Research Roundup: leadership at USAID, investments in global health research at US universities, and measuring the impact of open innovation

Trying to navigate and understand the post-2015 negotiations can be a challenge, so to help add some clarity, last week the Global Health Technologies Coalition (GHTC) convened a panel of experts to help explain the ongoing debates and where the negotiations stand and how health innovation is reflected in the agenda.Here are my seven takeaways from that discussion.1. There are still a lot of TBDsSix essential elements of the SDGs. Credit: UNAlthough we’re only five months away from September 2015 when the Sustainable Development Goals (SDGs) will be approved by United Nation (UN) member states, there is still much to be determined and worked out. While it’s expected that the goals and targets will look similar to those proposed by the Open Working Group (OWG)with some refinement of the targets, the process for determining the indicators has just begun and will likely continue through March 2016.While member states work to finalize the goals, targets, and indicators, countries are also discussing financing and means of implementation for the agenda and how to build an effective monitoring and accountability framework.2. The proposed SDG framework is comprehensive in a way the MDGs were notThe process for determining the SDGs was much more inclusive and consultative than the process for determining the Millennium Development Goals (MDGs). There were a range of opportunities for all member states, civil society representatives, nongovernmental organizations, other stakeholders, and even individuals to have their ideas and voice heard. The result is a proposed agenda that is much more comprehensive (and bigger) than the MDGs (17 goals and 169 targets in SDGs, compared to 8 goals and 21 targets in MDGs).This inclusive process has also produced an agenda that is supposed to be universal and apply to all nations, representing a major conceptual shift. Broadly speaking, the MDGs were 7 goals focused on low- and middle-income countries (LMICs) implementing changes and an 8th goal focused on high-income countries (HICs) footing the bill. The SDGs are meant to be universal with all nations collectively responsible for their implementation and success. However, given that some nations have more capacity and means to contribute to implementation and some targets and indicators are more applicable to certain categories of nations, it’s not clear how this concept will actually be translated into action.3. The agenda will succeed or fail based on the strengths of implementationGetting the global community to agree on a set of development goals is only half the battle. Once the agenda is codified, it will be up to each nation to develop and implement policies that will help the agenda be financed and realized. Individual countries will have to find ways to take national priorities already set out for their country and ensure they can feed into the process and drive progress towards the goals. Central to the success of implementing the agenda will be having clear targets and strong indicators to measure progress towards them.4. How the world will pay for the agenda is an open questionPhoto: PATH/Gabe BienczyckiOne of the most daunting questions for the post-2015 agenda is how this expansive and ambitious agenda will be financed. Along with the process of defining the SDGs, there is a secondary track and set of intergovernmental negotiations looking at how to finance development through the Third International Conference on Financing for Development (FfD) in July. A schism has arisen between LMICs and HICs on how the FfD process integrates with the post-2015 process. Many HICs would like to see the FfD process focused on the means of implementation for the SDGs and see the outcomes integrated into the post-2015 agenda, while many LMICs would like it to remain a separate process.Given the universality of this agenda, one should expect financing discussions to look beyond traditional development assistance. Discussions will center on not just how much funding is needed to achieve the agenda, but also on how those funding flows should look different in the future than they do today including how traditional donor recipient nations, especially middle-income countries, can increase their own domestic contributions to development and how the public sector can work together with the private sector to catalyze private-sector investment and financing for development.5. Measuring and monitoring progress towards the SDGs will be an enormous challengeIn the MDGs, there were 50 indicators created to measure the 8 goals and 21 targets. Applying the same ratio, it would take an estimated 480 indicators to measure the 17 goals and 169 targets of the SDGs. Even if negotiators rely on crosscutting indicators that can measure multiple targets and manage to pare down the list to around 100, it will still be enormously difficult and costly for the national statistics agencies to monitor and measure. It’s not currently clear how this will be financed or carried out. Yet getting the monitoring and measuring right will be essential. To get where we want to be by 2030, the world will need to make sure we’re on the right track and meeting our commitments by 2020, but determining if we’re on the right track will require an effective monitoring and reporting framework.6. Health innovation is critical to achieving the SDGs but is not strongly reflected in the agendaPhoto: PATH/Patrick McKernImproving global health will be essential to achieve the overarching goal of sustainable economic development and poverty reduction. However, achieving many of the current SDG health targets—including ending the epidemic of HIV and AIDS, tuberculosis, and malaria; ending preventable deaths in children and newborns; and significantly reducing the number of women dying in childbirth—will be impossible without new tools and technologies. Yet the development of these new technologies will not happen automatically. Thus, it’s essential that the post-2015 agenda prioritize and acknowledge the importance of global health research and development (R&D).Unfortunately, as it stands, the OWG proposal only includes one specific target related to R&D of new health technologies to meet the health needs of developing countries—target 3.b—and some soft targets related to R&D and innovation under goals 9 and 17. Further, various proposals for indicators either ignore the 3.b health R&D target entirely, focus only on the access element of it, or propose a voluntary indicator to measure it. To achieve health for all at all ages by 2030, we’ll need to make sure the SDGs include feasible and appropriate indicators to measure progress on global health R&D at both the global and national levels.7. It’s on all of us to make sure the vision of the SDGs can become a realityWe all own this agenda, and we all have a role to play in implementing it. We must work to hold our national governments accountable for their commitments and also ask ourselves what we can do as individuals to make this vision a reality. What’s clear is business as usual won’t cut it. We must ask each sector and ourselves what we can do differently this time around to achieve the vision of the SDGs.To watch the full panel discussion and webinar on health innovation in the post-2015 agenda, click here.

Scientists at the London School of Hygiene and Tropical Medicine have identified a mutation in Plasmodium falciparum—the parasite responsible for the majority of fatal cases of malaria—that makes the parasite more resistant to quinine and artemisinin, the leading antimalarials worldwide. The mutation was discovered in Kenya in 2013, where children were reported to still have the parasite in their blood after being treated for malaria. The mutation, found in the ap2mu gene, makes the parasite 42 and 32 percent more resistant to quinine and artemisinin, respectively. Congresswoman Martha McSally (R-AZ), Chairman of the House Committee on Homeland Security’s Subcommittee on Emergency Preparedness, Response, and Communications, called on the White House to name a “single coordinator for agencies responsible for responding” to public health crises or bioterrorist attacks in a recent hearing. Former Senator Jim Talent testified before the subcommittee, asserting that the Biomedical Advanced Research and Development Authority has been “chronically underfunded” and that a key lesson learned from the Ebola outbreak is that “it is too late to develop countermeasures after an outbreak or attack has happened.” The co-chairs of the Alliance for Biosecurity echoed this message in an op-ed published in The Hill last week. The authors, who serve as presidents of biotechnology companies Bavarian Nordic and Elusys Therapeutics, call for increased funding for biomedical research and development (R&D), specifically, consistent and multi-year investments in public-private partnerships. Stephen Ostroff, acting commissioner of the US Food and Drug Administration (FDA), does not have any major changes planned for the agency, and will continue former commissioner Margaret Hamburg's efforts to regulate tobacco products and enhance food safety. Dr. Ostroff also stated that the FDA is currently consulting the House Energy & Commerce Committee on the draft of the 21st Century Cures Act. During her final speech as commissioner, Hamburg expressed concern that the legislation could weaken the FDA’s rigorous drug approval process, leading to inefficient or even unsafe products on the market. Newt Gingrich, former United States representative (R-GA), called on Congress to double the National Institutes for Health (NIH) budget in an op-ed in the New York Times last week. Gingrich notes that 92 percent of NIH’s funding goes directly to research and that despite a 50 percent increase in grant applications, funding has either stagnated or declined each year since 2003. Gingrich asserts that “health is both a moral and financial issue” and that support for the NIH should be bipartisan. He admits that he is not usually a keen proponent of increased government spending, but that the government has a “unique” role to play in its ability to mobilize resources and due to the long-term health care savings realized by investing in research for treatments and cures.