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Claire Wingfield is a Product Development Policy Officer with PATH. This week, she’s blogging from the World Health Summit in Berlin, Germany. The third annual World Health Summit is currently underway in Berlin. The Summit brings together researchers, policymakers, funders, advocates, and health care providers to discuss global public health policy and research. This year’s theme is “Today’s Science – Tomorrow’s Agenda,” but the hot topic in almost every session that I have attended so far has been the need for innovative and sustainable funding mechanisms for global health in this time of financial uncertainty. Incentive prizes were highlighted as a mechanism for encouraging investment in research and development (R&D) of neglected and orphan diseases. These results-based rewards (as opposed to recognition awards like the Nobel Prize) “pull” innovation by encouraging applicants to submit ideas. The models and types of prizes vary. Some may offer millions of dollars while others provide the winner with access to laboratory services for future research. The first incentive prize, sponsored by the British Parliament in 1714, resulted in breakthroughs in navigation with the winner getting a whopping £100,000. The prize model often attracts new ideas and people to a field and is results focused which is attractive in an environment where funders want to see “quick wins.” Product development partnerships (PDPs) have also been highlighted at the summit as a successful model for accelerating R&D. Regina Rabinovitch of the Bill & Melinda Gates Foundation attributed the PDP model with feeding the largest research pipeline for neglected disease tools, increasing collaboration across the public and private sectors, and promoting a better understanding of the complexity of the product development process. While the successes are promising, she warned that as the number of products moving through the pipeline grows, so do the costs. Each phase of clinical studies requires more volunteers, more data points, more demands on the research site, longer trials, and increased regulatory complexity. Given these challenges in a constrained financial environment, PDPs and other research networks must increase collaboration and share costs by doing things like site sharing and harmonized training. They also need to focus their research efforts by prioritizing the products in the pipeline and weighing their potential public health impact. Bernard Pécoul, Executive Director of the Drugs for Neglected Diseases initiative (DNDi), stressed that it is critical for public sector partners to set objectives and priorities to ensure that product development is driven by health needs. Representatives from pharmaceutical companies—Novartis and Sanofi in the sessions that I attended—acknowledged that there are inherent difficulties with trying to reconcile limited profit potential with great public health need. There are many differing views on how to address this challenge with no clear consensus. One suggestion that seemed to be well received was that pharmaceutical companies can offer untapped areas of expertise, specifically in regulatory science, manufacturing, distribution, and pharmacovigilance. These are critical components of the R&D process, and many academic and public sector research institutions would benefit from training and mentoring in these areas. Recognizing that there is no magic bullet and that no one organizational or funding model can address the R&D needs for all neglected diseases, it is clear that limited resources must be leveraged, communication and coordination among research institutions across sectors needs to be increased, funding sources must be diversified, and current levels of support need to be sustained in order to maintain the recent momentum in global health research.

Dr. Christopher J. Elias is president and CEO of PATH, an international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. A new mother experiencing excessive bleeding after childbirth can die within minutes if the bleeding isn’t stopped. For women in developing countries, time too often runs out before they can get help. Postpartum hemorrhage is the leading cause of maternal mortality—deaths that cause a ripple effect on the children, families, and communities left behind. What if a simple device costing less than $10 could save a new mother’s life? USAID is building on its decades-long partnership with PATH by investing in our effort to develop a cost-effective solution: a balloon tamponade that can stop postpartum bleeding within 5 to 15 minutes and can be used in peripheral health facilities. Chris Elias leads USAID Administrator Raj Shah and Amie Batson, deputy assistant administrator, global health at USAID on a tour of PATH's product development shop. Photo Credit: PATH With a new grant of approximately $100,000 from Development Innovation Ventures—USAID’s new venture capital–style fund—we will adapt this existing technology to make it affordable in developing countries. Our goal is to lower the price from as much as $312 per device to less than $10 by streamlining the design and manufacturing process. Since 1987, PATH and USAID have worked together under a separate collaboration, the HealthTech program, to advance high-impact, low-cost health tools and technology breakthroughs designed for use in low-income countries. USAID recently announced it will renew its investment in the program through the HealthTech V Cooperative Agreement, committing $3 million in the first year. This partnership will continue to leverage USAID’s investment to attract additional resources and expertise from the private sector, ensuring the sustainability needed to scale up lifesaving innovations. Our public-private partnership approach has led to innovative solutions for some of the world’s most pressing health concerns, including: The SoloShot™ syringe that automatically disables after a single use to prevent reuse and infection from contaminated needles. Since commercial introduction by our private-sector partner, BD, 6 billion vaccinations have been delivered using SoloShot™ syringes by public health programs in more than 40 countries. HIV dipstick technology that provides point-of-care diagnosis for patients and inexpensive data collection for field surveillance and epidemiological use. PATH transferred the technology to manufacturers in four developing countries, with total sales now exceeding 19 million tests. Development of a malaria immunochromatographic strip test for the most deadly malaria parasite, Plasmodium falciparum, allowing same-day results. This technology was transferred to private-sector partners, with more than 40 million tests sold to date. The vaccine vial monitor, a dime-sized sticker that adheres to a vaccine vial and changes color to warn health workers if a vaccine has been spoiled by heat exposure. It prevents workers from having to throw out vaccines if they aren’t sure whether they can be safely used. We estimate the monitors, manufactured by our private-sector partner, Temptime, will allow health workers to identify more than 230 million doses of damaged vaccine and to deliver 1.4 billion more doses in remote settings, saving more than 140,000 lives. In a time of fiscal constraints, investing in simple, practical, and affordable health technologies is money well spent in the effort to solve global health challenges. USAID’s commitment to bringing cost-efficient and effective innovations to scale will be an essential driver in ensuring health solutions developed by PATH and others reach those who need them most.

Congress continues to debate how to keep the government running in the midst of a rollercoaster appropriations process, while at home and abroad global health research and development (R&D) programs struggle to continue their work and simultaneously juggle looming funding reductions. While the President's budget request for global health programs for fiscal year (FY) 2012 included funding increases in several areas, the outlook for global health funding in Congress is not as promising. Due to difficult economic times and conflicting priorities between the House of Representatives and the Senate, it seems unlikely that Congress will sustain the levels we saw in 2011 for additional years. The House of Representatives approves of deep cuts in nearly every government program. However, the Senate appropriation levels are much friendlier to global health and to foreign assistance overall, compared with the House levels. The two chambers must now reconcile the two different versions, while following the spending cap rules required by the new debt reduction law. In addition to the appropriations activities outlined above, the Congressional Debt Reduction Committee (the 'super committee') also must weigh in on funding levels for the next several fiscal years. It has until November 23 to make its recommendations to Congress for cutting at least $1.2 trillion over 10 years. To add yet another factor to this complicated equation, since Congress has (again) failed to complete the appropriations process by the end of the fiscal year, urgent continuing resolution legislation (CRs) have been required to keep the government open until the process is finalized. The CR currently up for debate enacts an across the board rescission of 1.5% from FY2011 levels to all government programs, but contains no other cuts targeted at international development or global health accounts. This is a temporary blessing for important programs that must continue its progress while funding levels are hammered out. It is likely that several CRs will be needed to buy enough time for Congress to negotiate the FY2012 budget. To read more details about specific global health programs and the appropriations activities in Congress read this piece.

This week, the GHTC is in Kenya, meeting with several GHTC members conducting ground-breaking work. Here are some photos from the field: Photo: Evelyn Hockstein/PATH Kombewa, Kenya - Martha Omondi puts her daughter Mercy Gloria, 3, under a mosquito net to take a nap. Photo: Evelyn Hockstein/PATH Siaya, Kenya - Fabian Oduor holds his sister Brittany's hand while she receives treatment for Malaria at the Siaya District Hospital in Western Kenya. Photo: Evelyn Hockstein/PATH Vihiga, Kenya - A mother vaccinates her child with pneumococcal vaccine at Vihiga District Hospital in Western Kenya. The free vaccine, manufactured as a result of donor support via an advance market commitment, is now administered to children under twelve months of age; protecting thousands of children across the country. Photo: Evelyn Hockstein/PATH Vihiga, Kenya - Festus Chabuga, who is HIV positive, receives ARV's at Vihiga District Hospital. "I feel fortunate I have the drugs. If the drugs were not available, I would have died by now." Photo: Evelyn Hockstein/PATH Vihiga, Kenya - Rister Kageha, 35, with her baby Sylvia Mboga, who is 14 months, at Vihiga District hospital. Rister learned she was HIV positive a month before she gave birth to her daughter Sylvia. She was put on ARV's in June 2010 and gave birth in July. Her baby was given Nevarapine after birth and is HIV negative. Photo: Evelyn Hockstein/PATH Kakamega, Kenya - Peter Owiti Motsi, a member of the Elwesero Men's Initiative Support Group, explains how ARV's have transformed his life from one of illness from HIV to health. His children are all negative, and now he is strong, able to farm, and lead a positive productive life. The men's support group helps educate, encourage, and support each other as they live life with HIV. Photo: Evelyn Hockstein/PATH Rawa, Kenya - Sharon Akinyi Ouma, 27, holds her daughter Winfrey Juma, 16mos, outside their rural home in Western Kenya. Sharon said she was happy to join the TB vaccine trial, because she would be helping children all over Africa. Photo: Evelyn Hockstein/PATH Kisian, Kenya - Wilfred Murithi, assistant research officer at KEMRI/CDC in Kisian, Kenya, prepares a sample to detect TB resistance to ritampicin, a TB drug.