Hannah Sachs-Wetstone

Preeclampsia affects millions of pregnancies around the world, claiming the lives of 42,000 women each year and contributing significantly to fetal and newborn mortality and complications. Early detection and management are crucial to prevent progression to eclampsia, which is characterized by seizures and can be life-threatening.  The burden of preeclampsia is greatest in low- and middle-income countries (LMICs), where workforce shortages, limited laboratory capacity, and procurement challenges undermine the implementation of recommended tools and protocols.  Despite its global impact, preeclampsia remains under-researched and under-represented in the health innovation pipeline compared to conditions with similar prevalence that are not specific to women. These challenges have created critical gaps in screening, diagnosis, and treatment, but new tools in the pipeline could help transform care, particularly in low-resource settings worldwide. Rethinking preeclampsia screening and diagnosis Preeclampsia screening aims to identify high-risk pregnant women before symptoms appear and before they can be formally diagnosed, enabling closer monitoring and preventive care. Screening has traditionally relied on a checklist to evaluate patient history and risk factors. While simple, this approach has shown limited effectiveness and depends heavily on the accuracy of assessment.Newer recommended approaches that combine risk-factor screening with biomarker testing offer improved predictive performance. However, they require medical and laboratory imaging infrastructure that is not widely available in LMICs, limiting their uptake.  Preventive therapies, including low-dose aspirin, calcium supplements, and antihypertensive medications, are recommended for women identified as high risk, but they are not consistently offered to women in LMICs. As a result, many women are diagnosed later in pregnancy, when risks are greater.  The Accelerating Innovation for Mothers project identified 89 preeclampsia risk screening tools in the R&D pipeline but concluded current approaches are unlikely to adequately address the needs of women in LMICs, underscoring the need for greater investment in tools explicitly designed to address their realities.  Artificial intelligence (AI) is emerging as a promising tool to bridge screening and diagnosis gaps. With support from the Gates Foundation, Siemens Healthineers is developing an AI-driven tool that leverages data from blood tests already routinely performed as part of prenatal care to screen for both preeclampsia and anemia. By using existing samples and integrating screening for multiple conditions, this tool could enable more efficient and scalable screening in resource-limited settings. Confirmatory preeclampsia diagnosis relies on detecting elevated blood pressure and the presence of protein in urine, alongside the potential presence of severe symptoms. This requires trained health care workers and access to laboratory equipment, which can hinder accurate, timely diagnosis in resource-challenged environments. Monod Bio, with Gates Foundation support, is developing a rapid, point-of-care diagnostic test that can deliver results in less than 15 minutes. Using an AI-derived algorithm to analyze results, this tool could significantly reduce workforce and equipment needs. Together, these innovations reflect a promising shift toward designing tools specifically to address the needs of low-resource environments, rather than adapting tools used in high-income contexts, a shift essential to closing global gaps in care. Expanding the treatment pipeline There is currently no specific cure for preeclampsia other than early delivery, which can be dangerous for both mother and baby, especially in low-resource settings. Existing treatments focus on managing symptoms, including preventing seizures with magnesium sulfate and controlling blood pressure with antihypertensive medications. A new generation of therapies aims to go further by addressing underlying disease causal pathways, rather than managing symptoms alone.  A research team at the University of Nebraska Medical Center, supported by a Gates Foundation grant, is advancing an innovative treatment based on a naturally occurring compound that reduces the levels of a protein that plays a key role in the development of preeclampsia. In preclinical studies, the compound has improved vascular function, reduced inflammation, and lowered blood pressure. Importantly, it is also stable at room temperature and inexpensive to produce, making it well-suited for settings with limited resources. Another Gates-supported team at the Medical College of Wisconsin has launched a clinical trial evaluating a promising supplement for preeclampsia. The compound, which occurs naturally in foods, has been shown to improve vascular functions in animal models and early human studies. It is also shelf-stable and inexpensive. These novel therapeutics could help transform preeclampsia care by slowing or halting the progression of the condition, rather than simply responding to the presence of symptoms. Their affordability and suitability for austere settings could also help expand access for women who currently lack effective treatment options. Looking ahead Preeclampsia mortality rates remain far too high, reflecting long-standing gaps in research advancing women’s health and a lack of tools suited to low-resource settings. Innovations that leverage emerging technologies like AI and respond to the needs of pregnant women everywhere could help save more mothers and babies worldwide. Solutions designed for LMIC health systems could also strengthen care in underserved or overstretched settings in high-income countries like the United States, where rising health care costs, workforce shortages, and even conflict-related supply chain disruptions are straining health care service delivery.  Turning this potential into impact will require sustained investment to ensure innovations are not only developed but designed for and delivered to the women who need them most. 

Last week, SC Johnson; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the US Department of State announced a new agreement to accelerate access to an innovative malaria vector control tool in high-burden countries. This marks the second such partnership between the State Department, the Global Fund, and a US company to expand global access to new products under the department’s global health strategy, after one with Gilead for lenacapavir for HIV prevention. This initiative will scale up the SC Johnson Guardian™ spatial repellant tool, a small mesh fabric sealed inside a pouch that is hung indoors, releasing an active ingredient that repels mosquitoes for up to a year. The tool was recommended by the World Health Organization last year, the first new category of vector control products to be recommended in 25 years. The partners aim to reach 60 million people across ten-high burden countries with 30 million products over three years, with manufacturing based in Nairobi, Kenya. A new observational study found that even with only moderate levels of malaria vaccine coverage achieved, the initial introduction of the RTS,S/AS01 malaria vaccine in high-burden African countries has contributed to a significant reduction in deaths among children. Specifically, despite only moderate uptake of three doses and low uptake of the fourth, the vaccine was found to have saved the lives of one in eight eligible children in the first three African countries to offer the vaccine from 2019-2023, which represents a 13.2 percent reduction in death. These results add to the evidence supporting continued scale-up of RTS,S—one of two malaria vaccines now included in national immunization schedules in 25 sub-Saharan African countries—and underscore the promise of continued investment in developing new and improved malaria vaccines. Nonprofit Caring Cross has shared an early copy of data showing that, in a small study, a single infusion of engineered immune cells suppressed HIV long term in several patients, offering proof-of-concept for a single-shot functional cure. The approach, adapted from cancer research, involves extracting immune cells from participants living with HIV, engineering the cells to carry molecules that simultaneously kill infected cells and prevent the immune cells from becoming infected, and injecting them back into participants. HIV is notoriously hard to control because the virus persists in hard-to-eliminate latent reservoirs, requiring lifelong ongoing treatment to suppress the virus.  This research could pave the way for the development of a single, low-cost intervention that could sustain viral suppression without the need for regular therapy. The research, which is still in the very early stages, is scheduled to be presented at an upcoming scientific conference. 

A team of researchers from the United Kingdom, the United States, and South Africa is developing a vaccine for hantavirus, the virus behind a worrying outbreak on a cruise ship in the Atlantic Ocean. Hantavirus is typically spread by rodents, and transmission between humans is very rare. There is no specific treatment of vaccine for hantavirus, which, as seen in the current outbreak, can be deadly. The researchers are using an innovative method called insilication to make the vaccine thermally stable, aiming to reduce the high resource and economic costs of meeting the cold chain and storage requirements that are associated with many vaccines. Moderna’s mRNA-based seasonal flu vaccine outperformed conventional flu shots in a late-stage international trial of more than 40,000 adults aged 50 and older. The US Food and Drug Administration is currently reviewing the vaccine after rejecting the initial application and is expected to make a decision by August 5. If approved, the vaccine would be the first mRNA seasonal flu shut in the United States. mRNA vaccines can be produced much more quickly than conventional flu shots, which could enable public health authorities to wait longer before choosing which flu strains to target, giving them more time to gather up-to-date data about circulating strains before flu season begins. A research team has discovered a previously unknown mechanism by which HIV-1 can infect resting cells, challenging previous assumptions and raising new possibilities for the development of improved treatments. For HIV to infect immune cells, it must deliver its genetic material into the cell’s nucleus, which is surrounded by a protective structure—how the virus has broken through the barrier has long puzzled scientists. Another obstacle to an HIV cure has been the latent reservoir of resting immune cells that house dormant virus, which cannot be cleared by treatment. The researchers found that when the virus spreads between immune cells, it triggers a signal that unlocks this protective gateway around the nucleus, allowing the virus to enter. They also found that this process does not require the immune cell to be activated, meaning that the reservoir can be established and maintained while cells are resting, upending long-standing assumptions and unlocking new avenues toward the development of a treatment that can destroy the virus and target the latent reservoir. 

A new US National Institutes of Health-funded study conducted in seven high tuberculosis (TB)-burden countries found that a new and improved near point-of-care TB test platform was highly accurate, effective, and scaleable. Pluslife Biotech’s MiniDock MTB test platform is battery operated, low-cost, provides results in 30 minutes, and can be used with tongue swabs in addition to sputum samples, which certain groups, including babies and people living with HIV, cannot produce. The new test is well-suited for low-resource, smaller, or more rural health clinics, which may not have access to current resource-intensive, expensive molecular testing options. The University of Oxford and the Serum Institute of India have signed a license agreement to support the development, large-scale manufacturing, and potential future commercialization of the malaria vaccine candidate R78C for use in clinical settings. R78C combines two Plasmodium falciparum blood-stage antigens, designed to target the malaria parasite at multiple points in its lifecycle, offering longer and more effective protection. This new license, which builds on a long-standing collaboration between the partners on malaria vaccine work, will initially help accelerate the candidate into clinical evaluation. The Serum Institute of India’s global manufacturing capabilities will also help ensure that resulting successful malaria vaccines can be manufactured at scale and deployed affordably to malaria-endemic countries. The Medicines for Malaria Venture (MMV) and Novartis recently announced that the World Health Organization (WHO) has prequalified Coartem® Baby, the first and only antimalarial drug developed specifically for newborns and young infants weighing between 2 and 5 kilograms. This treatment will help address a long-standing gap in malaria care for this group, who are often treated with antimalarial formulations intended for use in older children, which can increase the risk of toxicity or underdosing. The prequalification designation enables countries and global procurers to start purchasing and deploying the treatment in malaria-endemic countries; Novartis is making the treatment available on a largely nonprofit basis in malaria-endemic regions. 

Last week, the Medicines for Malaria Venture (MMV) and GSK announced the world’s first deployment of a novel cure for Plasmodium vivax malaria, the predominant malaria species in Latin America. Pediatric tafenoquine, codeveloped by MMV and GSK, replaces a multiday regimen with a single-dose, child-friendly formulation, improving treatment completion and preventing relapse. P. vivax can remain dormant in the liver, so if patients don’t receive combination treatment for both the blood and liver stages of the disease, they could have multiple malaria relapses. Up until now, the lack of child-friendly tafenoquine formulation left younger kids at risk of the disease, which is associated with long-lasting cognitive impairment. The rollout is taking place among the Yanomami people, an Indigenous population living in the Yanomami Indigenous Territory in northern Brazil. Last Tuesday, Moderna announced the start of a late-stage study of its experimental mRNA vaccine candidate for bird flu, marking the first time a mRNA pandemic bird flu vaccine has reached late-stage trials. The trial is being supported by a $54 million investment by the Coalition for Epidemic Preparedness Innovations (CEPI) following last year’s cancellation by the US government of more than $700 million in contracts with Moderna supporting the late-stage development of the vaccine candidate. Moderna’s trial will evaluate the candidate, mRNA-1018, in 4,000 healthy adults in the United States and the United Kingdom. Under the agreement, Moderna also committed to, if the vaccine is approved and a flu pandemic is declared, setting aside 20 percent of its manufacturing capacity for supplying the vaccine to low- and middle-income countries at affordable prices. The US Food and Drug Administration recently approved Merck’s once-daily, oral combination treatment for HIV, offering patients another treatment option. The combination of doravirine and islatravir is being branded as Idvynso. In two large late-stage studies, the treatment combination demonstrated its ability to significantly suppress replication of HIV-1 in adults receiving another HIV treatment. While another late-stage study in adults living with HIV who had previously received treatment found that Idvynso was not inferior to Gilead’s HIV drug Biktarvy, the approval still provides another treatment option for patients. It is also currently being tested in multiple trials in combination with other antiretrovirals for potential daily and once-weekly HIV treatments. 

We have made significant global progress against malaria over the last few decades, with three countries officially eliminating the disease just last year, joining the ranks of nearly 50 countries worldwide that have now achieved malaria-free status. Yet, malaria remains a formidable global challenge, with an estimated 282 million cases and 610,000 deaths in 2024, roughly 9 million more cases than in 2023. Climate change, conflict and instability, and funding disruptions all contribute to this persistent threat.  The rise of drug and insecticide resistance, a decades-old obstacle, has drawn renewed attention as it threatens to erode years of momentum. New tools addressing resistance, including novel drug combinations and vector control tools, offer hope for regaining lost ground. The long history of antimalarial drug resistance and new innovations to curb its riseAntimalarial drug resistance dates back nearly 75 years. Resistance to chloroquine, once of the most widely used antimalarial drugs, was first detected in the 1950s and spread unchecked for decades, contributing to a global rise in malaria-related mortality. Varying degrees of resistance also emerged to the therapies introduced to replace chloroquine. By the time artemisinin-based therapies were widely introduced in the 1990s, the World Health Organization took proactive steps to protect their efficacy by recommending they be used only in combination with other drugs.Artemisinin-based combination therapies (ACTs) have since become the global standard treatment. However, partial resistance to artemisinin-based drugs has now been confirmed or suspected in at least eight African countries, and several of the drugs used in combination with artemisinin are also showing declining efficacy. Emerging therapies in late-stage development could help address these growing challenges.In fall 2025, Novartis announced positive Phase 3 results for a novel, non-artemisinin combination malaria therapy developed with the Medicines for Malaria Venture. Delivered as a once-daily packet of oral granules taken over three days, the therapy was found to be highly effective against multiple forms of the malaria parasite and was also able to kill drug-resistant strains. If approved, it would represent the first major innovation in malaria treatment since ACTs.Another promising approach in late-stage development is triple ACTs, which combine artemisinin-based drugs with two additional drugs to fend off the emergence of resistance. In fall 2025, the Mahidol Oxford Tropical Medicine Research Unit, with funding from the Global Health Innovative Technology Fund, launched the first Phase 3 trial of a fixed-dose triple ACT in Rwanda. Taken once daily for three days, the therapy is designed to be affordable, easy-to-administer, and suitable across age groups, supporting adherence and reducing the risk of incomplete treatment, a key driver of resistance.  Historical lessons and new frontiers in vector control tools to tackle insecticide resistance Beyond parasite resistance, widespread insecticide resistance in mosquito vectors—dating back to the 1950s—has reduced the impact of existing vector control tools. The widespread uptake of insecticide-treated bednets helped drastically reduce malaria cases in Africa over recent decades, but most nets deployed since 2000 relied on pyrethroid insecticides. Resistance to pyrethroids is now widespread.In response, the World Health Organization recommended the first next-generation insecticide-treated nets in 2017. Since then, global partners, including the Innovative Vector Control Consortium, PATH, and the Gates Foundation, have collaborated to deploy more than 56 million of these new-generation nets, which have been shown to significantly improve malaria control outcomes.Additional innovations in the pipeline could complement these next-generation bednets. One promising group of tools is endectocides, or medicines taken by humans that kill mosquitoes when they bite. Ivermectin, an antiparasitic drug long used in mass drug administration campaigns for neglected tropical diseases, is the most studied endectocide to date. A 2025 study led by the Kenya Medical Research Institute, the Barcelona Institute for Global Health, and the Manhiça Health Research Center found that mass administration of ivermectin reduced new malaria infections by 26 percent when implemented alongside standard vector control measures. Unlike bednets or indoor residual spraying, which are limited to certain places or times of day, endectocides can protect people from malaria wherever they are.Early-stage research is also exploring gene drive technology, which genetically modifies mosquito populations to reduce their ability to transmit malaria. Target Malaria is investigating several gene drive approaches, including one of its most promising strategies: modifying male mosquitoes to carry a gene that causes some females to become sterile. Another approach involves genetically modifying males to produce predominantly male offspring, which can decrease mosquito numbers over time and reduce parasite transmission, since only female mosquitoes bite and transmit malaria. While still early in development, these tools could one day offer a transformative way to control mosquito populations.Drug and insecticide resistance represent some of the most urgent threats to the global fight against malaria, but they are not insurmountable. History shows that sustained innovation can blunt the impact of emerging resistance and help restore progress. Increased investment in new tools, alongside global coordination to ensure rapid and equitable deployment, will be essential to accelerating progress against malaria in the years ahead.