Breakthroughs Blog: Maternal health

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Last week, US policymakers and global health advocates came together to talk about progress made on preventing maternal and child deaths. The US Agency for International Development (USAID) hosted a high-level forum called Acting on the Call: Ending Preventable Child and Maternal Deaths to both celebrate progress and assess the challenges that remain. The National Institutes of Health has awarded Boston Medical Center $861,000 to train Ugandans basic research for tuberculosis and emerging diseases. Boston Medical Center is one of five institutions to receive similar funding to enhance infectious disease research in low- and middle-income countries. Sabin Vaccine Institute’s Peter Hotez writes in the Huffington Post about the latest developments in hookworm vaccine development and the efforts of HOOKVAC—a global consortium uniting academic, medical, and research partners to find a vaccine to prevent neglected tropical disease hookworm, which currently more than 400 million people suffer from. ASPIRE—one of two late-stage clinical trials for a microbicide to protect women from HIV—has completed enrollment of trial participants, with 2,629 women from 15 trial sites in Malawi, South Africa, Uganda, and Zimbabwe. Now that enrollment is complete, we could potentially find out results from this pivotal trial by late 2015, early 2016. GHTC member Jhpiego has been awarded the US government’s largest project to end preventable maternal and child deaths. The Maternal and Child Survival Program, a 5-year, $500 million agreement supported by the USAID, will accelerate the rapid expansion of innovative, high-impact health approaches in 24 priority countries in order to save the lives of every woman and child in need. At an event last week launching the Pediatric HIV Treatment Initiative, panelists discussed the need for “the right medicines for pediatric HIV”—including the need for simplified treatments, and developing, producing, and distributing these medicines to children in low- and middle-income countries.

Tomorrow US policymakers and global health advocates will come together to talk progress made on preventing maternal and child deaths. During the day, the US Agency for International Development (USAID) will host a high-level forum called Acting on the Call: Ending Preventable Child and Maternal Deaths to both celebrate progress and assess the challenges that remain. That evening, the 5th Birthday and Beyond coalition will celebrate America’s leadership and investments worldwide to help children reach their fifth birthday. US investment in R&D has led to new innovations that are saving the lives of mothers and children. Photo: PATH/Teresa Guillien While you’ll probably hear a lot of different facts and figures, one message will be clear—the world has made remarkable progress in preventing the deaths of millions of women and children. In fact, maternal and child deaths have been cut in half in just over two decades. That means that every day this year, 17,000 more children will live and 700 more mothers will survive childbirth than did two decades ago. Central to this progress has been US investment in research and development (R&D) that has led to new medicines and innovative health products that are saving the lives of mothers and children. Globally new vaccines, drugs, diagnostics, and other health innovations have led to 4.2 million fewer child deaths in 2013 compared to 1990, according to a report by the Institute for Health Metrics and Evaluation. Innovations like the polio vaccine, oral rehydration solution to treat diarrhea, and antiretroviral therapies that prevent maternal to child HIV transfer, and others treatments have resulted in incredible gains for maternal and child health.   No country has done more than the United States to help save the lives of the world’s poorest mothers and children. A critical part of the US approach has been our world-leading investment in global health R&D. In fact, the US government is the largest funder of global heath R&D in the world—contributing over 45 percent of total investment. US government investment in global health R&D has led to breakthroughs that have transformed or are poised to transform efforts to reduce maternal and child mortality. Some examples include: The Oxytocin-Uniject™ This is a device filled with oxytocin that helps contract the uterus to reduce post-partum hemorrhage—or excessive bleeding—the leading cause of maternal death worldwide. It is easy to inject and requires little training to administer, so it’s made a dramatic difference in the ability of health workers to administer oxytocin in emergencies or in remote locations outside of traditional hospital facilities. USAID played a crucial role in funding research towards the development of this product. RTS,S malaria vaccine candidate RTS,S is the most clinically-advanced vaccine candidate for malaria—a disease which kills a child every 40 seconds. A recent study showed that infants who receive the RTS, S vaccine had one third fewer cases of both clinical and severe malaria. A vaccine could be an important tool in reducing child sickness and death from malaria. The Department of Defense provided critical funding for the early development and clinical testing of RTS,S. Rotavirus vaccines Rotavirus-induced diarrheal disease kills roughly 435,000 children younger than five each year. Two currently available rotavirus vaccines were introduced in the past two decades, with other vaccines under development showing tremendous progress. The National Institutes of Health developed the first available rotavirus vaccine and has been a financial partner in the development of subsequent vaccines. In addition, the Centers for Disease Control and Prevention also monitors efficacy and safety, and supports clinical trials of rotavirus vaccines. New contraceptive technologies Family planning technologies allow women to space their pregnancies—making it more likely for both the mother and child to survive childbirth. An analysis of 172 countries found that family planning prevented 272,000 maternal deaths in just one year. However, the contraceptive options that exist today don’t always meet the needs of women in developing countries. New vaginal rings are being developed that will be long-lasting and easy for the user to insert and remove without a doctor’s assistance, while new multipurpose prevention technologies combine the delivery of contraceptives with microbicides which reduce the transmission of HIV and other sexually transmitted infections. USAID provides funding towards the development of many of these new contraceptive technologies. While tremendous progress has been made in decreasing maternal and child deaths worldwide thanks in part to new health innovations, each year 6.6 million children still die before their first birthday and 289,000 women still die from pregnancy-related causes. That translates to 18,000 children under the age of five and 800 pregnant women or women in childbirth dying every single day. The United States can and must do more. While the United States should increase access to proven and existing drugs, vaccines, and other health tools for maternal and child health, it is just as critical to develop the next generation of tools to prevent and treat existing and emerging diseases. Sustained and continued investment by the US government in global health R&D is critical to ending maternal and child deaths.

In this guest post, Sarah Alexander—director of external relations for the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS)—writes about the groundswell of momentum surrounding maternal and child health and the role research and development (R&D) can play in helping more babies have a healthy start to life. You may have noticed maternal and child health has been garnering a lot of attention lately. At the Saving Every Woman Every Child Global Summit in Toronto last week, the focus was on ending preventable deaths of mothers and children under 5, and the government of Canada pledged $3.5 billion toward those efforts. The week prior marked the launch of the Every Newborn series in The Lancet, as well as the endorsement of the Every Newborn Action Plan by the World Health Assembly in Geneva. Later this month, the Partnership for Maternal, Newborn & Child Health’s Third Annual Partners’ Forum will be held in Johannesburg. All of these events are building on each other and creating a groundswell that will help forge a blueprint for the post-Millennium Development Goal era.The momentum these efforts have gained is impressive, and great strides have been made in saving the lives of mothers and babies around the world. As the global health community looks toward the next 15 years, we are encouraged that more and more plans are incorporating R&D as pillars of a maternal and newborn health agenda. A focus on R&D will allow researchers to look upstream and investigate new ways of preventing problems from occurring in the first place—exemplifying the maxim that prevention is better than cure.There has been a groundswell of momentum for maternal and child health. There are many opportunities for high-impact R&D as part of the agenda. Photo: PATH/Mike WangAt the GAPPS—an initiative of Seattle Children's—we understand and advocate for all the great work that is being done to treat newborns—especially in low-resource settings—to give them a better chance of survival. With our focus on preterm birth and stillbirth, we envision a scenario where instead of treating infants born prematurely or laying to rest nearly 3 million stillborn babies every year, we could instead identify issues in utero and develop therapies to prevent preterm birth, stillbirth, and other pregnancy complications before they occur.Babies born too soon can face lifelong health complications, including respiratory issues, vision and hearing loss, cerebral palsy, developmental delays, and more. Stillborn babies are often not acknowledged with birth or death certificates, or prioritized in health efforts. While it’s essential that known interventions are scaled up to help save the lives of mothers and newborns, we are glad to see a comprehensive R&D movement picking up steam.There are many opportunities for high-impact R&D in maternal and newborn health. For example, new technologies allow for increased biomarker discovery and therapeutics development, which could allow doctors to screen for and treat conditions in pregnant women and their babies before birth, helping more babies have a healthy start to life.With so much momentum building around maternal and child health, we’re glad to see R&D into prevention is being prioritized so that one day every birth can be a healthy birth.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Kaitlin Christenson, director of the GHTC, summarizes news out of the World Health Assembly (WHA) impacting the global health research and development (R&D) community including debates on the post-Consultative Expert Working Group on Research and Development: Financing and Coordination and post-2015 development agenda, and themes related to regulatory system strengthening, access to essential medicines, and the value of R&D. Renate Baehr—executive director of Deutsche Stiftung Weltbevoelkerung—writes about the next rendition of the European & Developing Countries Clinical Trials Partnership and how its expansion will impact more lives in low- and middle-income countries. She discusses how the program has been broadened to include neglected tropical diseases and how African countries will now fully participate in the group’s governance and decision making. The Canadian government announced it would provide $12 million to Grand Challenges Canada to finance innovations to improve maternal and child health in the developing world. The funding will support 65 projects to be implemented across 25 low-and middle-income countries. The announcement came in advance of the Canadian Prime Minister’s global summit on maternal, newborn, and child health taking place in Toronto from May 28-30. Wired reports on the passage of a resolution at WHA to create a global action plan to tackle the emerging problem of antibiotic resistance that will include exploring technology innovations in diagnostic testing and new drug development. The article notes that some experts believe this will not do enough to stem the problem and are calling for the creation of an intergovernmental body on antibiotic resistance that would be similar to the Intergovernmental Panel on Climate Change.