Research Roundup: DNA from single mosquito sequenced, Pandemic Response Box to boost research, and experimental Ebola treatment proves safe in adults

On February 5, President Trump delivered his second State of the Union address. Among the long list of policy proposals and pledges in the speech was one of great interest to the global health research community—an announcement of a new whole-of-government plan to eliminate HIV transmission in the United States by 2030. Though just a few sentences long, this announcement hinted at a much-anticipated budget increase for HIV and AIDS efforts and linked the feasibility of this goal to “scientific breakthroughs”—many driven directly by US government investments in research for new tools to diagnose, treat, and prevent HIV and AIDS. As the President put it, “In recent years we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. We have made incredible strides. Incredible. Together, we will defeat AIDS in America. And beyond.”Though the announcement and the associated plan released shortly thereafter by the Department of Health and Human Services (HHS) is squarely focused on eliminating HIV transmission within the US, the wording of the statement and a subsequent editorial published in the Journal of the American Medical Association penned by key agency officials both connect to international efforts and reference advances in HIV research and product development supported by the US government.At this moment of excitement—a “once-in-a-generation opportunity,” as Alex Azar, HHS Secretary, put it in the release of the plan—it is worth noting how our “chance to end the HIV epidemic for the next generation” is based on decades of patient, bipartisan commitment by the US government to advancing our understanding of HIV and AIDS and our ability to diagnose, treat, and prevent it through the development of cutting-edge tools.As the AIDS crisis was growing in the 1980s, NIH research led to the development of the first screening tests to detect the virus in the blood supply and the first antiretroviral treatment, AZT. Later, NIH research led to strategies to prevent maternal-to-child transmission, improved combination therapies, and the discovery that antiretroviral therapies could be used to prevent and treat the disease—research that was foundational to the development of pre-exposure prophylaxis (PrEP). CDC research has expanded our understanding of the epidemiology of the disease, improved prevention and treatment programs, and supported the development of a novel diagnostic that can, for the first time, identify whether an infection is recent or longstanding to improve contact tracing.While many don’t associate the Defense Department with health research, the US Military HIV Research Program has been on the forefront of the battle against HIV to both protect US troops and reduce the global impact of the disease. The program supported a large-scale HIV and AIDS vaccine trial in Thailand that was the first to show that a safe and effective HIV vaccine is possible and continues to advance HIV vaccine research. The US Agency for International Development (USAID), in addition to funding the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) programs in nearly 100 countries, has also supported HIV vaccine research, as well as the development of microbicides to reduce transmission among women—including a microbicide-based vaginal ring. The US Food and Drug Administration has also played a crucial role in ensuring the availability of HIV treatment and prevention tools for those in need globally. The agency operates a program to facilitate the “tentative approval” of antiretroviral drugs for purchase by PEFPAR programs and recently launched a pilot program with the World Health Organization (WHO) to expedite the review of HIV drug applications through WHO’s prequalification program.The progress we have achieved through sustained whole-of-government investment in HIV research is astounding, but a need for new and improved HIV and AIDS prevention and treatment tools, including a vaccine, remains. As President Trump said, we can end the HIV epidemic—through both the scale-up of existing interventions and continued investment in the development of new tools. Even a cursory glance at the history of HIV and AIDS shows that every new product developed for treatment or prevention has both increased our ambition to end the epidemic and fundamentally altered our approach. We cannot know for certain that the tools we have in hand today are the most effective we will ever have, so our continued commitment to discover the next game-changer must ramp up in tandem with our efforts to expand access to existing interventions.While the President’s pledge to end HIV and AIDS in the US and his acknowledgement of the importance of scientific breakthroughs is encouraging, his past actions have failed to match this rhetoric. In 2017 and 2018, the administration proposed the elimination of HIV and AIDS vaccine and microbicides funding at USAID and deep cuts to NIH and CDC programs that fund HIV research. As the President prepares to release his fiscal year 2020 budget request, we hope it will include the resources necessary to realize the goals of this welcome pledge, including strong funding for the programs which develop and deliver the tools needed to end AIDS domestically and globally. This is an area of historically bipartisan consensus that offers a rare but important chance at this moment of divided government for Congress and the administration to work together to achieve a bold vision: defeating AIDS in America—and beyond.

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. Scientists have discovered the Ebola virus in a Miniopterus inflatus bat in Liberia—marking the first time the virus has been found in a bat in West Africa. Though no human cases of Ebola are linked to this discovery, it is nonetheless a step forward in understanding where human Ebola cases come from—an unanswered question surrounding outbreaks of the virus. Though bats have long been a suspected reservoir for Ebola—meaning the virus can live and grow inside them without harming them—researchers still don’t know what animal or animals carry the virus or how it spreads to people. Notably, the Miniopterus inflatus is an insect-eating bat, whereas most experts say that the natural animal host for Ebola is some type of fruit bat, not one that eats insects. Experts claim more study is required to determine which, if any, bat species are a natural host for the Ebola virus. Researchers are also working to determine whether the virus found in the bat in Liberia is the same exact virus that caused the West Africa Ebola epidemic and the current Ebola outbreak in the Democratic Republic of Congo. Global investment in research and development (R&D) for neglected diseases reached an all-time recorded high in 2017 of US$3.5 billion, a seven percent increase from the previous year, according to the G-FINDER report by Policy Cures Research, which has tracked annual global investment for 11 years. Though the United States remained the largest funder, G-FINDER reported significant increases in funding contributions from other governments—including the United Kingdom, the European Commission, Germany, and India. Notably, despite a record high in funding for neglected disease R&D globally, no country reached the World Health Organization target for member states to spend 0.01 percent of their Gross Domestic Product on research for the health needs of developing countries. A phase 1 human clinical trial has begun for a freeze-dried, temperature stable formulation of a tuberculosis (TB) vaccine candidate. A freeze-dried powder vaccine—which does not require a temperature-controlled transportation system—can be distributed at a lower cost and with reduced logistical burdens, especially in low-resource settings. In this trial, researchers are examining if the vaccine candidate, ID93, and the adjuvant GLA-SE, an immune response-stimulating protein, can be combined into a single vial and remain as effective at inducing an immune response as the previously tested two-vial combination. This recombinant vaccine candidate is being developed as a vaccine that could be administered to people who have already been exposed to TB or those who have received the TB vaccine Bacillus Calmette-Guérin—which is commonly given to babies in TB-endemic regions but does not adequately prevent TB in adolescents or adults. Early stage clinical trials in South Africa and the United States have shown the recombinant vaccine candidate to be immunogenic and safe.