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Seizing opportunities to stop infectious diseases Unitaid News – 28 November 2019

Contents

1. Price cut sparks real momentum toward ending tuberculosis

2. Unitaid Executive Board approves plans for malaria prevention in babies

3. Unitaid unveils its latest TB innovations at India conference

4. Two new projects help manage childhood fever, fight pneumonia deaths

5. Delegations: Unitaid participates in the ASTMH conference in Washington, D.C.; Launches call in Brasilia for proposals to stop Chagas disease

Price cut sparks real momentum toward ending tuberculosis

Unitaid and partners made headlines this month with their announcement of a deal that will lead to tuberculosis prevention for millions of people in more than 100 countries where the epidemic is at its worst.

The agreement, hammered out over the course of this year between Unitaid, the Global Fund and the pharmaceutical company Sanofi S.A., brings about a discount of nearly 70 percent on the antibiotic rifapentine, which was approved for use in 2017 but has been too expensive for the countries where it is most needed. The discount means the cost of a three-month course of the drug will drop from US$ 45 to US$ 15 in low- and middle-income countries.

“This is real momentum. It’s a breakthrough for prevention that can actually be rolled out at scale, starting next year,” said Robert Matiru, Unitaid’s director of programmes, who was involved in the negotiations.

To eliminate TB by 2030, the global health community has adopted a three-pronged strategy: Prevent. Diagnose. Treat. But while diagnostics and treatments have steadily improved, prevention has lagged—until now.

“That third piece of the puzzle that has long been missing is finally coming into place,” Mr. Matiru said.

The breakthrough presents new challenges: getting generic versions of the drug into the marketplace to provide an adequate supply, and persuading people with latent TB to take a preventive therapy, even if they don’t feel sick.

“Multiple partners, countries and stakeholders will be needed to roll this out,” Mr. Matiru said. “Mostly in sub-Saharan Africa, but also in Asia and Latin America.”

To learn more about TB prevention and the implications of the price drop, see articles from The Guardian, The Economic Times and other media in Unitaid in the Press. Or listen to Robert Matiru in conversation with BBC Newsday:

Unitaid Executive Board approves plans for malaria prevention in babies

Unitaid projects have shown the enormous potential of chemoprevention for protecting pregnant women and small children from malaria.

Last week, Unitaid’s Executive Board approved expanding malaria chemoprevention for infants in the first year of life. Chemoprevention refers to preventing disease through medicines.

“This will save a lot of babies’ lives,” said Janet Ginnard, director of Unitaid’s strategy team. “It will be a really important piece to add to the tools for malaria.”

The Board’s approval allows Unitaid to launch a call for proposals.

Infants and children are very vulnerable to malaria because they have not yet developed protective immunity. Of the 435,000 people who died of malaria in 2017, nearly two-thirds were children under 5. In that group, babies one year old and under were at the highest risk of death.

Unitaid's plan is to invest in a strategy called intermittent preventive treatment for infants, dubbed IPTi, in which babies get malaria chemoprevention at around 10 weeks, 14 weeks and 9 months of age, coordinated with their vaccine schedules.

Despite being recommended by the World Health Organization since 2010, and having been found to reduce clinical malaria by 30 percent, only one country, Sierra Leone is implementing IPTi.

Unitaid has invested in two other malaria chemoprevention projects: ACCESS-SMC with Malaria Consortium and TIPTOP with Jhpiego.

ACCESS-SMC (2014-2018) proved that at full scale, seasonal chemoprevention in Africa’s Sahel region could annually prevent about 18 million malaria cases among small children, and save about 100,000 lives.

Unitaid’s five-year TIPTOP project, which this month reached its halfway point, has increased anti-malaria coverage in pregnancy 74 percent on average across four countries. The project is gathering evidence that could lead the World Health Organization to update its recommendations on malaria prevention for pregnant women, a policy change that could have a far-reaching impact.

Unitaid unveils its latest TB innovations at India conference

At this month’s Union World Conference on Lung Health in Hyderabad, India, Unitaid and partners launched a trio of innovations that will work together to fight TB through precise, gene-based diagnosis, therapies for drug-resistant TB tailored to meet the unique needs of children, and ingenious digital technologies that help patients adhere to treatment.

Each of the projects fills a gap in the global TB response, while building on Unitaid’s previous work in TB, said Dr. Cherise Scott, a technical officer on Unitaid’s strategy team, who was present for the launches.

“Our challenge is always to ask ourselves: how do we reach this goal of eliminating TB in the world? How do we move health products from the research and innovation space to countries where they can be used by the people who need them?” Dr. Scott said. “The way Unitaid’s model works, we look for opportunities around health products, and find things that seem primed for our intervention.”

The new initiatives presented in India were the results of that exploration:

BENEFIT Kids: This three-year, US$ 18.9 million project will enable more effective treatment of children exposed to or suffering from multidrug-resistant TB. Led by Stellenbosch University in South Africa.

ASCENT: This project uses digital technologies to help TB patients take their medicines on schedule and enables healthcare workers to support them. It employs “smart” pill boxes that send a signal to a clinic when patients open them to take a pill, medication sleeves with toll-free phone numbers to call or text after taking a dose, and a mobile application to send confirmatory videos. The KNCV Tuberculosis Foundation leads the US$ 13.9 million project.

Seq&Treat: This project will pilot next-generation gene sequencing, an innovation that provides fast, accurate diagnosis of drug-resistant TB. Better diagnosis enables patients to get the right treatment earlier. The technology also has the potential to be an effective tool for diagnosing other drug-resistant microbes. The Foundation for Innovative New Diagnostics (FIND) leads the US$ 14.5 million project.

The US$ 50 million in new investments presented at the Union Conference confirms Unitaid’s position as one of the world’s largest multilateral funders of TB research and development, with a portfolio on track to reach US$ 300 million in 2020.

“These new projects are very complimentary to our entire TB portfolio,” Dr. Scott said. “It doesn’t mean we’re filling all the gaps. We’re still looking and determining—what’s the next thing we can to do contribute to the TB response?”

Two new projects help manage childhood fever, fight pneumonia deaths

Unitaid participated in a global call to action to mark the 10th anniversary of World Pneumonia Day on 12 Nov., helping draw attention to a neglected disease that has long been the single biggest infectious killer of children. Better, more holistic primary care, nutrition, access to vaccines, cleaner air and other factors can help reduce pneumonia, and at the same time support the UN Sustainable Development Goals’ 2030 target of ending preventable deaths of newborns and children under 5.

Two new Unitaid projects, ALIMA’s AIRE and PATH’s TIMCI, are aimed directly at improving primary care for children. The projects are expanding access to portable, easy-to-use devices called pulse oximeters that measure oxygen in the blood. The devices can help frontline health workers identify children who are dangerously ill with diseases including pneumonia and refer them to urgent care.

“If these new tools for detecting severe disease can be used effectively in low-resource settings to get sick kids the care they need, the impact of their widespread availability could be significant in preventing deaths and saving lives,” said Katerina Galluzzo, technical officer on Unitaid’s strategy team.

To keep the conversation going, the Every Breath Counts Coalition will publish a series of success stories on its website, running through the end of the year. AIRE and TIMCI will be featured in an article set to appear 23 December. The campaign is building momentum ahead of January’s Global Forum on Childhood Pneumonia. Unitaid is a member of the Every Breath Counts Coalition, the world’s first public-private partnership to help national governments end preventable child pneumonia deaths by 2030.

Delegation highlights:

Unitaid shares malaria results at ASTMH conference

A Unitaid delegation participated last week in the 68th annual meeting of the American Society of Tropical Medicine & Hygiene (ASTMH), a five-day event near Washington, D.C. that brought together hundreds of public health leaders, scientists and partners from all over the world. Unitaid hosted a symposium on biomarkers for managing fever in low-resource settings, and was co-chair, with the Bill & Melinda Gates Foundation, at an event exploring how market and economic data can be best used to help speed up access to innovative malaria products. Side events last Friday and Saturday featured lessons learned about seasonal malaria chemoprevention for small children from Unitaid’s ACCESS-SMC project in Africa’s Sahel region.

Unitaid broadens its efforts on behalf of mothers & children

On Monday in Brasilia, Unitaid launched a call for grant proposals to help eliminate mother-to-child transmission of Chagas disease, a neglected tropical parasitic infection that annually kills about 10,000 people. Working against Chagas falls within the scope of Unitaid's mandate to improve reproductive, maternal, newborn and child health, which is also a pillar of the UN Sustainable Development Goals for health. Worldwide, 75 million people are at risk of Chagas. Ideal grant proposals would improve diagnosis and treatment. The deadline to submit a proposal is 27 Feb, 2020.