Breakthroughs Blog: WHO

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week.Two male health workers on a motorcycle carrying a vaccine carrier and supplies, pulling up in front of a building where women and children are waiting. (PATH/Doune Porter)A breakthrough leprosy vaccine candidate will soon enter a Phase I clinical trial. The vaccine—LepVax—is the first vaccine specifically developed for leprosy, marking a critical step forward in efforts to eradicate the disease. Leprosy is a painful bacterial disease that causes nerve damage, skin disfiguration, and issues with mucous membranes. While treatment options exist, there are many side effects, and these treatments are not capable of reversing the permanent skin and nerve damage. Early results from the trial should be available in 2018. A massive cholera immunization campaign recently launched near the border of Bangladesh in an effort to provide emergency immunizations to host families and displaced Rohingya families and children. Over 200 mobile vaccination teams delivered 900,000 cholera vaccines to the border regions currently affected by both a cholera outbreak and a refugee crisis. A main target of the campaign is children ages one to five, though individuals of all ages will receive vaccines. This immunization campaign follows a recent global pledge to end cholera by 2030. Results from a clinical trial launched in 2015 at the end of Liberia’s Ebola outbreak have demonstrated that two Ebola vaccine candidates are safe and effective in promoting an immune response. The first vaccine—ChAd3—developed by the National Institute of Allergy and Infectious Diseases and GlaxoSmithKline, resulted in an immune response in 64 percent of recipients one year-post vaccination, while the second vaccine—VSV-EBOV—developed by Merck and Canadian scientists resulted in an immune response in 80 percent of recipients at the one-year mark. These results will help inform continued development of both vaccines.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. A new study suggests the Nanopatch vaccine delivery system is more efficacious in protecting against poliovirus than typical syringes or needles. Nanopatch, defined as “a microscopic vaccine delivery platform,” targets immune cells in the outer layers of the skin, as opposed to typical syringes and needles, requiring injection into the muscle. The change from muscle to immune cells results in easier administration of the vaccine as well as a reduction in the required dosage. While initial data on Nanopatch is promising, more research is needed. The World Health Organization has warned that an increase in antibiotic use in livestock will result in increased antibiotic resistance humans, potentially causing one of the biggest threats to human health. The agricultural sectors in both Europe and North America are advancing efforts to curb antibiotic use, but many countries are still lagging behind in efforts to scale back use of antibiotics. While new policies and reform around livestock antibiotic use are needed, experts note there is still a need to treat health complications in livestock, through antibiotic alternatives like animal vaccines, as well as a need for improved diagnostics. The World Health Organization, numerous aid agencies, and relevant stakeholders have announced the first global pledge to end cholera by 2030, following one of the worst outbreaks of cholera in modern history. Cholera is considered a “disease of the poor,” affecting individuals living in areas with poor sanitary and water conditions. The recent outbreak is associated with and exacerbated by weak health systems, poor infrastructure, and a lack of necessary supplies to prevent, diagnose, or treat cholera. The pledge will focus on a multifaceted approach involving improving water and sanitation as a long-term solution and use of an oral, three-year cholera vaccine to provide immediate protection.

The 72nd session of the United Nations General Assembly (UNGA) featured a number of firsts: It was the first UNGA for new United Nations (UN) Secretary-General António Guterres, as well as the first for recently elected World Health Organization (WHO) Director-General (DG) Dr. Tedros Adhanom Ghebreyesus. Both used this annual gathering of world leaders to solidify their signature issues in a public forum. DG Ghebreyesus’ signature issue was achieving universal health coverage (UHC), in which all people can access a basic standard of necessary health care without being driven into poverty. DG Ghebreyesus publicly stated at multiple events and in numerous tweets that he views achieving UHC as a political decision to support human rights. Research and development (R&D) and innovations in health care are a vital part of any agenda to achieve UHC. At a US Pharmacopeia event, President Ameenah Gurib of Mauritius discussed drug development as not only a key economic driver in her country, but also as a core part of achieving UHC. South African Minister of Health, Minister Aaron Motsoaledi, speaking at a Stop TB Partnership reception, stated that the fight against tuberculosis (TB) would never be won without accelerated investments in R&D to advance the next generation of tools needed to make treatment more effective. “Research and development (R&D) and innovations in health care are a vital part of any agenda to achieve UHC.” Using the example of TB, it is easy to see that the prospect of achieving overall UHC is dependent on innovations that will increase efficiency and drive down costs. Current analyses indicate that countries would need to spend an average of about 5 percent of their gross domestic product to achieve UHC—a goal that, for many nations, is “aspirational in the short term.” Multi-drug resistant TB (MDR-TB), which typically takes two years or longer to treat, can exact an enormous burden on a country’s financial resources. For example, data from the United States shows that MDR-TB is at least US$100,000 more expensive to treat than standard TB, with an estimated $134,000 spent treating every MDR-TB patient compared to $17,000 for regular TB treatment. Imagine if a new drug regimen could reduce treatment time to under a year. The savings in both human suffering and resources within the health system would be enormous. Fortunately, MDR-TB treatments in development today hold promise to offer faster, simpler, and more affordable solutions. “…It is easy to see that the prospect of achieving UHC overall is dependent on innovations that will increase efficiency and drive down costs.” Beyond the hugely positive impact of new technologies within health systems, global health R&D has other wide-reaching, positive externalities. To explore these, GHTC convened a panel discussion with Dr. Peter Singer of Grand Challenges Canada, Bumpei Tamamura of the GHIT Fund, and Jan-Willem Scheijgrond of Philips. Each of the panelists noted a variety of reasons their organizations view investments in global health R&D as not only the right thing to do, but also as good business. From the perspective of a government-supported innovation agency, Dr. Singer noted that through its investment in global health R&D, Grand Challenges Canada has achieved phenomenal bang for its buck. The agency has supported over 800 innovations with an investment of roughly $200 million. Further, two-thirds of this investment goes directly into low- and middle-income countries (LMICs), where it not only supports technological development, but also builds the human capital and innovation economy that will allow these countries to achieve long-term prosperity. Bumpei Tamamura highlighted how fostering multi-sector, multi-country partnerships can advance a nation’s health technology sector. Supported by both the Japanese government and Japanese pharmaceutical and technology companies, the GHIT Fund views its role as creating the incentives to support partnerships between Japanese companies and their global counterparts to leverage respective strengths. Noting the Fund’s success in supporting product development, Mr. Tamamura explained that the Fund is now looking to expand its portfolio of partnerships into manufacturing and distribution, potentially with developing country counterparts. From Philips’ perspective, Jan-Willem Scheijgrond explained investing in global health R&D is not about charity—it is about good business. He noted that Philips operates under a corporate mandate to improve the lives of 3 billion people worldwide, but can only reach half of those people through operations in developed markets like Europe and the United States. “We need to stop seeing health care as a cost, and instead see it as an investment,” he stressed. For Philips, investing in technologies to serve LMICs is part of meeting its core mandate. By investing in health for low-income groups, Philips helps improve health, create jobs, and lift families out of poverty while simultaneously building a new customer base for other products, especially as income levels rise. This can help build a virtuous cycle for both the public and the company, Scheijgrond explained. “Investing in global health R&D is not about charity—it is about good business.” Ultimately, global health R&D is vital not only to health, but also to achieving overall development in economic and social contexts. It improves the efficiency of health systems, allowing countries to move more quickly toward UHC. It creates jobs and generates economic impact across the world, raising incomes and lifting families out of poverty. It also creates bridges between industry in LMICs and global leaders, setting up the conditions for LMIC entrepreneurs to take their place on the global business stage. When asked to sum up the value of investing in global health R&D, Dr. Singer encapsulated it best: “You can reach your own goals that you’ve set for your own people, working with your own people, better, faster, and cheaper.” “[By investing in global health R&D] you can reach your own goals that you’ve set for your own people, working with your own people, better, faster, and cheaper.” For an UNGA session not explicitly focused on global health, the GHTC secretariat was pleased to see UHC—and the role global health R&D plays in contributing to UHC—recognized so prominently in the multi-stakeholder dialogues. We are looking forward to maintaining this momentum heading into the upcoming WHO Executive Board meeting, where a number of critical issues are on the agenda.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The World Health Organization (WHO) and UNICEF have reported nearly 1 in 10 children did not receive any immunizations in 2016. This includes immunizations for diphtheria-tetanus-pertussis (DTP). WHO and UNICEF reported that the global immunization rate for the full round of the DTP vaccine is only 86 percent, falling short of the 90 percent goal of global immunization. Furthermore, in 2016, eight countries had DTP immunization rates of less than 50 percent. Estimates by WHO and UNICEF suggest that 10 million more children in 64 countries need to be vaccinated every year in order to achieve the 90 percent goal. This highlights the need to bring vaccines to low-resource settings that have been chronically affected by low immunization rates. A new study published in Proceedings of the National Academy of Sciences highlights a new diagnostic tool that performed well in distinguishing Zika from other flaviviruses, including dengue. UC Berkeley and Humabs BioMed partnered to create a low-cost, easy-to-use diagnostic tool to specifically test for the Zika virus. Researchers found this tool was capable of distinguishing between Zika and other flaviviruses, as well as distinguishing current and past Zika infections in patients. The tool had 91.8 percent sensitivity—the ability to correctly identify those with the disease—and 95.9 percent specificity—the ability to correctly identify those without the disease. This tool could be used in Zika- and dengue-endemic areas, assisting in diagnostic processes and subsequent treatment, especially among populations adversely affected by Zika, like pregnant women. For the first time in history, more than half of all HIV-infected individuals are receiving treatment. In 2016, it was estimated that 19.5 million individuals were receiving HIV treatment, with a total of 36.7 million people infected with HIV. These estimates are both increases from the estimated 17.1 million treated and 36.1 infected in 2015. Further, AIDS-related deaths have decreased by more than half since 2005. Though these rates are promising in the fight against the global epidemic, the United Nations (UN) acknowledges that there is much left to do in the fight against HIV and AIDS, particularly in the context of less stable health systems in resource poor settings.