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South Africa’s presidency will be the first time an African country presides over the G20, representing a massive opportunity to shine a light on the needs and capacities of the region, and we welcome their government's focus on science-based innovation. The world remains dangerously unprepared to prevent and respond to emerging diseases and global health threats, and G20 leaders must take action and seize opportunities to ensure every country and community has the tools they need to address poverty-related and neglected diseases as part of universal health coverage and create a pandemic-ready future. This means investing in both new and existing mechanisms that facilitate the development of new health technologies and strengthen the research and development (R&D) ecosystem globally to create a more fit-for-purpose global health architecture.GHTC is calling upon G20 nations to support the Global Coalition for Local and Regional Production, Innovation, and Equitable Access; robustly fund R&D partnerships for pandemic preparedness; establish a global medical countermeasures platform; support investments to strengthen local R&D capacity globally; advance R&D for key priorities like antimicrobial resistance (AMR) and climate resiliency; and improve access to new technologies through regulatory strengthening, specifically prioritizing the R&D needs of underserved populations.1. Pandemic prevention, preparedness, and responseIt is clear that building up robust research and manufacturing capacities in regional science ecosystems is critical to ensuring access to quality and affordable health technologies for the most vulnerable populations, including women and children. Yet the challenge lies in catalyzing more geographically diversified local production of novel health products and building sustainable manufacturing capacity in low- and middle-income countries (LMICs). Cross collaboration is also essential, as these capabilities are not just necessary for strengthening pandemic preparedness and response, but also for combatting endemic diseases. GHTC calls on the G20 to consider the following recommendations:  Support the implementation and pilot testing of the Global Coalition for Local and Regional Production, Innovation, and Equitable Access.Ensure civil society and community voices have a seat at the table, including in the decision-making structures of the coalition.Highlight the need to focus on local and regional R&D to fill the gap in health tools for the world’s most neglected communities, including tools addressing historically neglected diseases, such as leishmaniasis, Chagas disease, and dengue, as well as higher-burden, poverty-related diseases such as HIV/AIDS, tuberculosis, and malaria.Boost upstream R&D through the coalition, harnessing and strengthening R&D capacities across G20 countries through both South-South and triangular partnerships. This could include supporting open drug discovery networks, undertaking preclinical and clinical evaluation of prioritized compounds, and initiating clinical trials.Foster regulatory cooperation by collaborating with stakeholders such as the World Health Organization, the Pan American Health Organization, the African Union, the European Union, and others, to share expertise and conduct joint reviews in order to overcome regulatory bottlenecks and facilitate rapid access to products.Strengthen local capacity and ownership through support for R&D hubs that span the product development value chain, from discovery to productive development to distributed manufacturing to clinical trial infrastructure in LMICs. Support regionally led plans for innovation and manufacturing of economically viable vaccines, diagnostics, and therapeutics.Couple manufacturing investments with commitments by private-sector companies and governments to step up support for technology transfer, technical assistance to local manufacturers for quality systems, regulatory authorization, market entry, and workforce development so that new manufacturing hubs have the equipment, expertise, know-how, and power to produce and deliver new quality-assured innovations safely and rapidly at scale.Support preferential procurement policies for regionally manufactured products from global procurers such as Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, Tuberculosis and Malaria; UNICEF; and Unitaid. Commit to developing globally accessible online prototype libraries of diagnostics, therapeutics, and vaccines for priority viral and bacterial families and for Disease X, in coordination with the World Health Organization’s updated priority viral family list.Accelerate clinical trials aiming to determine product safety and effectiveness and systematically include community engagement plans in clinical study protocols. Establish reference standards for diagnostics early in disease outbreaks and clinical trials.Fully and sustainably finance public-private R&D and access partnerships for strategic health products that will be crucial during a future health emergency or pandemic, including committing $80 million to FIND’s 100 Days Mission framework for diagnostics and $1.5 billion to fulfill the remaining financing needs for the Coalition for Epidemic Preparedness Innovations’s 100 Days Mission strategy for vaccines, as well as supporting Unitaid and others for therapeutics including oxygen therapy.Establish and adopt an end-to-end medical countermeasures platform guided by human rights principles, focusing on the needs of all, particularly those in LMICs, through sustainable financing, addressing R&D needs, and implementing mechanisms for equitable access.Support the coordination of vaccine manufacturing networks to service clinical trials and routine supplies in inter-pandemic and pandemic periods.Facilitate agreement between key stakeholders, countries and funders on how sustainable stockpiles of experimental vaccines, therapeutics, and diagnostics can be created to enable a rapid response to new outbreaks.2. Science and innovation for health and economic growthSouth Africa’s leadership in health research and commitment to science within its G20 health agenda reflects the important role that innovation plays in improving health outcomes and driving economic growth. A resilient product development value chain further fosters innovation of lifesaving products and elevates community expertise. To build on collaboration across G20 health priorities, it is critical to implement an end-to-end research pipeline that carries lessons learned throughout, from clinical trials to manufacturing and surveillance. Furthermore, the evolving threat of AMR underscores the need for crosscutting and sustainable innovation, touching on issues of pandemic preparedness, climate resilience, adaptability, and more. AMR is anticipated to cause 10 million deaths by 2050, with the highest burden in the Global South. While it was promising to see AMR commitments made last year on the global stage, it is imperative that South Africa carries this work forward as G20 lead this year. GHTC calls on G20 countries to consider the following recommendations:  Support cross-collaborative approaches for innovation—globally and across G20 health pillars—that foster localized capacity-building and equitable access to products that ensure the specific R&D needs of women, children, and other vulnerable populations are addressed.  Establish a comprehensive end-to-end product development pipeline that optimizes global health R&D outputs and maximizes return on investment across G20 priorities. G20 countries should ensure greater cross-sector collaboration—including the pandemic preparedness and science for health pillars—to advance the R&D ecosystem.Engage with local experts, such as primary health care providers, community members, and civil society, to identify specific health technology gaps for underserved populations and take actionable steps to close them, including specifying target product profiles and investing in therapeutics and diagnostic tools for children and pregnant women.  Leverage existing political frameworks dedicated to global health R&D, such as the African Union-European Union Innovation Agenda, to develop joint research and innovation agendas to improve the availability and affordability of emerging technologies. Support product development partnerships, which have been a key instrument in the fight against poverty-related and neglected diseases and make further investments in this essential component of the global health architecture. This is particularly critical to ensure that products are developed and distributed with the end user in mind and with characteristics, including affordability, acceptability, and ease of administration, that facilitate their uptake and delivery.  Prioritize addressing AMR by investing in the development of novel products and engaging in key partnerships with civil society and multilateral bodies to build on progress made in the fight against AMR.Invest in R&D to develop new antimicrobials and ensure investments align with global and regional push/pull incentives that harness the financial force and prowess of the private sector to bring novel antimicrobial products to market.  Contribute to existing global AMR players, such as the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator, or CARB-X, and the Global Antibiotic Research and Development Partnership, or GARDP.  Provide ongoing support to the Global AMR R&D Hub in its work providing countries and investors with the latest AMR R&D landscape information, helping to address market gaps. The Hub should also pave the way for efficient deployment of tailor-made incentives for R&D and facilitate global discussions on priorities and opportunities for increasing investments in R&D. With so many tectonic shifts for global health in 2025, GHTC urges G20 members to work with civil society to push for the successful implementation of these key principles, pledges, and initiatives and build a global health architecture with all relevant stakeholders that increases the development of and access to health technologies.