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South Africa’s presidency will be the first time an African country presides over the G20, representing a massive opportunity to shine a light on the needs and capacities of the region, and we welcome their government's focus on science-based innovation. The world remains dangerously unprepared to prevent and respond to emerging diseases and global health threats, and G20 leaders must take action and seize opportunities to ensure every country and community has the tools they need to address poverty-related and neglected diseases as part of universal health coverage and create a pandemic-ready future. This means investing in both new and existing mechanisms that facilitate the development of new health technologies and strengthen the research and development (R&D) ecosystem globally to create a more fit-for-purpose global health architecture.GHTC is calling upon G20 nations to support the Global Coalition for Local and Regional Production, Innovation, and Equitable Access; robustly fund R&D partnerships for pandemic preparedness; establish a global medical countermeasures platform; support investments to strengthen local R&D capacity globally; advance R&D for key priorities like antimicrobial resistance (AMR) and climate resiliency; and improve access to new technologies through regulatory strengthening, specifically prioritizing the R&D needs of underserved populations.1. Pandemic prevention, preparedness, and responseIt is clear that building up robust research and manufacturing capacities in regional science ecosystems is critical to ensuring access to quality and affordable health technologies for the most vulnerable populations, including women and children. Yet the challenge lies in catalyzing more geographically diversified local production of novel health products and building sustainable manufacturing capacity in low- and middle-income countries (LMICs). Cross collaboration is also essential, as these capabilities are not just necessary for strengthening pandemic preparedness and response, but also for combatting endemic diseases. GHTC calls on the G20 to consider the following recommendations:  Support the implementation and pilot testing of the Global Coalition for Local and Regional Production, Innovation, and Equitable Access.Ensure civil society and community voices have a seat at the table, including in the decision-making structures of the coalition.Highlight the need to focus on local and regional R&D to fill the gap in health tools for the world’s most neglected communities, including tools addressing historically neglected diseases, such as leishmaniasis, Chagas disease, and dengue, as well as higher-burden, poverty-related diseases such as HIV/AIDS, tuberculosis, and malaria.Boost upstream R&D through the coalition, harnessing and strengthening R&D capacities across G20 countries through both South-South and triangular partnerships. This could include supporting open drug discovery networks, undertaking preclinical and clinical evaluation of prioritized compounds, and initiating clinical trials.Foster regulatory cooperation by collaborating with stakeholders such as the World Health Organization, the Pan American Health Organization, the African Union, the European Union, and others, to share expertise and conduct joint reviews in order to overcome regulatory bottlenecks and facilitate rapid access to products.Strengthen local capacity and ownership through support for R&D hubs that span the product development value chain, from discovery to productive development to distributed manufacturing to clinical trial infrastructure in LMICs. Support regionally led plans for innovation and manufacturing of economically viable vaccines, diagnostics, and therapeutics.Couple manufacturing investments with commitments by private-sector companies and governments to step up support for technology transfer, technical assistance to local manufacturers for quality systems, regulatory authorization, market entry, and workforce development so that new manufacturing hubs have the equipment, expertise, know-how, and power to produce and deliver new quality-assured innovations safely and rapidly at scale.Support preferential procurement policies for regionally manufactured products from global procurers such as Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, Tuberculosis and Malaria; UNICEF; and Unitaid. Commit to developing globally accessible online prototype libraries of diagnostics, therapeutics, and vaccines for priority viral and bacterial families and for Disease X, in coordination with the World Health Organization’s updated priority viral family list.Accelerate clinical trials aiming to determine product safety and effectiveness and systematically include community engagement plans in clinical study protocols. Establish reference standards for diagnostics early in disease outbreaks and clinical trials.Fully and sustainably finance public-private R&D and access partnerships for strategic health products that will be crucial during a future health emergency or pandemic, including committing $80 million to FIND’s 100 Days Mission framework for diagnostics and $1.5 billion to fulfill the remaining financing needs for the Coalition for Epidemic Preparedness Innovations’s 100 Days Mission strategy for vaccines, as well as supporting Unitaid and others for therapeutics including oxygen therapy.Establish and adopt an end-to-end medical countermeasures platform guided by human rights principles, focusing on the needs of all, particularly those in LMICs, through sustainable financing, addressing R&D needs, and implementing mechanisms for equitable access.Support the coordination of vaccine manufacturing networks to service clinical trials and routine supplies in inter-pandemic and pandemic periods.Facilitate agreement between key stakeholders, countries and funders on how sustainable stockpiles of experimental vaccines, therapeutics, and diagnostics can be created to enable a rapid response to new outbreaks.2. Science and innovation for health and economic growthSouth Africa’s leadership in health research and commitment to science within its G20 health agenda reflects the important role that innovation plays in improving health outcomes and driving economic growth. A resilient product development value chain further fosters innovation of lifesaving products and elevates community expertise. To build on collaboration across G20 health priorities, it is critical to implement an end-to-end research pipeline that carries lessons learned throughout, from clinical trials to manufacturing and surveillance. Furthermore, the evolving threat of AMR underscores the need for crosscutting and sustainable innovation, touching on issues of pandemic preparedness, climate resilience, adaptability, and more. AMR is anticipated to cause 10 million deaths by 2050, with the highest burden in the Global South. While it was promising to see AMR commitments made last year on the global stage, it is imperative that South Africa carries this work forward as G20 lead this year. GHTC calls on G20 countries to consider the following recommendations:  Support cross-collaborative approaches for innovation—globally and across G20 health pillars—that foster localized capacity-building and equitable access to products that ensure the specific R&D needs of women, children, and other vulnerable populations are addressed.  Establish a comprehensive end-to-end product development pipeline that optimizes global health R&D outputs and maximizes return on investment across G20 priorities. G20 countries should ensure greater cross-sector collaboration—including the pandemic preparedness and science for health pillars—to advance the R&D ecosystem.Engage with local experts, such as primary health care providers, community members, and civil society, to identify specific health technology gaps for underserved populations and take actionable steps to close them, including specifying target product profiles and investing in therapeutics and diagnostic tools for children and pregnant women.  Leverage existing political frameworks dedicated to global health R&D, such as the African Union-European Union Innovation Agenda, to develop joint research and innovation agendas to improve the availability and affordability of emerging technologies. Support product development partnerships, which have been a key instrument in the fight against poverty-related and neglected diseases and make further investments in this essential component of the global health architecture. This is particularly critical to ensure that products are developed and distributed with the end user in mind and with characteristics, including affordability, acceptability, and ease of administration, that facilitate their uptake and delivery.  Prioritize addressing AMR by investing in the development of novel products and engaging in key partnerships with civil society and multilateral bodies to build on progress made in the fight against AMR.Invest in R&D to develop new antimicrobials and ensure investments align with global and regional push/pull incentives that harness the financial force and prowess of the private sector to bring novel antimicrobial products to market.  Contribute to existing global AMR players, such as the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator, or CARB-X, and the Global Antibiotic Research and Development Partnership, or GARDP.  Provide ongoing support to the Global AMR R&D Hub in its work providing countries and investors with the latest AMR R&D landscape information, helping to address market gaps. The Hub should also pave the way for efficient deployment of tailor-made incentives for R&D and facilitate global discussions on priorities and opportunities for increasing investments in R&D. With so many tectonic shifts for global health in 2025, GHTC urges G20 members to work with civil society to push for the successful implementation of these key principles, pledges, and initiatives and build a global health architecture with all relevant stakeholders that increases the development of and access to health technologies.

The World Health Organization (WHO) has faced tumultuous times over the past few years, and this year’s Executive Board (EB) meeting seemed to bring a chaotic new chapter. Major tectonic political shifts worldwide have plunged the global health organization into serious talks about its long-term funding, sustainability, scope, and ability to deliver on its core mandate.   The EB was anything but business as usual, though member states did their level best to address the political tensions du jour while trying to move through a regular agenda that spanned issues from noncommunicable diseases and maternal and child health to global health security and climate and health. Here are some reflections from a hectic week in Geneva: “We do expect things to change...”  - Assistant Director-General for Business Operations Raul Thomas1. Member states agree to reduce the WHO budget and mostly commit to a 20 percent increase in assessed contributions.In his opening remarks before the WHO EB, Director-General Dr. Tedros Adhanom Ghebreyesus noted that even before the United States and Argentina’s withdrawal announcements, WHO was planning to shrink spending because of a shortfall caused by economic difficulties in many donor countries.  WHO’s budgetary shortfalls overshadowed the first several sessions of the EB, with many member states expressing concern over the sustainability of WHO’s financing in the next biennial budget. Ultimately, a decision was made to lower the program budget to $4.9 billion (from $5.3 billion). Assistant Director-General for Business Operations Raul Thomas captured the general sentiment of EB funding conversations, conveying that WHO’s cash flow is secure for now, but WHO leadership “expects things to change” regarding the viability of the organization’s budget.   However, member states harped over what should change. Many supported a 20 percent increase in assessed contributions—something that members had agreed to at the World Health Assembly (WHA) two years ago—that would reduce the organization’s reliance on voluntary contributions from member states, while others, specifically Russia and China, showed opposition to this plan.   Several member states emphasized the importance of continuing down a path toward sustainable financing through the WHO investment round and developing alternative short- and long-term resource mobilization plans. Member states also urged WHO to distribute information about what the 20 percent increase in assessed contributions would mean for each country. Given the reduced budget, countries insisted on costing all 2025 draft resolutions and decisions prior to any vote during this year’s session.   “It’s back to basics...” - WHO Regional Director for Europe Dr. Hans Kluge2. WHO leadership and member states stress progress and continued need for reform.In the wake of the larger discussions held during the EB about prioritization due to the cash crunch the WHO is facing, there was also a strong focus on the continued need to streamline and reform the organization. WHO Regional Director for Europe Dr. Hans Kluge called for the organization to go “back to basics.” Dr. Kluge emphasized the importance of remaining steadfast to WHO’s organizational mission while being adaptive to emerging threats like antimicrobial resistance (AMR).  Director-General Dr. Tedros also referenced WHO reforms in his opening remarks, acknowledging the significant improvements the organization has made over the last five years, including the newly introduced prequalification framework for novel products. At the same time, Dr. Tedros emphasized the need for continued reform and underscored the importance of engaging in constructive dialogue with member states moving forward.  During the final two days of the EB, member states agreed to several internal improvements and left the door open for further reform discussions at WHA. Citing concerns over its unclear mandate and overlap with other divisions, member states decided to extend by one year the operations of the Standing Committee on Health Emergency Prevention, Preparedness, and Response—which was first established in 2022 to provide guidance and recommendations to the EB and the Director-General on WHO’s emergency response—through May of next year to further evaluate the role of the committee and other similar bodies in health emergencies.  3. Global health security, maternal and child health, and the nexus of climate and health remain key topics.Member states did manage to untangle themselves from WHO’s structural dialogues to fully engage with the more than 47 agenda items on the docket this year.  WHO’s work in health emergencies featured prominently on the agenda once more, though much of the discussion centered around the need to adjust the scope of WHO’s activities. A few member states, including the European Union, Australia, Ethiopia, Finland, and the Republic of Korea, reaffirmed their commitment to the Pandemic Accord, including the then-upcoming negotiations that took place last week, as critical to advancing the prevention, preparedness, and response agenda, including access to medical countermeasures.Dozens of member states shared their appreciation of WHO’s report and draft action plan on women’s, children’s, and adolescents’ health and emphasized their commitment to advancing this agenda item, though Dr. Tedros highlighted that despite progress, “we still have a long way to go.” Equity and access were primary topics of concern for many countries. Several countries also advocated for greater urgency in accelerating efforts for maternal and child health and stressed the importance of intersectoral policies for vulnerable populations. Mentions of research and development were notably absent from the discussion, despite its critical role in addressing gaps in maternal, newborn, and child health, particularly in low-resource settings.  Countries also deliberated the draft global action plan on climate change and health. The plan, which includes some strong R&D provisions, outlines strategic frameworks for building climate-resilient health systems. However, it was surprising to note the absence of the threat of AMR, which is mentioned only once in the document. AMR is poised to cause 10 million annual deaths by 2050 and likely more with the growing influence of rising temperatures and evolving zoonotic diseases. Concerns over cost also dominated the discussion on this agenda item, and several member states, including Malaysia, Bangladesh, and representatives from the Africa Group, highlighted the need to include common but differentiated responsibilities—a longstanding equity principle in climate negotiations that holds historical emitters to a higher bar of responsibility for climate action.4. Civil society engagement continues to be a challenge at the EB.At the tail end of the EB, member states zeroed in on the role of civil society in these debates. While there seemed to be general agreement on the overall usefulness of non-state actor (NSA) statements in WHO proceedings, we did see the continued trend of politicizing otherwise straightforward processes governing NSA access and status with WHO. Member states held a fervent debate over WHO’s Framework on Engagement with non-State Actors (FENSA), which outlines clear criteria and principles for attaining status with the WHO. During the debate, some member states questioned the framework, with representatives from the Eastern Mediterranean and African Regions, as well as China and Russia, all expressing concern over the Centre for Reproductive Rights and Women Deliver receiving status from WHO. The delegate from Egypt captured this sentiment best: “Our reading of FENSA is that it is the foundation and main criteria that we use to accept or reject NSAs — it’s the foundation, but it is not obligatory for member states to accept only on this criteria.”  While on the surface, this debate may appear like an outlier, it marks a broader shift in how some member states are approaching the global health agency, as it has become more commonplace in the last few years to overturn or question established frameworks, rules, and processes at WHO based on national politics. This is especially concerning for civil society, which has seen its ability to meaningfully engage in these forums curtailed over the years.Dr. Tedros concluded the EB by acknowledging the endurance of countries in getting through such a substantial agenda this year and the significance of WHA later this May. While we often talk about the importance of these forums for combatting specific health threats, this year feels like a bigger moment and pivot point for the global health architecture as a whole. Will WHO be able to shoulder the financial blow, make the necessary reforms, and find a way to become more sustainable in its operations? Or will the global health community look back at this moment as the start of the unraveling of the global health ecosystem? Only time will tell.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. A prospective cohort study of patients with drug-resistant tuberculosis (TB) found that the six-month, all-oral BPaL (bedaquiline, pretomanid, and linezolid)-based regimens recommended by the World Health Organization were safe and highly effective, providing critical data from real-world settings with a high burden of drug-resistant TB to support global guidelines recommending their use. The results were comparable to previous Phase 3 clinical trials testing the regimens. Further research is needed to test the regimens among other key populations, including children and people with severe forms of extrapulmonary TB.A recently published analysis found that the 2023 global supply of seasonal influenza vaccines has been stable since 2019, suggesting that production capacity was sustained through the COVID-19 pandemic. Monitoring seasonal vaccine production capacity is important for estimating the capacity to manufacture vaccines in the case of an outbreak of pandemic influenza because pandemic influenza vaccines are produced primarily by the same or similar manufacturers, technology, and facilities as seasonal flu vaccines. The analysis found drastic disparities in production capacity between high-income and low- and middle-income countries and found that the majority of pandemic vaccines, in the case of a novel flu pandemic in the near future, would be egg-based. The author noted that advancing novel influenza vaccines, including mRNA vaccines, could greatly improve global production capacity and pandemic preparedness in the face of pandemic influenza, given they would be faster to produce than egg-based vaccines.A team of researchers has engineered an improved paper-based device for collecting and transporting blood samples of HIV patients. In low-resource settings with limited clinical and laboratory facilities, paper-based devices have become one way that HIV patients can collect their blood to be shipped and analyzed in distant laboratories. The new device has wax-printed patterns that create precise channels and collection spots, ensuring that it consistently collects the same volume of blood and thereby reducing the chances of inaccurate readings. A clinical pilot found that the device more accurately measured the extent of HIV infection compared to the industry gold standard and was also better at detecting drug-resistant viral mutations, enabling physicians to make better care decisions.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last week, the Gates Foundation, the Novo Nordisk Foundation, and Wellcome announced the launch of the Gram-Negative Antibiotic Discovery Innovator, a new $50 million effort to boost the discovery of new antibiotics for gram-negative bacteria as the global threat of antimicrobial resistance continues to rise and there remains a lacking pipeline of novel antibiotics. The effort will function as a consortium, where multiple funders, research institutions, and industry partners share data and work collectively. Specifically, the project will focus on the discovery of direct-acting small-molecule antibiotics with broad-spectrum activity against Enterobacteriaceae, with Klebsiella species selected as the pathogen to be used in all proposed projects.An innovative, one-dose vaccine designed to offer high-level protection against malaria could transform global malaria efforts if proven effective in further studies. The Sanaria® PfSPZ-LARC2 Vaccine, designed by Sanaria and the Seattle Children’s Research Institute’s Center for Global Infectious Disease Research, uses advanced genetic engineering to delete two critical genes from the malaria parasite, ensuring that the parasite cannot advance to the blood stage and that the vaccine cannot cause or transmit disease. A pivotal study published last month demonstrated the remarkable potential of this approach, and clinical trials are scheduled for later this year.Last week, the Coalition for Epidemic Preparedness Innovations (CEPI) announced $5 million in funding to Ethris to support proof-of-concept research of spray-dried RNA vaccines that remain stable at room temperature and are suitable for mucosal delivery, an approach that could make these vaccines more accessible in low-resource settings and faster to roll out during outbreaks. The spray-drying technique is widely used for other health technologies and applying it to RNA vaccines helps minimize dependence on cold storage and complex delivery systems, especially in low-resource settings. Nasal delivery medicines are also well-established but used with RNA vaccines, this approach could also support their ability to remain stable and could help to offer mucosal immunity, which scientists believe can help reduce virus transmission.