Breakthroughs Blog: Access

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The only existing tuberculosis (TB) vaccine—the bacille Calmette-Guerin (BCG) vaccine—has proven to be more effective than previously thought, delivering protection against the disease for around 20 years. The London School of Hygiene and Tropical Medicine led a study that found half of those individuals who were given the vaccine at ages 12 or 13 were protected against TB for at least 20 years. The vaccine was thought to deliver protection for only 10 to 15 years. These findings strenthen the case for administering BCG to children in low- and middle-income countries with high TB rates. The Tanzanian government has announced that in 2018 the country will begin using Zipline drones to deliver essential medical technologies to citizens in the capital city of Dodoma. The drone service can deliver everyday goods like food, but can also deliver live-saving medicines and vaccines, and contraceptives like condoms. Technology in low-resource and rural parts of the world has been used in the past to help diagnose and track diseases, but these technologies have proven challenging to deliver due to rugged terrain or geographic isolation. The Zipline drones are the first of their kind and can deliver products within a 50-mile radius. The Tanzanian Ministry of Health is working to add three more drone locations within the nation. The University of North Carolina Chapel Hill is studying the efficacy of a rapid diagnostic tool for malaria in very rural areas of Uganda. Researchers testing the low-cost tool in these areas and found that it could perform diagnoses with high specificity and sensitivity for both uncomplicated and severe malaria. This level of accuracy in diagnosis may allow health professionals to prioritize treatment for cases that may be more life threatening than others. Accurately diagnosing children who contract a severe form of malaria makes it possible to prioritize cases and potentially save lives.

This coming week the “who’s who” of the global health community (as well as some much more modest global health advocates such as your humble author) will make the annual trek to Geneva, Switzerland, for the 69th World Health Assembly (WHA), where World Health Organization (WHO) member states will collectively decide WHO’s plans for the coming year. This year’s agenda is packed and includes many topics that could impact global health research and development (R&D). Below are the agenda items GHTC will be tracking in Geneva and topics we’ll dig into in more detail at a May 23 side event and webinar we are cohosting with the Geneva Centre for Security Policy, Global Health R&D: What’s at stake during the 69th WHA? Framework of engagement with non-State actors WHO routinely engages with a variety of non-State actors (NSAs)—any organization other than a member state. These collaborations support core components of WHO’s global health strategy. Some have argued, however, that WHO’s current ad-hoc approach to managing such engagements undermines its independence and impartiality. As I have written previously, the current draft framework runs the very real risk of excluding key WHO partners and actors in the global health R&D community. Given the significant member state pushback against the proposal, it will be fascinating to see how the tension is resolved.   Health in the 2030 Agenda for Sustainable Development With the approval of the Sustainable Development Goals (SDGs) in September 2015, the global development community has been trying to sort out how to implement and measure programming to achieve what are, by all admissions, extremely ambitious targets. WHO is no different, and has been hard at work laying out strategies to achieve the various components of goal 3, the “health SDG.” It is particularly heartening that target 3.b specifically commits member states to supporting health R&D. What shape this will take, and how WHO will engage are definitely hot topics to watch at this WHA.   Global Action Plan on Antimicrobial Resistance Following the 68th WHA’s adoption of the Global Action Plan on Antimicrobial Resistance (AMR), WHO has been working to develop strategic options to achieve the plan’s goals and will be presenting a progress update and an options paper to WHA this year for input. GHTC is closely monitoring plans for the R&D objective, which states: “… develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.” While the options paper is quite broad, in the R&D space the WHO Secretariat is specifically asking for input on methods to de-link R&D costs from sale price, how best to support access to innovative antimicrobials, and how to develop a prioritization mechanism to support appropriate R&D on AMR specifically. Given the danger that the global rise of AMR represents, the discussion is likely to be extensive and intense.   Follow-up to the report of the Consultative Expert Working Group (CEWG) on Research and Development: Financing and Coordination (Report of the open-ended meeting of Member States) GHTC has been following the CEWG process for some time as it winds its way forward after what has already been a decade-long process. The prototype R&D observatory is now online, and the demonstration projects are returning their progress reports. The WHO Special Program for Research and Training in Tropical Diseases (TDR) has prepared an analysis that outlines how a pooled fund and R&D observatory could work to identify unmet needs and channel funds to those R&D projects. While almost everyone agrees that additional funds and greater coordination are sorely needed, as we heard at GHTC’s webinar on CEWG, the jury is still split on the CEWG’s specific proposals. While it is unlikely that the CEWG process will come to an end at this WHA, the number of concerns that can be ironed out with all the decision-makers in the room will be telling in regards to future prospects.   For more analysis on these subjects, read GHTC’s fact sheet on Research and development at the 69th World Health Assembly.  

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a series of papers she developed for the GHTC that outlines key challenges, lessons, and potential solutions in advancing research and development (R&D) to address poverty-related and neglected diseases and conditions. New drugs and vaccines and other health technologies developed over the last few decades have significantly increased life expectancy in most countries. But a wide gap still exists between the health outcomes of the richest and poorest countries. While high-income countries have been able to benefit from recent innovations in health R&D, many of the poorest populations are not able to access these new and improved technologies. For years there has been global debate about how to improve the coordination and increase resources being devoted to R&D targeting poverty-related and neglected diseases and conditions. In order to inform these discussions, the GHTC recently developed a series of briefing papers providing the perspectives of nonprofit product development organizations (NPPDs) on accelerating product development to meet the health needs in low- and middle-income countries (LMICs). Today, GHTC is launching a summary of the findings from the briefing papers which provides an overview of the key challenges, lessons, and potential solutions identified by NPPDs, as well as a final briefing paper describing capacity strengthening activities. New drugs and vaccines and other health technologies developed over the last few decades have significantly increased life expectancy in most countries. But a wide gap still exists between the health outcomes of the richest and poorest countries. Photo credit: PATH/Umit Kartoglu The first paper in this series set the stage by providing examples of how NPPDs approach product development and describing the key challenges that NPPDs and their partners face in developing and introducing technologies that address the health needs of LMICs. The second paper provided the perspectives of NPPDs on the most significant funding challenges and the types of financing mechanisms that support their work. The third paper described how NPPDs and their partners try to ensure access in LMICs to the knowledge and technologies they develop. The fourth paper outlined the most significant regulatory challenges faced by NPPDs and partners throughout the product development process and described how these challenges affect their work. The fifth paper in the series describes NPPDs’ efforts to strengthen the research and manufacturing capacity of academic, nongovernmental, and commercial partners in LMICs, and provides examples of the criteria that NPPDs consider when determining investment in capacity strengthening. NPPDs were created to speed the development and adoption of new technologies targeting the public health needs of the world’s poorest populations. Through partnerships with the public and private sectors, NPPDs bring together the resources and expertise of various groups to advance and increase access to health products that would not otherwise be available for commercial reasons in LMICs. Although many NPPDs have effectively advanced R&D for poverty-related and neglected diseases over the past two decades, progress has been hindered by a number of challenges. The summary paper provides a high-level overview of these challenges which include insufficient funding, lack of consistent regulatory requirements and limited capacities of national regulatory authorities, and limited local capacity for research and manufacturing. Each briefing paper provides a deeper analysis of NPPD perspectives on each of the challenges and how they have worked with partners to address these issues. NPPDs are working toward more predictable, stable, and long-term funding across all phases of product development, as well as diversified funding sources and improved coordination across funders. They are pursuing policy changes and sustainable funding to improve regulatory capacities and pathways for products targeting LMICs. And they are strengthening local partners’ research and manufacturing capacities in line with international standards. Implementing these solutions will further enhance R&D for poverty-related and neglected diseases and conditions and thereby increase access to needed drugs, diagnostics, vaccines, and devices in LMICs. This will not only help to save lives and improve health among vulnerable populations but also contribute to local economic development.