By Michelle Childs, DNDi Policy Advocacy Director
At last week’s G20 meeting in Rio de Janeiro, G20 Health Ministers took a major step towards addressing the problem that is at the heart of DNDi’s mission: the lack of diagnostics, treatments, and vaccines to diagnose, treat, and prevent diseases that affect the world’s most neglected communities.
Brazil showed strong leadership by placing health equity at the heart of its G20 Presidency and championed the creation of the new G20 Coalition for Local and Regional Production, Innovation, and Equitable Access for Neglected Diseases and Vulnerable Populations.
By establishing the Coalition last week, the G20 acknowledged one of the hardest lessons of the COVID-19 pandemic: when equity is not a central determinant in how urgently needed health tools are developed, produced, and delivered, already vulnerable populations are the ones to suffer most.
The G20 Coalition can focus much-needed attention and public resources on existing health priorities that disproportionately affect poor and marginalized people in low- and middle-income countries – such as neglected tropical diseases (NTDs) – while simultaneously leveraging networks that can be activated in the event of future health emergencies, epidemic outbreaks, or pandemics.
Keeping the focus
NTDs thrive in impoverished regions, including remote, rural, and politically unstable settings with limited access to health services. They also disproportionately impact women and children.
But because they are not commercially lucrative, these diseases have long suffered from a lack of investment in research. As a result, patients are left with no option but medicines that are inadequate, ineffective, or toxic.
The Coalition offers a unique chance to rectify this fatal imbalance. To do so, it will have to sustain its focus on neglected diseases and persons in vulnerable situations among many competing priorities – and not lose sight of the transformative impact it can have for the most neglected communities.
The case for dengue
Dengue can serve as a clear example – and a tangible next step – of the Coalition’s potential.
The disease affects nearly half of the world’s population and is spreading rapidly with urbanization. Its global incidence has increased markedly over the past 20 years, posing a substantial public health challenge. Like many other NTDs, climate change is fuelling its expansion. The World Health Organization alerts that recent years “have been characterized by a significant rise in the number, scale, and simultaneous occurrence of multiple outbreaks, spreading into regions previously unaffected by dengue”, including many G20 countries.
Yet, despite its expanding global prevalence, there are still no specific treatments for dengue. While innovative vaccines and vector control methods are promising, alone they will prove insufficient.
There is existing G20 R&D expertise and infrastructure for dengue, as well as several private-sector and academic initiatives working on the disease, but the focus is limited largely to vaccines. Research and development coordination, cross-regional collaboration, and funding are lacking for therapeutics and diagnostics, including for human resources and health research infrastructure.
The G20 Declaration recognises the need to build synergies with existing initiatives. Together with public research institutions in Brazil, India, Malaysia, and Thailand, DNDi has formed the Dengue Alliance, which could be built upon and expanded with G20 support. The Alliance features dengue-endemic countries in the lead in defining strategies and ambitions for South-South and triangular partnerships, as well as specific commitments to knowledge- and technology-sharing to guarantee equitable access. The Dengue Alliance aims to launch new clinical trials of repurposed and novel treatments in the coming months.
The G20 Coalition aims to foster innovative, geographically diverse partnerships that break down traditional barriers to R&D and local production. Supporting collaborative models such as the Dengue Alliance would reinforce R&D capacity across the regions most affected by neglected diseases like dengue. It would also align with the G20’s commitment to equity in climate and health responses – reflected in the Climate Declaration that member states also made last week. Learnings from a pilot focused on the needs of neglected populations at risk from climate-sensitive diseases could support Brazil’s commitment to make equity in health a core focus of its Presidency of COP 30 in 2025.
Moving beyond the status quo
DNDi has worked closely with the G20 Presidency and members states during the Health Working Groups to share our experience, and we are committed to support the Coalition’s development.
Ultimately, the G20 Coalition has the potential to be more than the sum of its parts. In addition to supporting pilot projects and leveraging new or innovative funding streams, it is a chance to shift the paradigm in global health: moving beyond the traditional aid architecture and into an era where needs-driven innovation, equitable access, and sustainable production are not exceptions but norms.
By maintaining a steadfast commitment to neglected diseases and prioritizing dengue as a pilot test case, the G20 Coalition can pave the way for a new model of global health collaboration that prioritizes the needs of the world’s most vulnerable to ensure that no disease and no community is left behind.
