How to prevent 10 million deaths a year

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. 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.

"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.

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

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