Global Health Series: Support for global health is at the core of DSW’s advocacy work, and we focus increasingly on what is known as reproductive, maternal, newborn and child health (RMNCH for short). In particular, we work with partners to see where new and upcoming medical innovations can be used to improve the global health situation in low- and middle-income countries. As part of this work, we have launched a series of policy briefs on the issue of global health research and development. So far we in the last two weeks have looked at why we need to increase financial and political support (in Europe) for efforts aimed at creating new ways to tackle diseases such as HIV and AIDS, TB and malaria and how we can do this through mechanisms such as PDPs.
This week, we want to look at what kind of innovative mechanisms are in the pipeline or have already been developed that could improve the life chances of some of the most vulnerable in society – pregnant women, newborns and young children: how can R&D improve RMNCH.
Innovation for RMNCH
The need for innovation for RMNCH has long been recognised by various international and national strategies, road maps and partnerships. Yet significant R&D gaps around RMNCH persist, due mostly to chronic underfunding. Together with Global Health Advocates, Results UK, SABIN, AERAS, Iavi, IPPF EN and IPM, our new paper looks at what needs to be done and what is coming down the pipeline for RMNCH.
While strengthening health systems in low- and middle- income countries is a key strategy to reduce reproductive, maternal, new-born and child mortality, R&D would complement this scaling up of existing approaches. It would help significantly by tackling the most important direct and indirect causes of maternal, perinatal and child deaths, reducing the global burden of disease.
Both public and private investments are needed to stimulate this area of R&D: indeed low political priority has been given to women’s and children’s health in the past; in addition, the nature of clinical research in pregnancy is a challenge, which is exacerbated by a vicious cycle of research capacity dearth due to chronic underinvestment .
Why do we need innovations for reproductive health?
According to estimates, one in three deaths related to pregnancy and childbirth could be avoided if contraceptive services were accessible for all women. Delaying and spacing births enables women to bear children in their healthiest years, reducing the risk of maternal mortality, and empowers them to have their desired number of children. Babies born less than two years after the next oldest sibling are more than twice as likely to die in the first year as those born after an interval of three years . By preventing closely spaced births, improved access to family planning choices could save the lives of over a million infants and children annually.
In Sub-Saharan Africa, the reasons behind the low use of contraceptive methods are diverse and include previous bad experiences, fear of side-effects, and lack of access, often from logistical failures and products being out of stock. Innovation is needed to improve the development and delivery of new and safe contraceptive methods in LMICs.
How R&D can help reduce maternal mortality?
Strengthening investment in R&D will prevent a great number of avoidable deaths by providing new treatment as well as technologies more suitable for LMICs (e.g. heat stable vaccines), which can be administered by local health staff or by patients, themselves. Unfortunately, despite the need, investment into R&D in maternal and new-born health remains inadequate and is not particularly strategic. The number of pipeline drugs to treat maternal and new-born mortality is only 1–5% of that for other major disease areas. Estimates suggests that equitable pharmaceutical R&D and public sector health research funding over the next 10–20 years could avert 1.1% and 1.9% of the global disease burden from maternal and new-born diseases, respectively.
Additionally, despite the known negative health effects of NTDs, including on pregnant women, no vaccines for these diseases currently exist. There is a great need for additional R&D support to identify and develop new and improved preventative and therapeutic vaccines, diagnostics and treatments that can be delivered to girls and women to reduce parasitic infection before pregnancy and to improve sexual and reproductive health.
Protecting children from HIV, Malaria, TB and Pneumonia
For children, the leading causes of death of children under five are pneumonia, diarrhoea and malaria. For example, pneumonia is the single largest killer of children under five as well as the leading infectious cause of childhood mortality; diarrhoea accounts for 9% of all under-five deaths — a loss of more than 580,000 child lives in 2012. With these killers, as well as with HIV, Malaria and TB, there is a need for new and more affordable interventions – better diagnostics, more effective and accessible medicines and treatments, and in the case of malaria and HIV eventually a vaccine that can be rolled out where it is needed most.
What is coming down the RMNCH pipeline?
Our new factsheet on R&D for RMNCH gives an excellent (but obviously non-exhaustive) overview of some of the interventions coming down the R&D pipeline and aimed at addressing the problems for RMNCH. They include:
- The SILCS diaphragm, developed by PATH to better meet the need for a woman-initiated, non-hormonal, discreet contraceptive to enable women to protect themselves against sexually-transmitted infections and unintended pregnancies.
- The Progesterone Vaginal Ring, developed by the Population Council. The Ring provides breastfeeding women with an effective, user-initiated contraceptive option.
- The HOOKVAC consortium, working on clinical testing of the Human Hookworm Vaccine. It is testing Sabin PDP’s two lead candidate vaccines in African adults and children. Such a vaccine could provide a sustainable and effective means for controlling hookworm infection, reducing the anaemia, delayed physical growth and impaired cognitive development caused by hookworm infection.
- A new, highly sensitive blood test developed by The Foundation for Innovative New Diagnostics (FIND), together with the Hospital for Tropical Diseases (HTD), London, UK, the London School of Hygiene and Tropical Medicine, and Eiken Chemical Company, Ltd., Japan. The blood test quickly detects even the lowest levels of malaria parasites in the body. This first commercially available malaria assay called LAMP (“loop-mediated isothermal amplification”) is a simple test, which can be performed by a non-specialist health worker and does not need refrigerating like other tests. The whole process takes less than an hour.
As I have said, this is a very non-exhaustive list. Download the RMNCH paper for the full rundown on the new tools being developed as we speak.
How can politicians support R&D for RMNCH?
Given the clear need set out for new and improved, safe and effective, technologies and products that are acceptable to end-users, adequate to address causes of maternal, new-born and child mortality, European politicians have a huge role to play in creating a supportive policy environment to allow these developments to flourish. The RMNCH paper in particular calls on EU MEPs to:
– A sustainable EU investment in R&D for RMNCH, including funding for non-profit product developers partnerships which offer unique value in accelerating R&D through facilitating partnerships between the public, philanthropic and private sector, in mitigating R&D risks via a portfolio of product candidates, and in ensuring the affordability and adequacy of products in LMICs.
– That the EU’s commitment to making global health science, research, and product development is a key component of the final post-2015 development framework, as without it good health for all cannot be reached.