Research Roundup: Global immunization, Zika diagnostics, and an HIV treatment milestone

On July 8, G20 leaders committedto work together to combat the rise of antimicrobial resistance (AMR) and potentially pandemic diseases. This includes efforts to foster research and development (R&D) through cooperative initiatives, including a new collaboration hub for AMR R&D. This is a welcomed step forward by G20 leaders, and marks the first time R&D for global health has been featured as part of the G20 declaration. The inclusion of R&D commitments came about as the result of a sustained advocacy campaign by GHTC and our partners, including open letters, calls to action, a roundtable expert discussion event, and direct outreach to policymakers. Why does the G20 matter? The G20 is a leading forum for international coordination on a range of global challenges impacting economic growth and development. In representing the world’s 20 largest economies, it represents nearly two-thirds of the global population. While many world leaders have expressed concerns about global health crises and the rise of AMR, there was no certainty global health—much less health R&D—would be prioritized among tough debates on other pressing global challenges—including climate change, trade, the Syrian conflict, and migration. What was the win for health R&D? In its declaration, the G20 recognized the critical role of R&D in improving pandemic preparedness, tackling priority pathogens, and combatting AMR. It also pledged support for coordinated research initiatives, including existing structures like the World Health Organization (WHO) R&D Blueprint and the Coalition for Epidemic Preparedness Innovation—focused on preventing epidemics—as well as called for a new “R&D Collaboration Hub” for AMR research. The G20 declaration represents a statement of political will to move those initiatives forward, which is an exciting achievement for the global health R&D community. Firstly, support for WHO’s R&D Blueprint is a very welcomed development. The Blueprint lays out a global strategy to ensure the world is prepared to rapidly mobilize R&D activities and resources in response to an outbreak. The goal is to ensure that necessary technologies are available sooner to save lives and avert a large-scale crisis. In the wake of the West African Ebola outbreak—and as the world faces other threats like Zika—ensuring R&D resources and structures are in place to respond to outbreaks quickly is common sense, and GHTC welcomes the G20’s commitment to supporting it. Secondly, in calling for an international collaboration hub for AMR R&D, the G20 takes work that has been stalled by WHO and moves it in a more ambitious direction. As an outcome of the long-running Consultative Expert Working Group on R&D: Financing and Coordination process, WHO established a Global Observatory on Health R&Dto facilitate R&D coordination and prioritization. However, at the last World Health Assembly, WHO announced it will not proceed any further in expanding the observatory without additional funding. With G20 leaders not only committing to R&D coordination and collaboration—which is the goal of the observatory—but also committing to a concrete mechanism and fostering support for that mechanism, they have embraced the goals of the observatory as they relate to AMR. Showing the clear impact that this type of collaborative mechanism has in one area of R&D will greatly strengthen the drive for a global mechanism. That is a very exciting prospect for the continuation of this important work. Why is R&D a priority for the G20 now? Health crises are not simply a challenge for low- and middle-income countries: They increasingly affect the world’s leading economies as well. The rise of AMR not only heightens the threat of untreatable malaria in Africa, but also impacts hospital patients in Europe who could face incurable infections following surgeries. Given that the next disease outbreak could be a single plane flight away from becoming a global pandemic, R&D is vital to ensure we have the tools to respond quickly in all countries. It’s estimated that large-scale disease pandemics could cost the global economy more than US$60 billion per year, while an R&D investment of $1 billion per years could deliver the tools needed to protect against outbreaks. What’s next? Overall, although the G20 focused on R&D through the lenses of AMR and health security—which addresses only a portion of the health challenges for which new tools are needed—the declaration is a very good sign that the global health R&D community is making an effective argument about the need for health R&D to be viewed as a critical aspect of broader global discussions on development, trade, economic growth, and security. It is now imperative that G20 leaders follow through on commitments made at the summit and turn words in a declaration into concrete action, marshaling new resources and stronger incentive, and financing mechanisms to spur critically-needed R&D to unlock the cures and treatments of tomorrow.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. In response to a 2004 meningitis B epidemic in New Zealand, health clinics across the country offered free vaccinations over the course of two years for any individual under the age of 20. The vaccine, MeNZB, is used primarily to protect against meningitis B, but according to ecological data in Cuba, New Zealand, and Norway, the vaccine also appears to be associated with reduced rates of gonorrhea. To study this further, researchers took retrospective data from 11 health clinics across New Zealand, and compared rates of gonorrhea and chlamydia, analyzing the relationship between vaccination and infection rates. The researchers found that vaccinated individuals were significantly less likely to contract gonorrhea than their unvaccinated counterparts—but vaccine effectiveness rates fell for those co-infected with chlamydia. While this vaccine was only on the market from 2004–2006, these results suggest further study of the vaccine’s potential is warranted, especially as gonorrhea becomes increasingly resistant to first-line drugs. The path toward the elimination of measles, mumps, and rubella has been stymied by low vaccination rates in certain areas of the world, including in developed countries like Italy, Romania, Germany, and the United States. The surge in incidence and deaths from these diseases in developed areas of the world suggests there are pockets of low-immunized communities that are leaving thousands of neighboring children in danger of contracting these diseases. The debunked belief that vaccines cause autism has also contributed to this decline in immunization rates. The recent Ebola outbreak in the Democratic Republic of the Congo (DRC) helped the global health community understand the many complex, moving parts to contain an outbreak. While the DRC beat this particular outbreak in a short period of time, the global health community is still worried that this was merely an exception and the international community is still not equipped with the systems needed to deal with a complex, intercontinental pandemic. The outbreak happened in an incredibly remote area of the DRC, which limited the spread of the virus. While the response by the government and the World Health Organization was quick and effective, it is important to consider that outbreaks that occur in or closer to larger towns could pose a much greater threat and complicate the response. Another important factor in managing an outbreak like Ebola is the political health of a nation. Countries like Sierra Leone and Liberia, both heavily impacted by the 2014 outbreak, have been institutionally weakened by recent civil wars, leaving them more susceptible to large-scale and more deadly outbreaks.