Preparing the ground in the Brazilian Amazon for a new antimalarial to reduce relapse

As is always the case with the approach of summer, the global health community is gearing up for another session of the World Health Assembly (WHA), which will be held in Geneva from May 21–26. WHA brings together the World Health Organization’s (WHO) 194 member states, civil society, and the United Nations system to review WHO’s progress against previous commitments and chart the course for the next 12 months. This 71st session of WHA will see a number of debates on topics affecting global health research and development (R&D). 13th General Program of Work Perhaps most significantly, this year’s WHA will see the approval of the next General Program of Work (GPW 13), which will set WHO’s strategic objectives and activities for 2019–2023. Reflecting Director-General (DG) Dr. Tedros Adhanom Ghebreyesus’ first real opportunity to legislate a course change for WHO and put his stamp on the organization, the draft GPW 13 is framed around an ambitious “triple billion” set of targets, aiming to: Cover 1 billion more people with universal health care, Better protect 1 billion more people from health emergencies, and Ensure that 1 billion more people enjoy better health and well-being. Encouragingly, the current draft of the GPW 13 includes a concrete cross-cutting workstream across these three broad targets to support R&D by strengthening coordination and collaboration, stepping up WHO’s normative work to encourage uptake of new innovations, and by using WHO’s convening authority to ensure best practices and the latest techniques to support R&D are shared across geographies. The three ambitious targets will require significant additional investment by member states, as well as a significant reprioritization of WHO’s existing staff and resources—both of which are heavy political lifts for the DG and his team. The extent to which WHO succeeds in mobilizing additional resources will largely determine whether GPW 13 achieves its ambitious vision to fundamentally change the way WHO does business. Access to Medicines The debate on how WHO should engage in activities to address concerns around access to medicines continues unabated. The January Executive Board (EB) meeting saw intensely heated debate, with the Brazilian delegate challenging the United States representative by stating, “We have been debating this for five years. You say everything ‘poses implementation issues.” To move past this stalemate, the EB ultimately recommended a compromise solution calling for WHO to undertake a strategic consultation and strategy development process over the course of 2018 and to present the resulting strategic roadmap to the EB in January 2019. Notably, the current draft resolution specifically calls out the need for WHO to consult with member states, but excludes mention of non-state actors in official relations with WHO. GHTC will work to ensure that the final resolution includes a provision for civil society to be consulted. Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property Following the spirited discussion at the EB meeting regarding the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA-IP) and the appropriate role of WHO in advancing policies around intellectual property for health products, the EB proposed a compromise resolution. It calls on member states and WHO to implement those recommendations from the Expert Review Panel that align with the existing elements of the Strategy and Plan of Action, while continuing to discuss those recommendations that fall outside the current scope. Having led the charge for an expansive view of the GSPOA-IP mandate at the EB, Brazil will almost certainly take a very active role on this item at WHA as well. Much like the EB debate, the focus for WHA will be on the more aggressive recommendations proposed by the Expert Review Panel that some countries argue fall outside the scope of the original GSPOA-IP. Key recommendations include: The WHO Secretariat to identify mechanisms to increase health technology transfer in the context of the Technology Facilitation Mechanism established by the Sustainable Development Goals The WHO Secretariat, in collaboration with other international organizations working in intellectual property, to advocate for the development of national legislation to fully reflect the flexibilities provided in the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health and the Doha Declaration          Member States to commit to dedicating at least 0.01 percent of their gross domestic product to basic and applied research relevant to the health needs of developing countries Member States to encourage the implementation of schemes which partially or wholly delink product prices from research and development costs As a result, this agenda item will likely require a drafting group to convene to litigate line-by-line language changes given the profound disagreement among member states on whether recommendations that fall outside of the GSPOA-IP’s current scope should be implemented or not. GHTC will follow these negotiations closely given that the recommendations currently viewed as out of scope include provisions on a percentage of GDP target funding level for R&D, initiatives on price transparency, and local R&D capacity building.

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. In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. While wild poliovirus cases have dropped significantly over the years—with only 22 total reported cases in 2017—surveillance gaps still linger, making future progress in wild polio eradication more fragile. Three countries have yet to be declared free of wild polio transmission: Pakistan, Afghanistan, and Nigeria. Researchers found that health-facility surveillance was limited in these countries due to conflict situations. While community-based surveillance was effective in identifying cases, experts noted that more case searchers are needed in displaced persons camps and more community participation required to reach inaccessible areas. Researchers stressed that strong polio surveillance will still be needed long after eradication and after the oral poliovirus vaccine is discontinued. Researchers have created a new animal model to more effectively study Crimean-Congo hemorrhagic fever, according to new research published in Nature Microbiology. Crimean-Congo hemorrhagic fever, a viral disease spread by ticks, is fatal in nearly one of three cases, and there are no specific treatments or vaccines for the disease. To advance this research, scientists at the National Institute of Allergy and Infectious Diseases conducted a pilot study infecting African green monkeys, rhesus macaques, and cynomolgus macaques with the virus. While the first two monkey species showed no signs of disease, two of the three cynomolgus macaques developed the virus. In a larger study with the cynomolgus macaques, all of the animals developed the virus. Because this species developed the virus in the same way humans do, researchers believe this animal model will be useful in studying how infection interacts with the immune system and ultimately help scientists develop treatments and vaccines. Scientists at the University of Waterloo have developed a new tool to prevent HIV transmission in women. The tool, a vaginal implant that looks similar to an intrauterine device, decreases the number of cells that HIV can target within a woman’s genital tract. HIV infects the body by taking over T cells that the immune system mobilizes in response to the virus; however, if these cells remain in a resting state and do not attempt to respond to the virus, they are not infected. Scientists believe this tool, which releases a medicine to induce T cells into a resting state, could be a more reliable way to encourage the cells not to respond to infection, lowering the rates of HIV transmission. While more research is needed into the reliability and validity of the tool, scientists are optimistic that this may be a useful tool to protect women at high risk for developing HIV.