Breakthroughs Blog: United Nations

President Joe Biden has made clear that addressing climate change is a top priority for his administration. Since January, the president has issued executive actions in pursuit of tackling the climate crisis; opened a new federal office for climate change, health, and equity; and convened two meetings of the Major Economies Forum on Energy and Climate, one of which was part of a larger leaders summit intended to rally world leaders to strengthen climate ambition in the lead-up to the 26th United Nations Climate Change Conference of the Parties (COP26) in early November, during which countries hope to negotiate shared climate commitments.Amid these ongoing and vital conversations, GHTC is taking stock of how global health and climate are intertwined and how innovation can address these twin issues and mitigate the impact of climate change on human health. As the Unites States prepares to engage in COP26, we hope to see continued commitments and concrete actions to combat the climate crisis, including climate-related global health challenges.Climate-related global health risksClimate and global health are inextricably linked: Climate change could put billions more people worldwide at risk of vector-borne and zoonotic diseases like malaria and dengue. Changing temperatures have been described as a “threat multiplier” of antimicrobial resistance, due to warm conditions being more favorable for bacterial reproduction. The climate crisis exacerbates food instability and malnutrition as a result of droughts and other extreme weather events—circumstances which also prove opportune for disease outbreaks. The threat of a “Disease X” outbreak occurring, and spreading globally, is greater than ever before due to deforestation and other climate-related risk factors.These risks will not be felt equally around the world. Children are among the most vulnerable—and will be exposed for the longest—to health risks resulting from climate change, given their physical and cognitive immaturity. Health effects are also expected to be worse for people who are older, have preexisting medical conditions, or are living in poverty or in low- and middle-income countries. These populations are less able to insulate themselves through technology, housing, social networks, health services, and other infrastructure. Food insecurity is likely to particularly affect Indigenous communities, many of which rely on local food sources, such as fish. Women and girls, too, are often underprioritized in responses to climate-induced disasters, which can inhibit their agency and access to sexual and reproductive health services, from contraception to HIV prevention and treatment.Existing efforts by US agenciesThe US government is beginning to recognize and take on the interconnected fight against climate change and global health crises through programs at the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and US Agency for International Development (USAID).For example, CDC’s Climate and Health Program assists states, cities, territories, and tribes in the United States with protecting human health from a changing climate by providing data, tools, and technical guidance to reduce vulnerability and increase resilience.NIH has launched a Working Group on Climate Change and Health aimed at addressing climate change and its health effects through research and innovation, and its National Institute of Environmental Health Services Climate Change and Human Health Program funds research aimed at understanding the health effects of climate change.USAID conducts a breadth of climate-related work, playing a crucial role in mitigating climate change and supporting resilience against its global impact—including by strengthening resilient food systems. USAID-supported programs have worked to develop and distribute disease-, heat-, and drought-tolerant seeds as well as nutrient-dense foods. For example, to support response to climate change–induced droughts and dry climates, USAID has invested in a public-private partnership to develop a variety of drought-tolerant maize, which was used by 6 million farmers in 2016 when the El Niño drought hit Southern and Eastern Africa.Looking ahead: What more should the US government do?In line with its expressed priorities, the US administration should continue to sustain and expand investment in climate change innovation—embracing a comprehensive agenda that recognizes the need to not only directly improve climate health, but also mitigate its impact on human health. While US health agencies have demonstrated some capacity to take on climate action for health, there is much more to be done.US agencies addressing climate change should consistently consider its ripple effect on global health and integrate a broad range of health-related climate innovation into their work—for instance, through emerging infectious disease surveillance, health and environmental systems capacity strengthening, or research to further understand both threats and the ways they interact.We will never achieve global health goals without also protecting our environment, and we won’t succeed in preventing the climate crisis’s worst impacts without bolstering investments in global health. GHTC looks forward to seeing continued commitment and global leadership from the US government to advance innovation to address these deeply intertwined challenges.

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.  According to a report by the AMR Industry Alliance, a private sector coalition, there is a “concerning shortfall” in investment in late-stage research and development (R&D) to battle antimicrobial resistance (AMR). Though in 2018 the Alliance’s members invested US$1.6 billion in R&D for antibiotics, vaccines, and disease diagnostics needed to tackle AMR,—a figure which dropped by one-third between 2016 and 2018—the report cited this investment as likely insufficient to deliver the tools needed to address growing AMR. It also cited a lack of access to quality and responsibly manufactured antibiotics as a significant challenge in low- and middle-income countries. The report calls on the public sector to provide greater R&D investment, particularly for later-stage research, and advance policy solutions like incentives to spur greater R&D investment and improve access. According to the United Nations, AMR is estimated to result in 700,000 deaths annually, a figure that is forecast to increase to 10 million by 2050. German researchers have developed the first diagnostic test for a new coronavirus that has emerged in central China. The virus was first detected in the city of Wuhan last year and has since sickened dozens of people with recent cases reported in Japan and Thailand. The diagnostic test developed at the Institute for Virology at Berlin’s Charite hospital will allow labs to reliably diagnose the new coronavirus “in a very short period of time,” according to its developers. The test protocol is being made available by the World Health Organization (WHO), and laboratories will be able to order a molecule from the German team to compare patient samples with a positive control. Until now, doctors have only been able to perform a general virus test and then had to sequence and interpret the genome—a difficult task for smaller labs, for facilities in countries where it’s not easy to transport samples or staff aren’t trained thoroughly, or those handling a large number of patients who need to be tested. Last week, WHO published its list of urgent global health challenges facing the next decade, which included climate change, infectious diseases, anti-vaxxers, and AMR, among other challenges. The list was developed with input from experts around the world and “reflects a deep concern that leaders are not investing enough resources in core health priorities & systems, putting lives & economies in jeopardy," according to a tweet by WHO Director-General Dr. Tedros Adhanom Ghebreyesus. Last year, WHO published a list of ten global health threats for the year 2019 which also included climate change, AMR, weak primary health care, and vaccine hesitancy. WHO noted that these challenges demand a response from the health sector, governments, communities, and international organizations.

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. A study has revealed that an antibody, known as IgM, is far more influential in combating malaria than previously thought—which may have important implications on the development of a malaria vaccine. It was previously thought that IgM played a supporting role in the body’s immune response to malaria, that it would initiate this response and then disappear when the primary antibody, IgG, took over. However, this new research shows IgM acting as a co-lead with IgG to block and clear malaria infection in the blood. As a next step, scientists are seeking to understand why the immune system generates both antibodies in response to malaria infection and determine whether vaccines that stimulate an immune system to produce IgM antibodies give better protection against malaria. Researchers hope this new insight brings them one step closer to developing a highly effective vaccine against malaria. The Biomedical Advanced Research and Development Authority (BARDA) announced that it will provide US$14 million and organizational expertise to support the continued development of the investigational Ebola treatment known as mAb114. BARDA will assist Ridgeback Biotherapeutics of Miami, the company manufacturing mAb114, with its application for licensure with the US Food and Drug Administration (FDA). mAb114, a monoclonal antibody that works by binding to virus proteins, thus reducing their ability to infect human cells, is currently being used in the Democratic Republic of the Congo to help combat the ongoing Ebola outbreak as part of a clinical trial. mAb114 has already obtained an FDA Breakthrough Therapy Designation, which allows participating companies to work more closely with FDA officials in pushing for approval. Last week, at the United Nations (UN) General Assembly High-Level Meeting on Universal Health Coverage (UHC), member states reached a comprehensive agreement which commits countries to advance UHC for their citizenry. UN Secretary-General António Guterres called the political declaration “the most comprehensive agreement ever reached on global health” and a “significant achievement” that will drive progress over the next decade on tackling diseases like HIV and AIDS, tuberculosis, and malaria, along with the growing burden of non-communicable diseases and antimicrobial resistance through primary health care systems. In adopting the declaration, member states have committed to investing in policies that expand access to health care while preventing financial hardship and developing and implementing high-impact health interventions to combat diseases and protect women’s and children’s health.

On Monday, the United Nations (UN) members unanimously adopted a high-level political declaration on universal health coverage (UHC), which World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus called a “landmark for global health and development.” While the adoption of the declaration is welcome news, in many ways it represents a starting point for the next phase of UHC, in which the thornier issues of financing, follow through, and accountability will rise to the forefront. UHC declaration adopted unanimously at United Nations High-Level Meeting It was a bit of a bumpy journey to Monday’s political declaration. After months of tense negotiations among member states, the UHC debate had stalled over two hot-button issues—sexual and reproductive health and the rights of migrants and refugees—which weren’t resolved until a few days before the High-Level Meeting. Thankfully, countries were able to push the UHC declaration across the finish line, with a several countries, including the United States, disassociating themselves from the provisions linked to those thornier issues. It was encouraging to see that the final declaration was inclusive of GHTC-supported language on research and development (R&D), focused in particular on innovative financing for new products and technologies, emphasizing the role of the private sector and new models for sustainable investment.  “This declaration represents a landmark for global health and development,” Dr Tedros Adhanom Ghebreyesus The UHC process now moves into a new phase: countries are tasked with developing their own strategies or national action plans to fulfill these commitments and advance UHC within their own borders. The agreement is intended to be country-led, and as member states adopt the commitments to their own geographic contexts, they must outline a clear path for how they will mobilize their governments and increase investment in UHC.  Assessing gaps in the tools to mitigate each countries’ priority health challenges also needs to be considered as part of this new phase.  It’s all about the money Now that countries have committed to UHC, how will they pay for it? That question seemed to be on everyone’s mind as numerous events throughout the week of the UN General Assembly focused on the financing side of UHC. The message was clear: not enough is being done, particularly on domestic resource mobilization. Most countries don’t have a UHC investment strategy to achieve the lofty goals set forth in the UHC declaration and the Sustainable Development Goals. As countries start to develop their health investment plans, it is crucial that investment in R&D remain an integral pillar. UHC cannot be achieved without stepping up the fight against the world’s endemic and emerging infectious diseases. This will require new tools and technologies, as was echoed by stakeholders throughout the week, including Global Fund Executive Director Peter Sands and Dr. Tedros. We also need to invest more in the uptake and scaling of innovations and technologies and ensure that we are thinking of end-to-end solutions.  "Existing tools won't be enough"@PeterASands highlights that innovation hasn't been fast enough. We need to push more aggressively to scale up innovation and integration of new tools. @GlobalFund #TBinnovation #HealthForAll pic.twitter.com/7tSluSlIL5— GHTC (@GHTCoalition) September 22, 2019 There were several side events this week on financing reforms, tax redistribution into UHC—from the tobacco industry, for example—and the need for innovative financing approaches. Outcomes-based finance such as social impact bonds and blended finance models, in particular, attracted some attention. All countries did commit to spending one percent or more of their GDP on public health as part of the declaration. That is likely insufficient to achieve UHC, but money isn’t the only factor for success. Some countries, such as the United States, already spend more on health care but still lack access to coverage for all citizens.  Accountability emerges as central focus after the political declaration Now the real work begins. Many speakers this week devoted time to discussing the challenge of accountability and follow through, drawing on past experiences from other high-level meetings.  Stakeholders recognized that the declaration is just a starting framework and that the lofty language needs to be translated into tangible actions and investment. While this declaration symbolizes a major shift for the global health agenda, fears persist that the momentum will dissipate and that countries won’t be able to follow through on their commitments by 2030—just over a decade from now.  Those fears are warranted. Just last week, WHO published a report stating that while advances have been made on UHC, as many as five billion people will be left without full access to healthcare in 2030 at the current rate of progress. Countries must set clear targets for moving their populations on the journey towards UHC and create specific metrics through which progress can be monitored. Mechanisms and incentive structures must be put in place to allow for follow-up and accountability, underscoring the political will expressed in New York this week. In adopting the declaration, member states have committed to investing in policies which would allow everyone, everywhere to have access to quality health care products and services without financial hardship. Leaders must now pivot to move from commitment to concrete action.