Breakthroughs Blog: United Nations

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda. The new paper make the case for the inclusion of research and innovation for health as a central component of the post-2015 agenda. Photo: PATH/Gabe Bienczycki A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV and AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda. In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV and AIDS, malaria, and other diseases). These investments have helped to create an enabling environment for research in and for the benefit of LMICs by increasing demand for new health technologies, expanding coverage of proven interventions, and strengthening the innovation infrastructure in these countries. Building on the work of The Lancet Commission on Investing in Health—a group of renowned economists and global health experts—the paper discusses the need for increased R&D investments by all countries to achieve the dramatic health gains envisioned in the post-2015 agenda. Adequate investment in R&D is important, but it alone does not guarantee more products or drive innovation toward the right type of products. PATH/Patrick McKern Adequate levels of investment, as suggested by The Lancet Commission, are critical for spurring the development of new health tools, provided they align with financing needs in R&D—notably predictability and flexibility. But even that sort of investment alone does not guarantee more products, and it does not drive innovation toward the right type of products—those that are suitable, acceptable, affordable, and accessible to populations most in need. It is essential, therefore, that indicators for R&D for health tools that primarily affect LMICs address a comprehensive set of outcomes including financing needs, infrastructure and human resources needs, enabling policies, necessary partnerships, capacity strengthening, and access requirements. Because poor health and disability contribute substantially to poverty, research and innovation for health is linked to improving economic prosperity and is critical to eradicating poverty. Therefore, it must be continuously prioritized within the post-2015 development agenda. Ultimately, the success or failure of the post-2015 agenda relies just as much on how the goals and targets are implemented as it does on how progress will be measured. Thus any research and innovation indicators measuring progress against the goals and targets outlined in the post-2015 agenda must also increase accountability of researchers, governments, and funders, and inform research processes. Inclusion of research and innovation for health must facilitate an enabling environment for research and innovation in LMICs and encourage endemic countries to set and pursue a domestically-driven health research agenda. The post-2015 development agenda is an opportunity for LMICs to set their own health agendas and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Therefore, it is essential that there is broad agreement among all of the relevant stakeholders that research and innovation for health—which includes the scaling up of proven health interventions as well as the development of new and improved high-priority health technologies—is critical to meeting the ambitious goals of eradicating poverty and ensuring sustainable development for all within a generation. In support of the inclusion of research and innovation for health in the post-2015 agenda, over 150 organizations and individuals recently signed a petition to United Nations (UN) Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools for diseases and conditions impacting LMICs at the heart of the post-2015 development agenda. It is our hope that the Members States and other UN officials shaping the agenda will head this call.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The Senate Appropriations Labor and Health and Human Services (LHHS) Subcommittee released its fiscal year 2015 appropriations legislation, after a lengthy internal debate on domestic health concerns. The legislation is—for the most part—good news for funding levels and policy issues for several key global health research programs at the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), and the Office of Global Affairs at the Department of Health and Human Services. Since its discovery nearly 40 years ago, we have learned a lot about Ebola. Yet there are still no effective treatments or vaccines to protect people against this deadly disease. According to an article in Vox, this is not because of “a lack of human ingenuity or scientific capacity,” but rather due to a global innovation system that does not prioritize the health research needs of world’s poorest populations. Drs. S. Patrick Kachur, MD, MPH, FACPM—chief of the Malaria Branch in the Division of Parasitic Diseases and Malaria at CDC’s Center for Global Health—and Larry Slutsker, MD, MPH—director of the Division of Parasitic Diseases and Malaria at CDC’s Center for Global Health— write in Breakthroughs about the emerging global security threat of anti-malaria drug resistance and CDC’s efforts to prevent, detect, and respond to this growing threat. They write: “…to sustain momentum and move toward elimination of malaria, new tools and technologies will be required.” Despite progress made to prevent maternal and child deaths by the United Nations’ Millennium Development Goals (MDGs), still too many mothers and children are compromised or killed by preventable diseases. PATH President and CEO Steve Davis writes for Devex about the need to take advantage of the progress made thus far by the MDGs and accelerate innovation to meet the health needs of millions of people in low- and middle-income countries. It’s World Breastfeeding Week (August 1-7) and as breastfeeding has served as the primary method for a mother to feed her infant since the dawn of humanity, we wonder if this could be a way for a mother to administer life-saving medicines to her baby? According to a group of researchers in the United States and United Kingdom, the answer is yes. Two recent promising developments in the fight against malaria were announced last week. Malaria is one of the leading killers of women and children in the world, and in sub-Saharan Africa particularly—where 90 percent of the more than 620,000 annual malaria deaths occur—new tools to fight the disease are desperately needed.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. In a bit of good news, the fiscal year (FY) 2015 defense appropriations bill—which was approved by the Appropriations Committee last Thursday—includes a $7 million increase for peer-reviewed medical research—from $200 million in FY 2014 to $207 million this year—despite a reduction in overall Department of Defense (DoD) funding from FY 2014 levels. In addition, in the accompanying report, the Appropriations Committee included very strong language recognizing DoD’s substantial contributions to global health research and development (R&D) and the need to support sustained US investments in this area. FHI 360 sat down with International Partnership for Microbicides CEO Zeda Rosenberg to discuss last week’s 20th International AIDS Conference. In this short video, Rosenberg highlights the need to focus on key populations—such as young women in sub-Saharan Africa—and the importance of women-initiated products like microbicides as a HIV prevention tool. Nearly 40 years after the discovery of the Ebola virus, no licensed treatments or prevention options are currently available. With the largest outbreak ever of the virus currently underway in West Africa, some are arguing that scientists should begin to develop new drugs and vaccines to combat this deadly disease. According to CNN, it’s likely too late for a vaccine to have enough of a preventative impact now, but using this time to test experimental vaccines—such as one developed by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health—could help when Ebola emerges again in the future. Last week, the United Nation (UN) General Assembly’s Open Working Group on Sustainable Development Goals released its proposal for a set of goals to succeed the UN Millennium Development Goals which come to an end in 2015. These proposed goals—referred to as the Sustainable Development Goals—will define the post-2015 development agenda. Of the 17 proposed goals put forward by the group, two contain targets related to R&D of new health technologies. Chagas disease—a neglected tropical disease (NTD) transmitted from the kissing bug and affecting millions of people in Latin America—is now on the rise in northern Virginia. Some doctors in the United States are not familiar with the disease and therefore do not test their patients regularly, which poses a risk to the general population in the United States. Many of the 8 million people with Chagas disease around the world never show signs of the disease, but about a third develop heart disease or megacolon and—when untreated—appear to die from sudden heart attacks. Chagas disease is just one example of NTDs affecting more and more people in the United States.

  After a busy week of negotiating police barricades and security checks in New York during the United Nations General Assembly (UNGA), we’re back in Washington, DC, with more thinking about the post-2015 development agenda and some reflections about what was heard throughout the week. First, hardly anyone seems to be talking about health as a component of the post-2015 development agenda—except the global health community. Although health remains a critical piece of the priorities coming from UN Member States—such as in the outcome document Member States endorsed during UNGA—the discussions among broader civil society groups last week tended to focus on other topics, like human rights, water and sanitation, environmental degradation, and inclusivity. R&D for new, innovative health tools will be essential to achieve any international development goals. Credit: PATH/Evelyn Hockstein That said, there does seem to be broad recognition there will be a health goal included in the post-2015 agenda, as well as more clarity on how such a goal might be framed. Though it’s unclear what the ultimate language will look like, there seems to be general accord that there will be one overarching health goal with related targets.These targets will call out such topics as: Universal health coverage. Non-communicable diseases. Child health. Maternal mortality. HIV and AIDS. Tuberculosis. Malaria. What is less clear is how innovation will fit into this goal. As we’ve said before, research and development (R&D) for new, innovative health tools will be essential to achieve any international development goals, as well as to enable more equitable and sustainable improvements across health services and health outcomes. Additionally, the discussions in New York raise some red flags about perceptions of the private sector—particularly, that some stakeholders view private industry as a monolith with only negative objectives. There is admittedly a spectrum of intentions when it comes to private industry and health. But when it comes to health R&D, it must be recognized that partnerships between the public and private sectors have been key to moving forward major public health successes: from established products like treatments for HIV and AIDS to new products such as a vaccine to prevent childhood diarrhea. Though we must determine how the private sector can be engaged in appropriate ways in discussions on a post-2015 development agenda, we certainly can’t exclude our private sector partners altogether from discussions about future sustainable development goals and plans to achieve them. GHTC will continue to follow the debates and engage in discussions alongside the rest of the health and development community. Next up: the Open Working Group on Sustainable Development Goals’ meetings in November and December, when the theme of science and technology will be discussed among many other topics.