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In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda. The new paper make the case for the inclusion of research and innovation for health as a central component of the post-2015 agenda. Photo: PATH/Gabe Bienczycki A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV and AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda. In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV and AIDS, malaria, and other diseases). These investments have helped to create an enabling environment for research in and for the benefit of LMICs by increasing demand for new health technologies, expanding coverage of proven interventions, and strengthening the innovation infrastructure in these countries. Building on the work of The Lancet Commission on Investing in Health—a group of renowned economists and global health experts—the paper discusses the need for increased R&D investments by all countries to achieve the dramatic health gains envisioned in the post-2015 agenda. Adequate investment in R&D is important, but it alone does not guarantee more products or drive innovation toward the right type of products. PATH/Patrick McKern Adequate levels of investment, as suggested by The Lancet Commission, are critical for spurring the development of new health tools, provided they align with financing needs in R&D—notably predictability and flexibility. But even that sort of investment alone does not guarantee more products, and it does not drive innovation toward the right type of products—those that are suitable, acceptable, affordable, and accessible to populations most in need. It is essential, therefore, that indicators for R&D for health tools that primarily affect LMICs address a comprehensive set of outcomes including financing needs, infrastructure and human resources needs, enabling policies, necessary partnerships, capacity strengthening, and access requirements. Because poor health and disability contribute substantially to poverty, research and innovation for health is linked to improving economic prosperity and is critical to eradicating poverty. Therefore, it must be continuously prioritized within the post-2015 development agenda. Ultimately, the success or failure of the post-2015 agenda relies just as much on how the goals and targets are implemented as it does on how progress will be measured. Thus any research and innovation indicators measuring progress against the goals and targets outlined in the post-2015 agenda must also increase accountability of researchers, governments, and funders, and inform research processes. Inclusion of research and innovation for health must facilitate an enabling environment for research and innovation in LMICs and encourage endemic countries to set and pursue a domestically-driven health research agenda. The post-2015 development agenda is an opportunity for LMICs to set their own health agendas and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Therefore, it is essential that there is broad agreement among all of the relevant stakeholders that research and innovation for health—which includes the scaling up of proven health interventions as well as the development of new and improved high-priority health technologies—is critical to meeting the ambitious goals of eradicating poverty and ensuring sustainable development for all within a generation. In support of the inclusion of research and innovation for health in the post-2015 agenda, over 150 organizations and individuals recently signed a petition to United Nations (UN) Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools for diseases and conditions impacting LMICs at the heart of the post-2015 development agenda. It is our hope that the Members States and other UN officials shaping the agenda will head this call.

The Global Health Technologies Coalition (GHTC) today released a new paper—co-authored with the Council on Health Research for Development (COHRED), the International AIDS Vaccine Initiative (IAVI), and PATH—which makes a case for why the research and development (R&D) of new and improved high-priority health technologies targeting the needs of low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda. The paper—The Role of Research and Innovation in the Post-2015 Development Agenda—builds upon the findings of The Lancet Commission on Investing in Health and existing literature by: Highlighting the ways in which R&D for health has contributed significantly to progress made towards the Millennium Development Goals (MDGs) Discussing the rationale for continuous prioritization of R&D for health in the post-2015 development agenda Providing preliminary suggestions for areas to consider as potential indicators of progress in global health R&D and innovation While the paper details how past R&D investments have led to new health products which have driven significant progress toward achieving the health-related MDGs in the last decade, it also argues that current health technologies and levels of R&D investment are insufficient to overcome existing and emerging health threats and ultimately achieve the goals of the post-2015 agenda—poverty eradication and sustainable development. As the global community organizes around these ambitious goals, the paper calls on key players to recognize the value of health improvements in ending poverty and the role that research and innovation for new health technologies plays in not only improving health outcomes, but also driving economic growth and progress in LMICs. The paper notes the recommendations of The Lancet Commission on Investing in Health—which in its Global Health 2035 report—calls for a doubling of current R&D investments in health from all countries to bridge the health divide between the richest and the poorest in a generation. The Commission’s recommendation is based on data demonstrating that past investments in health innovation have driven not only significant progress in terms of increasing valuable life years in LMICs, but also in terms of economic growth. While adequate financing for health innovation is critical to spur the development of new health tools, it alone does not guarantee the development of more products and the right type of products for those populations most in need. Therefore, the paper recommends that any indicators used to measure progress against targets described in the post-2015 agenda also measure R&D outputs, as well as the enabling environment for innovation—including infrastructure, capacity, enabling policies, and partnerships. The paper concludes by noting that the post-2015 development agenda presents an opportunity for LMICs to set their own health and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Finally, it calls for broad agreement among stakeholders that research and innovation for health—which includes both the scaling up of proven health interventions, as well as the development of new and improved technologies—is critical to meeting the ambitious goals of the post-2015 agenda. In addition to releasing this paper to inform discussion and debate, COHRED, GHTC, and IAVI released a petition last week—signed by over 150 organizations and individuals—calling for support in the post-2015 Sustainable Development Goals-Framework the research, development, and delivery of new and improved medicines, vaccines, and other health tools for the diseases and health conditions that predominantly affect LMICs as well as marginalized, vulnerable populations globally.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. With the 69th session of the United Nations (UN) General Assembly going on this week in New York and the global community debating how best to refine the post-2015 development agenda, over 150 organizations and individuals signed a petition to UN Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools at the heart of the post-2015 development agenda. A new public-private partnership to fight against HIV and AIDS has been launched—part of a Clinton Global Initiative five-year Commitment to Action that will strengthen laboratory systems in sub-Saharan Africa. The $15 million, five-country collaboration—called Stronger Together—will leverage the expertise of each partner country to build up laboratory infrastructure, which remains critical to disease control and product development. This week, the Obama administration announced a new set of federal executive actions to combat antibiotic-resistant bacteria in an effort to protect public health. The administration will put forth an executive order that would direct the federal government to work both domestically and internationally to reduce the emergence and spread of antibiotic-resistant bacteria. Specifically for health research and development, the National Institutes of Health, Biomedical Advanced Research and Development Authority, and the Food and Drug Administration will launch a $20 million prize to facilitate the development of a rapid diagnostic test that can be used by health providers to identify highly resistant bacterial infections. GHTC member the Global Health Innovative Technology Fund (GHIT Fund) has awarded seven new grants totaling US$15.3 million to tackle malaria, Chagas disease, and dengue fever. The investments aim to speed up the development of promising drugs and vaccines to battle these three insect-borne diseases.

Photo: © 2011, Charlotte Raymond Photography for International AIDS Vaccine Initiative (IAVI) With the 69th session of the United Nations (UN) General Assembly opening this week in New York and the global community debating how best to refine the post-2015 development agenda, over 150 organizations and individuals signed a petition to UN Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools at the heart of the post-2015 development agenda. Specifically, the petition—which was circulated by GHTC, the Council on Health Research for Development, and the International AIDS Vaccine Initiative—requests that the “UN fully supports in the post-2015 Sustainable Development Goals [(SDGs)]-Framework the research, development, and delivery of new and improved medicines, vaccines, and other health tools for the diseases and health conditions that predominantly affect low- and middle-income countries as well as marginalized, vulnerable populations globally.” The signing organizations and individuals represent a diverse group of research and academic institutions, private sector entities, and nongovernmental organizations from all regions of the globe: Africa, Asia, Europe, Oceania, and North and South America. GHTC is pleased to see such broad and substantial support for the inclusion of health R&D components in the post-2015 agenda, and hopes that the Member States and officials who are shaping the agenda will take note. Below is the full text of the petition and list of signatories: Excellency, Secretary General Ban Ki-moon, Member States of the UN, We, the below signatory organizations request that the UN fully supports in the post-2015 SDG-Framework the research, development, and delivery of new and improved medicines, vaccines, and other health tools for the diseases and health conditions that predominantly affect low- and middle-income countries as well as marginalized, vulnerable populations globally.  Thanks to the leadership of the UN and investments by Member States, the current Millennium Development Goals have made major contributions to improving the health and lives of millions of people around the world. A sustained focus on some of the greatest global health challenges has led to enormous progress in many areas, including significant improvements in the development and delivery of health tools such as drugs to treat HIV and AIDS, tuberculosis (TB) and malaria. Efforts to tackle diseases have also helped underpin progress in other important areas, such as gender equality, child mortality, and maternal health. Millions of lives have been saved. However, major challenges remain, and the health burden imposed by poverty remains far too high. In this context, it is essential that the post-2015 development agenda retains a strong focus on eliminating poverty-related diseases and conditions. The post-2015 agenda must build on previous achievements to ensure that healthy lives and access to health services can be achieved in an equitable and sustainable way, leaving no one behind. This means ensuring universal access to proven health interventions. But it also means developing and delivering new health technologies which can help address the shortcomings of existing interventions and sustainably reduce morbidity and mortality over the longer term. This will require continued support for the research, development, and delivery of new tools to the combat major epidemics like HIV and AIDS, TB, and malaria, as well as other poverty-related diseases and conditions ranging from neglected tropical diseases to reproductive, maternal, and child health. Continuous investment of human and financial resources in science, technology, and innovation is essential to achieve both economic and social development for all. We are encouraged by the current inclusion of the need to support the development of new medicines and vaccines for diseases particularly affecting developing countries in the Zero Draft document of the SDGs. Concern remains, however, about the omission of medical devices and diagnostics which also contribute to improving health outcomes, the lack of clarity on how this effort will be funded, and how supporting policies, incentives, capacity building, collaboration, and knowledge and technology sharing will be defined and implemented. As organizations working to save lives and improve health, we urge you to commit explicit and full support to health research and related policies and capacity building as a core component of a new, post-2015 agenda for equitable health and sustainable development for all. We ask that you press Member States to offer similar support, and to formally assess how to measure progress towards this goal, and how to fully and sustainably finance and enable the research, development, and delivery of essential new and improved health tools. Sincerely, ACTION Aeras African Services Committee AIDS-Fondet Amsterdam Medical Centre, University of Amsterdam American Society of Tropical Medicine and Hygiene Asociacion Gestion Salud Poblacion Association of Commonwealth Universities AVAC Bishkek Feminist Collective SQ Boston University Canadian Coalition for Global Health Research Canadian HIV and AIDS Legal Network Caribbean Public Health Agency Caribbean Vulnerable Communities Ciflorpan, University of Panamá COHRED Comité Nacional Cubano de Bioética Community Health Evangelism Programme Commonwealth Human Rights Initiative Department of Epidemiology, University Hospital F Hached, Tunisia Department of Psychiatry, Chiang Mai University Dept of Paediatrics, IrruaTeaching Hospital Edo State Nigeria Deutsche Stiftung Weltbevoelkerung Development of People's Foundation Drug Discovery Unit, University of Dundee Drugs for Neglected Diseasesinitiative Duke University ECOM - Eurasian Coalition on Male Health Egerton University Estonian Network PLWHIV European Investment Bank European Public Health Association Euvadis Facultad de Quimica, Universidad de la Republica, Uruguay Faculty of Tropical Medicine Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria FIND FIOCRUZ Fiocruz Minas Friends Africa (Friends of the Global Fund Africa) GAT George Institute GESPAM GlaxoSmithKline Global Alliance for TB Drug Development Global Health Advocates Global Health Consulting Global Health Council Global Health Technologies Coalition Global HIV Vaccine Enterprise Government of Kenya gTt-VIH (Spain) Hanoi School of Public Health Health Reform Foundation of Nigeria Edo State Chapter, HKMU Hospital Nelson Piccolo Hospital Sionsberg Hubert Kairuki Memorial University icddr,b IHCAI Foundation INDEPTH Network Institute of Human Nutrition and Food Institute of Tropical Medicine Institute Tropical Medicine Antwerp Instituto de Investigaciones Epidemiologicas, Academia Nacional de Medicina, Buenos Aires Instituto de Observação da Terra Instituto de Salud Carlos III Instituut voor Tropische Geneeskunde Interagency Coalition on AIDS and Development International AIDS Vaccine Initiative International Consortium on Anti-Virals International Organization for Chemical Sciences in Development International Partnership for Microbicides International Vaccine Institute Johns Hopkins Bloomberg School of Public Health Kairuki Memorial University Kapkatet medical training Centre Kenya National Bureau of Statistics Koningklijk Instituut voor de Tropen Kyrgyz Indigo La Gazette Law Office of Laurel G. Yancey, P.C. Medical Research Council of Zimbabwe Medicines for Malaria Venture menZDRAV Foundation Micro Insurance Academy Ministry of Education and Sports, Philippines Ministry of Health and Social Welfare, Tanzania Ministry of Health, Barbados National AIDS Research Institute National Institute of Health Research & Development NEPAD Science, Technology and Innovation Hub Netherlands Health Research Organization Nige Academy of Science North Eastern Council, Health Adviser One child-one world One Family Health Oswaldo Cruz Institute Parviflora Research Organization PATH People’s Health Movement Philippine Council for Health Research and Development Philippine Department of Health Policy Cures Population Council Public Health Institute Public Private Partnership Health Society RALSA Foundation Research Department, National Hospital Rosales Research into Cultura and Reproductive Health For Sustainable Human Development (RECARDEV) RESULTS UK Royal Tropical Institute, Netherlands Rural Community Health Research SA Medical Research Council Sabin Vaccine Institute School of Population Health, University of Queensland Section of Infectious Diseases, Dept of Medicine, St Luke's Medical Center, QC, Philippines Sensoa South Africa-Department of Health South African Research Ethics Training Initiative STOP AIDS Swiss Tropical & Public Health Institute The Africa Centre for Health and Population Studies The Environment Ameliorators The University of Western Australia Tools To Work Treatment Action Group Uhamka University Unidad de Investigacion Cientifica, Facultad de Ciencias Medicas, UNAH Universidad del Valle Universidad Nacional Autonoma de Mexico Universidade de Sao Paulo University of Bergen University of Birmingham University of Brasilia University of Cagliari University of California, Irvine University of Cape Coast University of Edinburgh University of Health and Allied Sciences, Ho. Ghana University of KwaZulu-Natal University of Melbourne University of Nigeria, Nsukka University of Oslo University of the Witwatersrand Washington Global Health Alliance Y+ Network Individuals: Alix Beith Francesca Coloni Franko Family Wanjiku Kabiru Malcolm McNeil Ophelia Mendoza Ellene Mocria