The Hummingbird Unitaid News - October 2018


1. The UN high-level meeting on TB is over. What's next?

2. Malaria - 3 things you need to know about the New Nets Project

3. Meet Cherise P. Scott, technical officer with Unitaid's strategy team

The UN high-level meeting on TB is over. What´s next?

Unitaid and partners look back at the UNHLM and ahead to The Union Conference on Lung Health in The Hague, Netherlands

On 26 September in New York, world leaders endorsed the UN political declaration on TB with the most ambitious commitments made to date. Unitaid took the opportunity to highlight the agency's role in speeding up the large-scale introduction of health innovations that are essential to end the epidemic. This work, which Unitaid conducts together with partners, was acknowledged in the political declaration and through our participation in ten high-level events organized by key global health partners including WHO, the Global Fund, Stop TB Partnership, PIH, TB Alliance, CDC.

Back in Geneva, we asked partners and top TB players to share with us their impressions of the meeting, and their expectations for the 49th Union World Conference on Lung Health, which takes place from 24 to 27 October in The Hague. Here's what they told us:

1. Dr. Tereza Kasaeva, director of WHO Global TB Programme

“To reach targets, 2019 will have to be a watershed year for scaling up access to care and in financing research. Our top tasks are to help national leaders set priorities for immediate action and support the implementation and research strategy. We look to Unitaid for their strong leadership and cooperation in supporting TB innovations, especially in access to TB preventive treatment, and addressing childhood TB and drug-resistant TB.”

2. Lucica Ditiu, executive director, StopTB Partnership

“I left New York with mixed feelings: excitement over a high-level political declaration on TB being adopted for the first time, and disappointment over the low turnout of presidents from the high-burden and donor countries. The Union Conference will be an opportunity for country programmes, partners and communities to start the hard job of turning words into concrete and bold actions”

3. Dr. Francis Varaine, endTB project leader, Médecins Sans Frontières

“Global leaders have to truly commit to increase investments and mobilize the research community to develop new medical tools. The 10 million people who develop TB each year are desperately waiting for a fast, safe, and simple cure.”

4. Charles Gore, executive director, Medicines Patent Pool (MPP)

“TB is not just a ‘health’ issue: all of us in the TB response must pool our expertise to develop new tools and make them accessible to greater numbers, quickly and efficiently. The Union Conference is an opportunity to take conversations to the next level, focusing on accountability mechanisms and specific delivery points.”

5. Chip Lyons, president and CEO, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)

"The political declaration recognized the specific TB prevention, treatment, and research needs of children, and this is a strong step forward. The Union Conference is an opportunity to translate political commitments into action; we cannot bask too long in the glow of a successful high-level meeting."

6. Dr. David Ripin, executive vice president, infectious diseases, and chief science officer, Clinton Health Access Initiative (CHAI)

"We should be doing much better at controlling TB with the tools we have, and build programs towards the elimination of TB that can immediately use better tools. If the TB community wants stronger engagement from political and donor circles, it must provide a more credible, specific 'investment' case."

7. Janet Ginnard, head of strategy, Unitaid

"We are excited to see such momentum in tackling the truly global disease that is TB. Accelerating progress toward global targets requires doing things differently and adopting a comprehensive approach to test, treat and prevent all forms of TB in all populations. This is why our current priorities include scaling up better treatment for children; enabling preventive TB therapy; and bringing better, shorter treatments for MDR-TB."

THREE things you need to know about the next generation of bed nets

Unitaid and The Global Fund team up with IVCC, LSHTM, PSI and PATH to evaluate and pilot next-generation insecticide-treated nets to fight mosquitoes resistant to commonly used insecticides

Malaria-carrying mosquitos are becoming more and more resistant to the insecticides used on bed nets, which are one of the main weapons against malaria. The Global Fund and Unitaid have joined forces to evaluate and pilot nets treated with a new combination of insecticides —a pyrethroid plus an unrelated active ingredient— that could be more effective against resistant mosquitoes.

Each organization is contributing US$33 million, and a consortium led by the Innovative Vector Control Consortium (IVCC) will lead the four-year initiative in six to eight sub-Saharan African countries. Here are three things you need to know about the New Nets Project:

1. The obstacle

The new nets could enhance the fight against malaria, but they are likely to be more expensive and the World Health Organization has yet to weigh in on their added impact on the disease above-and-beyond the current standard nets. "One of the new nets being evaluated has been prequalified by WHO as a standard long-lasting insecticide-treated nets, but it does not have a policy recommendation stating it can, and should, be used to address resistance," explains Unitaid senior technical manager Alexandra Cameron.

"Often new products reach the market, but due to their higher price and limited understanding of their added value and cost-effectiveness, they have minimal uptake. This limits public health impact and acts as a disincentive for future research and development," says Cameron.

2. The strategy

The initiative will generate the epidemiological data WHO needs to evaluate the added public health benefit of the nets. At the same time, implementers will start to pilot the new bed nets in countries, and will establish the market conditions for future deployment through increased volumes and other market-shaping activities that could facilitate price reductions.

"Through this pilot implementation, we want to prime the market and answer some operational questions, so if and when WHO recommends these nets, adoption at country level can be faster," says Cameron. Partners will conduct operational research on how to distribute the nets in the context of large-scale campaigns and look at the direct and indirect costs and benefits of new nets under a range of operational settings.

3. The partners

Another innovative aspect is the partnership with the Global Fund, which will facilitate bed net delivery and lay the foundations for scale-up as the world's largest procurer and distributor of insecticide-treated nets. The initiative also brings together four implementing partners, "each of them responsible for very distinctive activities in line with their skills and experience," says Unitaid’s Programme Manager Ana Álvarez.

Consortium leader IVCC will be in charge of market interventions such as price negotiations with suppliers and a time-limited co-payment for the nets, to absorb their likely extra cost so that bed net coverage in countries is not reduced. The London School of Health and Tropical Medicine (LSHTM) will conduct randomized control trials of the nets; Population Services International (PSI) will support the pilots, drawing on their experience in mass distribution of nets; and PATH will conduct research on cost-effectiveness.

"Here's the spirit of the project: we want to determine the additional public health gains that could be achieved with new nets. If new nets have public health value and WHO recommends them, we want to achieve these gains in countries as quickly as possible by priming the market for future deployment" — Alexandra Cameron, senior technical manager, Unitaid

"We all want to do something that means something, and I believe I am"

Meet Dr. Cherise P. Scott, technical officer with Unitaid's strategy team

"We all want to do something that means something, and I believe I am," says Dr. Cherise P. Scott, technical officer with Unitaid's strategy team and global health specialist with over a decade of experience in advancing innovations for neglected diseases. Scott worked with non-profit partnerships developing vaccines and medicines for TB and other neglected diseases before joining Unitaid in 2018.

"I had always been on the grantee side of things, and realized there is a big gap in terms of scaling up innovations and integrating them into healthcare, which is precisely what Unitaid aims to do," she says. Scott also wanted to acquire a better understanding of how funding decisions are made. What she found is that it is not straightforward.

"This is an interesting time in global health, with a combination of ambitious targets, limited funding and a real desire to change the status quo." Hence, the current focus on partnerships as a means of doing more (and better) with less. "Things are now starting to be the way they should have always been," she says.

As a member of the strategy team, her job is to identify gaps in the global response to diseases such as TB and hepatitis C, and to find the best innovations Unitaid could support to significantly improve that response.

"It is about making the smartest decisions to achieve the biggest possible impact with the available resources."

Scott believes meeting global health goals is both about making better use of existing tools and developing new ones. "The global health community has set ambitious targets, and old tools alone just won't get us where we want to go."

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