Research Roundup: Antimicrobial resistance research agenda, New DNA HPV test, HIV protein identified

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. Last week, the Bill & Melinda Gates Foundation and Wellcome Trust announced that they will jointly invest more than $500 million in phase 3 trials for the GSK-developed M72/AS01E tuberculosis (TB) vaccine, which could become the first new tuberculosis vaccine in 100 years. 2018 phase 2b trials showed that the vaccine was 50 percent effective, but after GSK pulled out because they did not see a commercial market for the vaccine, the company passed the license to the Bill & Melinda Gates Medical Research Institute in 2020. The phase 3 trials will involve 26,000 people in Africa and Southeast Asia, hopefully confirming the vaccine’s viability as TB cases and deaths rise around the world.A new initiative led by Gavi, the World Health Organization, and the Coalition for Epidemic Preparedness Innovations will work to stockpile experimental vaccines for infectious diseases with epidemic potential to improve preparedness for future outbreaks. This global virtual pooled inventory will initially focus on Marburg and the Sudan strain of Ebola, for which there are no existing vaccines or proven treatments. Last year’s outbreaks in Africa of these two hemorrhagic fevers saw aborted attempts to move forward clinical trials for vaccines, losing crucial opportunities to gather essential data on potential tools and highlighting the need for this kind of stockpiling, preparation, and partnership.The Medicines Patent Pool recently announced sublicensing agreements with seven manufacturers to produce and distribute generic versions of Shionogi’s COVID-19 antiviral treatment in low- and middle-income countries, improving availability and equitable access in these countries, even after the end of the Public Health Emergency of International Concern. The oral antiviral, Ensitrelvir, is currently only approved in Japan, although it is being considered in the United States and all 117 countries in the agreements. Medicines Patent Pool previously signed sublicensing agreements with Pfizer in 2021 to manufacture and distribute its treatment, Paxlovid, in 95 low- and middle-income countries.

2023 has seen a flurry of new and old bills relating to global health and pandemic preparedness introduced in the 118th Congress. To help you navigate them and understand how they could ultimately impact global health research and development (R&D) broadly, GHTC has provided a summary below of key pieces of legislation we are closely tracking. 1. PAHPA  The Pandemics and All-Hazards Preparedness and Advancing Innovation Act (PAHPA), the latest version of legislation authorizing the work of the Biomedical Advanced Research and Development Authority (BARDA) and the Administration for Preparedness and Response (ASPR), is set to expire at the end of this fiscal year on September 30, setting up a process for Congress to develop new authorizing legislation. While Congress could choose to ‘cleanly’ reauthorize this work, essentially extending the prior bill and the work of these entities to a new end date, in the wake of the COVID-19 pandemic, some congressional stakeholders want to consider additional reforms to improve the nation’s health preparedness. GHTC has put forward a series of recommendations to influence this forthcoming legislation, including a recommendation to establish and authorize a specific division within BARDA devoted to the development of medical countermeasures (MCMs) for emerging infectious diseases (EIDs), alongside other policy changes to enhance programming for EIDs, antimicrobial resistance, and pandemic influenza and to ensure tools developed by BARDA are fit-for-purpose for use in low-resource settings. As this bill progresses in development, it could become what many in Washington, DC call a “Christmas tree” vehicle, meaning some of the proposed bills below related to pandemic preparedness could ultimately find themselves incorporated into the bill before its passage.  2. End TB Now Act The End Tuberculosis Now Act of 2023 seeks to advance and modernize US engagement in the global fight to end tuberculosis (TB) by improving US and international coordination on research, prevention, diagnosis, and treatment. Specifically, the legislation mandates the US government to update its TB strategies to reflect the latest scientific advances and to align with the World Health Organization’s TB strategy, as well as requires annual reports to Congress on TB assistance activities and technology development and calls for more robust coordination with global bodies and among US agencies, in doing so reinforcing USAID’s mandate to conduct TB R&D. GHTC provided input to and endorsed the legislation, which dates back to the 117th and 116th Congresses and was reintroduced earlier this year in the Senate, by Senators Bob Menendez (D-NJ) and Todd Young (R-IN), and in the House, by Reps. Ami Bera (D-CA) and María Elvira Salazar (R-FL).  3. Disease X ActThe Disease X Act of 2023, introduced earlier this month by Reps. Lori Trahan (D-MA), Michael Burgess (R-TX), Dan Crenshaw (R-TX), and Susie Lee (D-NV), endeavors to improve US preparedness for future pandemics by establishing a program at BARDA to advance MCMs for unknown viral threats, colloquially called “Disease X.” The legislation, which GHTC has endorsed, directs BARDA to accelerate the research, development, and procurement of tools that are designed to address viral families with pandemic potential. While BARDA has in the past played a key role in advancing MCMs for health emergencies, including Ebola, Zika, and COVID-19, financial support for this work has largely come through reactive emergency supplemental funding bills once the crisis has begun, and surprisingly, the agency does not currently have a distinct program or division focused on proactively advancing tools for EIDs, either known and unknown, an oversight this bill could help rectify.4. SUPER BUGS Act The Savings Us from Pandemic Era Resistance by Building a Unified Global Strategy (SUPER BUGS) Act of 2023, which GHTC has also endorsed, would require the US government to develop a strategy to coordinate with multilateral organizations and other countries on the development and commercialization of new antimicrobials and other products to fight antimicrobial-resistant pathogens, or “superbugs.” Introduced in the House in March by Reps. Drew Ferguson (R-GA), James McGovern (D-MA), and Mark Amodei (R-NV), the bill seeks to apply lessons learned from COVID-19 about the need for international cooperation and partnership in R&D.  5. FIGDA  The Fostering Innovation in Global Development Act (FIGDA) of 2023 aspires to support and further innovative and evidence-based approaches in foreign assistance. First introduced in the 117th Congress and reintroduced this past April in the House by Reps. Joaquin Castro (D-TX) and Young Kim (R-CA), FIGDA would see USAID establish or participate in three programs—Development Innovation Ventures, the Global Innovation Fund, and a new Proven Solutions program—that are focused on applying nimble, venture-capital style approaches to finance the scale-up of interventions with good evidentiary backing. Additionally, it would establish several new innovation-focused roles, including a chief innovation officer, senior adviser for innovation, and innovation fellows throughout the agency, as well as expand the use of certain contracting instruments that tie funding to performance. While the legislation covers foreign aid broadly, GHTC has endorsed this legislation, which broadly aligns with our proposal calling for the creation of a Supporting Innovative Global Health Technologies Fund, or SIGHT Fund, at USAID to bolster the agency’s health innovation activities.  6. Reach Act The Reach Every Mother and Child Act of 2023 was introduced on May 10 in the Senate by Sens. Susan Collins (R-ME), Chris Coons (D-DE), Dick Durbin (D-IL), and Roger Wicker (R-MS). The legislation aims to support and increase resources for US maternal, newborn, and child health and nutrition programs. Specifically, Reach would implement a new strategy, establish a coordinator at USAID, and require detailed public reporting, all to ensure coordination and efficiency across US agencies with a focus on high-impact, evidence-based interventions; greater transparency and accountability; and greater country and community ownership. GHTC supports the legislation because it includes innovation, specifically mentioning the development and scale-up of new technologies and approaches as one part of strengthening support for maternal, newborn, and child health and nutrition following backsliding in progress due to the COVID-19 pandemic.  7. PASTEUR Act The Pioneering Antibiotic Subscriptions To End Up surging Resistance (PASTEUR) Act of 2023 would establish a subscription-style model that would offer antibiotic developers an upfront payment from the US government in exchange for ensuring the US health care system has access to their products when they emerge from the pipeline. Endorsed by GHTC, PASTEUR represents an approach to incentivizing private-sector innovation of novel antibiotics in response to the growing threat of antimicrobial resistance. First introduced in the 117th Congress, the bill was reintroduced by Rep. Drew Ferguson (R-GA) in the House and Sen. Michael Bennet (D-CO) in the Senate in April. 8. VALID Act The Verifying Accurate, Leading-edge IVCT Development Act of 2023 aims to reform and modernize regulatory oversight for diagnostic testing. Specifically, the legislation would give the US Food and Drug Administration the power to regulate certain laboratory-developed tests (LDTs), now overseen by the Centers for Medicare and Medicaid Services, by reclassifying them as in vitro clinical tests (IVCTs) and placing them under a single regulatory framework with in vitro diagnostics. While GHTC has not taken a position on the legislation, proponents say the bill will help ensure the safety and effectiveness of LDTs, which have traditionally been developed and performed by single laboratories but are increasingly being broadly marketed, while opponents argue it could impose additional costs and regulations to smaller academic, clinical, and hospital labs that could impede innovation and slow or halt lifesaving research. First introduced in 2018 during the 115th Congress, the bill was introduced in March in the House by Reps. Larry Bucshon (R-IN) and Diana DeGette (D-CO).  9. DTPP Act The Diagnostic Testing Preparedness Plan (DTPP) Act seeks to facilitate coordination between the public and private sectors to speed the development of diagnostics during public health emergencies. Newly introduced in the House by Representatives Greg Pence (R-IN), Larry Bucshon (R-IN-6), Andre Carson (D-IN-7), and Kim Schrier (D-WA-8), the bill requires the Department of Health and Human Services via ASPR to develop a cross-government plan to support the rapid research, development, approval, scaling, procurement, and distribution of diagnostics during public health emergencies. ASPR would also be required to update the plan every three years and submit an after-action assessment following any activation during a public health emergency.  10. BIO Early Warning Act Reps. Dan Crenshaw (R-TX) and Scott Peters (D-CA) recently released a discussion draft for a proposed piece of legislation called the Biosecurity Infrastructure for Operation (BIO) Early Warning Act, which aims to reorient public health situational awareness and disease detection as issues of national security and create better early-warning systems. The bill includes measures to improve coordination and streamline disease detection programs across different government agencies; gives ASPR new authorities and responsibilities to oversee and provide early warning of impending disease threats; and requires the US government to stockpile technologies necessary for the safe collection, storage, and transportation of biological hazards during an emergency. Opponents are concerned that as originally proposed, the bill would shift bio-surveillance and other core surveillance and outbreak investigation programs that currently sit in the Centers for Disease Control and Prevention to ASPR.  While some of these bills may pass this Congress and others will be unable to garner enough support, it is certainly exciting to see so much congressional energy around improving global health R&D-relevant activities, particularly in the wake of the COVID-19 pandemic. GHTC will continue to track these bills as well as forthcoming legislation, so stay tuned to our channels for more updates.