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In this guest post, Dale Halliday—an analyst at Policy Cures—discusses the finding of Policy Cures’ report on funding for reproductive health technology research and development (R&D) in developing countries. Developing countries need better reproductive health tools According to the World Health Organization, 800 women died each day in 2013 due to complications from pregnancy and child birth. Nearly all of these deaths occurred in developing countries, and many could have been prevented if effective and appropriate reproductive health technologies were available. Unfortunately, current products for reproductive health are often not suited to those living in developing countries who need them most. For example, contraceptives currently on the market may be ill-suited to the target population, have a prohibitively high cost, require highly trained providers or specialty equipment, or require refrigeration, a barrier in some developing countries. Although there is a great deal of investment into reproductive health R&D, the vast majority is for commercial research directed towards developed markets. While there is some overlap in the reproductive health needs of developed and developing countries, there is little investment into new products that address the complex needs specific to developing countries. A new report for reproductive health R&D Today, Policy Cures launched a first-of-its-kind, comprehensive report on the landscape of reproductive health R&D funding focused on products for developing countries. This new report—Reproductive Health: R&D for the developing world—examines how much is invested in reproductive health R&D for the developing world and how this funding is allocated among product areas. The report found that in 2013, total funding for developing country-specific reproductive health R&D was just under US$88 million. Investment in reproductive health R&D for developing countries is focused on contraceptives The majority of reproductive health R&D funding, US$63 million, was directed towards contraceptives. The pharmaceutical industry was the largest funder in this area, providing $33 million; followed by the philanthropic sector, which gave $17 million; and the public sector at US$13 million. This large investment from industry funders comes as little surprise considering the crossover between commercial and developing country markets in this area. Funding directed towards R&D for other reproductive health areas was considerably lower. Each of the following areas received less than US$10 million each: multipurpose prevention technologies, postpartum hemorrhage, platform technologies for reproductive health, diagnostics for sexually transmitted infections, and core funding to reproductive health R&D organizations. Several areas for which there was an identified need for new products received no R&D investment at all, including syphilis drugs and ultra-short-acting contraceptives. There is a global imbalance in R&D funding for reproductive health A major finding of the report was that R&D funding for reproductive health relies heavily on a limited number of funders. Excluding industry, the top three funders (the Bill & Melinda Gates Foundation, the US Agency for International Development, and the Indian Council for Medical Research) together provided almost half of total reported global funding (US$41 million, 47 percent). The lack of funders for reproductive health R&D means that future funding, and therefore the future of lifesaving tools, could be vulnerable if exposed to unexpected economic shocks. This vulnerability is amplified by the large geographic imbalance among investors into new technologies. Although funders in both the United States and Europe provide substantial support for programmatic, operational, and capacity development work for reproductive health in developing countries, when it comes to R&D funding, the US-based funders provide much greater investment than European funders—contributing over 15 times that of the whole of Europe. India alone contributed more than all European funders combined. New technologies to save lives are in development Although the report finds that R&D funding for reproductive health technologies for developing countries is not particularly high, it identifies a number of key technologies that could revolutionize reproductive health for women living in developing countries. FHI 360’s portfolio of contraceptive technologies includes a longer-acting injectable that would provide women with six months of protection from a single shot. This could offer an alternative to current options that provide protection for only 1 to 3 months and require up to 12 visits to a health clinic each year—a potential barrier to access in low-resource settings. CONRAD—a US-based product development partnership—is developing an innovative intravaginal contraceptive ring that also provides protection against HIV and herpes simplex virus type 2 infection. This product has the potential to transfer the decision-making power for reproductive health to women while also providing protection against sexually transmitted infections. A heat-stable formulation of inhaled oxytocin—a drug used to prevent postpartum hemorrhage (PPH)—is being developed through a collaboration between Monash University and GlaxoSmithKline. If successful, this product could replace the injectable oxytocin formulation that is the current standard in PPH prevention and treatment but is ill-suited to developing country settings due to its need for refrigeration. Reproductive health R&D has severe funding gaps Considering the health burden, capacity for health improvements, and potential impact on broader poverty indicators, as well as the size of the reproductive health R&D sector as a whole, investment in R&D for reproductive health products in developing countries is small. Perhaps the most important point to be taken from the report is the large amount of space within this sector for more funders. Despite the strong portfolios demonstrated by well-established product developers, only a few dedicated funders provide necessary resources for new products. With several of these lifesaving technologies approaching the mid-to-late stages of product development, now is the ideal time for a high-impact investment. Hopefully this will be the trend in times to come. The G-FINDER Reproductive Health report was launched in Washington, D.C. on February 4th 2015 by the report’s lead author, Dr. Mary Moran, Executive Director of Policy Cures , and an international panel of experts. Conducted by Policy Cures and funded by the Bill & Melinda Gates Foundation, G-FINDER reports on global funding of R&D for new products for neglected diseases and reproductive health.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Last April, Representatives Fred Upton (R-MI) and Diana DeGette (D-CO) launched the 21st Century Cures initiative, holding hearings and consultations to identify ways that Congress can accelerate Americans' access to new treatments from the development to delivery stage. A discussion draft of the legislation was released last week by Republican members of the House Energy & Commerce Committee. Senator Lamar Alexander (R-TN) announced on Thursday that the Senate Health, Education, Labor and Pensions committee will release legislation to complement the 21st Century Cures Act, stating that “One of the committee’s top priorities this year will be modernizing the Food and Drug Administration [FDA], helping to get treatments and medicines to patients as quickly and as safely as possible.” President Obama submitted his annual budget request to Congress yesterday, in which he asked for US$1.2 billion to fight antimicrobial resistance. This funding would be invested into developing new antibiotics and diagnostics, monitoring drug-resistant infections, and preventing the spread of resistant “superbugs,” particularly in healthcare settings. Obama also asked for $280 and $77 million, for the Centers for Disease Control and Prevention and FDA, respectively, to combat the overuse of antibiotics in both humans and livestock. Last week witnessed major wins for vaccine development and access. The US Agency for International Development announced that the US Government will commit $1 billion to Gavi, the Vaccine Alliance, over the next four years. Pfizer, Inc., a major American pharmaceutical company, pledged to reduce the price of its pneumococcal vaccine by 6 percent in poor countries. The announcement has been greeted with disparate responses. Kate Elder, a vaccines policy advisor at Doctors without Borders called the price cut "tiny" and "inadequate," however Bill Gates warned that such criticism discourages pharmaceutical companies from investing into the research and development of drugs for developing countries. Serum Institute of India is currently developing several products intended to rival existing vaccines and to be sold at significantly lower prices. The Institute’s human papillomavirus vaccine could be available as early as 2018, and the manufacturers plan to sell it at one-third of the price of Merck & Co.’s Gardasil vaccine.

Today the Global Health Technologies Coalition (GHTC) welcomes Erin Will Morton as its Coalition Director. Morton joins the GHTC from her previous position as Senior Policy and Advocacy Advisor at the District Policy Group. While at the District Policy Group, Morton worked with a range of clients to develop and implement strategic government relations and advocacy programs. Morton has extensive experience in managing and convening coalitions and building support among coalition member organizations, and she has worked on a variety of policy areas, including grassroots advocacy, global health, medical simulation, Medicare reimbursement, and cancer care. Before joining the District Policy Group, Erin worked in the political department of NARAL, a national nonprofit women’s reproductive health organization in Washington, DC, where she participated in grassroots organizing during the 2006 Congressional elections. Erin received her bachelor’s degree from Dickinson College and a master’s degree from Johns Hopkins University. Morton is succeeding Kaitlin Christenson, who served as GHTC Coalition Director from May 2009 to October 2014.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Trials of an experimental Ebola vaccine candidate developed by GlaxoSmithKline (GSK) and the US National Institutes of Health (NIH) will begin in Liberia within the next few weeks. The vaccine has been successfully tested on 200 volunteers in the United States, United Kingdom, Switzerland, and Mali. GSK sent an initial 300 doses to Liberia on Friday and plans to ultimately enroll 30,000 volunteers in the trial. GSK and NIH are partnering with Merck & Co to inject 10,000 volunteers each with the GSK/NIH vaccine, a vaccine candidate developed by NewLink Genetics Corp, and a placebo. National Geographic took an in-depth look at three tropical diseases that present an emerging threat to Americans: dengue, Chagas, and chikungunya. The article highlights the need for research and development (R&D) of improved diagnostics for Chagas, and vaccines for chikungunya and dengue. All three diseases are spread by insects, and specialists fear they could spread to insect populations in the United States. Bill and Melinda Gates released their annual letter last week, in which they discussed the progress they hope to see in the next 15 years in global health and development. The Gates Foundation is making an ambitious bet—that the lives of poor people will improve faster in the next 15 years than ever before. They are calling on decision-makers involved in the post-2015 development agenda processes to make realistic goals. The letter emphasizes the importance of innovation in improving the lives of people in poor countries, claiming “these breakthroughs will be driven by innovation in technology—ranging from new vaccines and hardier crops to much cheaper smartphones and tablets.”