Viewpoint by

Bernard Pécoul, Executive Director, DNDi

While the epidemic peak of the Ebola crisis slightly begins to wane and with it potential avenues for treatment beginning to emerge, the global health community simply cannot go back to business as usual. A strong public opinion has been mobilized and with Ebola now a household term, there is simply no turning back. A hard stance is being taken on many fronts, including policy makers, scientists, pharmaceutical companies, philanthropists, civil society members, global health experts, and journalists to ensure that beyond this one crisis, the lessons learned from several hitherto seemingly unrelated public health issues be brought together and examined with the same scrutiny. But we cannot stop there; a comprehensive and lasting solution could be at our doorsteps but requires a serious look at what is not working currently, and what is!

Today’s unparalleled convergence of innovation and access crises, notably antimicrobial resistance, Ebola, hepatitis C, and all neglected diseases – requires a substantive response that is in tune with the reality of the currently broken innovation system, as well as the shifting of wealth and poverty to middle income countries, and all that this entails. Admittedly, it is challenging to ‘connect the dots’, and paradigm shifts are generally seen in hindsight. We cannot afford to wait for that hindsight. Greater mobilization by governments and global health stakeholders is vital to securing the political and financial commitments required for the solutions proposed today to address public health priorities in a sustainable way with public leadership at the helm.

Recent member state discussions at the World Health Organization’s Executive Board show that there is a political momentum. The Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, which proposed the elements for public-driven sustainable research and development for poverty-related diseases, has been extended to 2022, essentially maintaining its importance and scope on the political agenda. The follow up to the Consultative Expert Working Group (CEWG) on Research and Development: Financing and Coordination (CEWG) process received strong moves of support with funding commitments and consensus over the establishment of a pooled fund for R&D programmes. Ebola was brought into the discussions, elucidating the urgent need for a sustainable mechanism to ensure innovation is timely and access secured. A draft global action plan on antimicrobial resistance was tabled, and sets out far-reaching objectives, which call for a rapid, high-level global political response to stimulate R&D to be approved at the next World Health Assembly. The recent WHO Neglected Tropical Diseases (NTD) report has also placed great emphasis for the need to invest both politically and financially, calling for innovative financing mechanisms and endemic country investment, notably from middle-income countries, where the majority of the poor, and thus the majority of NTD patients, reside.

As the frontiers of poverty, disease, and policy and market failures are blurring, we see that the commonality between ‘traditional’ poverty related diseases and emerging global health crises (for example Ebola, or hepatitis C) all point to patients for whom there is no, or insufficient innovation, and who lack access to adapted treatments. They point to patients who deserve to benefit from anticipation, from innovation in R&D in the way it is prioritized, coordinated, financed, and conducted, and certainly from the way it is made accessible to them. The conditions are present now, and we could be at the brink of ‘connecting the dots’ with a framework for a global, adapted response to the innovation and access crises with:

• Patient-needs driven priority setting;
• De-linkage of the cost of R&D from the price of products delivered;
• Integration of global health R&D monitoring, coordination, and financing;
• Creation of a more enabling regulatory environment to expedite approval of essential medicines;
• Setting up of sustainable financing mechanisms, including through a global health pooled funding for long-term innovation.

At the upcoming World Health Assembly, the next G7 Summit in Berlin, G20 meetings, and the upcoming BRICS Summit, all of these global public health issues will be on the respective agendas – including antimicrobial resistance, Neglected Diseases, and Ebola. World leaders will have the political opportunity to ensure that public health priorities are addressed in a sustainable way. It is their responsibility to ensure that at this highest political level the dots are connected. It is our responsibility as civil society and research groups to remind them of their mandate.

Dr Bernard Pécoul, Executive Director, DNDi