Research Roundup: an affordable hepatitis C regimen, rapid diagnostics for neglected diseases, and fighting Zika with tires and milk

On Tuesday, GHTC launched our seventh annual policy report through a congressional briefing and panel discussion. The critical role played by the US government in catalyzing global health research and development (R&D) was a recurring theme, as panelists discussed the interconnectedness of global and American health and emphasized the need for new health tools to protect against outbreaks and continue progress. As moderator, GHTC Director Erin Will Morton opened the briefing, reminding attendees that despite the landmark progress achieved in global health over the past fifteen years, the US government must continue to invest in health R&D to achieve the next milestones in global health. “Goal setting works. And R&D for new technologies is key to achieving global health goals,” said Morton. Morton emphasized how past investments have had a remarkable impact, highlighting that the neglected disease pipeline has grown from 365 products under development in 2012 to 485 in 2015. However, as the GHTC policy report points out, US funding for global health R&D has stagnated or declined since 2009, and with the exception of the emergency funding for Ebola, 2014 funding levels were down 13 percent. “Our dollars are best spent when [US] agencies are working closely together,” said Morton, highlighting three goals the US government should embrace to advance innovation, as detailed in the report, including the importance of sustainable, long-term funding and innovative financing mechanisms; improved coordination of global health R&D efforts across US agencies; and streamlined and strengthened regulatory pathways. Panelist Dr. Peter Hotez—president of the Sabin Vaccine Institute and US science envoy—reiterated the need for long-term, sustainable funding for global health R&D, noting that the science to develop an Ebola vaccine was first published in 2013, but the technology sat there and was not advanced to product development because Ebola is a neglected disease and the technology offered little financial incentive to the private sector. He emphasized the role of US government investment in catalyzing health research, noting that when the US government “stepped in” and put up more than US$100 million to develop an Ebola vaccine, three leading pharmaceutical companies joined in. Dr. Hotez called for new actors, partnerships, and innovative models to advance R&D, lamenting that “our technical ability to make these innovations has outpaced our social, political, and financial instruments.” Further, Dr. Hotez challenged the notion that neglected tropical diseases (NTDs) are restricted to low- and middle-income countries, noting that 70 percent of NTD cases occur in G20 countries and that “there are 12 million Americans living in poverty with a neglected disease,” adding that neglected diseases are common but are “mostly striking the poor, mostly people of color, more in the American South.” Ambassador Jimmy Kolker discusses how HHS work contributes to both helping individuals overseas and protecting the health of Americans. (Photo: GHTC/Marissa Chmiola)The other panelists concurred, echoing that global health is American health. Panelist Dr. Patrick Kachur—principal deputy director of the Center for Global Health at the US Centers for Disease Control and Prevention (CDC)—made clear that CDC’s global health work is grounded in the agency’s responsibility to protect Americans. Ambassador Jimmy Kolker, assistant secretary for Global Affairs at the US Department of Health and Human Services (HHS), added that “over the next 50 years, the cost of lives and money to the global system of the threat of terrorism, climate change, and epidemics is in the same ballpark,” however, noting that what the US government is investing in fighting terrorism and climate change “so far outstrips what we’re doing in terms of outbreaks and epidemics.” Dr. Kachur called for enhanced coordination, stating “R&D is a whole-of-government and cross-sector affair.” Panelist Dr. David Shoultz—global program leader for Drug Development and Devices and Tools at PATH—furthered this point, noting that “innovation takes place within an enabling ecosystem, and in our context, that enabling ecosystem involves the NIH [National Institutes of Health], the FDA [Food and Drug Administration], HHS, the CDC, our close colleagues and friends at other product development partnerships, and private-sector participants.”In closing, Ambassador Kolker argued that the US government must continue to invest in R&D and consider “how the public sector can be the enabler of the private sector,” both to develop new health tools and to ensure the United States keeps its “competitive edge” as a leader in science and innovation. Dr. Shoultz agreed, stating that “US leadership [in global health] has mattered, it continues to matter, it will matter” in an increasingly globalized world and that investing in health research and innovation is “enlightened self-interest.”To watch the entire discussion, see below:

Aedes aegypti mosquitoes which carry Zika. Photo: Dean Calma/IAEAApril showers bring standing pools of water, the onset of mosquito season, and a new wariness of getting bitten. In 1999, we were caught off guard when the West Nile virus first appeared in North America. In 2010, an outbreak of dengue fever spread locally in Florida after an absence of 60 years. In 2014, chikungunya first arrived in the United States after travelling breathtakingly fast through the Western hemisphere. Now, in 2016, Zika virus is the latest mosquito-borne disease to threaten Americans. Yet our collective national response continues to be one of short-term planning rather than long-term preparedness.Since Zika virus arrived in the Americas in May 2015, there has been an alarming spike in reports of birth defects such as microcephaly, particularly in Brazil. Zika infection has also been linked to adverse pregnancy outcomes and Guillain-Barré syndrome—a temporary paralysis that can prove deadly. The World Health Organization has declared Zika a Public Health Emergency.The virus has now spread to 26 countries, including 312 travel-associated cases in the United States. So far, mosquitoes in the United States haven’t infected anyone, but the Centers for Disease Control and Prevention (CDC) just issued a revised map that shows the mosquitoes that carry this virus and others can be found across the Southern tier of the United States all the way up to southern New England on the East Coast.Faced with this chilling situation, we don’t have ready the tools we need to fight Zika. Just like with Ebola, crucial tools did not exist or were still under development when the outbreak began. R&D is urgently needed to understand the Zika virus and its associated health conditions, and develop new diagnostics, vaccines, or other treatments to combat it. A pregnant woman in El Salvador receives an ultrasound as part of the country's response to the Zika outbreak. Photo: Office of the President of El Salvador Today, the Band-aid approach of emergency funding is the only option available to mitigate the crisis. We applaud President Obama’s call for accelerated research efforts, and the need to inform Americans about how to protect themselves, which the CDC has been quick to do. The National Institute of Allergy and Infectious Diseases, led by Dr. Anthony Fauci, has also called for a “full court press” on research.This requires increased funding for those searching for ways to stop this virus. Diverting resources from the Ebola response, however, is short-sighted. Those efforts are just beginning to show the promise of new diagnostics, advanced therapeutics, and more resilient health systems in Ebola-affected countries. Redirecting funding before the job is finished is dangerous, and will most certainly leave the United States and the world unprepared for the next Ebola outbreak.The fact remains that this long-standing patchwork approach to global health R&D funding only degrades our ability to respond to the guaranteed next global health crisis. With more than 500 mosquito-borne diseases across this globally interconnected world, the question is not if but when we see another virus or disease.Just as we need primed and ready firehouses and firefighters, we need a primed and ready research infrastructure. That requires a prioritized agenda and sufficient funding. America’s “firehouses and firefighters” are the National Institutes of Health, CDC, President’s Malaria Initiative and the Army and Navy’s tropical infectious disease programs.Global health means everyone’s health. It’s time US policymakers stop funding by crisis and commit to sustainable, long-term investment in global health R&D so the most effective health solutions are available when they are needed.Stephen Higgs, PhD, FRES, FASTMH is the president of the American Society of Tropical Medicine and Hygiene and a professor at Kansas State University. Erin Will Morton, MA is director of the Global Health Technologies Coalition, a group more than 25 nonprofits that work to save and improve lives by encouraging the research and development of essential health technologies.