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Photo: CDC/ Prof. Woodbridge Foster; Prof. Frank H. Collins Findings of a study presented at the American Society of Tropical Medicine and Hygiene Annual Meeting last week suggest that ivermectin—a drug long used to treat river blindness and elephantiasis—can combat malaria when used in mass drug administration programs. The study, which was conducted by researchers from Colorado State University and the Institut de Recherche en Sciences de la Santé, found that mass distribution of ivermectin (six times, in three week intervals) resulted in a 16 percent decrease in incidence of childhood malaria. Ivermectin isn’t toxic to the malaria parasite; rather, it weakens the mosquito vector, serving as a form of vector control. After a mosquito becomes infected with malaria, it can take up to two weeks before it is able to transmit the parasite to humans. With ivermectin present in the human population, multiple humans might transmit ivermectin to the mosquito before it is able to spread the malaria parasite to even one human. The study was conducted in the West African nation of Burkina Faso, and the leading malaria parasite and mosquito vectors vary between sub-Saharan Africa and Southeast Asia. However, researchers at the US Walter Reed Army Institute of Research have recently determined that ivermectin can inhibit the development of the malaria parasite and kill the mosquito vector endemic to Southeast Asia. Researchers at the University of Malaya in Kuala Lumpur, Malaysia, have developed LED street lights that are environmentally friendly and a public health tool. The street lights are powered by wind and solar energy, and serve a dual purpose of trapping mosquitos to combat dengue fever and other infectious, mosquito-borne diseases. The lamps release carbon dioxide, to which mosquitos are attracted, and use a fan to trap the mosquitos. The lamps are currently being piloted in Malaysia at two different sites. Professors at Duke University have designed a colposcope, a cervical cancer diagnostic tool, to be used in low-resource settings, and will soon begin testing the device in a pilot study in Peru. Existing colposcopes are large and include equipment to magnify and illuminate the cervix (see Image 1), whereas this device, the Point of Care Tampon (POCKeT), includes a camera that provides images of comparable quality. The POCKeT is small (see Image 2), connects to a smartphone or tablet, requires less training, and is expected to be more culturally appropriate than a traditional colposcope. The testing of the POCKeT will be supported by a US$3.7 million grant from the US National Institutes of Health. A recent report from the Review on Antimicrobial Resistance, commissioned by United Kingdom Prime Minister David Cameron to address the growing threat of drug-resistant infections, calls for the research and development of rapid, point-of-care diagnostics to reduce the overuse of antibiotics. Such diagnostics would allow health care workers to pinpoint the cause of an illness and treat it accordingly, rather than prescribe a broad-spectrum antibiotic without confirmation that the cause is bacterial and/or that the pathogen will be susceptible to the drug. The Review notes that drug companies, which benefit from antibiotic sales, have little incentive to invest in diagnostics that could limit those sales. The report includes a diagnostic 'wish list,' which identifies 12 potentially "game-changing" tools, including an at-home test to determine if an illness is an infection at all or to distinguish between bacterial and viral infections.

Maximilian Geigenmueller, advocacy officer at the Berlin office of DSW, answers questions about the German PDP funding call. Earlier this month, Germany’s Federal Ministry of Education and Research (BMBF) the renewal of the German funding program for product development partnerships (PDPs) conducting research and development (R&D) for health technologies to combat poverty-related and neglected diseases (PRNDs). The call for proposals for €50 million over five years (2016–2021) is expected to be published shortly. GHTC Breakthroughs blog is joined by Maximilian Geigenmueller, advocacy officer at the Berlin office of Deutsche Stiftung Weltbevoelkerung (DSW)—an international development organization that conducts global healthR&D advocacy—to learn more about this funding call and its importance in advancing R&D for lifesaving global health technologies. Q: Why is this funding call significant among efforts to advance global health R&D? A: This funding call is very significant in the sense that it ensures the continuation of German PDP funding. The first funding round was considered to be a pilot, and it was by no means a given that there would be a second one. Germany was late in joining the group of governments funding PDPs in 2011, when the United States and United Kingdom had already been funding the model for years. Germany also started out at a small scale—€20 million over four years. Over the duration of this time, it was gradually increased to over €26 million, which I think was an indication that the German government began to understand and increasingly appreciate the PDP model. This was further reinforced by an independent evaluation of the first funding round which was very positive. I think with this second call Germany has established itself as a PDP supporter in the medium and long term—albeit at a still rather modest funding level. Q: How does this second funding call differ from the first? A: First of all, there will be more money: €50 million over five years from 2016 to 2021, which is still not quite what we had hoped for but almost double the first funding round. Secondly, this call will be open for proposals not only on the 17 neglected tropical diseases (NTDs) and malaria, which were included in the first funding round, but also HIV and AIDS and tuberculosis (TB). Q: The announcement of this funding call occurred at the G7 Research Ministers conference which Germany chaired. How does this funding call reflect Germany’s broader global health priorities? And how does it align or differ with the priorities agreed upon at the G7 conference? Photo: PATH/Jennifer Fox A: I think the German government finally decided it was time to take on a leadership role in global health that appropriately reflects the country’s economic and financial standing in the world. I am sure the Ebola crisis—an outbreak of an infectious disease spreading at a breathtaking rate with no immediate treatment available and relatively close to home—had a lot to do with it. The prioritization of PRNDs/NTDs, antimicrobial resistance, and Ebola on the G7 agenda has given a lot of visibility to health issues in the international debate this year. For a while it looked like the G7 were leaving out the big three diseases of poverty—HIV and AIDS, malaria, and TB—and would only discuss NTDs, particularly as the G7 leaders’ summit communiqué only referred to NTDs. Fortunately, at the G7 Research Minister Conference in Berlin on October 8–9, the ministers of research included not only NTDs but also explicitly mentioned malaria, tuberculosis, HIV and AIDS, and several other infectious diseases. There are some interesting commitments in the communiqué, such as better coordination of research efforts. Germany’s Minister of Research Johanna Wanka has offered to host a brainstorming workshop on this in 2016. Also, the communiqué states the intent to develop a joint G7 pilot research activity for R&D projects to build research capacities in high PRND/NTD burden countries. Combined with the Japanese 2016 G7 presidency which is very likely to have health as one of its priorities as well, I think we have a good chance that health is going to stay at the center of the international agenda for a while. Q: As a global health R&D advocate, what excites and disappoints you about this funding call? A: I am excited about it being out and that there is significantly more budget available this time. It is of course not enough, not by a long shot, but maybe there will be some top-ups to the second funding round, as was the case in the first funding round when Germany started out with €20 million and ended up with €26 million. There is also the prospect of institutionalizing German PDP funding, moving away from providing limited funding for a number of years to making it a permanent feature in the German budget, but this is most likely only going to happen at the end of the second funding round. What was also really exciting was the process of ensuring this second funding round happened. I think all advocates—PDPs, nonprofits, philanthropic organizations, and others—did a great job in keeping global health R&D in the political debate. For example, during the summer the All Parliamentary Group on Population and Development of the German Bundestag wrote a letter to Chancellor Angela Merkel voicing their support for global health R&D and the PDP model, which was signed by 19 members of parliament (MP). I think nineteen MPs coming together from three out of the four parties in the Bundestag to sign a letter in support of a measure which represents only a minuscule share of the research ministry’s annual budget is fairly remarkable.

Photo: National Institute of Allergy and Infectious Diseases (NIAID) Researchers at Tulane University successfully tested an experimental aerosol tuberculosis (TB) vaccine in monkeys, demonstrating that the candidate was more effective in protecting against infection than BCG—the only TB vaccine on the market. To create the vaccine, the researchers genetically modified the TB bacterium, removing a gene that plays a key role in infection. The vaccine was then administered to seven monkeys, while another seven each received either an aerosol version of BCG or no vaccine. After eight weeks, the monkeys were exposed to TB at a lethal level. The experimental vaccine not only was more protective than BCG, but it also induced a stronger immune response in the lungs, which is thought to be key to preventing infection. A new formulation and coating for existing HIV and AIDS medicines could significantly decrease the frequency with which the drugs must be taken. Researchers at the University of Nebraska Medical Center used a process called nanoformulation, which involves modifying drugs at the most basic level (i.e., atomic or molecular level) in order to convert them into nanoparticle crystals. In this experiment, the antiretroviral medicine crystals were coated with fat and protein, allowing them to last much longer in the body. In the lab, the drug proved to be effective in combatting HIV and AIDS. The team hopes its findings could eventually lead to the development of an HIV and AIDS treatment that could be administered once or twice per year, rather than daily. Resistance to the leading antimalarial—artemisinin—was first reported in Cambodia in 2008, and a new study in Nature Communications suggests that the drug-resistant parasite has the ability to infect African mosquito species. A team of researchers at the US National Institute of Allergy and Infectious Disease infected two Asian and one African mosquito species with the drug-resistant malaria parasite, and all three species proved to be susceptible. Furthermore, the African species were no less vulnerable to infection, which came as quite a surprise as the species have evolved independently for more than 30 million years. Health officials from the United States and Saudi Arabia are considering a collaboration for the development of a vaccine against Middle East Respiratory Syndrome (MERS), which has infected more than 1,500 people across 27 countries. There are currently a number of MERS vaccines in development and several have yielded promising results in animal studies. The Saudi Ministry of Health has US$70 million available for the project; however, the proposed role of the US government remains unknown.

Moderator Lisa Cohen and panelist Tony Pipa. With the Sustainable Development Goals (SDGs) freshly adopted, the Global Health Technologies Coalition (GHTC) gathered representatives from the private, public, and nonprofit sectors on Capitol Hill this past Wednesday to discuss what it will take to achieve the global goals. One message rang loud and clear during the briefing: health innovation will be critical to achieving the SDGs, and it will take political commitment, funding, partnerships, and accountability mechanisms to deliver the next generation of health innovations needed to get us there. The panelists agreed that the SDGs—which set ambitious targets to end poverty, infectious disease epidemics, and preventable maternal and child deaths—are an important device for catalyzing political commitment and driving collective action to improve global health. Anthony Pipa, the US special coordinator for the Post-2015 Development Agenda, called the SDGs “a very optimistic global moment” and noted the power of the 193 United Nations member states coming together to agree on a set of goals, a point reinforced by moderator Lisa Cohen, executive director of the Washington Global Health Alliance. Pipa explained that the success of the Millennium Development Goals (MDGs) demonstrates the power of goal setting in advancing global health, and that the SDGs must build on that success. But he also clarified that “the SDGs are not just the MDGs 2.0,” as the SDGs are broader and more ambitious than the MDGs when it comes to health—they set goals to eliminate disease and preventable deaths, not just reduce them. He also described the inclusivity of the development process and the universality of the agenda, which promoted a sense of ownership among member states that are now starting to integrate the SDGs into their own national agendas. In the case of the US government, Pipa explained that the SDGs closely align with US priorities in global health and reflect the government’s longstanding commitment to health research and development (R&D). Panelists Dr. Dean Jamison and Kaitlin Christenson The need for strong and sustained investment in global health R&D to reach the SDGs was highlighted throughout the briefing. Dr. Dean Jamison, co-chair of the Lancet Commission on Investing in Health, explained that “we benefit today from investments in R&D of products made decades ago” and that health innovations have driven significant progress in global health over the past few decades. Jamison noted the Lancet Commission report’s conclusion that it is possible to achieve the ambitious SDG vision, but not without greater investment in R&D for new health technologies. He emphasized that, although health R&D can be a long and expensive process, it delivers huge returns on investment. The panelists all underscored that, because the SDGs are so ambitious, no one sector alone can ensure their success. Instead, it will take partnerships between the public, private, academic, philanthropic, and nonprofit spheres to reach the targets, particularly for health. Kaitlin Christenson, acting director of Advocacy and Public Policy at PATH, discussed the importance of product development partnerships (PDPs) in advancing the development of health technologies. Christenson remarked that PDPs leverage resources, expertise, and financing from across sectors and help “multiply” the impact of public sector investment. Gary Cohen Gary Cohen, senior vice president at BD, echoed this sentiment, noting that “so much of what we’ve achieved in health is due to collaboration, we couldn’t see doing it any other way.” Moving a promising idea through product development, regulatory approval, scale up of manufacturing, and market strengthening, in order to ultimately get the health innovation into the hands of patients who need it, is a daunting process. It’s not possible to do this, Cohen explained, without the involvement of the private sector. Cohen noted that throughout the process of developing the SDGs, it was widely acknowledged that the private sector would be critical to their successful implementation. Christenson pointed out that, while it is clear new health tools are needed to reach the global goals, it is not just about designing any technology, but the right technology. She explained that developers must stay focused on the needs of the end user and ensure that the product is affordable and contextually appropriate in order to achieve the desired health impact. She also noted that the community must be diligent in identifying health technologies with the greatest potential to drive dramatic improvements in health and rally the necessary investment and political support to bring them to scale. As an example, she highlighted PATH’s Innovation Countdown 2030 initiative, which identifies 30 innovations with the greatest promise to accelerate progress toward the SDGs. Attendees check out health technologies funded by US government investment. Pipa also emphasized that reaching the SDGs will require “doing business differently” and pointed to innovation within the US government to promote new thinking in global health, like USAID’s Saving Lives at Birth Grand Challenge. In the same vein, Christenson pointed out that “innovation comes from everywhere, not just white-coated scientists” and called for systems and policies that support a broad view of innovation. Cohen said that “innovation in business models will be just as important as innovation for technologies” and called for greater collaboration among key players to ensure that R&D investments are translated from the development of new tools and technologies to the ultimate delivery and use of lifesaving products. An audience member from PATH pointed out that, despite the importance of new health technologies to achieving the SDGs, the agenda does not currently include any indicator to measure progress in global health R&D, citing concern that “unless something is measured, it doesn’t necessarily happen.” Panelists agreed that data and measurement is a critical part of ensuring we are on the right track to reach the health targets. Pipa highlighted the expanded availability of data and the need to leverage data from different sectors, while Jamison cited the importance of data and monitoring in holding actors accountable to their SDG commitments. Though it will be a challenging road ahead to reach the SDG targets by 2030, the panelists were optimistic it could be done. Cohen emphasized that “these seemingly intractable problems are solvable.” Pipa agreed, saying, “the political consensus around ending extreme poverty is really powerful, and we shouldn’t underestimate that power.”