Research Roundup: Understanding the severity of antimicrobial resistance and a request to review a sleeping sickness medicine

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. An old malaria compound—primaquine—and a common dye with antimalarial properties—methylene blue—have shown effectiveness in preventing malaria transmission, according to a new study published in The Lancet Infectious Diseases. Researchers found that by adding a single dose of primaquine and three doses of methylene blue to existing malaria medicines, it resulted in near complete cessation of human-to-mosquito transmission within two days. When infected with malaria-causing parasites via mosquito bite, a host may transmit the parasite back to mosquitos, which will likely cause future infection of a different host. These two compounds may aid in preventing this transmission and help curb future malaria infections. Public health experts recently met to review the latest data on chikungunya vaccine candidates and plan how to promote progress to get the candidates to market. Currently, there are 23 chikungunya vaccine candidates in the pipeline, with two vaccine candidates in phase 2 clinical trials. Researchers discussed the challenges facing developing an effective chikungunya vaccine, citing the unpredictability of where the next chikungunya outbreak could take place. Because of this, phase 3 clinical trials could prove difficult to conduct, unless the trials are conducted in non-human primates injected with human antibodies. Though more research and clinical trials are needed to bring an effective and safe chikungunya vaccine to market, experts believe these conversations will help. Recent data from Médecins Sans Frontières (MSF) suggests one dose of the oral cholera vaccine is effective in delivering short-term protection against the disease. Previous research from MSF suggested the single dose cholera vaccine provides protection for those with recent exposure to the disease, but the new data—collected from the 2016 cholera outbreak in Zambia—also suggests the vaccine provides protection to those ho have not been exposed to cholera for several years. While this data further demostrates the effectivesness of the single-dose oral cholera vaccine, more research—like the effectivness of the vaccine on children under five years of age—still must be determined.

Last week’s World Health Organization (WHO) Executive Board (EB) meeting featured a packed agenda covering diverse topics ranging from WHO’s overall plan of work for 2019-2023 to the global burden of snakebite envenoming—as well as some unexpected chicken dancing by delegates. Given that the EB sets the agenda for May’s World Health Assembly (WHA), the inclusion of an agenda item on access to medicines and WHO’s plan on intellectual property (IP) indicates that we can expect a contentious few months leading to the WHA. Here is how debates on these agenda items shook out:Access to medicines For the third consecutive year, the EB addressed the issue of access to medicines and health technologies—a topic that has received much attention in recent years and sparked strong, diverse opinions from member states on how best to address. Last year at the WHA, member states reached a compromise to allow consideration of the findings of the United Nations Secretary-General’s High-Level Panel on Access to Medicines (HLP) at this year’s EB. For the meeting, the Secretariat produced a comprehensive report mapping out WHO’s current activities against the specific HLP recommendations. Though a number of countries objected to this approach on the grounds that it implicitly endorsed the findings of the HLP report, there was broad consensus in the room that access to medicines is a global problem that requires WHO action and that the agency could not afford to delay any longer.As a result, the EB agreed on a decision point calling for WHO to develop a “roadmap report” outlining WHO’s work plans on access as part of the process of finalizing the overall 2019-2023 plan of work. This report will be submitted to the 2019 WHA.Intellectual property Speakers at the EB, 2018 (Photo: GHTC/Matt Robinson) While the access to medicines agenda item reached a consensus decision more quickly than expected, the debate on IP raged over multiple days during both formal and informal sessions at the EB. The debate ultimately boils down to a divergence between high-income countries—countries with significant pharmaceutical industries—and low- and middle-income countries on whether WHO is an appropriate forum to address IP. Those against WHO taking an active role on IP (including the United States and Japan) argue that the World Trade Organization and the World Intellectual Property Organization are the appropriate forums. On the other side, a coalition of countries led by Brazil and India argue that IP in medicines is a unique category and that international policy must be set with a health perspective first. As the global normative organization for health, WHO is thus the appropriate venue to address IP.After many days of closed-door negotiations, the board ultimately decided to move forward with a consensus resolution text. It called for member states to implement recommendations from the new WHO report on IP and public health as appropriate for their national contexts and to continue further discussions and for the Director-General to begin implementing the recommendations and submit a progress report to WHA in 2020. Notably, the following provisions were stripped out of the resolution, including calls for member states to:1. Promote transparency and understanding of research and development costs2. Identify essential products at risk of shortages and take measures to prevent stock outs3. Commit to dedicating at least .01 percent of gross domestic product to basic and applied research relevant to developing countriesGHTC will continue tracking these issues over the coming months heading into WHA, and we look forward to what will be a spirited meeting in May!