Press Release – Strategic investments to discover and develop new health tools, together with innovations in effectively delivering today’s health tools and services, could avert 10 million deaths a year within just one generation, argue leading global health experts in a new PLOS Collection, Grand Convergence: Aligning Technologies and Realities in Global Health.
The unique collection of papers involves 69 authors from high-, middle- and low-income countries, and includes some of the world’s leading disease control experts. As described in an accompanying Editorial, the goal of the collection is to “inspire the global health research community to contribute to an unprecedented opportunity to boost human development worldwide.”
“Grand Convergence: Aligning Technologies and Realities in Global Health” builds on the Lancet report “Global Health 2035” which argued that it is possible, through a strategic investment plan, to achieve a “grand convergence” in health that would reduce avertable infectious, maternal, and child deaths down to universally low levels within a generation by aggressively scaling up health tools. But the report came to an important conclusion: the world cannot reach convergence with today’s tools alone; tomorrow’s tools will also be needed.
The collection, led by Gavin Yamey, Professor of the Practice of Global Health and Public Policy at the Duke Global Health Institute, who led the writing of Global Health 2035, and Carlos Morel, Director of the Center for Technological Development in Health and a Senior Researcher at the Oswaldo Cruz Foundation (Fiocruz) in Brazil, focuses on five conditions that disproportionately affect the world’s poorest people: HIV/AIDS, tuberculosis, malaria, maternal and child mortality, and neglected tropical diseases. The articles, published across PLOS Biology, PLOS Medicine and PLOS Neglected Tropical Diseases and written by experts directing global disease control campaigns or international research efforts, explore the diverse array of innovations that will be needed to prevent and treat diseases, and to successfully ramp-up the delivery of health tools and services to those most in need.
The prospect of achieving a grand convergence in global health within a generation can only be realized through a serious, renewed effort to step up investments in R&D to tackle the health conditions of poverty, argue Yamey and Morel. This collection aims to inspire the international health community to contribute to an “unprecedented opportunity to boost human development worldwide.”
“We have a once in human history opportunity to save 10 million lives a year,” said Professor Yamey, “but we can only achieve this extraordinary transformation in global health by massively stepping up our efforts to discover and deliver new health technologies.”
The February 1st declaration by WHO that the cluster of microcephaly cases and other neurological disorders are a PHEIC –Public Health Emergency of International Concern – should remind us not to neglect or underestimate neglected diseases, as at any moment they could come knock at our door,” said Professor Morel; “rapidly developing and delivering new solutions to new threats is critically important.”
In their paper on ending AIDS, Glenda Gray, President of the South African Medical Research Council, and colleagues argue that although widespread elimination of HIV will require the development of new, more potent prevention tools, true containment will depend on the creation of what has proven frustratingly elusive: a highly effective vaccine.
Development of a safe, effective vaccine will also be needed to end the global tuberculosis epidemic, argue Christian Lienhardt, Senior Research Adviser at the WHO Global TB Programme, and colleagues, along with better treatment protocols and rapid point-of-care diagnostics.
Janet Hemingway, Director of the Liverpool School of Tropical Medicine and Professor of Insect Molecular Biology, and her co-authors offer cautious optimism in the fight to eliminate malaria. “The product development pipeline for malaria has never been stronger,” they argue, “with promising new tools to detect, treat, and prevent malaria, including innovative diagnostics, medicines, vaccines, vector control products and improved mechanisms for surveillance and response.” Yet successful development and adoption of these tools will require better systems for information management, surveillance and response, they note, which in turn depend on continued financial and political commitment to support eradication programs.
Highlighting the problem of delivering health care to those in need, Margaret Kruk, Associate Professor of Global Health at the Harvard T.H. Chan School of Public Health and colleagues argue that gains in health will require major investment in what they call “policy and implementation research,” which can be defined as the “systematic and rigorous analysis of which delivery approaches worked across a variety of health needs and which did not.”
Substantial gains in reducing the burden of neglected tropical diseases, which continue to rank among the world’s biggest health problems, will require new drugs, vaccines, diagnostics, and vector control agents and strategies, Peter Hotez, Dean of the National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology and Microbiology at Baylor School of Medicine, and his co-authors argue. But to eliminate these ancient scourges, they say, it is especially important to build up local capacity in research and development in the affected countries.
The innovations that could have the most impact in reducing maternal and infant mortality, Cyril Engmann, global program leader for the Maternal, Newborn, Child Health and Nutrition Program at PATH, and colleagues say, will be those that tackle stillbirth, adolescent health and preconception care, mental health, integrated early childhood development, and especially vulnerable populations such as the urban poor and those displaced by emergencies.
Such ambitious global health goals cannot be reached unless the two vastly different worlds of innovation and public health can be brought together, argues Mary Moran, Executive Director of Policy Cures. “This convergence, and the R&D underpinning it, will first require an even more fundamental convergence of the different worlds of public health and innovation, where a largely historical gap between global health experts and innovation experts is hindering achievement of the grand convergence in health.”
So far, global health funders have mostly succeeded in mobilizing resources when the need is clear and imminent, argues Trevor Mundel, President of the Global Health Division of the Bill and Melinda Gates Foundation. But maximizing the impact of global health funding remains a major challenge and will demand a serious reconsideration of the ways foundations fund and organize health research and development worldwide. A more strategic, data-driven approach to investment is still needed, he says.
Contact:
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Collection Articles
Investing in Health Innovation: A Cornerstone to Achieving Global Health Convergence
Gavin Yamey & Carlos Morel
PLOS Biology
Transformative Innovations in Reproductive, Maternal, Newborn, and Child Health over the Next 20 Years
Cyril M. Engmann, Sadaf Khan, Cheryl A. Moyer, Patricia S. Coffey, Zulfiqar A. Bhutta
PLOS Medicine
Which New Health Technologies Do We Need to Achieve an End to HIV/AIDS?
Glenda E. Gray, Fatima Laher, Tanya Doherty, Salim Abdool Karim, Scott Hammer, John Mascola, Chris Beyrer, Larry Corey
PLOS Biology
Tools and Strategies for Malaria Control and Elimination: What Do We Need to Achieve a Grand Convergence in Malaria?
Janet Hemingway, Rima Shretta, Timothy N. C. Wells, David Bell, Abdoulaye A. Djimdé, Nicole Chee, Gao Qi
PLOS Biology
Transforming Global Health by Improving the Science of Scale-Up
Margaret E. Kruk, Gavin Yamey, Sonia Y. Angell, Alix Beith, Daniel Cotlear, Frederico Guanais, Lisa Jacobs, Helen Saxenian, Cesar Victora, Eric Goosby
PLOS Biology
Translational Research for Tuberculosis Elimination: Priorities, Challenges, and Actions
Christian Lienhardt, Knut Lönnroth, Dick Menzies, Manica Balasegaram, Jeremiah Chakaya, Frank Cobelens, Jennifer Cohn, Claudia M. Denkinger, Thomas G. Evans, Gunilla Källenius, Gilla Kaplan, Ajay M. V. Kumar, Line Matthiessen, Charles S. Mgone, Valerie Mizrahi, Ya-diul Mukadi, Viet Nhung Nguyen, Anders Nordström, Christine F. Sizemore, Melvin Spigelman, S. Bertel Squire, Soumya Swaminathan, Paul D. Van Helden, Alimuddin Zumla, Karin Weyer, Diana Weil, Mario Raviglione
PLOS Medicine
The Grand Convergence: Closing the Divide between Public Health Funding and Global Health Needs
Mary Moran
PLOS Biology
Honing the Priorities and Making the Investment Case for Global Health
Trevor Mundel
PLOS Biology
New Study on Feasibility of Sustainable Development Goal for Health
October 14, 2015
The stark disparities that exist in health today across countries and communities can be greatly reduced, creating more equal opportunities for survival and well-being everywhere, say the authors of a new study published in PLOS ONE (October 9).
At the annual United Nations General Assembly meeting last month, the UN adopted a new set of Sustainable Development Goals (SDGs), which includes one goal for health (SDG 3). The health goal includes a set of targets to be achieved by 2030, such as reducing the global maternal mortality ratio by two thirds (from 210 to 70 per 100,000 live births) and reducing the child mortality rate in all countries to 25 per 1000 live births or below.
How feasible are these targets? Colin Boyle, deputy director of Global Health Sciences at University of California, San Francisco, and colleagues addressed this question in a study in which they modeled what would happen if all low-income countries (LICs) and lower-middle-income countries (LMICs) were to build strong health delivery systems and to aggressively scale up the delivery of existing medicines, vaccines, diagnostic tests, and other health tools and any new tools that will become available in the next 15 years.
The Commission on Investing in Health’s Global Health 2035 report estimates the investment case for a grand convergence in health outcomes globally. In this study, Achieving a “Grand Convergence” in Global Health: Modeling the Technical Inputs, Costs, and Impacts from 2016 to 2030, Boyle and colleagues estimate what the grand convergence investment case might achieve – and what investments would be required – by 2030.
The authors found that, on average across all LICs and LMICs, the maternal mortality ratio would fall to about 169 for LICs and 69 for LMICs per 100,000 live births by 2030 and the child mortality rate would fall to 27 for LICs and 13 for LMICs per 1000 live births. The authors conclude that “by 2030, the time horizon for the SDGs, an integrated investment plan for low-income and lower-middle-income countries could yield under-5 mortality rates comparable to upper-middle-income countries today, and set the stage for continued convergence with high-income countries”
“The last 15 years have seen unprecedented improvement in human health in low-income settings. Our analysis suggests that we have just scratched the surface of what is possible,” Boyle said. “We hope that policymakers striving to achieve the SDGs will see this convergence analysis as an indication that further dramatic, rapid gains in health are both possible and affordable.”
Read the study at PLOS ONE Achieving a “Grand Convergence” in Global Health: Modeling the Technical Inputs, Costs, and Impacts from 2016 to 2030.
Bellagio workshop on implementing pro-poor universal health coverage
July 28, 2015
The CIH hosted a three-day workshop, July 6-10, 2015, at the Rockefeller Foundation’s Bellagio Center on “Implementing Pro-Poor Universal Health Coverage.” During this meeting, a diverse group of 21 participants, including officials from the Ministries of Health of nine countries, academics, and representatives of global health agencies, foundations, and civil society organizations, shared their experiences to build the evidence on how to successfully implement pro-poor UHC.
The Commission on Investing in Health, in its Global Health 2035 report, set out an ambitious investment framework for global health with UHC at its foundation. The CIH endorsed “pro-poor” pathways to UHC — in which there is a determination to include poor people in service provision from the outset — as the most efficient way to achieve both improved health and financial risk protection.
Countries worldwide are now embarking on health systems changes that move them closer to achieving UHC. As they do so, they can draw from a significant body of research and evidence about the technical aspects of UHC implementation — which we call the “what” of UHC — such as defining service packages and developing health financing systems. However, there is little information available on what we call the “how” of UHC implementation, for example: how do countries build and sustain political commitment for UHC over time? How do UHC leaders manage opposition to pro-poor service delivery? How can countries secure and maintain adequate long-term health systems finance while moving away from out of pocket payments?
Participants at the Bellagio workshop discussed their experiences and country evidence to tackle a set of key “how” questions about pro-poor UHC implementation. These “how” questions covered political will and public engagement, information and evidence generation, the growth and evolution of UHC schemes, quality assurance, and international action. Some of the key lessons emerging from the meeting include:
- Take advantage of political windows of opportunity: UHC advocates should be ready to use policy windows to push pro-poor UHC higher up on the political agenda. Participants at Bellagio shared their experiences about “what works” in getting UHC on the agenda, including how to bring the ministry of finance on board as an ally and how to handle opposition.
- Engage the public through accountable and open communication: Civil society movements can be effective in generating political will for and shaping UHC programs. Participants discussed effective strategies for bringing the public into decision-making and engaging the NGO community.
- Generate and use evidence to guide successful UHC implementation: Gathering and using information is essential for UHC priority-setting, quality assurance, and sustainability. Participants shared strategies for data collection and dissemination to inform evidence-based decision-making at a country level.
