Breakthroughs Blog: United Nations

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.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. According to a recent study out of Oxford University, rapid evolution of the HIV virus is slowing the virus’s ability to cause AIDS. In this study of 2,000 women in South Africa and Botswana, researchers found that the HIV virus had evolved to adapt to a specific gene known as HLA-B*57, which provides some protective effect against HIV, slowing the progress to AIDS. As the virus has adapted to reduce this protective effect in individuals, the virus has also reduced its ability to replicate, making it less virulent over all. Last Thursday, the UN Secretary-General launched his synthesis report for the sustainable development goals. In this report, Secretary General Ban Ki-moon reaffirmed his support for the 17 goals and 160 targets proposed by the United Nations Open Working Group, despite concerns from some member states that the current list is too long. Of the 17 proposed goals, two contain targets related to the research and development of new technologies. Researchers are developing a powdered form of the measles vaccine which could make it easier and safer to deliver the vaccine to people in developing nations. The current FDA-approved measles vaccine is a live virus that has been freeze-dried into a powder, which requires reconstitution with water before being administered via syringe. The new vaccine under development is a powder that can be inhaled. This new formulation would eliminate the need for sterile water and needles, as well as cold-chain storage. A modified regimen of the HIV vaccine candidate RV144 was shown to be safe and capable of inducing a robust immune response in safety trials in South Africa. RV144—which was developed by the US and Thai military—showed early promise in clinical trials, but it was found to lose efficacy over time. This new regime is the same earlier RV144 vaccine regime with an added booster shot one year later. Further clinical trials of this new regime are set to begin in South Africa in early 2015.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. In a new paper—developed by the Council on Health Research for Development, GHTC, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV and AIDS, malaria, and other diseases). In a recent special report from the Global Post, the prominence of public-private partnerships in global health is analyzed as governments laud private sector partners for their expertise and vast resources. However, while most believe public-private partnerships to be highly effective, the Global Post looks into how to quantify their impact given the lack of comprehensive and transparent metrics for evaluation. Last week we at the United Nations General Assembly, the US Agency for International Development, the UK Department for International Development, the Swedish International Development Cooperation Agency, the Australian Department for Foreign Affairs and Trade, and the Omidyar Network have launched a US$200 million Global Innovation Fund. Grants ranging from $50,000 to $15 million will be available for social enterprises, for-profit businesses, researchers, government agencies, and nonprofits. The Atlantic highlights a recent incident in El Paso, Texas, where a former hospital nursery employee tested positive for tuberculosis (TB), which caused panic and precautionary screenings of more than 700 infants who passed through the nursery over the last year. In addition to demonstrating that Americans are not immune to this diseases, the article also asks why an effective vaccine to prevent TB in the first place has yet to be discovered. The National Institutes of Health (NIH) and the US Food and Drug Administration (FDA) have received national recognition for the “most outstanding intellectual property deal” for MenAfriVac™—a low-cost meningitis vaccine developed specifically for populations in sub-Saharan Africa. The vaccine—developed by GHTC member PATH and the Serum Institute of India—incorporated technology from the FDA, as well as a patent license for a manufacturing process granted by the NIH.

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda. The new paper make the case for the inclusion of research and innovation for health as a central component of the post-2015 agenda. Photo: PATH/Gabe Bienczycki A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV and AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda. In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV and AIDS, malaria, and other diseases). These investments have helped to create an enabling environment for research in and for the benefit of LMICs by increasing demand for new health technologies, expanding coverage of proven interventions, and strengthening the innovation infrastructure in these countries. Building on the work of The Lancet Commission on Investing in Health—a group of renowned economists and global health experts—the paper discusses the need for increased R&D investments by all countries to achieve the dramatic health gains envisioned in the post-2015 agenda. Adequate investment in R&D is important, but it alone does not guarantee more products or drive innovation toward the right type of products. PATH/Patrick McKern Adequate levels of investment, as suggested by The Lancet Commission, are critical for spurring the development of new health tools, provided they align with financing needs in R&D—notably predictability and flexibility. But even that sort of investment alone does not guarantee more products, and it does not drive innovation toward the right type of products—those that are suitable, acceptable, affordable, and accessible to populations most in need. It is essential, therefore, that indicators for R&D for health tools that primarily affect LMICs address a comprehensive set of outcomes including financing needs, infrastructure and human resources needs, enabling policies, necessary partnerships, capacity strengthening, and access requirements. Because poor health and disability contribute substantially to poverty, research and innovation for health is linked to improving economic prosperity and is critical to eradicating poverty. Therefore, it must be continuously prioritized within the post-2015 development agenda. Ultimately, the success or failure of the post-2015 agenda relies just as much on how the goals and targets are implemented as it does on how progress will be measured. Thus any research and innovation indicators measuring progress against the goals and targets outlined in the post-2015 agenda must also increase accountability of researchers, governments, and funders, and inform research processes. Inclusion of research and innovation for health must facilitate an enabling environment for research and innovation in LMICs and encourage endemic countries to set and pursue a domestically-driven health research agenda. The post-2015 development agenda is an opportunity for LMICs to set their own health agendas and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Therefore, it is essential that there is broad agreement among all of the relevant stakeholders that research and innovation for health—which includes the scaling up of proven health interventions as well as the development of new and improved high-priority health technologies—is critical to meeting the ambitious goals of eradicating poverty and ensuring sustainable development for all within a generation. In support of the inclusion of research and innovation for health in the post-2015 agenda, over 150 organizations and individuals recently signed a petition to United Nations (UN) Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools for diseases and conditions impacting LMICs at the heart of the post-2015 development agenda. It is our hope that the Members States and other UN officials shaping the agenda will head this call.