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. Novartis has launched patient testing of a new anti-malaria compound with the hopes of staving off the development of further drug-resistance. The experimental compound—KAF156—will be tested in combination with another medicine in children and adults across nine countries in Africa and Asia over the next few months. In recent years, there have been increasing reports of malaria parasites that have become resistant to the standard treatment regimens against malaria, spurring the need for new treatment options from different classes of antimalarial compounds. Novartis expects to complete phase 2b studies of the compound by late 2019. It remains too early to tell whether the product will eventually reach market. A strain of gut bacteria taken from the diaper of a baby could hold promise in saving the lives of thousands of newborns in poor regions. Scientists conducting a large clinical trial in India found that babies who were fed a probiotic strain of Lactobacillus bacteria for a week were 40 percent less likely to develop a deadly infection called sepsis, which kills 600,000 newborns per year in India and other nearby nations. Babies who took the probiotic also had fewer cases of pneumonia, diarrhea, and ear infections. Researchers believe this probiotic—which costs only US$1—could be a “game changer” in advancing the health of infants in poor nations. Scientists at Harvard University are genetically engineering relatives of Mycobacterium tuberculosis (TB) in the hopes if speeding development and clinical trials to develop a better TB vaccine. The only currently available TB vaccine is partially effective in children and performs poorly in adults, so scientists are working to develop other vaccine candidates. However, performing clinical trials on vaccines is challenging because a typical clinical trial involves observing large numbers of people over long periods of time to monitor results in a small subset of people that naturally come into contact with the microbe. Alternatively, “challenge studies” infect people on purpose, so are faster and less expensive, but these studies are only possible if the disease can be detected and treated easily. TB can take time to detect and many months to treat, so is not appropriate for this type of study. The team at Harvard is working to genetically modify TB so it can be safely given to people as part of challenge trials, and thus help speed vaccine development. 

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Researchers in Brazil have discovered the structure of the protein responsible for replicating the Zika virus thousands of times in cells, causing the virus to break through the cell wall and infect the body. Through many months of collecting data and studying the origins of the virus, the researchers put together a three-dimensional model of the protein and published their findings in Nature Communications. Zika is a flavivirus and in the same genus as diseases like yellow fever, dengue, and hepatitis C. Because of the genetic similarity, researchers and scientists have found that sofosbovir, a commonly used drug to treat hepatitis C, is a good therapeutic option for those suffering from Zika. The unlocking of Zika’s genetic code will lead to the development of new solutions to the virus. It recently became global news that RTS,S (trade name Mosquirix™), the candidate malaria vaccine furthest along in development, is beginning vaccine pilot programs in three chosen countries: Ghana, Kenya, and Malawi. The vaccine, created through a partnership with PATH’s Malaria Vaccine Initiative and GlaxoSmithKline, is given in four doses over a specific period of time. It is not yet known if tracking of these vaccine doses will be 100 percent. Any vaccine administered in multiple doses, whether for malaria or HPV, requires a lot more work in educating individuals about the need to return for all treatments necessary to ensure the vaccine’s success. UNICEF and members of the vaccine community will work with government authorities to ensure the supply chain delivers vaccines to children in need. If successful, the burden of malaria could decrease drastically. While this vaccine is promising to many individuals in these three countries, the search for a more perfect vaccine is high on the priority list for health researchers around the globe. In order to increase global access to immunization, successful and smooth-moving supply chains are necessary. The problem? Immunization supply chains are complex and every part of the chain needs to be working perfectly to ensure access to the vaccines. Many members of the immunization community have neglected the supply chain facet of vaccine delivery, and as a result, these supply chains have suffered and grown obsolete. With these chains being out-of-date, many children remain unvaccinated from even the most common diseases. A special issue published in Vaccine highlights these issues and brings the need for supply chain renewal to the forefront of the conversation. But even after this publication, more has to be done to ensure all members of the vaccine community work together to guarantee access to vaccines is in reach for all. Despite vaccine initiatives being stronger than ever, there is still a glaring gap in the number of children receiving basic vaccines. Currently, there are over 19 million children who are unvaccinated, leaving them susceptible to diseases that can be protected against. The American Academy of Pediatrics and the Centers for Disease Control worked together to establish the Global Vaccine Action Plan (GVAP) aimed at closing the gap of vaccine inequality around the globe. GVAP has already seen many successes, including fostering a working relationship with government institutions to implement surveillance techniques to figure out what vaccines children need most in each country. Kenya and Nepal, for example, have initiatives through pediatricians to educate families about the importance of vaccines for children’s development and longevity of life. GVAP is in the forefront of bridging the gap of health inequity and bringing immunization to all.

Scientists at the University of Oklahoma are looking for the next breakthrough drug in an unusual place: roadkill. Every animal hosts a unique microbiome—a community of microorganisms, including bacteria, fungi, and molecules with antibacterial and antifungal properties. The research team is collecting swabs from dead animals found along a state highway and has already discovered two compounds (taken from an opossum’s ear) that could prevent the spread of yeast infections. Hypothermia is a significant driver of morbidity and mortality among babies born prematurely, even though the condition is easy to detect and treat. Detection relies on temperature monitoring, and current standard of treatment is Kangaroo Mother Care (skin-to-skin contact). Now, an electronic alert bracelet is being used to prevent hypothermia among preemies in India. If the infant is healthy, the bracelet flashes a blue light every ten seconds; if the infant’s temperature drops, the light turns to red and an alarm goes off. The single-use device is safe and can be used for a month straight—even at home. Though a daily dose of pre-exposure prophylaxis (PrEP) can prevent HIV infection, stigma, cost, and frequent stockouts can impede adherence to the regimen. While only four doses per week is sufficient to protect men from infection, if women miss a single daily dose, they risk infection. To mitigate these barriers, researchers at Intarcia Therapeutics Inc. are developing an implant that would release PrEP over time, meaning just one visit to the doctor’s office would protect patients for an entire year. The device has already undergone advanced testing and is currently under review by the US Food and Drug Administration for the delivery of diabetes drugs. Researchers at the Center for Infectious Disease Research (CIDR) in Seattle are using mosquitoes, rather than syringes, to deliver an experimental malaria vaccine. The vaccine uses live, but weakened malaria parasites, which can only grow inside living mosquitoes. In an initial trial, ten volunteers were vaccinated, none of whom developed malaria and all of whom produced antibodies that could confer immunity against malaria. The antibodies were extracted from volunteers and successfully used to protect mice against malaria, however, additional trials are needed to determine their efficacy in humans. CIDR is partnering with the Maryland-based biotech company Sanaria to develop a more standard and sustainable vaccine delivery system, producing the weakened parasites and extracting them from the mosquitoes, and attempting to grow the parasites outside of the mosquitoes.

It’s that time of year when Americans join together with family and friends and give thanks for the many things in life for which they are most grateful. In the spirit of the Thanksgiving holiday, GHTC asked our members and staff to share what they are most thankful for in global health. Here’s what they had to say: “I am thankful for all patients who take part in clinical trials so that the world will have more effective regimens to end TB, in all its forms.” Willo Brock, Senior Vice President of External Affairs, TB Alliance “I’m thankful there is increasing global interest in the development and production of vaccines for diseases of poverty, like hookworm, schistosomiasis, and Chagas.” Tara Bracken, Communications Associate, Sabin Vaccine Institute “I am thankful that 2016 was a turning point for women’s HIV prevention research—one that brought us hope for one day soon expanding women’s options with a long-acting vaginal ring. I am also grateful for the amazing partners who believe women’s health and empowerment matter!” Zeda Rosenberg, Founder and CEO, International Partnership for Microbicides “I’m thankful for the new generation of emerging R&D leaders who are both generating new knowledge and achieving global health impact.” Dr. Timothy Mastro, Chief Science Officer, FHI 360 “I’m thankful for sustained US government funding to fight emerging epidemics, like Ebola and Zika, through R&D and scientific advancement.” Lindsay Litwin, Jhpiego Innovations “I’m thankful that elimination of sleeping sickness is now a real possibility thanks to new tests being strategically implemented alongside new vector control technologies and improved treatment regimens.” Dr. Joseph Ndung’u, Head of Neglected Tropical Diseases Programme, FIND “I’m thankful that the six antimalarials MMV and partners have brought forward are saving young lives today!” Andrea Lucard, Executive Vice President of External Relations, Medicines for Malaria Venture “I’m thankful for research that has shown promise for an effective six-month regimen to cure XDR-TB [extensively drug-resistant TB].” Rabita Aziz, Policy Research Coordinator, ISDA Global Health “I’m thankful for the inspirational dedication and continued participation of all HIV vaccine clinical trial volunteers. Without you, the important work of finding a safe and effective HIV vaccine would not be possible.” Dr. Fran Priddy, Chief Medical Officer, International AIDS Vaccine Initiative “I’m thankful for the over 200 members of Congress who have co-sponsored the Reach Act to accelerate efforts to end preventable deaths of mothers and children around the world.” Brandon Ball, Policy and Advocacy Officer, PATH "I'm thankful for low-cost interventions like chlorhexidine gel for umbilical cord care being made more accessible to Sub-Saharan Africa to reduce newborn mortality." Assumpta Nantume, Communications Associate/Global Health Corps Fellow, Global Health Council “I'm thankful a new generation of Middle Eastern scientists are advancing the development, production, and characterization of new vaccines to help endemic countries better respond to the threat of infectious diseases like MERS, schistosomiasis, and leishmaniasis.” Chris Bennett, Senior Program Officer, Sabin Vaccine Institute “I’m thankful for pioneering donors such as UNITAID for funding development of new hepatitis C tests for countries where fewer than 1 percent of people living with hepatitis C have been diagnosed.” Catharina Boehme, Chief Executive Officer, FIND “I’m thankful for scientists and researchers who devote their lives to important global infectious disease work to help people around the world and to protect Americans here at home and the funding the US government provides for such important work.” Karen Goraleski, Executive Director, American Society for Tropical Medicine and Hygiene “I’m thankful for the tremendous progress we’ve made in advancing child and maternal survival and excited for the prospect of saving the lives of more than 6 million mothers and children by 2030 if we work together to advance and scale-up 11 promising innovations.” Heather Ignatius, Multilateral, US, and Europe Policy & Advocacy Team Lead, PATH “I’m thankful for researchers across the globe whose efforts have, with unprecedented speed, deepened our scientific understanding of and advanced new tools to prevent, detect, and treat Zika.” Kat Kelley, Senior Program Assistant, GHTC “I'm thankful so many good dengue vaccine candidates are in development that could help curb the growing global dengue epidemic.” Tara Bracken, Communications Associate, Sabin Vaccine Institute "I'm thankful for increased awareness on global antibiotic resistance and WHO's new evidence-based Infection Prevention and Control Guidelines." Danielle Heiberg, Advocacy Manager, Global Health Council “I'm thankful for the lives of mothers and babies that have been saved, sustained, and supported by midwives across the globe.” Shannon Egan, Jhpiego Innovations “I’m thankful that malaria rapid tests have contributed to better malaria control, which in turn has helped fuel a massive decline in childhood mortality over the past decade—and that partners around the world are working together to find innovative new solutions for identifying non-malarial causes of fever. Diagnosis matters!” Dr. Iveth J. González, Head of Malaria and Acute Febrile Syndrome programme, FIND “I’m thankful for the support of MMV’s committed donors and partners that make our work to develop new antimalarials for vulnerable populations possible.” Andrea Lucard, Executive Vice President of External Relations, Medicines for Malaria Venture “I’m thankful to be a part of the #StartStayAIDSFree initiative which aims to end AIDS in children by 2020.” Catherine Connor, Senior Director of Public Policy and Advocacy, Elizabeth Glaser Pediatric AIDS Foundation “I’m thankful that members of both major US political parties have continued to demonstrate strong, bipartisan support for global health research and development and US efforts to save lives around the world.” Marissa Chmiola, Communications Officer, GHTC