Bringing Health Innovations To Market Is Key In The Global Fight Against HIV/AIDS, Malaria And Tuberculosis

Lyon, France – The global health community needs to scale-up collaborations with product development partnerships (PDPs) that could bring life-saving innovations for prevention, diagnosis, and treatment of HIV/AIDS, Malaria and Tuberculosis to market faster, said health experts at a side event ahead of the Global Fund’s Sixth Replenishment Conference.

A local healthcare worker tests a young girl for malaria in Cambodia.

There are some 55 “potentially transformative” products for HIV/AIDs, tuberculosis and malaria in the drug development pipeline, but the challenge is “how do we take them to the next level” so that they actually reach patients as soon as possible, said David Reddy, chief executive officer of Medicines for Malaria Venture (MMV).

“Products don’t become prevention tools or medicines until they reach the patients that need them, so we need to think end- to-end; we also need the Global Fund. Ending the three diseases won’t be possible without a fully funded Global Fund, and domestic funding and commitment.”

“This is about innovation with urgency, so let’s do it,” he said, noting that planning, better coordination, demand forecasting and demand creation, and innovation in delivery are all necessary to bring promising innovations to market faster, and then ensure that they reach patients.

Reddy spoke at the side event co-sponsored by MMV and six other PDPs, to explore how their unique public-private structure and innovation expertise could be harnessed more effectively for improving public health outcomes for vulnerable groups and Global Fund’s impact. Other co-sponsors included Drugs for Neglected Diseases Initiative (DNDi), Foundation for Innovative New Diagnostics (FIND), Innovative Vector Control Consortium (IVCC), International Partnership for Microbicides (IPM), PATH, TB Alliance.

Michèle Boccoz

The World Health Organization’s top official for health diplomacy, Michèle Boccoz, said that innovation could also help reduce the medicines costs, increasing access.

“The cost of medicines and treatment is too high, innovation, I’m sure, will bring more solutions,” said Michèle Boccoz, director-general envoy for multilateral affairs at the WHO. “We need to ensure we are everywhere,” she said, adding that WHO will support efforts to overcome bottlenecks in bringing new health innovations to those who need them the most.

Marijke Wijnroks, chief of staff at the Global Fund, lauded the large number of innovative new diagnostics and drugs in development. However, she said that prioritizing the most promising tools in the pipeline is a difficult exercise.

Marijke Wijnroks

“Collectively we can do better to leverage all of the great things that are happening in these organizations,” Wijnroks said, referring to a July meeting hosted by WHO, that looked at ways to improve collaboration between the Global Fund and product developers on ways to speed up drug innovation and remove access barriers.

In that vein, panelists at the event highlighted the importance of strong market incentives and collaboration with countries in stimulating innovation and bringing the most essential new products to the populations that need them.

Opportunities for more impact is “not only upstream” with the product developers, but also “downstream” in bringing innovations to the countries and communities that need them, said Renuka Gadde, Vice President for global health with BD, a global diagnostics company.

“Companies care, and we are all in this together. We want to play our part in solving complex global health problems,” she stressed.

Market Incentives for Innovation

Health product innovation can be especially difficult to stimulate in “broken markets,” said Sanne Fournier-Wendes, chief of staff at UNITAID.

Sanne Fournier-Wendes

She noted that in these markets, demand is so dispersed across countries that manufacturers find it overwhelming to develop products. Poor children represent one such market, and pediatric product development across the three big diseases of HIV/AIDs, TB and malaria faces “major bottlenecks.”

But solutions can be found. “Partnership along the whole value chain is important,” she stressed.

“And not just looking at individual projects, but realizing you might need a lot of different pieces of the puzzle to succeed in getting impact.”

Bernard Pécoul, executive director at DNDi, noted that today, after years of effort, new antiretroviral formulations exist for children. To make sure these new medicines are rapidly available, all stakeholders need to work together.

Tom McLean, market access director at IVCC, argued strong demand for new products was crucial.

“Industrial partners need to have confidence that the marketplace will be sustainable and affordable. ”

McLean said pilot studies on a new generation of bednets, conducted with partners such as the Global Fund and UNITAID, looked at how volume guarantees can stimulate bednet production and ensure they get to market.

“One of the things that is very clear to us is that [volume guarantees] have energized many of our other partners who now say ‘we have confidence that the world will actually support these products coming through’.”

Addressing Policy and Regulatory Barriers

Catharina Boehme, chief executive officer of FIND, called for the global health community to work together to tackle bottlenecks in bringing innovative new products to the people who need them most.

In the last two decades, the innovator community of PDPs has delivered about 35 innovations, many of which have played a critical role in the progress achieved by countries and the work of the Global Fund, Boehme told participants.

The emphasis should be to develop innovative systems that are open and “less closed, cheaper, and use more generics,” said Professor François Dabis, President of France Recherche Nord & Sud, Sida-hiv Hépatites (ANRS).

Others noted strategic moves PDPs could make while waiting for guidelines on the use of new products to be developed.

Willo Brock

Willo Brock, senior vice-president for external affairs at the TB Alliance, a PDP that recently developed the 3rd new drug to be approved for TB in half a century, said that even after products receive approval at the country level, it can take WHO up to a year to issue guidance on a new product.

“Waiting loses a lot of time,” he said. “With TB that means tens-of-thousands of lives in one year.”

Brock outlined the importance of using that time to coordinate with countries interested in new products, saying that the TB Alliance, along with Unitaid, are leveraging the waiting period to “understand the process of planning for countries and expose ministers of health to products in the pipeline.”

“Feedback works two-ways…country mechanisms will be very valuable,” he said.

Countries and Communities as Demand Generators

Estelle Tiphonnet Diawara, director of partnerships and capitalization, Coalition PLUS, provided a perspective from affected communities; she emphasized the importance of “taking into account the need of patients and people who are not going into health systems.”

“We need advocates in these countries to work with underprivileged communities …to buy good quality medicines and train people in good procurement policies,” she said.

“Major roadblocks” to downstream introduction of new health tools include low awareness among health professionals and users, low implementation, not enough research and development, and funding, said Sherwin Charles, chief executive officer of Goodbye Malaria, an organization active in public-private partnerships addressing malaria in southern Africa.

On how Goodbye Malaria has been trying to improve awareness of new products, Charles said, “We encourage staff to go and get embedded in health programmes and encourage them to do more.”

Chitalu Chilufya

Chitalu Chilufya, Zambia’s minister of health, provided a country perspective and stressed the importance of political will, noting that Zambia’s President ” has shown unprecedented political will on health.”

With regards to health promotion and innovation, he said, engagement with communities and religious and traditional leaders “is key ” and the trickle-down effects have a high impact. He mentioned examples in HIV/AIDS, TB and Malaria.

“On malaria we saw, for instance, the introduction of rectal artesunate as a pre-referral treatment in children in the rural community reduced mortality by 96%. Now this has been a pilot phase. So it is important that we find resources to roll it out in Zambia”

Dr Chilufya said “innovation is critical,” but overall efforts to re-engineer the country’s health systems are also crucial, especially efforts in improving health promotion and universal health coverage.

As next steps, work streams bringing together implementers and innovators are being created to map out a path for future progress against these key barriers.

“We need a steady pipeline of innovation tools needed to address resistance, facilitate elimination and also to address the underserved and vulnerable populations…. The great news is that we  are working together,” concluded David Reddy.

 

Image Credits: The Global Fund/John Rae, John Zarocostas.

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