatory plan has been thoroughly vetted and would consist of a database documenting worldwide global health R&D projects and initiatives, with an expert committee responsible for ensuring that insights are gleaned from the database through data mining. There appears to be broad consensus among member states and advocates that this repository of data would be helpful in coordinating and organizing R&D, but it has yet to receive full funding from member states. The pooled fund proposal is much less developed. At this point, member states are only being asked to weigh in on broad principles and terms of reference. Overall the fund is proposed to disperse $100 million per year over 10 years, supporting 35 to 40 R&D projects of varying complexity (from simple repurposing of existing drugs to possibly developing new chemical entities). One key advantage many advocates see to the proposal is that access requirements could be baked into the mechanism from the very beginning so there is a strategy in place to ensure the availability and affordability of resulting products. What is much less clear is how the pooled fund would be sustainably financed in the long term. The paper outlines a number of options, including a cyclical replenishment and voluntary contributions, though these are all untested at this point. R&D for potentially epidemic diseases The WHO Secretariat will present a progress report and request for input on its efforts to develop and execute an R&D blueprint to combat potentially epidemic diseases in response to lessons learned and challenges faced during the Ebola outbreak. The goal of the blueprint overall is to reduce delays between the identification of an outbreak and the deployment of effective medical interventions. To support this goal, the WHO Secretariat has developed roadmaps or blueprints to support R&D projects for both Middle East respiratory syndrome coronavirus (MERS-CoV) and Zika. The Secretariat will also outline their future plans in supporting platform technologies, building regulatory capacity, and encouraging coordination among global health stakeholders in epidemic scenarios. These future activities are much more malleable, and stakeholders will have the chance to help shape them as work continues. Given the uncertainties around how a pooled fund and R&D observatory will be fully operationalized and sustainability funded and the necessity of enhancing global preparedness to address future disease outbreaks, it will be important to see what comes out of these EB discussions since they will set the stage for what will be voted on and address at WHA in May. GHTC will continue tracking these processes closely to ensure that the concerns of the global health R&D community remain front and center. For more information about the policy issues that will be addresses at the 140th WHO EB meeting, check out an archived video of webinar briefing on the topic organized by the Global Health Council.