Duke Global Health Fellows Engage with Global Health Leaders in Geneva


Duke Global Health Fellows Engage with Global Health Leaders in Geneva

July 23, 2013

Spending the summer interning in Geneva, Switzerland, a hub for global health policy, the ninth cohort of Duke Global Health Fellows capped a week-long policy course by attending the opening session of the Trilateral Joint Technical Symposium on Medical Innovation.

The 23 fellows are from universities around the world, including Duke alumni and a student in the Duke Master of Science in Global Health. Hosted by the World Health Organization (WHO), World Trade Organization (WTO) and World Intellectual Property Organization, the event allowed fellows to pose questions to each of the Director Generals and to GAVI Alliance CEO Seth Berkley.

“It was very exciting to be a part of the symposium,” said Xiaochen Dai, a global health fellow and Master of Science in Global Health student at Duke. “The director-generals of WHO, WIPO and WTO and the CEO of GAVI gave inspiring presentations on medical innovations in global health.”

Also presenting at the technical symposium, Program Director and Duke professor Dr. Anthony So discussed new business models that overcome scientific and financial bottlenecks to pharmaceutical innovation and can transform how health technologies are distributed and brought to market. His talk “Antibiotic Resistance- Today’s Challenges, Tomorrow’s Solutions” highlighted the need for new approaches that involve tiering, pooling and push-and-pull financing mechanisms.

The symposium and a week-long course leading up to it helped the fellows gain new perspective into emerging global health policy issues. The course involving 25 expert seminar sessions and site visits enabled fellows to understand how policy issues come together in the field, from innovation and technology transfer to intellectual property rights and access to medicines.

“The Geneva Global Health Fellow Program is fantastic,” said Dai. “I loved the one-week course during which we were exposed to many interesting topics in global health and visited many important organizations in Geneva. This program has definitely broadened my horizon in global health and helped me make connections with future leaders in this field.”

“I felt like my comprehensive understanding of the vast domain of global health challenges was holistically influenced by hours of intense exchange from the over 40+ individuals from numerous organizations across Geneva who took time out of their busy schedules to share their insights with us,” said Braveen Ragunanthan, a fellow who recently graduated from Duke with a public policy degree and global health certificate. “We are equipped with a sharper sense of what challenges exist, and now have a greater sense of urgency to help address them.”

Organizations that work closely with the fellows include many WHO departments, the UN Development Program, UN Environment Program, the Global Alliance for Vaccines and Immunizations, the World Heart Federation, and the International Organization for Migration. Students also attended a dinner with various mentors in global health and visited the Strategic Health Operations Center (SHOC), where WHO monitors pandemic threats and infectious disease outbreaks.

Antibacterial Resistance takes Center Stage in Geneva



22 July 2013

Antibiotic resistance took center stage in Geneva, both at the Trilateral Symposium on Medical Innovation, hosted by the World Health Organization, the World Trade Organization and the World Intellectual Property Organization, on July 5th and in the findings of the 2013 update of Priority Medicines for Europe and the World launched on July 9thMany experts addressed antibiotic resistance as an urgent global health threat, including WHO Director General Margaret Chan.

In her opening remarks to the WIPO-WTO-WHO technical symposium on “Medical Innovation & Changing Business Models,” WHO Director-General Margaret Chan noted the urgent challenge of a post-antibiotic era and the dire consequences of running out of effective, first-line antibiotics. ReAct’s Strategic Policy Unit Director, Dr. Anthony So from Duke University, gave focus to these policy concerns by discussing the scientific and financial bottlenecks to innovation through the lens of antibiotic resistance (see symposium agenda and presentation here)

Discovering novel classes of antibiotics has proven to be a significant scientific challenge. Curing an infection in a few days- as opposed to treating a disease, like high blood pressure, for life- also results in lower returns for companies investing in antibiotic R&D compared to other therapeutic classes. The shortage of novel antibiotics is particularly worrisome given the growing burden of resistance and punctuates the need for looking at new business models. He suggested the need to innovate our approach to innovation, applying tiering and pooling as well as push and pull financing mechanisms in concert.

He called attention to the importance of piloting approaches that delink R&D investment from both prices and–in the case of antibiotics–quantity as well. However, with push financing like the EU’s Innovative Medicines Initiative or U.S. BARDA (the Biodefense Advanced Research and Development Authority) program or pull mechanisms like prizes for diagnostics, there also must come commensurate returns on these public sector investments, especially in ensuring life-saving antibiotics are affordable to those in need.

Illustrating the importance of collaborative R&D, he showed how the fledgling, but promising India Council on Scientific and Industrial Research’s Open Source Drug Discovery Initiative had already made significant strides in successfully sharing resources, risks and rewards to improve upstream innovation with an eye on downstream access. This 3Rs framework was discussed in an article in the BMJ.

In contributing to this panel, Richard Laing–lead author behind the WHO reportPriority Medicines for Europe and the World launched on July 9th–described the importance of antibiotic resistance in the 2013 update, that recalls the 2004 report’s conclusion that “we are facing the possibility of a future without effective antibiotics.”

In the report’s chapter on priority diseases and their reasons for inclusion, antibacterial drug resistance leads off as the first of a series of conditions. These conditions are “associated with a pharmaceutical gap in that many pharmaceutical treatments for them are already ineffective and many others will soon become ineffective. Both [antibacterial resistance and pandemic influenza] pose enormous threats to global public health which will require major multi-sectoral responses.”

In closing, Professor So reminded policymakers of how penicillin was brought to market, with concerted public-private partnership, as a generic drug during the second World War. And he concluded that: “Indeed the need today for a global R&D framework, beginning with efforts to address the public health challenge of antibiotic resistance, may give our children a future free from the fear of untreatable infections.”