Breakthroughs Blog: Child health

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. This month at the Saving Lives at Birth: A Grand Challenge for Development’s DevelopmentXChange event in Washington, DC, bright minds from all over the world came together to display groundbreaking prevention and treatment approaches for pregnant women and newborns in low- and middle-income countries. The event also offered an opportunity for policymakers and decision makers to talk about the importance of science, research, and innovation for global health. During last week’s US-Africa Leaders Summit, the White House released a fact sheet on American and African cooperation for global health. As the world’s largest donor to global health, the United States is committed to working with African governments to improve the health of its citizens—including achieving an AIDS-free generation, ending preventable maternal and child deaths, enhancing global health security, and supporting African countries invest in the health of its own citizens. The World Health Organization said it thinks an Ebola vaccine should be ready for public use by 2015. There is currently no vaccine or cure for Ebola, which is currently widespread in parts of West Africa and has killed over 900 people since March of this year. This year’s outbreak is the biggest ever reported since Ebola was discovered over 40 years ago. In the Huffington Post’s blog, Dr. Jonathan Mermin—director of the Center for Disease Control and Prevention’s National Center for HIV and AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis (TB) Prevention—writes about the desperate need for new tools to prevent, detect, and treat TB and that “until we have better ways of detecting and treating TB, thousands of Americans and millions of people worldwide will continue to suffer from an illness that should have been consigned to history long ago.” An experimental vaccine to prevent dengue could be commercially available by July 2015, according to the vaccine’s makers—pharmaceutical company Sanofi Pasteur. There is currently no vaccine to prevent this mosquito-borne disease that affects thousands of people—mainly in low- and middle-income countries—every year.

“Innovation can’t take place if people say we don’t need new tools,” said Partners in Health Co-founder Paul Farmer at an event sponsored by the Saving Lives at Birth: A Grand Challenge for Development program last week in Washington, DC. And new tools were certainly on display at DevelopmentXChange 2014—a key component of the Saving Lives at Birth program. The DevelopmentXChange is an opportunity for hundreds of bright minds to come together and display groundbreaking prevention and treatment approaches for pregnant women and newborns in low- and middle-income countries. The event is also a time for key policymakers and decision makers to talk about the importance of science, research, and innovation for global health. Saving Lives at Birth—a partnership between the US Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the Government of Norway, Grand Challenges Canada, and the UK Department for International Development—provides funding for a select group of finalists that offer the most innovative new tools. Large crowds were spotted at the DevelopmentXChange Marketplace the morning of the event. The DevelopmentXChange opened up with a marketplace where finalists of the Saving Lives at Birth challenge could display their innovations and demonstrate how these new tools could make a difference in the lives of mothers and children in low-resourced settings. Imagine a giant science fair where, instead of competing for a blue ribbon, the participants are competing for funding to make their innovation a reality. On display were several proposed innovations from GHTC members FHI 360, Jhpiego, and PATH. FHI 360 proposed a synchronized schedule for postpartum women to receive family planning services and for their newborns to receive immunizations and growth monitoring all at the same time. One of the innovations Jhpiego developed was the E-Partogram—an affordable, easy-to-use handheld electronic decision-making tool for preventing and managing complications during labor. PATH was one of many other organizations to address postpartum hemorrhage by developing heat-stabilized oxytocin—a common treatment for hemorrhaging women after childbirth—in a fast-dissolving oral tablet that would treat postpartum hemorrhage.   USAID Administrator Raj Shah addresses the crowd at the DevelopmentXChange Forum After the marketplace, policymakers, scientists, members of the global health community, and the Saving Lives at Birth finalists gathered together for the DevelopmentXChange Forum, which included opening remarks from USAID Deputy Assistant Administrator for Global Health Katie Taylor, USAID Administrator Raj Shah, and Paul Farmer. Administrator Shah commended many of the past year’s innovations for making a real difference in the lives of women and children, and commented on how the Saving Lives at Birth program influenced the creation of USAID’s new Global Development Lab. The rest of the forum featured innovators from all over the world, including past Saving Lives at Birth challenge winners. One of the innovations featured at the forum was a new, low-cost device that assists in delivering babies when complications occur in the second stage of labor. The device—called the Odon Device—was originally thought of by an Argentine mechanic named Jorge Odon when he was thinking about how to get a cork out of a bottle one night. The Odon device is made of a film-like polyethylene material and could be a safer and easier way to deliver complicated births rather than using than forceps or a vacuum extractor. After Mr. Odon partnered with Becton, Dickinson and Company, and received funding from Saving Lives at Birth at last year’s DevelopmentXChange, the Odon Device was finally ready for full development. Now the device is being tested in clinical trials and—if approved—has the potential for wide application in resource poor settings. If there was one thing very apparent during the day, it was that great, life-saving ideas can come from anyone—no matter what they do or where they live. Saving Lives at Birth is a good example of a mechanism that brings governments, foundations, and for-profit companies together to encourage creativity and innovation to tackle some of the world’s most pressing problems. The day concluded with Wendy Taylor—director of USAID’s Center for Accelerating Innovation and Impact—announcing the winners of the Saving Lives at Birth challenge. GHTC members PATH and FHI 360 both won seed grants to get their ideas up and running so that one day they could have the potential to protect and improve the lives of mothers and children all over the world. GHTC congratulates all of the challenge winners and is inspired by every single one of the innovators who were at this year’s DevelopmentXChange.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The Senate Appropriations Labor and Health and Human Services (LHHS) Subcommittee released its fiscal year 2015 appropriations legislation, after a lengthy internal debate on domestic health concerns. The legislation is—for the most part—good news for funding levels and policy issues for several key global health research programs at the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), and the Office of Global Affairs at the Department of Health and Human Services. Since its discovery nearly 40 years ago, we have learned a lot about Ebola. Yet there are still no effective treatments or vaccines to protect people against this deadly disease. According to an article in Vox, this is not because of “a lack of human ingenuity or scientific capacity,” but rather due to a global innovation system that does not prioritize the health research needs of world’s poorest populations. Drs. S. Patrick Kachur, MD, MPH, FACPM—chief of the Malaria Branch in the Division of Parasitic Diseases and Malaria at CDC’s Center for Global Health—and Larry Slutsker, MD, MPH—director of the Division of Parasitic Diseases and Malaria at CDC’s Center for Global Health— write in Breakthroughs about the emerging global security threat of anti-malaria drug resistance and CDC’s efforts to prevent, detect, and respond to this growing threat. They write: “…to sustain momentum and move toward elimination of malaria, new tools and technologies will be required.” Despite progress made to prevent maternal and child deaths by the United Nations’ Millennium Development Goals (MDGs), still too many mothers and children are compromised or killed by preventable diseases. PATH President and CEO Steve Davis writes for Devex about the need to take advantage of the progress made thus far by the MDGs and accelerate innovation to meet the health needs of millions of people in low- and middle-income countries. It’s World Breastfeeding Week (August 1-7) and as breastfeeding has served as the primary method for a mother to feed her infant since the dawn of humanity, we wonder if this could be a way for a mother to administer life-saving medicines to her baby? According to a group of researchers in the United States and United Kingdom, the answer is yes. Two recent promising developments in the fight against malaria were announced last week. Malaria is one of the leading killers of women and children in the world, and in sub-Saharan Africa particularly—where 90 percent of the more than 620,000 annual malaria deaths occur—new tools to fight the disease are desperately needed.

Tomorrow US policymakers and global health advocates will come together to talk progress made on preventing maternal and child deaths. During the day, the US Agency for International Development (USAID) will host a high-level forum called Acting on the Call: Ending Preventable Child and Maternal Deaths to both celebrate progress and assess the challenges that remain. That evening, the 5th Birthday and Beyond coalition will celebrate America’s leadership and investments worldwide to help children reach their fifth birthday. US investment in R&D has led to new innovations that are saving the lives of mothers and children. Photo: PATH/Teresa Guillien While you’ll probably hear a lot of different facts and figures, one message will be clear—the world has made remarkable progress in preventing the deaths of millions of women and children. In fact, maternal and child deaths have been cut in half in just over two decades. That means that every day this year, 17,000 more children will live and 700 more mothers will survive childbirth than did two decades ago. Central to this progress has been US investment in research and development (R&D) that has led to new medicines and innovative health products that are saving the lives of mothers and children. Globally new vaccines, drugs, diagnostics, and other health innovations have led to 4.2 million fewer child deaths in 2013 compared to 1990, according to a report by the Institute for Health Metrics and Evaluation. Innovations like the polio vaccine, oral rehydration solution to treat diarrhea, and antiretroviral therapies that prevent maternal to child HIV transfer, and others treatments have resulted in incredible gains for maternal and child health.   No country has done more than the United States to help save the lives of the world’s poorest mothers and children. A critical part of the US approach has been our world-leading investment in global health R&D. In fact, the US government is the largest funder of global heath R&D in the world—contributing over 45 percent of total investment. US government investment in global health R&D has led to breakthroughs that have transformed or are poised to transform efforts to reduce maternal and child mortality. Some examples include: The Oxytocin-Uniject™ This is a device filled with oxytocin that helps contract the uterus to reduce post-partum hemorrhage—or excessive bleeding—the leading cause of maternal death worldwide. It is easy to inject and requires little training to administer, so it’s made a dramatic difference in the ability of health workers to administer oxytocin in emergencies or in remote locations outside of traditional hospital facilities. USAID played a crucial role in funding research towards the development of this product. RTS,S malaria vaccine candidate RTS,S is the most clinically-advanced vaccine candidate for malaria—a disease which kills a child every 40 seconds. A recent study showed that infants who receive the RTS, S vaccine had one third fewer cases of both clinical and severe malaria. A vaccine could be an important tool in reducing child sickness and death from malaria. The Department of Defense provided critical funding for the early development and clinical testing of RTS,S. Rotavirus vaccines Rotavirus-induced diarrheal disease kills roughly 435,000 children younger than five each year. Two currently available rotavirus vaccines were introduced in the past two decades, with other vaccines under development showing tremendous progress. The National Institutes of Health developed the first available rotavirus vaccine and has been a financial partner in the development of subsequent vaccines. In addition, the Centers for Disease Control and Prevention also monitors efficacy and safety, and supports clinical trials of rotavirus vaccines. New contraceptive technologies Family planning technologies allow women to space their pregnancies—making it more likely for both the mother and child to survive childbirth. An analysis of 172 countries found that family planning prevented 272,000 maternal deaths in just one year. However, the contraceptive options that exist today don’t always meet the needs of women in developing countries. New vaginal rings are being developed that will be long-lasting and easy for the user to insert and remove without a doctor’s assistance, while new multipurpose prevention technologies combine the delivery of contraceptives with microbicides which reduce the transmission of HIV and other sexually transmitted infections. USAID provides funding towards the development of many of these new contraceptive technologies. While tremendous progress has been made in decreasing maternal and child deaths worldwide thanks in part to new health innovations, each year 6.6 million children still die before their first birthday and 289,000 women still die from pregnancy-related causes. That translates to 18,000 children under the age of five and 800 pregnant women or women in childbirth dying every single day. The United States can and must do more. While the United States should increase access to proven and existing drugs, vaccines, and other health tools for maternal and child health, it is just as critical to develop the next generation of tools to prevent and treat existing and emerging diseases. Sustained and continued investment by the US government in global health R&D is critical to ending maternal and child deaths.