Breakthroughs Blog: Antimicrobial resistance

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. Major funders are betting that a new online platform for genetic sequencing will help health workers worldwide more easily identify mysterious infections and track disease outbreaks. The platform, IDseq, seeks to make metagenomics sequencing—the analysis of genetic material and the matching of those readouts to databases of known microbes—, which can be expensive and technically demanding, more accessible and affordable, particularly in low-resource settings. Free and based in the cloud, IDseq allows researchers to upload patient data, which is then “crunched” against existing databases, to determine what infection a patient has. The Chan Zuckerberg Initiative is supporting the platform’s development, and the Bill & Melinda Gates Foundation announced last week a new training program to support clinicians around the world in using the platform. In an early stage trial, a combination of two broadly neutralizing antibodies (bNAbs)—proteins that can bind to different strains of HIV and prevent the virus from entering human cells—suppressed blood levels of HIV for months after treatment in some people. Participants received up to three infusions of bNAbs over a six-week period with their viral load monitored every one to two weeks. Though further testing and refinement is required, long-acting bNAbs combinations may eventually become an alternative to daily anti-HIV drugs. Researchers hope to test whether engineering the antibodies to last longer in the blood can improve viral suppression and explore new combinations with additional antibodies or other drugs. The Global Antibiotic Research & Development Partnership (GARDP) and Novartis are joining forces to reduce child deaths from antimicrobial resistance (AMR) by accelerating the development of generic antibiotic treatments for children. The strategic partnership will focus on: 1) enhancing the availability of generic antibiotics and increasing access for children in low- and middle-income countries, 2) developing heat-stable pediatric formulations, and 3) leveraging the knowledge and shared expertise of both partners. The partnership between GARDP and Novartis is a response to the World Health Organization’s call for affordable, improved, and adapted antibiotics for this vulnerable population, for which treatment options are limited.

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. Rotasiil, a first-of-its-kind thermostable vaccine to prevent rotavirus—the most common cause of severe diarrheal disease in children worldwide—has achieved prequalification from the World Health Organization. This status will allow United Nations agencies and other organizations to procure the vaccine at low-cost for use in low- and middle- income countries. Developed by the Serum Institute of India with clinical trial and licensure support from PATH, Rotasiil is an oral vaccine administered to infants in a three-dose course, which does not require refrigeration—making it easily distributable in places where power shortages and failures can disrupt the cold chain necessary to keep traditional vaccines viable. Rotasiil is the fourth rotavirus vaccine on the market, and the second developed by an Indian organization. Japanese company Kansai Plascon has launched the world’s first mosquito repellent paint in Zambia. The paint technology, which has shown to be safe in humans, disrupts the nervous system of a mosquito upon contact, reducing its ability to remain on walls where the paint has been applied. “The knock-down effect lasts for up to two years, offering lasting protection from malaria infection and other mosquito-borne diseases,” Kansai said. Mosquito repellent paint offers a new tool in the arsenal to fight malaria—one of the world’s deadliest diseases—alongside other anti-malarial measures such as bednets, prophylactics, and insecticide spraying. The Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Defense Advanced Research Projects Agency (DARPA) has launched a new partnership to strengthen the health security of the United States by focusing on the research, development, and deployment of medical countermeasures and advanced technologies to combat these threats. ASPR and DARPA will focus on two initial areas of collaboration—bacterial pathogens to combat microbial threats and the discovery of molecular biomarkers. ASPR’s Biomedical Advanced Research and Development Authority (BARDA) and DARPA will conduct preclinical and clinical trials of a new type of therapeutic for antibiotic resistant bacteria with an aim to develop a product that mitigates the effects of multidrug-resistant infections. BARDA and DARPA will also focus on discovering and validating biomarkers—which define a person’s exposure to a virus before the person shows symptoms of infection—and developing tests that can identify infected patients quickly to help contain disease outbreaks. Through the partnership, ASPR and DARPA will increase collaboration and share data—maximizing the impact and investment of both agencies.

A “who’s who” of politicians, philanthropists, CEOs, and civil society leaders descended upon New York City this week for the annual United Nations General Assembly (UNGA)—a gathering renowned for its policymaking, pledging, and perennial traffic problems. GHTC was on the scene all week—attending side events, tuning into the official debates, and navigating police barriers—to be your eyes and ears on the ground. Here is what we heard and our top four takeaways on global health research and development (R&D): 1. We can’t end TB without new tools, so it’s vital for world leaders to marshal the political will and resources to close the TB R&D funding gap. Tuberculosis (TB) was a top topic at this year’s assembly with the convening of the first high-level meeting (HLM) on TB. Repeatedly, we heard—from advocates and policymakers, at side events and in in the official proceedings—how poor treatment options are a cornerstone of our failure to eradicate TB and of growing drug resistance, and that new vaccines and improved treatments and diagnostics will be key to turning the tide. While much attention focused on this lack of necessary tools, equal attention focused on the lack of political will and resources to end the epidemic. Many speakers lamented how shamefully slow progress has been since the World Health Organization (WHO) declared TB a global emergency 25 years ago and highlighted the urgent need to close the funding gap for TB, including the US $1.3 billion gap for TB R&D.   As the curtain closed on the HLM, world leaders, as expected, endorsed a carefully negotiated political declaration. GHTC was pleased to see it include a commitment to increasing investment in TB R&D by $2 billion and strong recognition of the importance of cross-border, cross-sector collaboration in driving product development. However, we also share concerns raised by other advocates on accountability. For this meeting to catalyze true change, rhetoric must now translate to action, and commitments must be matched with mechanisms that track investments and hold nations accountable. 2. There are many roads on the path to universal health coverage, but innovation can be an accelerator. Universal health coverage (UHC) was another topic that took the spotlight at UNGA 73, championed by the issue’s top “cheerleader in chief” WHO Director-General Dr. Tedros Adhanon Ghebreyus, who has made achieving UHC a centerpiece of his directorship. Given the focus of the world’s doctor on UHC, many advocates at UNGA framed their specific issues through the lens of UHC, highlighting the myriad of steps needed to achieve this ambitious goal‒from building a stronger health workforce, to expanding access to medicines, to tackling leading killers like malaria, HIV and AIDS, and TB. Yet, a common theme heard across these conversations is that along each of these roads, innovation can be an accelerator.   Throughout the week, speakers highlighted how innovations and new technologies can help deliver care more efficiently and effectively, improve access and drive down costs, and accelerate countries along the path to achieving UHC. TB advocates highlighted how shorter treatment regimens can improve care, decrease costs, and free up resources, while digital health advocates argued that better use of data can empower health workers to track and treat patients and allocate precious health resources most effectively. Others highlighted how innovative new tools like point-of-care diagnostics can bring improved care to the community level and to people in the most remote corners of the globe. 3. We need additional resources for R&D, and that requires countries to step up in an equitable way. Domestic resource mobilization and equitable financing were words repeated throughout the week, particularly in conversations around the TB HLM and closing the TB R&D funding gap. Advocates, think tanks, and even government officials, argued that high-burden TB countries need to increase domestic investment in TB R&D and treatment. Some advocates have called for a “fair share” or equitable financing approach to TB R&D financing, with each country committing to spend .1 percent of their GDP on R&D. Others spoke to the potential of the BRICS nations—Brazil, Russia, India, China, and South Africa—to play a greater role in financing R&D.   While much of the TB financing dialogue focused on increasing public sector contributions, conversations also highlighted the impact and further potential of financing models like the airline-tax-funded work of UNITAID or public-private partnership approaches—like product development partnerships and the work of the Global Health Innovative Technology Fund—which have married multisector contributions to bring novel, affordable, accessible tools to market. Other speakers highlighted the opportunity for industry to increase its TB R&D investment, though many lamented that although industry has brought new TB drugs and diagnostics to market in recent years, uptake has been slow due to high product costs. 4. There is reason for optimism and reason for concern. The mood seemed mercurial in midtown Manhattan, as UNGA orators vacillated between optimism and concern about the future of global health and development. In the drumbeat to UNGA, the always-impatient optimists Bill and Melinda Gates unveiled their foundation’s Goalkeepers report. The report’s stylish line graphs, which show a downward trajectory on health issues like child mortality, are uplifting and inspiring—a great reminder of the staggering progress we’ve achieved in global health and what’s possible for the future.   The basis of our optimism about the world has always been our belief in the power of innovation to redefine what’s possible – Bill and Melinda Gates   Yet, three years in, it has also become clear the world is not on track to meet the Global Goals. And even the optimistic Gates are reminding us that though we hold the blueprint for a healthier world, continued progress is not inevitable. The choices our policymakers implement today will determine whether progress continues or stalls. Throughout the week, many speakers gave voice to fears, highlighting concerns that foreign aid spending is under increased attack in leading donors countries like the United States—a notion echoed in President Trump’s speech to the Assembly—and that political changes like Brexit and an “America First” doctrine signal a movement toward isolationism over collective action. Given significant global health R&D funding comes through foreign aid budgets and the necessity of collaborative global action to deliver the cures of tomorrow, these developments are worrisome. Will these trends threaten progress, or will momentum continue? That’s a question we’ll surely continue to reflect on for many UNGAs to come.

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. Germ-eating microbes may offer a new line of defense in fighting back against antibiotic-resistant bacteria, according to lab studies funded by the Defense Advanced Research Projects Agency. The most impressive predatory bacteria from the studies was an organism called Bdellovibrio, which preyed upon 145 of the 168 human pathogens tested, invading larger bacteria and eating them from the inside out. Researchers collected remaining ‘survivor’ bacteria, allowing them to reproduce to see if they were able to mutate and resist attacks from Bdellovibrio; however, no direct mutants ever became resistant. This microbe-eating method has been shown effective in fighting bacterial lung disease in rats. No germ-eating microbe experiments have been performed in humans to date. The government of Burkina Faso has granted scientists permission to release genetically engineered mosquitoes, marking a key step in using bioengineering to eventually eliminate malaria in the region. The impending release will also mark the first time a genetically engineered animal will be released into the wild in Africa. The mosquitoes being released will be mostly male with a ‘sterile male’ mutation, meaning none will be able to produce offspring. Although these mosquitoes won’t have any specific mutations related to malaria transmission, researchers hope this release will foster improved trust in science and research among government regulators and local residents and inform future releases. This inaugural release will lay the groundwork for teams in Burkina Faso, Mali, and Uganda to eventually release “gene drive” mosquitoes that will dramatically and rapidly reduce the mosquito population. NASA is using weather satellites to track and predict disease outbreaks before they occur, deploying this technology to track cholera outbreaks in Yemen. Given cholera infections typically result from drinking contaminated water, the team at NASA used environmental data such as rainfall levels and water and air temperatures to build their prediction map and pinpoint where the worst cholera outbreaks will likely occur. NASA’s model proved 92 percent accurate in predicting cholera outbreaks in Yemen, though the information came too late to be useful to the medical teams on the ground. Researchers have continued to improve their prediction algorithm and hope to deploy their data this year to direct health workers to critical areas and save lives.