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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. The European Medicines Agency has approved the first vaccine against meningitis B, manufactured by Novartis, for use in individuals from two months of age and older. The Institute of Medicine has released a new discussion paper that examines issues related to global health research and development (R&D) coordination, financing, and prioritization. The paper was written in response to recommendations offered by a World Health Organization group on R&D financing and coordination. Investments by the US government and pharmaceutical companies are leading to new-and-improved vaccines. Scientific advances in the next decade, for instance, could lead to a "universal" flu vaccine given every five to 10 years that would fight many strains of a virus, making annual shots obsolete. Disease burden has an enormous impact on a country’s economic situation, halving household incomes in some highly endemic countries, according to a new study. The study authors write that their findings have direct policy implications. A new opinion piece argues that US investments in foreign aid should not become a casualty of the “fiscal cliff.”

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Outgoing Rep. Howard Berman (D-CA) this week released a bill that aims to reform US foreign assistance efforts, including those focused on global health. Among other goals, the new bill would promote research and innovation in US foreign assistance efforts. A new clinical trial will examine an investigational drug’s early efficacy in patients newly diagnosed with drug-sensitive tuberculosis. The clinical trial—sponsored by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health—is led by researchers at the Tuberculosis Research Unit at Case Western Reserve University in Cleveland. A new report from Médecins Sans Frontières and the Drugs for Neglected Diseases initiative finds that despite important progress in research and development for global health over the past decade, only a small fraction of new medicines developed between 2000 and 2011were for the treatment of neglected diseases. Susan Rice, the US ambassador to the United Nations, withdrew her name from consideration for secretary of state this week. In a letter to President Barack Obama, she said "the confirmation process would be lengthy, disruptive, and costly—to you and to our most pressing national and international priorities. That trade-off is simply not worth it to our country." A new report finds a decline in deaths from malnutrition and infectious diseases has caused a shift in global mortality patterns over the past 20 years, with more of the world’s population now living longer and dying from diseases mostly associated with wealthy countries, like cancer and heart disease.

This post originally appeared on the Center for Global Health R&D Policy Assessment blog. Depending on who you ask, you’ll come up with a number of different definitions for what exactly characterizes a neglected disease, as there’s no generally accepted definition. I personally like the one offered by the NIH: “Global health organizations define neglected diseases as those that are prevalent among impoverished and marginalized populations in the developing world. Tropical environments, poor living conditions, and limited access to health care contribute to the risk and spread of these diseases.” But even this definition leaves something lacking. There are a number of conditions that cause severe morbidity or mortality in low and middle-income countries and still go unrecognized when we talk about neglected diseases. For instance, we at the Global Health Technologies Coalition (GHTC) tend to think of “neglected” in terms of the urgent need for tools to prevent, diagnose, treat, and generally improve the health of people in low- and middle-income countries around the world. If increased investments from governments and other stakeholders in research and development (R&D) are needed to create new and improved products for a certain disease or health need in the developing world, then we would define that health issue as neglected. As an example, reproductive health issues and sexually transmitted infections can have devastating health effects for women on par with infectious diseases like tuberculosis, malaria, and neglected tropical diseases. Although pregnancy is not often thought of as a neglected condition, it could be, as there is an incredible demand for contraceptive options that don’t yet exist. Additionally, issues like non-communicable diseases are not traditionally neglected when considering the amount of funding and other investments pharmaceutical companies devote to developing products for conditions like diabetes. However, the distinct technological and infrastructure needs of health systems in the developing world, as well as the alarming climb in the prevalence of non-communicable diseases in these settings, have made them a much more urgent concern. But why should a definition matter anyway? For those of us thinking about global health policy, terms and nomenclature are important. Consider, for instance, one of the many programs implemented by the US government to improve public health around the world. The US Food and Drug Administration’s (FDA) priority review voucher program lists specific diseases that are eligible for the agency’s incentive program. This list leaves out a whole host of neglected diseases. Among them is Chagas disease, which Congress has been attempting to include via new legislation for the past two years. This disease remains ineligible for the incentive according to the legislation and guidelines governing the program. So we need to adapt the way we think about neglected health needs worldwide to reflect conditions—like pregnancy and reproductive health needs—that impact people worldwide, in addition to infectious diseases. Perhaps instead of framing our thinking around neglected diseases, we should instead consider a different term: neglected conditions. By changing our thinking on neglected conditions, we open the door to increased attention, support, and programming to address all of these pressing health needs as a package—from infectious disease to childhood health needs like nutrition, reproductive health issues, and pregnancy-related complications. For instance, new and improved contraceptive and microbicide products, including multipurpose prevention technologies under development, could be an easy, cost-effective way to help women plan their pregnancies, address reproductive health needs, and prevent HIV and other STIs. We also may be able to leverage funding and government policies to give greater attention to the important conditions and other contributing factors to illness that don’t fit precisely into current definitions of neglected disease. Programs like PEPFAR have evolved from a narrow focus on urgent needs related to HIV and AIDS to one that considers the impact of other diseases and conditions, like malaria, TB, nutrition, family planning, and others. This evolution has created important successes for the program, and has pushed programs and policymakers to think outside typical disease boundaries. The US government is the largest supporter of research and other programs for neglected conditions worldwide and, as demonstrated by the FDA’s priority review program above, implements a number of programs that can have important impact on the development of critically-needed new tools. Given that the US government has long been a leader in supporting R&D for a range of global health diseases and conditions, leadership cannot abandon this legacy now. There are significant gaps in the development of new tools to address neglected conditions, and there is a critical unmet need for tools that address reproductive health, non-communicable disease in low-resource settings, and other health issues. By changing our definition of neglected diseases to include neglected conditions, the US government and other governments, donors, and advocates can make an even greater impact on health worldwide.

Ahead of World AIDS Day, Secretary of State Hillary Rodham Clinton launched a new State Department blueprint to reach an “AIDS-free generation” within five years. “An AIDS-free generation will be within our sight,” Clinton said as she described the blueprint, which outlines key strategies the US will undertake to fight the HIV and AIDS pandemic. She also warned: “Now we have to deliver. … The history of global health is littered with grand plans that never panned out.” According to Clinton, an AIDS-free generation means that the world “can reach a point where virtually no children are born with the virus, and as these children become teenagers and adults, they are at a far lower risk of becoming infected than they are today. And if they do acquire HIV, they have access to treatment that helps prevent them from not only from developing AIDS, but from and passing the virus on to others.” The blueprint outlines several key actions to reach this goal, including: Scaling up the most effective prevention and treatment interventions. Targeting the populations at the greatest risk of contracting HIV, including people who inject drugs, sex workers, those trafficked into prostitution, and men who have sex with men. This also includes ensuring that HIV and AIDS programs recognize the particular needs of women and girls. Promoting sustainability, efficiency, and effectiveness. Promoting a global effort to achieve an AIDS-free generation. There have been several notable breakthroughs in HIV and AIDS science and research in recent years, and it’s critical that the US government prioritizes the development of new tools in any HIV and AIDS strategies and goals it creates. Photo credit: PATH. According to Clinton, science and research are key principles that must underlie each aspect of the AIDS-free generation blueprint. This includes US support for research to develop the next generation of “innovative technologies for prevention and treatment, such as microbicides and approaches that stave off opportunistic infections” like tuberculosis. It’s commendable that the US government is continuing its legacy as a leader in the fight against HIV and AIDS, as this blueprint indicates. It’s also encouraging that the blueprint focuses on developing new scientific breakthroughs in the fight against the disease. As Mitchell Warren from AVAC said in response to Clinton’s speech, “Powerful new HIV prevention options could together lead to dramatic reductions in HIV infections, but we don’t have all the information we need to scale them up in the right combinations for various communities. Urgent questions about the real-world use of new prevention tools in combination have been clear for months or even years, yet the work to answer them is barely under way. That’s as unconscionable as it is unnecessary.” There have been several notable breakthroughs in HIV and AIDS science and research in recent years, and it’s critical that the US government prioritizes the development of new tools in any HIV and AIDS strategies and goals it creates. But as Clinton stressed, it’s vital that the United States and its partners deliver on the promises outlined in the blueprint. According to the International AIDS Vaccine Initiative, the “realization of all this promise depends on sustained funding for HIV prevention research. Political will, too, must be sustained to secure the progress already made in the campaign against HIV. We must remember that any call to bring about the ‘end of AIDS’ will only be fulfilled if HIV prevention remains high on the list of global health priorities.” As the Obama Administration enters its second term in the new year, leaders across the Administration must ensure that the priorities outlined in this blueprint are fulfilled, particularly the US commitment to research and new HIV and AIDS tools. We cannot reach an AIDS-free generation otherwise.