Reimagining global health 30 high-impact innovations to save lives  BPaZ Innovation Countdown 2030 is reimagining what’s possible in global health. Led by PATH, the initiative is identifying and showcasing technologies and interventions with great promise to accelerate progress toward solving the world’s most urgent health issues. The initiative is supported by the Norwegian Agency for Development Cooperation, the Bill & Melinda Gates Foundation, and the US Agency for International Development.

By engaging entrepreneurs, investors, innovators, and experts across sectors and around the world, the Innovation Countdown 2030 initiative aims to accelerate high-potential innovations, catalyzing investment and increasing awareness of and support for transformative ideas to improve health and save lives.

www.ic2030.org

© 2015, PATH. July 2015 PATH/Gabe Bienczycki PATH/Gabe Introduction

We stand on the cusp of an unprecedented opportunity—the chance to transform health through the power of innovation, ensuring a brighter future for people in every 01 corner of the globe. Advances in science, technology, and health care delivery are already opening the doors of possibility in ways that were previously unimaginable. The United Nations (UN) Millennium Development Goals catalyzed a new global focus on ending preventable maternal and child deaths, goals that have driven unparalleled progress since 2000. Reimagining Global Health, the inaugural report of the Innovation Countdown 2030 initiative, highlights 30 lifesaving innovations with great promise to accelerate health global reimagining that progress over the next 15 years to reach the proposed health targets of the UN Sustainable Development Goals (SDGs). The report also features commentaries by leading health, business, and technology experts on the essential role of innovation in driving health impact. The report is the result of a yearlong effort to identify, evaluate, and showcase game-changing health technologies and ideas. We sought innovations from across sectors, disciplines, and borders, crowdsourcing hundreds of ideas from developers, entrepreneurs, and experts. Dozens of independent health experts then evaluated and ranked them, selecting the 30 innovations featured here. On the eve of launching the SDGs, the global community now knows what we can accomplish by coming together around a common set of goals and throwing our collective weight behind health solutions with the most potential for impact. As world leaders consider how to finance and scale up those solutions, we know that coordinated investment and financing will be essential in our efforts to reach the 2030 health targets—and to ensure we can financially sustain those gains into the future. We can accelerate our progress by prioritizing promising new vaccines, diagnostics, and other innovations and by expanding access to existing interventions and tools that have already proven themselves effective and affordable. Many of the solutions we need to tackle the world’s greatest health challenges are poised for impact. Will we grasp the opportunity to reimagine global health?

Steve Davis Christopher Elias President and CEO President, Global Development Program PATH Bill & Melinda Gates Foundation

Tore Godal Ariel Pablos-Méndez Special Advisor on Global Health Assistant Administrator for Global Health Ministry of Foreign Affairs, Norway US Agency for International Development P. falciparum

Contents

30 high-impact 01 Introduction innovations 04 to save lives Navi Radjou explains how frugal innovation can deliver more value to more people using fewer resources. 05 Lawrence Summers and Gavin Yamey on How to accelerate innovation to solve the the economic returns of investing in global 06 world’s most urgent health issues health innovation. Amie Batson on game-changing health solutions— and four key strategies to accelerate their impact.

Innovations for maternal, newborn, 13 and child health 13 New formulations of oxytocin 14 Uterine balloon tamponade 14 Handheld device to measure blood pressure 15 Simple, safe device for assisted delivery 15 Chlorhexidine for umbilical cord care “We have come a long way in a short time…[but] there are still far too many women and children dying from preventable conditions.” ­—flavia bustreo, page 16 16 Kangaroo mother care 17 New neonatal resuscitators 17 New treatments for severe diarrhea 18 Rice fortification 18 New tools for small-scale water treatment 19 Portable pulse oximeters to measure oxygen 19 Better respiratory rate monitors

PATH/Gabe Bienczycki Innovations for combating 20 infectious diseases 20 Protective malaria vaccine candidates

21 Malaria transmission-blocking vaccine Joel Santos PATH/Aaron 21 Potent, single-dose antimalarial drug 22 Expanded use of rapid malaria tests 22 Broadly neutralizing antibodies in HIV vaccines 23 Long-acting injectable antiretrovirals “To end HIV, TB, and malaria as epidemics, we have to accelerate progress…” ­—Mark Dybul, page 23 24 Oral preexposure prophylaxis 24 Novel multidrug treatment regimen for TB 32 25 New vaccines to prevent TB Crosscutting solutions to catalyze 25 Nucleic acid amplification tests health impact

Innovations for 34 reproductive health Ramez Naam on mobile, digital, and wired 26 development and health. 26 Expanded access to implants and intrauterine devices 27 Injectable contraceptives 35 Derek Yach explores how personalized “Innovation in reproductive health is a key to technology and behavioral economics can future health and prosperity for all.” tackle noncommunicable diseases. ­—Joy Phumaphi, page 27 28 One-year contraceptive vaginal ring 36 Christopher Egerton-Warburton Innovations addressing on creating a new source of capital for 28 noncommunicable diseases global health. 29 Polypill 29 Broader use of HPV vaccine 37 Our methodology “We should measure the health loss from noncommunicable diseases…to guide investment and innovation.” 42 ­—Christopher J.L. Murray, page 30 Advisory and evaluation panels 30 Task-shifting for diabetes care 31 mHealth innovations 44 31 Portable, affordable screening for eye problems The way forward Frugal innovation: the engine of sustainable development 04 How to achieve better health care for more people at lower cost

By Navi Radjou o rt

Development goes hand in hand with innovation. Western countries became “developed” economies by investing heavily in research and development (R&D) to create new technologies and processes.

Yet today, the R&D-driven innovation model This scanner, which processes images more

T DOWN 2030 rep T ION COUN is running out of steam because it is too quickly and uses less energy, cuts the cost of costly, elitist, and rigid and fails to address treatment by 30 percent and curbs radiation Navi Radjou is a even basic socioeconomic needs. More by up to 60 percent. It is now successfully Fellow at Cambridge Americans are getting sicker—45 percent commercialized in the United States.

the INNOVA Judge Business School. have at least one chronic disease—even as Use what is abundant to address what is He is co-author of health care spending skyrockets. Jugaad Innovation scarce. Health care providers should use and Frugal Innovation. The West’s “more with more” innovation resources that already exist widely—like He won the 2013 model uses ever more financial and natural abundant mobile and satellite connectivity— Thinkers50 Innovation resources to produce ever more costly to deliver care faster, better, and cheaper. Award and spoke at and sophisticated products and services. For example, Dr. Mohan, a world-renowned TED/Global 2014. Low-income countries don’t stand to gain diabetologist, operates a mobile clinic in An Indian-born much by importing this model. French national, he India housed in a satellite-enabled van lives in California. Inclusive and sustainable development in that links low-income patients in remote both emerging and advanced economies villages to urban doctors. Dr. Mohan requires frugal innovation—a disruptive teamed up with the Indian space agency approach that strives to deliver more to get free satellite communication for his economic and social value to more people telemedicine service. using fewer financial and natural resources. Collaborate across sectors for greater By delivering “more (and better) with less,” impact. Private-sector health providers frugal innovation enables socially and should team up with public and nonprofit environmentally responsible economic entities and integrate their knowledge and development through products and services networks to boost their reach. that combine four qualities: affordability, For instance, to help reduce infant and accessibility, sustainability, and quality. maternal mortality in Bangladesh, General Based on my in-depth study of pioneers of Electric partnered with Grameen Kalyan (a frugal innovation in the global health care sister company of Grameen Bank) to train sector, I identified three core principles that paramedics in rural clinics in the use of public, private, and nonprofit organizations ultrasound devices, making this solution can use to create and deliver health more widely available. The nonprofit ColaLife solutions at lower cost to more people. “piggybacks” on the cold-chain process of soft drink distributors as an inexpensive way to Favor simplicity over sophistication. preserve lifesaving medicines and distribute Easier-to-use medical solutions are less them to African villages. expensive to develop and maintain and more accessible. For instance, to address Ultimately, frugal innovation could boost China’s shortage of qualified doctors, collaboration between emerging and Siemens’ Chinese engineers created a advanced economies, enabling them to CT scanner that can be used by health cocreate affordable and sustainable health professionals who are not doctors. solutions that benefit everyone. The astonishing returns of investing in global health R&D How to reach a “grand convergence” by 2035 05

By Lawrence Summers and Gavin Yamey

We have a once-in-human-history opportunity to achieve a “grand convergence” in global health—a reduction in infectious, maternal, and child deaths down to universally low levels everywhere on the planet.

The Global Health 2035 report that we have the institutional capacity to deliver health global reimagining co-authored with 23 other economists new tools. One of the striking features and health experts came to a startling of health innovations is that they can be Lawrence Summers conclusion: With the right investments, we “capacity-conserving.” Our main tool for is President Emeritus could reach grand convergence in just one preventing malaria is arranging regular and Charles W. Eliot generation, averting 10 million deaths every mass distributions of bednets and teaching University Professor of year by 2035. households how to use them properly, a Harvard University and hugely resource-intensive intervention. But today’s health tools alone won’t get a former US Treasury When we develop a highly effective malaria us there. We’ll need tomorrow’s tools as Secretary. He chaired vaccine, we will be conserving such well, including new medicines, vaccines, The Lancet Commission resources. Bednets will come to be seen as a on Investing in diagnostics, and other innovations. cumbersome relic, akin to the iron lung in Health (CIH) and co-chaired the Investing in global health R&D won’t just the era before polio vaccines. save millions of lives. It will also reap Center for American In Global Health 2035, we called on donors astonishing economic returns. Progress’s Inclusive to step up their R&D investments. Public, Prosperity Commission. Take the polio vaccine. In the 1950s, the private, and philanthropic investors are March of Dimes invested about US$26 now on the lookout for high-impact R&D million in developing the vaccine. Since opportunities to catalyze global change. routine vaccination was introduced in the Today, 129 billionaires have pledged to United States, more than 160,000 polio deaths give at least half of their wealth to charity and about 1.1 million cases of paralytic polio through The Giving Pledge. Health is their have been prevented. Treatment cost savings number one interest. have generated a net benefit of around But investors want more guidance on how $180 billion. It’s hard to think of a better to achieve maximum impact. We believe $26 million investment in human history. a new “health investors’ platform” could Gavin Yamey is Today’s scientists are focusing on equally provide this kind of strategic knowledge Associate Professor game-changing innovations, like an HIV about the greatest health challenges facing of Epidemiology and vaccine. Our colleagues Dean Jamison poor populations, the most promising Biostatics in the Global and Rob Hecht have shown that every candidates in the R&D pipeline, and the Health Group (GHG) $1 invested in this vaccine would return likely health and economic impacts of at the University between $2 and $67, assuming a vaccine developing these into health tools that will of California, San Francisco. He directs of 50 percent efficacy becomes available by reach the poor. 2030 and R&D costs of about $900 million the GHG’s Evidence Global Health 2035 challenged all of us to annually. Other game-changers—like to Policy Initiative. reach higher and faster. But we will fail a single-dose malaria cure or inhaled He is a member of unless we find creative ways to bring new the CIH and The oxytocin to treat life-threatening maternal health tools to those with the greatest Lancet Commission bleeding—are likely to bring similar health needs. on Global Surgery. economic returns. Discussions about global health R&D often lead to concerns about whether countries high-impact innovations 30to save lives% TB HIV PrEP high-impact 07 innovations How to accelerate innovation to save lives to solve the world’s most urgent health issues

30 health global reimagining By Amie Batson

What if the solutions to the greatest health challenges of our time were within reach? Imagine if the world came together around those solutions and worked to accelerate the ones with the most potential to transform health. How might the world source, assess, finance, and coordinate investment in the highest-impact innovations and dismantle the barriers that keep them from reaching the very people who %need them most? This is the intriguing premise behind the PATH-led Innovation Countdown 2030 (IC2030) initiative. With support from the Norwegian Agency for Development Cooperation, the Bill & Melinda Gates Foundation, and the US Agency for International Development, we set out to identify, evaluate, and showcase health technologies and interventions with great promise to accelerate progress toward solving the world’s TB HIV most urgent health issues. We turned to experts and innovators all over the globe, crowdsourcing transformative ideas and innovations that could dramatically increase the affordability, accessibility, or effectiveness of health care compared to the current standard of care. Reimagining Global Health, the inaugural report of the IC2030 initiative, features 30 innovations that experts believe could quicken the pace of progress toward the health targets in the proposed UN Sustainable Development Goals (SDGs), along with commentaries from health, technology, and business leaders. These 30 innovations are presented in four categories mapped to the proposed health targets: maternal, newborn, and child health (MNCH); infectious diseases, including malaria, HIV/AIDS, and tuberculosis (TB); reproductive health; and noncommunicable diseases (NCDs), including diabetes, cancer, PrEP and chronic respiratory and cardiovascular disease. We cast a wide net in our search because driven, relevant, and affordable. The innovation is truly diverse and global. Our opportunities for accelerating innovation— call for nominations brought in more than wherever it comes from—have never been 500 ideas submitted by people in nearly greater, empowered by digital platforms 50 countries across five platforms: devices; where new ideas, data, and approaches can 08 diagnostics; drugs and therapeutics; be shared, developed, and deployed. systems and services, including digital Our crowdsourcing approach for gathering health; and vaccines. innovations is one example of the new o rt We then tapped more than 60 health tools that are redefining health innovation. experts to evaluate and rank those Nearly 30 percent of the 500-plus Amie Batson, MBA, innovations, selecting the final set featured submissions received by IC2030 came is PATH’s Chief here. For a detailed look at our methodology, from people in low- and middle-income Strategy Officer. please see pages 37–41. countries, giving voice to their growing Her 20-year career role in health innovation. in global health includes positions Four strategies to accelerate There were many more promising ideas with the World Health the impact of innovation than we could feature in this report. More

T DOWN 2030 rep T ION COUN Organization, the innovation submissions we received will World Bank, UNICEF, Our list of 30 promising innovations and be available on our website over the coming and most recently, our dialogue with experts and innovators months: www.ic2030.org. the US Agency around the world offer important insights Strengthening the capacity of low- and the INNOVA for International into what it will take to harness the power middle-income countries to identify, Development, where of innovation to save lives. she served as Senior develop, adapt, produce, regulate, assess, Deputy Assistant and share innovations is critical for a Administrator for 1. Tap and support innovation wherever robust innovation pipeline. Investments Global Health. it occurs. in countries’ innovation ecosystems will Innovators are everywhere, not just in catalyze better overall global health while well-funded labs and technology companies ensuring that innovations are appropriate in wealthy nations. Today’s innovation for low-resource markets and local ecosystem is diffuse, with smart ideas contexts and cultures. Innovators with coming from every corner of the globe and direct experience working with limited across every sector and discipline. resources may be the best source for frugal innovations—cost-effective solutions to The world increasingly sees the importance address the needs of the poor, wherever of user-centric solutions that are demand- they live. PATH/Gabe Bienczycki PATH/Gabe

By accelerating innovations, including vaccines and other high-impact health solutions, we can transform health, save lives, and open the doors of opportunity to new generations. 2. Assess and advance innovations that foundational structure of the health system deliver the most health for the money. that supports them. In this first year of IC2030, we did not systematically evaluate Rigorous and transparent assessment of crosscutting innovations, but they will be a an innovation’s health impact, market size, focus going forward. and technological feasibility compared to alternatives in the pipeline is important New assessment tools and more comparable, 09 for informing decisions about where to comprehensive, and reliable financial and invest precious health resources. Low- and technical data are critical to help spotlight Proposed SDG 3: middle-income country governments are and advance innovations with particular Key health targets requesting assistance in evaluating the promise that might otherwise be overlooked. potential health and economic value of Ensure healthy A clear and rigorous framework to gauge the introducing one innovation versus another lives and promote best value for money in a range of low- and amid a burgeoning supply of new tools and well-being for all middle-income settings is needed to inform interventions. Investors are also demanding at all ages. national and subnational purchasing more and better data on which to base By 2030: decisions and the decisions of those investment decisions. health global reimagining purchasing on behalf of countries. This Reduce the global However, comparing innovations across will also help innovation investors more maternal mortality diseases and conditions is a challenge. accurately assess potential impact, markets, ratio to less than Health experts frequently focus on specific and revenue flows. 70 per 100,000 conditions and make decisions with a single Zeroing in on health solutions that offer the live births and health outcome in mind. end preventable greatest value for money is the essential next deaths of newborns A key feature of IC2030 is the health and step in reaching the millions of people still and children under cost impact modeling process we developed waiting to share in the gains of our progress. five years old. to quantify lives saved, cases of disease averted, and costs for a subset of MNCH 3. Develop new financing mechanisms for End the epidemics innovations. This model could provide a global health innovation. of AIDS, TB, malaria, common framework to assess innovations and neglected with the greatest potential to address the The pool of public and private funds to tropical diseases SDG health targets. invest in health innovations is large and and combat other evolving. Funds from traditional R&D and infectious diseases. Our impact modeling results for select development donors—typically dedicated maternal, newborn, and child health public funds from wealthy countries— Reduce by one- innovations are featured on pages 13–19. are being augmented by resources from third premature The data provide new insights into philanthropies, social impact investors, mortality from prioritizing global health investments for private-sector mechanisms, and domestic NCDs. greatest impact. sources. This new mix of innovation Ensure universal For example, we found that new tools funding creates both opportunities access to sexual and for community-level water treatment to and challenges. reproductive health prevent diarrheal disease and the scale-up Domestic funding to introduce and scale care services. of a low-cost drug to prevent newborn up health innovations is becoming central infections could save more lives over the to innovation funding. As low- and middle- next 15 years compared to other innovations income economies grow and countries we modeled. graduate from aid, they are expected to Measuring the impact of crosscutting finance their own health expenditures, innovations is equally important. These creating new markets for affordable health health systems and platform innovations, tools and interventions. including digital tools and broad diagnostics, Sustainable financing of innovation will have the potential to address multiple SDG depend on the decisions of domestic health targets simultaneously. About one in stakeholders, including governments, five of the innovations submitted to IC2030 insurance entities, corporations, and was crosscutting in nature. individuals. As more viable markets emerge, Yet assessing their impact is particularly we will see a rebalancing of innovation challenging because of the complexity of from being primarily supply-side driven by linking multiple health outcomes to the donors and the R&D community to being more demand-side driven by countries and markets. Supporting country decision- increasing fragmentation of investment makers to buy or, in the case of insurance decisions and growing transaction costs. mechanisms, cover or reimburse cost- Each investor—whether a public agency effective health innovations must be representative, a social impact investor, or a at the heart of a new and improved minister of health—brings a unique mix of 10 financing model. risk tolerance, due diligence processes, data Global funding mechanisms, including the sources, expected returns, and interest in Global Fund to Fight AIDS, Tuberculosis specific platforms, geographies, or health o rt and Malaria and the new Global Financing areas. For any investor, the difficulty and Facility at the World Bank, may be well- risk of investing alone is high, but today, the positioned to act as intermediaries, as transaction cost of coordinating decisions Gavi, the Vaccine Alliance, currently and investment can be even higher. Global does for vaccines. These mechanisms can health investment funds try to address this increase the certainty that funds will be challenge but require all investors to align readily available to purchase high-priority on risk/reward preferences. innovations if countries demand them. To The growing diversity of funders, while play this role, they will need a window T DOWN 2030 rep T ION COUN currently a challenge, has the potential into the innovation pipeline and a means to be a benefit if investors can leverage of engaging with eligible governments to their different interests and risk tolerance. identify high-impact innovations. If actively coordinated, mixed sources

the INNOVA The next generation of health financing of funding can be structured to finance mechanisms must also be responsive different stages in the innovation cycle with to the increasing requirements of social a focus on the market. impact and private investors who base This means recognizing the growing role of their investment decisions on not only the purchasers in establishing a market, as well potential health impact of an innovation as finding new ways to align the decisions but also its probable of investors and purchasers. All parties market in low- and Coordinated investments would make better decisions if they knew, middle-income and could count on, what others were doing. in innovations across the countries. While continuum of care have traditional funders 4. Coordinate investments to ensure a the potential to ensure a have always understood the strategic approach to health innovation. comprehensive suite of health importance of Coordinated investments in innovations tools and services designed for having a clear across the continuum of care, including the greatest possible impact. “line-of-sight” to the prevention, diagnosis, treatment, and market, it was often disease management, have the potential discounted. The to ensure a comprehensive suite of health assumption has been that if an innovation tools and services designed for the greatest demonstrated significant public health possible impact. The proposed SDGs provide value, a donor would eventually support it. the opportunity for investors to work New financing mechanisms must spotlight toward shared health targets and better and bridge the critical links between coordination in how they source, assess, R&D decisions, market uptake, and and invest in innovations that achieve health impact. Innovators will respond those targets. to incentives that encourage them to Yet we found potential inefficiencies in maintain a focus on the market from the investment approaches that may underscore beginning of the development process to the current lack of coordination. In certain ensure the creation of sustainable and health areas, for example, we received affordable innovations. nominations for multiple devices all taking New financing mechanisms must also a similar approach to address the same provide more efficient and effective models health condition. While competition might for making and executing investment result in better tools at better prices, it also decisions. Over the past decade, the evolving raises the question of whether donors are spectrum of innovation funders has led to aware of what others are investing in and whether scarce resources could be more innovations is the second step. Countries strategically targeted. are in great need of health technology assessment tools that allow governments In maternal health, we received many and insurance entities to decide which of submissions for diagnostics to predict and the many innovations available today and detect preeclampsia/eclampsia—the second in the future should be procured, covered, leading cause of maternal mortality—but 11 and reimbursed. These tools also will few innovations for the treatment of improve the quality of market estimates, these life-threatening conditions. In one of the most critical and yet weakest many low-resource settings, the existing Expert advisory components of innovation assessment for treatment, magnesium sulfate, is underused, panels all investors. incorrectly administered, or unavailable. We thank the Diagnostics will have limited value unless The third step is to develop innovative more than 60 innovations in new treatments and delivery financing mechanisms that both recognize independent systems are developed in parallel. the growing importance of domestic experts who finance in determining markets in low- contributed A broader understanding of where and middle-income countries and benefit health global reimagining investments in innovation are high—or their time and from the growing diversity of investors. very low—is also warranted. NCDs now insights to the Financiers have the potential to leverage account for about two-thirds of global IC2030 innovation their investments by aligning with other deaths, yet we received very few innovation selection process. funders while maintaining a strategic nominations. Donors may assume others For our list of focus on the market. Aligned investment are funding NCD innovations while they experts, please see across the different stages of the innovation focus on infectious diseases. pages 42–43. cycle, from development to production, Will they be surprised when they pivot to commercialization, purchase, and wide- NCDs and discover the lack of appropriate scale use, has the potential to dramatically innovations for people in low-resource accelerate our progress. settings? Could investments in preventive The fourth step may be the most essential— innovations today allow countries to coordinating the resources and attention effectively leapfrog developed nations and of investors, innovators, and policymakers avoid creating the huge treatment burdens on innovations with the greatest potential associated with NCDs? value for money. Our progress depends on decision-makers sharing information Conclusion to ensure that collectively, the world is investing in the portfolio of innovations The robust and growing innovation pipeline that will allow us to achieve our shared presents an exciting opportunity to goals embodied in the SDGs. accelerate high-impact solutions that can Innovation is the key to sustainable health create better health and opportunity for all. impact. But innovation isn’t a random Ensuring the best ideas are surfaced— set of ideas and inventions. High-impact wherever they come from—is the first innovation is more likely to result from the critical step we must take to deliver on the kind of sourcing, assessment, financing, promise of the SDG health targets. This and coordination described above. should include investing in the innovation It is our hope that one or more of the ecosystem in low-resource countries to innovations highlighted in this report will enable local entrepreneurs to develop, become a game-changer for global health produce, and share their ideas. It also means over the next 15 years. using new crowdsourcing tools to gather ideas and data visualization to make the But beyond the success of any single comprehensive pipeline more visible to innovation, we hope IC2030 will be national and global investors, policymakers, a platform to catalyze discussion, and innovators. collaboration, investment, and momentum toward the day when everyone has an equal Developing and adopting assessment chance for a healthy life. methodologies that provide common, consistent, and comparable evaluations of Featured innovations

The 30 health innovations showcased on the following pages are the result of a yearlong Innovation process to find technologies and interventions with great potential to accelerate progress 12 platforms toward the proposed SDG health targets. The innovations From the more than 500 ideas submitted to IC2030, independent experts assessed and

o rt submitted to selected the 30 innovations they believe show the most promise to improve global health by IC2030 fall into contributing to a significant reduction in the burden of disease by 2030. five platforms:

devices Impact modeling

diagnostics For select MNCH innovations, IC2030 modeled introduction scenarios based on assumptions drugs/Therapeutics about availability and use in various settings to assess the potential lives saved, innovation and delivery costs, and downstream treatment costs (Figure 1). The results should be viewed systems & services as estimates. T DOWN 2030 rep T ION COUN vaccines Time and resource constraints limited the number of innovations modeled. Going forward, we intend to apply the model across all highlighted innovations with the goal of informing decision-making on health investments and policies. the INNOVA

Figure 1. Reading the impact modeling data for MNCH innovations.

Estimated time frame for Estimated impact 2022–2030 the innovation’s introduction and use. Incremental cost of new Maternal lives saved innovation compared to 146,000 Incremental lives saved by cost of existing intervention. new innovation compared to Estimates include the 9% reduction in deaths due to postpartum existing intervention. innovation costs, delivery hemorrhage (atonic uterus) costs, and downstream treatment costs, as well as Cost LIVES SAVED SENSITIVITY The approximate change for a +/- 5 percentage point treatment costs averted. $57M +/- 20,000 change in coverage in the home in lives saved for a specified increase or Scenario modeled: Expand access to uterotonics for the decrease in coverage. A description of how the prevention and treatment of postpartum hemorrhage, innovation will be used. including use in home births where current use is limited. Innovation assumptions: Modeled an average peak coverage increase of 25%, 20%, and 10% in home, clinic, Coverage is the availability and hospital settings, respectively, over currently available uterotonics. Effectiveness is based on conventional oxytocin. and use of an innovation Impact could increase if research and development timelines in a given setting. are accelerated.

Cost figures are presented in US dollars. M=million.

We received many more promising innovations than could be featured in this report. Please visit www.ic2030.org, where more innovation submissions we received will be available over the coming months.

PATH/Gabe Bienczycki innovations for

Maternal, newborn, drugs and child health New formulations The world has made significant strides in reducing maternal and child mortality, of oxytocin 13 gains that have increased during the Improving access to drugs to control past 15 years. Yet too many mothers and bleeding after childbirth children still die every year from entirely preventable causes. The 12 innovations Severe bleeding after childbirth kills many women featured in this section show promise for in low-resource settings. Although oxytocin can accelerating our progress. effectively control postpartum hemorrhage, this drug is not available to many women, especially They include new water treatment tools, a drug to prevent newborn infection, in remote areas. It currently comes only in liquid and better respiratory rate monitors form and needs to be injected. It also must be reimagining global health global reimagining to improve diagnosis and treatment of transported and stored under refrigeration. pneumonia—innovations that could each Alternative formulations PATH/Patrick McKern save approximately 1 million lives by 2030. are needed to improve access. Products under development include a fast-dissolving tablet placed under the tongue and a dry powder that can be administered with a simple, disposable inhaler. Unlike conventional oxytocin, these formulations do not require refrigeration during transport and storage or require injection, making them especially suitable for use in outlying areas by lower-level health workers.

Estimated impact 2022–2030

Maternal lives 146,000 saved 9% reduction in deaths due to postpartum hemorrhage (atonic uterus)

Cost LIVES SAVED SENSITIVITY for a +/- 5 percentage point $57M +/- 20,000 change in coverage in the home

Scenario modeled: Expand access to uterotonics for the prevention and treatment of postpartum hemorrhage, including use in home births where current use is limited. Innovation assumptions: Modeled an average peak coverage increase of 25%, 20%, and 10% in home, clinic, and hospital settings, respectively, over currently available uterotonics. Effectiveness is based on conventional oxytocin. Impact could increase if research and development timelines are accelerated. devices devices Uterine balloon Handheld device to 14 tamponade measure blood pressure Low-cost kit to manage Improving early detection of postpartum hemorrhage pregnancy complications o rt Postpartum hemorrhage is a leading cause of Preeclampsia is a condition that affects more maternal death. When first-line treatments than 1 in 20 pregnant women and is associated such as oxytocin don’t control bleeding, one with dangerously high blood pressure. Some option is to insert a balloon tamponade into women have few symptoms until it is too late. the uterus. Health care professionals in wealthy Undetected and untreated, preeclampsia can countries have used uterine balloon tamponades lead to eclampsia, or seizures. Together, these for years, but cost and lack of access to hypertensive disorders are a leading cause T DOWN 2030 rep T ION COUN equipment and training have limited their use of maternal death, especially in settings with in low-resource settings. inadequate prenatal care. One promising product is the Every Second the INNOVA Matters for Mothers and Babies uterine balloon tamponade. This simple, low-cost kit consists of a condom that is tied to a Foley catheter and then inflated with clean water through a syringe and one-way valve. Using readily available materials, it is especially suitable for use in remote settings.

Estimated impact 2015–2030 Photo courtesy of Dawid De Greeff and King’s College London College and King’s Dawid De Greeff Photo courtesy of

Maternal lives 169,000 saved Better methods to check blood pressure 11% reduction in deaths due to postpartum during pregnancy are needed. One promising hemorrhage (atonic uterus) technology is the Microlife Vital Signs Alert, an Cost LIVES SAVED SENSITIVITY easy-to-use, low-cost handheld device that for a +/- 5 percentage point $27M +/- 15,000 change in coverage in the clinic measures both blood pressure and shock index

Scenario modeled: Introduce uterine balloon tamponades (a reliable predictor of adverse clinical outcomes). in clinics and hospitals for use when women fail to respond Widespread use may enable earlier detection of to uterotonic therapy. a key symptom of preeclampsia, as well as other Innovation assumptions: Modeled an average peak coverage of 0%, 50%, and 75% in home, clinic, and hospital hypertensive disorders. settings, respectively. Effectiveness is based on existing products. Impact could increase if the product is used in all birth settings. summary • Some pregnant women develop preeclampsia, which is associated with dangerously high blood pressure. • Health workers in low-resource settings need better methods to check blood pressure during pregnancy. • Widespread use of new low-cost, handheld devices may improve detection of preeclampsia, leading to prompt treatment to save lives. devices drugs Chlorhexidine for umbilical cord care 15 Low-cost antiseptic prevents infections

Photo courtesy of BD

Simple, safe device for assisted delivery Protecting mother and baby at birth health global reimagining

Complications during prolonged labor can be fatal to both mother and baby. Although a cesarean Inc. Institute, Training and Research CNCP/JSI Photo courtesy of section or operative vaginal delivery is an option for some women, simple, low-cost alternatives Hundreds of thousands of newborns in are needed. Ideally, these alternatives could low-resource settings die each year from be used by mid-level health workers in remote infections. Unsanitary conditions during childbirth locations and would be safer and easier to use and a lack of antiseptics in the first week of than a forceps or vacuum extractor. life increase the risk of life-threatening disease, One solution is the BD Odon Device™, which including serious infections. Affordable, feasible, features a polyethylene film that is wrapped and efficacious interventions to reduce neonatal around the baby’s head, allowing a health worker infections are needed. to assist with delivery. If proven safe and effective, Chlorhexidine liquid or gel substantially reduces the device could become an important innovation the risk of infection when applied to the for reducing the risk of infection and injury for umbilical cord stump soon after birth. It delivers mother and baby. chlorhexidine at a safe and effective 7.1 percent The BD Odon Device is a trademark of BD. concentration, appropriate for use at home by low-level health workers or family members. Estimated impact 2015–2030 Estimated impact 2015–2030 Maternal and fetal lives saved 249,000 Neonatal 2% reduction in deaths due to prolonged 1,004,000 lives saved and obstructed labor 9% reduction in deaths due to sepsis Cost LIVES SAVED SENSITIVITY for a +/- 5 percentage point Cost LIVES SAVED SENSITIVITY $189M +/- 35,000 change in coverage in the clinic for a +/- 5 percentage point $81M +/- 95,000 change in coverage in the home Scenario modeled: Expand access to assisted vaginal delivery devices in clinics and hospitals to treat prolonged Scenario modeled: Introduce chlorhexidine in the home and obstructed labor. setting for umbilical cord care. Innovation assumptions: Modeled an average peak coverage Innovation assumptions: Modeled an average peak of 40% in the clinic. Assumes that the Odon Device can be coverage of 55% in the home setting. A 23% reduction in used for prolonged labor and approximately 30% of obstructed neonatal mortality for chlorhexidine was modeled. Impact labor cases. Effectiveness is based on existing vacuum devices. could increase if chlorhexidine is used in all birth settings. Impact could increase if the Odon Device shows improved effectiveness or reduced cost over existing tools. commentary Innovating to improve the

health of women, children, systems & services and adolescents

We have come a long way in a short time. Kangaroo mother care 16 Since 1990, maternal and child mortality have Using skin-to-skin contact dropped by nearly half. In 2015, nearly 240,000 to improve survival maternal and 1.9 million newborn deaths will be averted compared to 1990. But on the eve Kangaroo mother care involves prolonged skin- o rt of the 2015 deadline to achieve the Millennium to-skin (chest-to-chest) contact between the Development Goals, we know that the newborn and mother immediately after birth. maternal and child health targets will not be met. There are still far too many women and Studies have found that this intimate physical children dying from preventable conditions. contact improves thermal regulation of newborns We can and must do even better. Innovation and promotes exclusive breastfeeding, which is will be critical to our continued progress. especially important for survival in low-resource The task ahead is for countries and their settings. It also creates a strong psychological partners to focus on the most promising T DOWN 2030 rep T ION COUN bond between the newborn and parent. innovations to save the lives of vulnerable women, children, and adolescents—and for Kangaroo mother care was originally developed all of us to help ensure these innovations to improve newborn survival for low-birthweight

the INNOVA reach scale and can be sustainably financed. or preterm babies in areas where incubators are Our experience with the Every Woman Every either unavailable or unreliable. Based on the Child (EWEC) movement shows what is observed benefits and simplicity, the method possible when we come together around a common strategy. has been recommended for widespread use, especially in developing countries with high In only five years, the global EWEC movement newborn death rates. has rallied unprecedented energy and financial support for women and children to put into action the Global Strategy for Women’s and summary Children’s Health. We estimate that more than US$255 million in investments have been made • Prolonged skin-to-skin contact between mother to support more than 1,000 maternal and child and newborn has previously shown many health innovations in various R&D pipelines. benefits for low-birthweight or preterm babies in low-resource settings. The World Health Organization has a long history with R&D to address public health • Expanded use of this kangaroo mother care will needs, especially in developing countries. improve newborn survival and well-being, especially We are committed to working with our in developing countries. partners in country governments, multilateral organizations, the private sector, and civil society to address the major health challenges facing women, adolescents, and children. By ensuring that the new Global Strategy is a cornerstone of the United Nations Sustainable Development Goals—and with the help of promising innovations like those in this report—we will continue to improve the lives of women, children, and adolescents worldwide.

Flavia Bustreo, MD, MSc, is Assistant Director-General for Family, Women’s, and Children’s Health at the World Health Organization. devices therapeutics New treatments for severe diarrhea 17 Combating a major cause of child deaths

Diarrheal disease is a leading cause of death among young children. Most of these deaths Photo courtesy of Laerdal Global Health Global Laerdal Photo courtesy of occur in areas with poor sanitary conditions, contaminated drinking water, and limited access to lifesaving treatment and prevention tools. Several new treatments promise to reduce the

burden of severe diarrhea. One, called Qwell, aims health global reimagining New neonatal to rehydrate the child, reduce stool output, and restore intestinal function, helping to improve resuscitators nutrition. Another, called DiaResQ, supplements Addressing cost issues and other challenges use of oral rehydration solution and provides nutrients for intestinal repair. It has the advantage As many as one in ten newborns needs help of being given orally only once each day. These breathing at birth; many of these babies will new treatments and others used in conjunction die without proper care. Most deaths occur in with oral rehydration solution will help children developing countries, where health centers and with life-threatening diarrhea in developing birth attendants often lack the equipment to help countries have a better chance at recovery. babies breathe. Although neonatal resuscitation devices can help save lives, health workers often Overall costs are relatively high due to the face roadblocks, including costs, lack of training, frequent bouts of diarrhea young children and limited access to devices suitable for use in experience in developing countries. Evaluating low-resource settings. related nutritional benefits and other health outcomes of new treatments could improve New low-cost, reusable, and easy-to-use understanding of their value. resuscitators can help to prevent deaths among newborns in low-resource settings. One product with potential is the Laerdal Upright Resuscitator, Estimated impact 2018–2030 which is designed to improve the mask-mouth seal and features easy assembly and cleaning. Child lives 251,000 saved

summary 3% reduction in deaths due to diarrhea • Many newborns need help breathing at birth. Cost LIVES SAVED SENSITIVITY for a +/- 5 percentage point change • Health care workers in low-resource settings often $3.5B +/- 59,000 in diarrhea treatment coverage lack access to suitable neonatal resuscitation Scenario modeled: A new diarrhea treatment used in devices. conjunction with oral rehydration solution (ORS) to reduce stool output and restore intestinal function expands the • New low-cost, easy-to-use resuscitators will better number of children receiving diarrhea treatments. meet needs in low-income countries, saving many Innovation assumptions: Modeled an average peak newborn lives. coverage of 80% for diarrhea treatments (ORS + new therapy). Effectiveness is based on existing ORS therapy. New therapy improves ORS adherence by 25%.

Jonathan Torgovnik/Getty Images Reportage devices devices Rice fortification 18 Using technology to improve nutrition

Micronutrient deficiencies threaten the health and Zimba Photo courtesy of development of millions of children. Key problems o rt include deficiencies in iron, which can reduce cognitive function, and vitamin A and zinc, which can reduce immune function, leaving children vulnerable to disease. Enriching the foods children regularly eat with needed vitamins and minerals can help to avoid these problems. For children who live in areas where rice is a staple New tools for small-scale T DOWN 2030 rep T ION COUN food, rice fortification is a cost-effective, wide- water treatment reaching, and sustainable Helping to prevent diarrheal disease way to boost nutrition. Rice

the INNOVA fortification technologies can Many households in developing countries lack access match added micronutrients to clean water. Large-scale public water systems with local dietary needs are often inadequate, and households may lack the and ensure ingredients are resources to buy treated water. Use of contaminated consistently mixed and then blended with milled water at home can cause severe diarrheal disease. rice at the correct proportions. The result is nearly New technologies are making the use of chlorine identical to unfortified rice in aroma, taste, and for disinfecting water at small-scale community texture. Expanding use of this innovation may water sources both feasible and economical with improve child nutrition in many countries. the potential for significant savings in diarrhea treatment costs. The Zimba automated batch summary chlorinator, for example, is a rugged device fitted directly to a hand pump or community tap • Many children suffer from micronutrient deficiencies, which threaten their health and that automatically chlorinates water to a safe development. concentration without electricity or moving parts. • New rice fortification technologies can add It treats up to 8,000 liters of water between refills micronutrients to meet specific local dietary needs. of the chlorine dispenser. • Expanded use of rice fortification is a cost-effective, sustainable way to improve child nutrition and Estimated impact 2015–2030 health in many countries. Child lives 1,515,000 saved 16% reduction in deaths due to diarrhea

savings LIVES SAVED SENSITIVITY for a +/- 5 percentage $1.2B +/- 337,000 point change in coverage

Scenario modeled: Equip community water sources with a device that automatically mixes chlorine in the water at the correct proportions. Innovation assumptions: Modeled an average coverage of 23% for individuals who receive water through a community water source. An 84% reduction in diarrhea incidence was modeled. Cost savings occur by reducing diarrhea incidence and downstream treatment costs. devices devices Portable pulse oximeters Better respiratory to measure oxygen rate monitors 19 Improving detection of pneumonia Improving diagnosis and treatment of pneumonia Measurement of blood oxygen levels could be used to detect pneumonia, the leading cause Pneumonia is often difficult to diagnose, leading of death among children under age five years. to treatment delays and increased risk of death. Methods to measure oxygen levels in the body Health workers in low-resource settings visually include testing blood samples in a laboratory and count the number of breaths each minute to the use of pulse oximeters. These small devices help determine diagnosis and treatment—a crude are typically placed on fingertips to measure light method prone to error. reimagining global health global reimagining transmission through the body to determine the New respiratory rate monitoring tools will blood oxygen level. improve the diagnosis and timely treatment of A new type of oximeter uses a mobile phone infants and children with pneumonia. The INSPIRE attachment to accurately measure oxygen levels sensor, for example, is a robust, low-cost device without touching the body. that monitors respiratory rate as well as body temperature. It is also more reliable and easier to use than existing tools and transmits data to Estimated impact 2015–2030 nearby devices. Other new automated monitors use smart sensing technology. Child lives 772,000 saved 6% reduction in deaths due to pneumonia Estimated impact 2015–2030 Cost LIVES SAVED SENSITIVITY Child lives for a +/- 5 percentage point $101M +/- 24,000 change in coverage in the clinic 908,000 saved Scenario modeled: Expand access to pulse oximeters in 7% reduction in deaths due to pneumonia clinics and hospitals to more accurately identify children with hypoxic pneumonia and increase percentage of children cost LIVES SAVED SENSITIVITY diagnosed and treated. for a +/- 5 percentage point change in coverage in the clinic Innovation assumptions: Modeled an average peak $182M +/- 61,000 coverage of 0%, 72%, and 81% in home, clinic, and hospital settings, respectively. Assumes availability of pulse Scenario modeled: Expand access to respiratory rate oximeters increases the accuracy of diagnosing hypoxic counters in clinics and hospitals to increase the percentage pneumonia by 15 percentage points to 85% and increases of children with pneumonia who are diagnosed and treated. the fraction of children under age five with pneumonia Innovation assumptions: Modeled an average coverage screened for infection by 9 percentage points to an average of 0%, 50%, and 60% in home, clinic, and hospital of 50% across countries in scope. Impact could increase if settings, respectively. The availability of respiratory rate bundled with other diagnostic tools. counters increases the fraction of children under age five with pneumonia who are screened for pneumonia from an average of 41% today to an average of 54% across the countries in scope. innovations

for combating vaccines Infectious diseases Protective malaria Infectious diseases such as malaria, 20 HIV/AIDS, and TB kill millions of people vaccine candidates each year, mostly in low- and middle- Preventing deaths from malaria income countries. Despite advances in among young children o rt science, technology, and health care, these diseases continue to take a heavy Malaria affects more than 200 million people toll on children and on adults in their each year and kills about 600,000, mostly young most productive years. children in sub-Saharan Africa. It is caused by microscopic parasites transmitted to people The innovations featured in this section hold special promise for reducing the through the bite of a mosquito. Efforts to control global burden of infectious diseases, malaria have included indoor spraying to kill collectively addressing the spectrum of mosquitoes, use of bednets to keep them from T DOWN 2030 rep T ION COUN prevention, detection, and treatment. biting at night, and broader use of drug treatments. Further development, introduction, and Vaccination against malaria could be a low-cost, scale-up of these creative solutions effective way to prevent disease and save lives.

the INNOVA will improve health, save lives, and Advanced clinical trials have shown that a vaccine contribute to economic prosperity. candidate known as RTS,S can safely reduce the incidence of clinical and severe malaria in young children. Other vaccine candidates include genetically attenuated–parasite vaccines in early stages of development. It will be important to determine how vaccines can best be applied in concert with other interventions.

summary • Vaccination to prevent malaria could provide a low-cost, effective way to avoid many deaths. • Several vaccine candidates are now being developed. • Vaccination could be used in conjunction with other interventions to eliminate disease.

PATH/Aaron Joel Santos vaccines drugs Potent, single-dose antimalarial drug 21 A simple treatment that avoids drug resistance

Malaria treatment aims to rapidly and completely eliminate the Plasmodium parasite from the patient’s blood to prevent the progression of uncomplicated malaria to severe disease or death and to prevent chronic infection that leads to serious anemia. Artemisinin is a key ingredient of the gold-standard treatment for uncomplicated health global reimagining malaria caused by the P. falciparum parasite. In some regions, however, the parasite is Malaria transmission- developing resistance to artemisinin-based blocking vaccine combination therapies. Helping to facilitate disease eradication This innovation is a potent synthetic Malaria vaccine candidates target various stages antimalarial drug in the life cycle of the parasite that causes the candidate known as disease. Some aim to protect against the early OZ439 that may also stage of infection, and others target the parasite be effective against during its rapid replication in red blood cells. Yet artemisinin-resistant strains of malaria. A others aim to interrupt the parasite’s life cycle complete cure for malaria could be completed by inducing antibodies to keep it from maturing with a single oral dose. This drug may also be in the mosquito after the mosquito bites a useful for malaria prevention. vaccinated person, limiting the spread of infection. This innovation is a malaria transmission-blocking summary vaccine candidate based on a parasite antigen. The candidate is designed to block transmission of the • Malaria parasites are developing resistance to Plasmodium falciparum parasite from humans to existing drug treatments. mosquitoes. If successful, the vaccine’s impact • A new drug candidate may enable single-dose would be at the population level because the treatment that is effective even against resistant strains. candidate does not directly protect vaccinated individuals. summary • One type of malaria vaccine candidate aims to block transmission of disease-causing parasites from people to mosquitoes, interrupting the parasite’s life cycle. • This type of vaccine has the potential to block the spread of infection, though it would not prevent malaria among those who are vaccinated. diagnostics vaccines Expanded use of rapid Broadly neutralizing 22 malaria tests antibodies in HIV Enabling faster, more effective treatment vaccines

o rt Patients with suspected malaria should be tested Efficient, effective prevention to confirm the presence of malaria parasites of HIV infection before beginning treatment. Parasites can be About 35 million people worldwide are infected detected by either microscopy or with HIV. Although treatment with antiretroviral rapid diagnostic tests (RDTs). drugs is effective, only one-third of those eligible Early, accurate diagnosis is for treatment in low- and middle-income important because malaria countries actually receive the medication, and treatment should begin within treatment is relatively expensive and lifelong. T DOWN 2030 rep T ION COUN 24 hours of fever onset to prevent life-threatening complications, Because vaccines are typically the most effective, and misdiagnosis can result in affordable, and practical way to eliminate an

the INNOVA serious illness or death. infectious disease, many researchers have worked to develop an HIV vaccine. The AAV-PG9, VRC01, This innovation consists of VRC07-523LS, and 3BNC117 vaccine candidates, improving on malaria RDTs and and several others in the pipeline, hold special improving access to them for promise. These candidates aim to harness the better disease management, potential of broadly neutralizing antibodies to especially in areas with limited access to render HIV variants harmless. It may be possible microscopy. Also, novel tests such as the Rapid to induce production of these antibodies in most Assessment for Malaria (RAM) prototype could or all people. provide more accurate results than conventional RDTs. The RAM is a reusable, low-cost, point-of- care device that uses magnetic fields and light summary to detect malaria parasites without the need for • Many people with HIV infection do not receive temperature-sensitive reagents. treatment, which is expensive and lifelong. • Vaccines are effective and affordable for prevention of infectious diseases. summary • Candidate vaccines that use broadly neutralizing • Malaria needs to be diagnosed and treated quickly antibodies may prove effective for protecting to get the best results. against HIV infection. • Expanded use of malaria rapid diagnostic tests could help to speed treatment. • Several novel tests promise to make rapid diagnosis even more widely available. commentary Transforming the fight against

drugs AIDS, TB, and malaria Innovative approaches by partners in global Long-acting injectable health have achieved tremendous progress against AIDS, TB, and malaria since 2000. antiretrovirals For example: 23 Improving adherence to treatment regimens • The number of children dying of malaria has been reduced by half, accelerated by Taking an oral antiretroviral medication every innovations such as insecticide-treated day can effectively treat HIV infection and bednets and logistical advances that slow or stop progression to AIDS. Studies have delivered more than half a billion nets. shown, however, that many people have difficulty • Innovation that reduced the price of adhering to a daily pill regimen. Researchers have antiretroviral drugs from US$10,000 to $125 a year has contributed to saving the pursued long-acting formulations of antiretroviral lives of millions of people. drugs that can be given less frequently, with the

• An innovative tool called GeneXpert health global reimagining hope of improving treatment adherence. dramatically improved TB diagnosis. Two current candidates are GSK1265744 and Local governments and community TMC278-LA, which could be injected once every organizations have pioneered creative two months to suppress HIV infection. Long-acting solutions to effectively deliver technological drugs such as these could improve treatment advances. The partnership model itself is a great innovation, by aligning governments, adherence and outcomes in HIV patients and civil society, the private sector, and people reduce transmission. They may also be an affected by the diseases in common cause. attractive alternative to a daily pill for prevention As many aspects of global health transform of infection among individuals at high risk. from emergency response to sustainable solutions, innovation will save even more lives. To end HIV, TB, and malaria as epidemics, we summary have to accelerate progress, and that requires • Oral medication to treat HIV infection must be finding, using, and catalyzing innovative taken daily, which reduces treatment adherence. approaches. Technical and programmatic • New long-acting drug formulations could be innovation will play a role, and so will injected once every two months. innovations in business models. • These formulations could also be useful for The Global Fund partnership has created an preventing HIV among high-risk groups. innovation hub that is advancing work in procurement and supply chain management, financial and risk management, and program quality. We’re already seeing gains. Pooling the procurement of medicines and health products has saved nearly $500 million in a two-year period. New approaches to accounting training and services are improving financial management. Creating an e-marketplace, where medicines and health products are bought and sold on an online platform, will accelerate delivery of high- quality goods at reasonable prices. As the global health landscape changes, we must adapt with sustainable solutions and new partnerships.

Mark Dybul is the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

PATH/Evelyn Hockstein drugs drugs

Br N Oral preexposure CONH2 prophylaxis N 24 OH Taking a daily pill to prevent HIV infection N N O o rt Groups at high risk of HIV infection include young O

women in sub-Saharan Africa, men who have sex N+ with men, injection drug users, and female sex O-

F O N O workers. Although routine use of condoms can O

reduce risk, condoms are not always available, and F F N ongoing, consistent use can be challenging. Preexposure prophylaxis (PrEP) is the use of Novel multidrug

T DOWN 2030 rep T ION COUN oral formulations of antiretrovirals, such as tenofovir or emtricitabine-tenofovir, to prevent treatment regimen HIV infection. PrEP is an important addition to for TB existing methods of HIV prevention, and access the INNOVA Shortening treatment to improve should be expanded. patient outcomes Treatment adherence has been challenging in some populations, and PrEP is not widely available. Despite the availability of effective antibiotic PrEP is intended for use with condoms to ensure treatments for tuberculosis, more than a complete protection. Long-acting, injectable PrEP million people die from TB each year, mostly in candidates may offer new options to improve low-resource settings. TB treatment is difficult for adherence. several reasons, including the unusual chemical composition of the bacterial cell wall, which hinders the effectiveness of many antibiotics. summary Especially for patients with drug-resistant TB, • Taking oral formulations of antiretroviral drugs can treatment may require use of multiple drugs over help to prevent HIV infection. prolonged periods. • Many people at risk of HIV cannot access these A novel multidrug treatment regimen known as drugs. BPaZ includes two new, promising drugs for TB • Expanding access to these oral drugs as well as and one established drug. It has potential to safely long-acting, injectable forms under development treat TB and some forms of multidrug-resistant could help to reduce HIV infections in high-risk groups. TB in as little as three months without injections and at low cost. The shorter course may improve adherence, enhancing health outcomes and reducing the evolution of drug resistance.

summary • Current treatments for TB are often lengthy and difficult. • A novel multidrug treatment regimen has the potential to safely and more rapidly treat TB, including drug-resistant forms. vaccines diagnostics New vaccines to Nucleic acid prevent TB amplification tests 25 Potential new protection for adults at risk Improving TB diagnosis

TB prevention and control efforts rely primarily Pulmonary tuberculosis is difficult to diagnose on infant vaccination and the detection and based on signs and symptoms. A definitive appropriate treatment of active cases. The only diagnosis is made by culturing a clinical sample, available vaccine is the bacillus Calmette-Guérin such as sputum, to identify the bacterium that (BCG) vaccine, which decreases causes TB, but this process can take many weeks. a child’s risk of TB disease by Initial diagnosis is often done by microscopy, nearly 60 percent. Most children which is slow, requires extra patient visits, and reimagining global health global reimagining worldwide are vaccinated, but misses many cases. immunity decreases after about ten years. Several new vaccines are under PATH/Will Boase PATH/Will development. One is vaccine candidate Ad35/MVA85A, which is a combination of two novel vaccine candidates given in sequence to boost immune response. Available data indicate that this combination is highly immunogenic in adults. A highly effective vaccine is essential for achieving global targets for TB prevention and control.

New nucleic acid amplification tests allow more summary sensitive and rapid diagnosis, facilitating prompt • The only available vaccine to protect against TB has treatment. For example, the Xpert MTB/RIF is an serious limitations. automated assay for detection of TB and drug • Several new vaccines may overcome some of these resistance that gives results in two hours and can shortcomings. be used in district-level facilities. The automated • Better vaccines are essential to improve TB Alere Q prototype assays for diagnosis and prevention and control. resistance typing could give fast, accurate results when run on a test platform designed for lower- level laboratories and clinics.

summary • Tuberculosis is often difficult to diagnose. • For the best results, treatment needs to begin promptly. • New nucleic acid amplification tests allow rapid diagnosis in more remote locations, enabling prompt treatment. innovations for

Reproductive health devices drugs Many women around the world lack Expanded access access to modern contraceptive methods 26 or rely on methods controlled by men, to implants and such as male condoms. More than 200 million women have an unmet need intrauterine devices

o rt for family planning, and the absence of Saving lives by increasing options options for preventing pregnancy leads for family planning to many maternal and infant deaths. Increased use of contraception to delay The innovations described here range motherhood, space births, prevent unintended from scaling up use of proven methods pregnancy, and avoid unsafely performed to development and introduction of abortions could substantially reduce maternal and new options for woman-controlled contraception. Providing women with infant deaths. More than 200 million women have

T DOWN 2030 rep T ION COUN more choices will help to save lives an unmet need for family planning, and meeting and enable more young women to this need could save an estimated 80,000 women complete school and contribute to local and 1.1 million infants each year. economic development. the INNOVA Long-acting reversible contraceptive methods such as implants and intrauterine devices are an appealing option for many women. They are highly effective, easy to use, and readily reversible if a woman wants to become pregnant. This intervention consists of scaling up counseling and provision of long-acting reversible methods. Efforts may focus on women who are currently irregular users or nonusers of contraception.

summary • Meeting the unmet need for family planning could prevent many maternal and infant deaths each year. • Long-acting reversible contraceptive methods such as implants and intrauterine devices, are an attractive option for many women.

PATH/Will Boase commentary Innovation in reproductive health is key to prosperity devices drugs Innovation in reproductive health has given Injectable contraceptives women more control over family planning and more power over their lives. We are now Improving access to an effective method of seeing the benefits, including better health for 27 family planning women and children and improved economic conditions for families and communities. Injectable contraceptives are among the world’s most popular methods for preventing pregnancy. Increased access to injectable contraceptives, for example, has given women a more They offer women safe and effective protection, convenient, discreet option for preventing or convenience, and privacy. Until now, however, delaying pregnancy. The introduction of the they have not been widely available outside of female condom has enabled some women clinic settings. to prevent both pregnancy and HIV infection. Mobile phones have increased women’s access to health information and services. reimagining global health global reimagining Innovative partnerships are reaching more

PATH/Will Boase PATH/Will women with needed services. Through new total market approaches, the public and private sectors have joined forces to increase coverage of affordable family planning options. Community health insurance has leveraged resources to improve the public- and private- sector health systems in some countries. Other innovations have improved service delivery. These include results-based financing, where health workers are paid based on verified results, and innovations that improve Sayana® Press promises to make injectable the quality of care, especially for poor women. contraception more widely available to women Additional innovation in health financing will in low-resource settings, especially in remote be essential for further improvements. The areas. This product is a lower-dose formulation Discovery Health insurance plan in South and presentation of the injectable contraceptive Africa is one example of how financing systems Depo-Provera® packaged in the single-use Uniject™ can contribute to health and well-being. injection system. One subcutaneous injection To build more support for advancing provides protection for three months. The product reproductive health, we need to focus on the links between family planning, employment, is small, lightweight, and easy to use, and it and economic development. Delaying requires minimal training. It is especially suitable for pregnancy and spacing births enables more community-based distribution—potentially enabling young women to complete school, prevents women to administer it themselves at home. death and disability among many young women and their children, and contributes to Sayana Press and Depo-Provera are registered trademarks of Pfizer, Inc. Uniject is a trademark of BD. economic development. Economic gains, in turn, provide more resources for improving health. summary Innovation in reproductive health is a key to • Although injectable contraceptives are a good future health and prosperity for all. Expanding option for many women, their use has largely been access through creative funding restricted to clinic settings. models will accelerate the gains we are already seeing. • Because Sayana Press is easy to administer and requires minimal training, it is ideal for community- Joy Phumaphi is Executive Secretary of based use, making it accessible to more women. the African Leaders Malaria Alliance • The product may potentially enable women to self- and Co-chair of the independent administer injectable contraceptives at home. expert review group for Every Woman Every Child. innovations

devices drugs addressing Noncommunicable One-year contraceptive diseases vaginal ring 28 NCDs have overtaken infectious diseases Giving women more options and control as the primary cause of illness and death around the world. Changes in diet and o rt  lifestyle have contributed to a surge in diabetes, cardiovascular disease, cancers, 1 2 3 4 and chronic lung disease, which together now account for about two-thirds of 6 7 8 9 10 11 all mortality.

13 14 15 16 17 18 NCDs present special challenges for low- and middle-income countries

T DOWN 2030 rep T ION COUN 20 21 22 23 24 25 still struggling to overcome infectious diseases, such as malaria, as well as 27 28 29 30 31 challenges related to maternal, newborn, and child health. They typically have

the INNOVA too few health professionals and other resources to provide high-quality care for NCDs, which are placing enormous For many women, pregnancy prevention is largely health and economic burdens on families out of their control. They may lack access to any and communities. type of contraception, or their access may be The innovations described here hold limited to methods controlled by men, such as potential for improving access to low- male condoms. cost solutions to address NCDs. A one-year contraceptive vaginal ring may be a good option for many women. The ring can be inserted by a woman at home and provides long-acting, reversible protection through the slow, sustained release of Nestorone® and ethinyl estradiol. The ring is left in place for 21 days and removed for 7 days, for up to 13 cycles.

Nestorone is a registered trademark of the Population Council.

summary • Many women lack control over pregnancy prevention. • A one-year contraceptive vaginal ring that women can insert at home may provide a convenient, reversible option for women who want more control over family planning. drugs vaccines Polypill Broader use of Low-cost prevention of HPV vaccine 29 cardiovascular disease Protecting more women from cervical cancer By 2020, heart disease and stroke will be the Cervical cancer kills about 266,000 women leading causes of death and disability worldwide, each year, with more than 85 percent of deaths with the vast majority of these deaths occurring in occurring in low- and middle-income countries. low- and middle-income countries. A key strategy Most cases are caused by infection with human for reducing deaths from cardiovascular disease is papillomavirus (HPV). Currently available vaccines addressing modifiable risk factors, can prevent infection with two common types of including hypertension. HPV that cause cancer and are targeted to girls reimagining global health global reimagining The polypill contains a and young women who are not yet sexually active. combination of well-known, Broader use within these groups will accelerate inexpensive medications that can the decline of cervical cancer mortality. reduce the risk of cardiovascular disease or help to control progression. It is intended to be taken daily by a broad segment Boase PATH/Will of the population at high risk for disease or with recognized disease. The need for only one pill a day makes it easier for patients to adhere to their treatment regimens. summary • Heart disease and stroke will soon become the leading cause of death in low- and middle-income countries. Studies suggest that these vaccines may be • Readily available medications, such as blood almost as useful in adult women who test pressure drugs, can reduce risk. negative for HPV as in girls and young women. • A polypill containing a combination of low-cost This innovation consists of broadening the medications can simplify preventive care for people at high risk. eligibility for vaccination to include women in their late 20s, and possibly older groups, assuming cost-effectiveness can be demonstrated. Reducing vaccine costs will facilitate wider use.

summary • Cervical cancer is mainly caused by infection with certain types of HPV. • Vaccines that can prevent HPV infection and cervical cancer have previously been targeted to girls and young women before they are sexually active. • Expanding vaccination to older women may further reduce deaths from cervical cancer.

PATH/Aaron Joel Santos commentary Measuring the true

impact of NCDs systems & services When the Ebola virus reemerged, the world’s public health community called for better Task-shifting for tracking of infections and deaths from the 30 disease. The same urgency could be applied diabetes care to a range of NCDs that cause widespread Increasing access to services suffering and death. and reducing costs o rt Take chronic obstructive pulmonary disorder (COPD). It causes more than 70 million years Because of changes in diet and lifestyle, the of healthy life lost, making it the fifth leading number of people with diabetes has surged to driver of disease burden globally. In Sri Lanka, nearly 400 million. Many are unaware they have COPD, diabetes, ischemic heart disease, and low diabetes, and more than 80 percent live in low- back pain make up four of the top five leading and middle-income countries. Health systems in causes of premature death and disability. many countries, however, have too few physicians These diseases rob people of health over and other health professionals to manage

T DOWN 2030 rep T ION COUN decades while a swift-moving virus like Ebola diabetes diagnosis, treatment, and monitoring. can kill in a matter of days. Can we finish the unfinished agenda of childhood, maternal, Task-shifting is a health system innovation with and infectious diseases, especially vaccine- potential to improve access to care for diabetes

the INNOVA preventable diseases, while bringing more focus to the chronic conditions that cause massive and related conditions. It focuses on training health loss worldwide? We can and must. lower-level health workers to provide many components of diabetes care, providing them Outside of sub-Saharan Africa, chronic illnesses devour health resources, even in financially with decision-support tools, and then giving them stable countries. In low-resource settings in more responsibility. The result is increased access Africa and elsewhere, as NCDs become more to lower-cost services. Task-shifting will require prominent, they could challenge the ability of additional innovation in diagnostics, devices, and health systems to adequately address disease digital tools to broaden the scope of practice for outbreaks like Ebola. Currently, development lower-level health workers. assistance for health is rightly focused on lessening the toll exacted by nutritional disorders and infectious diseases. We have not summary truly assessed how a rising NCD burden would change the financial needs of countries. • The number of people with diabetes is growing rapidly. To do that, we must rethink how we gather information about levels and trends in • Low- and middle-income countries have too musculoskeletal disorders, cardiovascular few physicians and other highly skilled health diseases, mental health conditions, and other professionals to provide diabetes care. NCDs. We need true surveillance through • Task-shifting to enable lower-level health workers to surveys, biological sampling, and disease provide diabetes care can increase access to services. registries. Rapid diagnostics for cancers and other diseases are available to be deployed with smart investments and could radically transform the health landscape. To meet a challenge, you must take its full measure. We should measure the health loss from NCDs and use those measurements to guide investment and innovation.

Christopher J.L. Murray, MD, DPhil, is a Professor of Global Health at the University of Washington and Director of the Institute for Health Metrics and Evaluation. systems & services devices mHealth innovations Portable, affordable Using mobile devices to address NCDs screening for eye 31 Although the prevalence of NCDs is growing problems rapidly in low- and middle-income countries, Preventing vision impairment in low- these diseases are unfamiliar to many resource settings patients and health care workers. Also, proper management of diabetes, cardiovascular disease, About 40 million people worldwide are blind, and other long-term conditions requires sustained and another 250 million have moderate to behavior change by patients, support for decision- severe visual impairment. Most live in low- and making by health professionals and patients, middle-income countries, especially in Asia. The and ongoing engagement of patients and health prevalence of vision problems is expected to grow health global reimagining care providers—all of whom will benefit from with aging populations around the world. increased use of technology to share information. Although 80 percent of visual impairment is Mobile devices and communications networks avoidable with proper eye care, many countries have growing potential for implementation of have a shortage of ophthalmologists and other NCD management strategies, data collection, eye care professionals. encouragement of healthy behaviors, and New portable, affordable decision-making support for providers and devices screen for patients. Increased use of these tools will also early signs of diabetic pave the way for other, more specific innovations. retinopathy, cataract, glaucoma, and other eye conditions that may summary signal a serious health • Growth in the prevalence of NCDs, such as diabetes, condition. One example has paralleled expansion in the use of smart is the 3nethra Classic, phones and other information and communications which can be operated technology in low- and middle-income countries. by a minimally trained • Mobile devices and communications networks can technician and uses web-based storage of results be used to improve information exchange, modify so programs can leverage the expertise of eye behaviors, and enhance services to reduce the burden of NCDs. doctors in distant locations.

summary • Nearly 300 million people suffer from significant vision loss or blindness. • Although proper eye care can prevent most visual problems, many people in low- and middle-income countries lack access to eye doctors. • New portable, affordable devices can be used by low-level technicians to check for eye problems, and web-based storage of results enables consultation by eye care professionals in distant locations.

PATH/Gabe Bienczycki Crosscutting solutions to catalyze health Nearly 20 percent of the innovations submitted impact to IC2030 were crosscutting in nature—broad 32 systems solutions and platform innovations that can create the foundation to successfully These health innovations could address Behavior change two or more SDG health targets introduce and scale up specific health communications and o rt simultaneously by strengthening the interventions. demand generation underlying foundation of innovation Innovative processes and tools have the innovations platforms and health systems. potential to create a ripple effect of health impact that reaches beyond a single disease area, accelerating the world’s ability to reach the proposed SDG health targets by 2030. Health care workforce and The systems solutions we received are capacity-building T DOWN 2030 rep T ION COUN emblematic of an emerging consensus that tools achieving a “grand convergence” in global health—with lower-income countries achieving

the INNOVA health outcomes similar to those of wealthier countries—requires moving beyond the health Data collection, and funding siloes that have historically defined management, and the global health and development sector to use innovations strengthen systems overall. Among the systems innovations nominated for inclusion in the IC2030 report, those using digital technology—software applications, mobile phones, and related tools—were by far the most common. We classified the nominations according to three broad themes: behavior change communications (BCC) and demand generation; health care workforce and capacity-building; and data collection, management, and use. BCC and demand generation innovations aim to influence health behaviors and increase demand for a health service or product. One nomination featured a digital tool that serves as a virtual health center with a toll-free hotline and an SMS service to increase access to timely, appropriate information and care for mothers, infants, and children. While the goal is to reduce maternal, neonatal, and child mortality rates, this intervention also holds promise for improving outcomes related to reproductive health and other areas.

PATH/Gabe Bienczycki 33 Behavior change communications and demand generation innovations

Health care

workforce and health global reimagining capacity-building tools

Data collection, management, and use innovations

Health care workforce and capacity-building Despite their promise, digital health innovations tools provide job aids, diagnostic and treatment used in the context of health systems have not protocols, and more to health service providers. yet proven their ability to create broad impact. For example, an open-source software application Short-term funding models, a proliferation of provides a multilingual and multimedia tool pilot approaches, and low levels of investment for community health workers to improve their in crosscutting platforms and national-level technical skills and quality of care. Health workers infrastructure have so far kept digital health receive mobile phones preloaded with the solutions from achieving broad systemic change. application, enabling them to register and track The global community must prioritize long-term patients, provide referrals, and access information investments in strengthening platforms and to guide counseling messages. health systems, including comprehensive digital Data collection, management, and use health solutions. There is no shortage innovations aim to create or improve existing of innovation in this space. Investments in data systems and generate high-quality, timely national infrastructure and back-end platform information to inform decision-making. One innovations will create the launching pad we need submission featured a mobile device to guide to quicken the pace of progress toward health health workers through clinical work flows while equity, financial sustainability, and impact on a automating data capture. The innovation provides global scale. real-time data to health care decision-makers and other stakeholders. Petabytes for pennies Mobile, digital, and wired development and health

34 By Ramez Naam o rt

Between 2015 and 2030, the costs of computation, storage, and bandwidth will drop by roughly a factor of 1,000, with enormous implications for economic development, poverty, and global health.

By 2030, we can expect Internet access that Health monitoring and reporting:

T DOWN 2030 rep T ION COUN is effectively ubiquitous around the globe Ubiquitous connectivity will increase through handheld or worn devices that are intentional and incidental self-reporting of Ramez Naam is a at least 100 times more capable than what health data and the ability of individuals computer scientist we have today. Here are five ways that may and health care practitioners to report on

the INNOVA and the award- affect development and health. infectious disease outbreaks or other events. winning author of five books, including Education: The ability to deliver text, images, The greatest benefit may be the innovations the Nexus series of and video at gigabit speeds and tailor that that take place atop this expanded digital science fiction novels delivery to the person’s responses, knowledge, platform. Health innovators should ask and The Infinite and skill level opens up incredible new themselves the question that Google Resource, a book about possibilities. Education drives income and reportedly asks its engineers: What would innovating to beat development, which in turn increases health. you do if computational cost, bandwidth, climate change and and storage were no limit? other environmental Democracy, corruption, and good and natural resource governance: Informed populaces demand Yet the dissemination of hyper-connected challenges. better governance and less corruption, one supercomputers into the pockets of 7 or 8 of the thorns in the side of development. billion people will not automatically cure Corruption thrives in the shadows created all ills. by power and information asymmetries. Today, more people around the world have Ubiquitous devices armed with cameras mobile phones than toilets. Our best hope erase those shadows. is that widespread mobile Internet access Health education and information: will accelerate economic development Worldreader, a charity that delivers digital and thus increase access to clean water, books in Africa, reports that their most-read sufficient food, and other underpinnings book of 2014 was Ebola: Practical Info. The third of global health. most-read book: Male Condom Instruction (read There will also be challenges as billions primarily by girls, apparently). Ubiquitous, come online. How do we direct people to high-bandwidth mobile devices can accurate information instead of myths or deliver health information to more people rumors? How do we build trust in legitimate and leverage the power of celebrities and institutions? In the developed world, we authority figures to convey a message. often fail at this. Can we do better with the Remote health and diagnostics: The rapid billions to come? dissemination of smart devices will make Even with the many challenges, in the them universal health care terminals. For next 15 years, the exponential price decline example, an ultrasound probe connected of digital technology will put more power to a smartphone can transmit images to a and information in the hands of the poorest physician in a far-away city for diagnosis. people than ever before, catalyzing a By 2030, algorithms will make many such surge of global economic development and diagnoses, transforming health in the most health innovation. remote and least developed areas with few health care providers. The future has never looked brighter. Innovation for global health: tackling chronic diseases Personalized technology and behavioral economics to advance health 35

By Derek Yach

Chronic diseases—diabetes, cardiovascular disease, and various cancers— threaten the stability of societies worldwide. They account for 38 million deaths annually, with 28 million occurring in low- and middle-income countries.

Tobacco use, unhealthy diets, physical advice and encouragement to promote health global reimagining inactivity, poor mental health, and healthy activities. nonadherence to prescribed medications In the future, eye tracking and brain games contribute to chronic diseases but are Derek Yach, MBChB, will facilitate better understanding and areas that have not benefited from advances MPH, is Senior Vice management of stress and sleep levels. President (SVP) of the in innovation. Miniature sensors will track physiological Vitality Group, part of Discovery Holdings Personalized health technologies activate functions and environmental changes. Ltd., where he leads users, measure steps and sleep, support Sensors that detect gestures, assess body the Vitality Institute better medication adherence, guide healthy functions, and track facial movements will for Health Promotion. food choices, and quantify biological be embedded in individualized devices and Previously, he was measures that are predictive of chronic physical spaces. SVP for Global Health diseases. A Technology Catalysts Map A variety of stakeholders—entrepreneurs and Agriculture developed by the Vitality Institute and the and policymakers, researchers and health Policy at PepsiCo and Institute for the Future outlines emerging providers, large and small employers Executive Director, innovations and their potential for impact and their communities—are pioneering Noncommunicable on chronic diseases and related risks. Diseases, at the World investment in new technologies to catalyze Health Organization. Wearables, adhesives, and ingestible better health and well-being. Affordable, sensors are already encouraging healthy sustainable, and high-quality technological behavior change. Inexpensive stick-on innovations are emerging in low- and sensors help to manage risks by providing middle-income countries, which may lead personalized feedback through aggregating the world in cost-effectively addressing the and analyzing health data. Artificial prevention and control of chronic diseases. intelligence-based coaches incorporate Mobile money transfers through M-Pesa in Kenya, electrocardiogram machines by General Electric in China and India, and Five future forces working to align intuitive point-of-care diagnostic devices private and social stakeholders by PATH are transformative examples with immediate applications to chronic diseases. Connected science: Stakeholders contribute data The lack of legacy infrastructure, regulations, and connections to the art and science of health promotion and chronic disease prevention. and mindsets that impede progress in high- income countries could spur advancement Rise of networks: Bottom-up solutions address in low- and middle-income countries. health promotion and disease prevention. Quantified generations: Data-driven self- Combining personalized health technology knowledge ignites intergenerational health with behavioral economics has emerged engagement and promotion. as a powerful mechanism to encourage New business models: Business and social sustained uptake of and engagement with interests align for upstream interventions. technology. This combination holds potential Entrepreneurial ecosystems: Lean iteration for promoting health and preventing chronic creates vital human and economic systems. diseases more effectively to yield reductions in health care costs over the long term. Creating a new source of capital for global health 36 A collaboration of governments, industry, foundations, and individuals for health o rt By Christopher Egerton-Warburton

Global health is traditionally linked with the concept of philanthropy, not investment. From the generous gifts of individuals, foundations, and corporations (primarily in the pharmaceutical industry) to government donor grants, philanthropy has changed the health prospects of billions of

T DOWN 2030 rep T ION COUN people. For example, basic vaccination is now the norm in all countries, while millions are being treated with HIV, TB, and malaria drugs. Christopher Egerton- Warburton, MA But philanthropy alone cannot meet the form of a partial capital guarantee. This

the INNOVA Oxon Biochemistry, challenges of the next 15 years. We have structure attracted a group of both new is Founding Partner successfully reduced the number of child and long-time investors who had never of Lion’s Head Global deaths by nearly half since 1990. But previously come together. Partners, a London- sustaining the pace of progress going Governments (Grand Challenges Canada, based investment firm forward will be harder yet. The goal to bring the International Finance Corporation, focused on sustainable all countries to the same low levels of child development. and KfW Development Bank), foundations mortality as those in Europe and the United Previously, Christopher (Children’s Investment Fund Foundation), States by 2030 represents one of the most spent 14 years at and corporations (AXA, GlaxoSmithKline, audacious challenges ever attempted. Goldman Sachs. JP Morgan, Merck, Pfizer, and Storebrand) Lion’s Head serves At its core, this is about efficiency. joined together with a number of as fund manager for Achieving the health targets outlined in the individuals seeking to invest with purpose. the Global Health Sustainable Development Goals will ensure The objective was not only to make an Investment Fund. better health for millions of vulnerable investment return but also to have a women and children. Our challenge is to significant global health impact. ensure these health gains can be sustained The GHIF has built a pipeline of financially. This requires a cauldron of opportunities and is now in the process innovation to literally boil over, spilling of completing its investment program. new solutions to the corners of our world. Transactions to date include: But what is the fire that can provide the • A new TB diagnostic test that can operate energy to achieve this goal? Fortunately, a outside a laboratory. new sector is emerging: impact capital. • A cholera vaccine that is lower cost and Two years ago, a new investment fund was has the potential to be heat-stable to launched. The Global Health Investment protect adults and children alike from Fund (GHIF) sought to provide a new type this Victorian-era disease. of capital for global health, with a focus on • The registration of a drug for the late-stage development of new technologies, treatment of onchocerciasis (river drugs, and vaccines and the explicit target blindness), a disease spread by flies, of shrinking the burden of infectious particularly in West Africa. disease and improving maternal health in the poorest countries of the world. The GHIF’s pipeline includes additional new vaccines, improved diagnostics, and tools to The project’s first investors were true improve the cold chain. Taken together, we pioneers. They were offered a safety cushion believe this will be the start of a significant from the Bill & Melinda Gates Foundation pool of investment into this historically and the Government of Sweden in the overlooked sector. Our methodology: selecting the final 30 innovations 37 The 30 promising global health innovations featured in this report are the culmination of a yearlong process that sought ideas and input from thousands of people around the world. Our methodology involved a three-step process: • Crowdsourcing more than 500 innovations from developers, innovators, private-sector leaders, and experts across the globe. • Assessing submitted innovations using a novel qualitative methodology. • Ranking 175 of the most promising innovations through a two-step selection process that involved dozens of independent health experts. reimagining global health global reimagining Separately, we also worked with Applied Strategies, a life sciences and global health consulting firm, to develop and apply a quantitative methodology to evaluate the potential cost and health impact of a select list of specific MNCH innovations.

Crowdsourcing innovations

In May 2014, PATH launched a survey to gather global health innovations from multidisciplinary experts in technology, investment, the nonprofit sector, academia, and government.

“The innovations submitted to The survey was sent to thousands of people in more than 150 countries, including health experts from nearly 100 professional IC2030 included health solutions associations, conferences, and networks; the World Health with exciting potential. They are Organization and the US National Institutes of Health; and PATH’s tangible examples of the kinds of global network of collaborators and partners. new tools that we need.” The public was also invited to participate in the survey, which was promoted through social media, blog posts, electronic newsletters, — Lucy Chen, MD, MPH and electronic mailing lists for 40 international universities and Final interdisciplinary panel research institutes. By the time the survey closed in October 2014, we had received 380 nominations from experts in 33 countries, including technology developers, health leaders, academics, industry experts, investors, donors, and representatives from nongovernmental organizations. About 30 percent of respondents were people in low- and middle-income countries (Figure 2).

Figure 2. Innovation nominations* by health category and respondent location.

health categorY Respondent location

47% 60% Maternal, child, and Americas newborn health 14% 18% Africa Infectious diseases 11% 9% Europe Noncommunicable 8% diseases Southeast Asia 6% 3% Reproductive health Western Pacific 20% 1% Crosscutting/systems Eastern Mediterranean 3% Unknown *Some innovations were not classified due to lack of information. Figure 3. Innovation selection methodology.

38 500+ o rt innovations identified and screened Submissions and nominations collected

Innovations

  categorized T DOWN 2030 rep T ION COUN health Malaria diseases HIV/AIDS innovations Tuberculosis Child health health Child Crosscutting Reproductive Reproductive Maternal health Maternal Newborn health Noncommunicable Noncommunicable

Health system and platform innovations not the INNOVA included in analysis.

Health categories with more than 30 submissions filtered for most potential.

175

   innovations Results selected for independent review   A separate process modeled select maternal, newborn, and child innovations for health impact.

Eight health expert panels ranked innovations.

        61 Results highest-scoring innovations identified

Final panel of interdisciplinary experts ranked innovations within each health area.

30 Innovations grouped into four categories: Results promising maternal, newborn, and child health; infectious diseases; reproductive health; and noncommunicable diseases.    innovations selected We also added more than 120 additional innovations separately identified through the Saving Lives at Birth initiative and Grand Challenges Canada. Saving Lives at Birth seeks groundbreaking prevention and treatment approaches for pregnant women and newborns around the time of delivery. Grand Challenges Canada seeks ideas that integrate science and technology with social and business innovation to impact global health. We assigned these 500-plus innovations to eight health categories aligned with health 39  targets included in the proposed SDGs: maternal, newborn, and child health; HIV/AIDS; TB; malaria; reproductive health; and noncommunicable diseases, including diabetes, cancer, cardiovascular disease, and chronic respiratory disease (Figure 3). SDG health categories Crosscutting innovations More than 500 innovations There was one additional health category that received a substantial number of were assigned to submissions—crosscutting systems solutions and platform innovations that could eight SDG health accelerate progress toward two or more SDG health targets simultaneously. reimagining global health global reimagining categories: Nominations included innovations targeting behavior change communication and Maternal health demand generation (such as a workplace-based intervention with peer educators providing Newborn health information and access to women’s health services), health care workforce capacity- building (such as diagnostic and treatment protocols), and data collection and management Child health tools (such as electronic medical record systems). We have highlighted these crosscutting HIV/AIDS innovations on pages 32–33. Tuberculosis Systems and platform innovations are essential for the global community’s efforts to Malaria achieve the SDGs by 2030. Our evaluation framework focused specifically on an innovation’s potential to meet individual SDG targets; thus, we did not evaluate the crosscutting Reproductive health innovations this year. In future years, we plan to develop a new assessment tool that will Noncommunicable allow us to evaluate these solutions. diseases Assessing the innovations: qualitative analysis

We narrowed the list of submitted innovations using an innovative qualitative assessment methodology developed with input from a panel of nine public- and private-sector experts. We created an assessment tool (Figure 4) to narrow the field of submissions in health areas where we received more than 30 nominations. This allowed us to select innovations with the most potential to accelerate progress toward the SDGs. We categorized these innovations by health area and type of innovation. We then assessed the innovations based on their: • Accessibility, affordability, and scalability. • Stage of development. • Expected performance compared to existing solutions. • Potential health impact. • Number of nominations. For health areas with fewer than 30 nominations, we performed a basic assessment to ensure that they were credible and met our standards for inclusion. For more on our assessment criteria, please see www.ic2030.org.

Ranking the innovations: Health expert selection process

Our next step involved eight independent panels of health area experts ranking the innovations. Before the selection process began, the experts were invited to submit additional innovations in certain health areas to address gaps. In all, 175 innovations made it to this next round of evaluation. The panelists then rank-ordered the innovations from Figure 4. Sample innovation scorecard.

40 o rt

This sample scorecard for a fictional malaria vaccine candidate T DOWN 2030 rep T ION COUN illustrates the criteria we used to assess an innovation’s potential to accelerate progress the INNOVA toward the SDG health targets.

one to ten in each health area. The 61 highest-scoring innovations from this round of voting were selected to move on for a final assessment by a separate independent expert panel. This final interdisciplinary panel reviewed the list but was not invited to submit additional innovations for consideration. Panelists followed the Delphi process, a widely used approach to facilitate consensus among experts, by ranking innovations within each health area in two rounds of voting. Their rankings were based on what they believed had potential to accelerate progress toward the SDG health targets based on the innovation descriptions provided by nominators and their broader contextual knowledge of global health. For consideration in the second round of voting, panelists were provided with aggregated Delphi process results from the first round of voting and anonymous comments from fellow panelists on the This method invites rationales for their top choices. The second vote determined the final list of 30 innovations. a group of experts Throughout the process, experts were reminded that innovations were independently to each rank options nominated, the innovation descriptions relied primarily on information provided with and comment the nominations, and inclusion in the list of innovations did not imply endorsement by on their choices either PATH or the expert panelists. Innovations developed or supported by PATH were also anonymously, independently assessed by the experts following the process described here. review the group’s comments and initial ranking, and Impact modeling: quantitative analysis then each rank the options again To assess the potential cost and health impact of these innovations, PATH also modeled to give a final introduction scenarios for select MNCH innovations to provide insights on the innovation’s result that reflects potential to accelerate progress toward the SDG health targets. Estimated lives saved something closer to and costs are provided for eight MNCH innovations in this report. In the future, we expert consensus. plan to expand our impact modeling to include innovations that address additional SDG health targets. Working with Applied Strategies, we developed a quantitative methodology that models the uptake and cost associated with procuring and delivering a new innovation, including the impact on downstream costs and treatment costs that may be averted compared to the current standard of care. We then estimated the potential incremental lives saved and additional life-years gained from introducing the innovation. The model methodology and approach, as well as the outputs, were vetted with external advisors. Health impact and cost estimates are based on a number of assumptions and should be viewed as estimates that contain a level of uncertainty. The incremental impact of each innovation was modeled between the years 2015 and 2030 based on assumptions of care- seeking behavior, innovation launch timing, and uptake to peak coverage by treatment 41 setting (home, clinic, or hospital). Cost and effectiveness were generated based on publicly available literature and consultation with PATH experts. Sensitivity and scenario analyses were performed where there was a high level of uncertainty in the assessment or available data. Coverage estimates The analyses assumed that innovations would successfully meet technical milestones and launch, but recognized that some innovations are still in early development and their arrival Adjusting on the market is uncertain. Costs for R&D, innovation training, and patient transport were assumptions not included. about the peak

coverage rate for This model methodology could be expanded to include other health and economic value health global reimagining each innovation measures, providing a common framework to assess the potential impact of innovations in in home, clinic, and other SDG health areas. For more information on reading the impact modeling data, see hospital settings page 12. has a significant impact on the potential number Limitations of lives saved. In our first year of the IC2030 initiative, PATH’s scope of work was defined by the time and resources available. There were necessarily certain limitations in our approach. We assessed innovations based on their potential impact on mortality, not morbidity, tracking the SDG health targets. We received innovations that addressed areas such as chronic pain management, but these were not included in our analysis. We did not systematically evaluate the crosscutting innovations submitted. While we sought to create the broadest possible list of high-impact health innovations, we know that there are many promising technologies and products in development that were not among the submissions we received.

Accelerating progress toward the SDGs

In addition to the expert panels described above, a senior advisory committee of 14 experts and thought leaders from nine countries provided input and guidance throughout this yearlong process. They represented academia, research, foundations, global health, social impact investing, and the private sector. In all, 61 experts on 11 different panels provided important contributions that informed the selection of the final 30 innovations highlighted in this report. PATH is grateful to each of our distinguished panelists. We thank them for their time and valuable insights. advisory and evaluation panels

More than 60 international experts contributed their insights and knowledge to guide the selection of the 42 30 innovations highlighted in this report. We are grateful for their time and valuable contributions. We also thank Applied Strategies for its role in the impact modeling work. o rt

SENIOR ADVISORY COMMITTEE Michelle Barry, MD, FACP Tore Godal, MD, PhD Allan Pamba, MD Center for Innovation in Global Health, Office of the Prime Minister of Norway GlaxoSmithKline Stanford University Norway Kenya United States Glenda Gray, MBBCH, FCPaeds (SA), DSc Tone Rosingholm, MSc Ann Mei Chang, BS (honoris causa) JP Morgan US Global Development Lab, US Agency for South African Medical Research Council United Kingdom International Development South Africa Peter Singer, OC, MD, MPH, FRSC United States Marc Jouan, MD Grand Challenges Canada

T DOWN 2030 rep T ION COUN Lucy Chen, MD, MPH Institut Pasteur Canada Institute for Global Health, Beijing University France Paul Stoffels, MD China Frederik Kristensen, MD, MBA, MPH Johnson & Johnson Christopher Elias, MD, MPH World Health Organization United States Global Development Program, Bill & Melinda Switzerland

the INNOVA Gates Foundation Rakesh Kumar, MD United States Ministry of Health and Family Welfare, Julie Gerberding, MD, MPH Government of India Merck India United States

QUALITATIVE METHODOLOGY PANEL Amanda Glassman, MSc Mike Kubzansky, MBA Damian Walker, PhD Center for Global Development Omidyar Network Integrated Delivery, Bill & Melinda Gates United States United States Foundation Tore Godal, MD, PhD Peter Singer, OC, MD, MPH, FRSC United States Office of the Prime Minister of Norway Grand Challenges Canada Gavin Yamey, MD, MPH, MA, MRCP Norway Canada Evidence to Policy Initiative, University of Glenda Gray, MBBCH, FCPaeds (SA), DSc Wendy Taylor, MPP California, San Francisco (honoris causa) Center for Accelerating Innovation and United States South African Medical Research Council Impact, US Agency for International South Africa Development Frederik Kristensen, MD, MBA, MPH United States World Health Organization Switzerland

HEALTH AREA PANELS Child health Elwyn Chomba, MD Jan Willem Rosenboom, MSc Mark Young, MD, MHSc University Teaching Hospital, Water, Sanitation & Hygiene, United Nations Children’s Fund University of Zambia Bill & Melinda Gates Foundation United States Zambia United States Fabian Esamai, MB ChB, M Med, MPH, PhD College of Health Sciences, Moi University Kenya HIV Stephen Becker, MD Jonathan Mermin, MD, MPH Veronica Miller, PhD HIV and Tuberculosis, Bill & Melinda National Center for HIV/AIDS, Viral Hepatitis, Forum for Collaborative HIV Research Gates Foundation STD, and TB Prevention, US Centers for United States United States Disease Control and Prevention Connie Celum, MD, MPH United States Department of Global Health, University of Washington United States Malaria Steven Chapman, PhD, JD Patrick Moonasar, DrPh, DCVBU Kirsi Viisainen, PhD, MA Children’s Investment Fund Foundation Malaria and Other Vector-Borne Diseases, The Global Fund to Fight AIDS, Tuberculosis United States National Department of Health and Malaria Nick Hamon, PhD South Africa Switzerland IVCC, Liverpool School of Tropical Medicine John Reeder, PhD United Kingdom Special Programme for Research and Training in Tropical Diseases, World Health 43 Organization Switzerland Maternal health John Borrazzo, PhD Metin Gülmezoglu, MD, PhD Ana Langer, MD Maternal and Child Health, US Agency for Maternal and Perinatal Health Department of Global Health and Population, International Development and Preventing Unsafe Abortion Team, Harvard University United States World Health Organization United States France Donnay, MD, Ob/Gyn, MPH Switzerland Maternal, Newborn, and Child Health, Justus Hofmeyr, MBBCh, MRCOG Bill & Melinda Gates Foundation Effective Care Research Unit, University of United States the Witwatersrand South Africa reimagining global health global reimagining Neonatal Zulfiqar Bhutta, PhD, MBBS, FRCPCH, FAAP Steve Hodgins, MD, DrPH Centre for Global Child Health Healthy Newborn Network Canada United States Noncommunicable diseases Mukesh Agarwal, MBBS Naomi Levitt, MBChB, MD and FCP (SA) Adolfo Rubinstein, MD, MSc, PhD College of Medicine and Health Sciences, Department of Medicine, University of Instituto de Efectividad Clínica y Sanitaria United Arab Emirates University Cape Town Argentina India South Africa Louise Brinton, PhD, MPH Jixiang Ma, MD National Cancer Institute, National Center for Chronic and National Institutes of Health Noncommunicable Disease Control and United States Prevention, China Center for Disease Control Gene Bukhman, MD, PhD China Program in Global NCDs & Social Change, D. Prabhakaran, MD, DM, MSc Partners in Health Centre for Chronic Disease Control United States India Reproductive health Kelly Blanchard, MSc Judy Manning, PhD, MA Kirsten Vogelsong, PhD Ibis Reproductive Health Office of Population and Reproductive Health, Family Planning, Bill & Melinda Gates United States US Agency for International Development Foundation United States United States Tuberculosis Helen Ayles, PhD, MSc Aamir Khan, MD, PhD Wendy Stevens, MBBch, MMed (Haem.), Zambia AIDS-related TB Project, London Interactive Research and Development FCPath (Haem.) School of Hygiene & Tropical Medicine Pakistan National Health Laboratory Service, United Kingdom Madhukar Pai, MD, PhD University of the Witwatersrand Christopher Gilpin, PhD, MPH McGill International TB Centre, South Africa TB Diagnostics and Laboratory Strengthening McGill University Unit, World Health Organization Canada Switzerland

FINAL INTERDISCIPLINARY PANEL Shashi Buluswar, PhD, MBA Christopher Egerton-Warburton, MA T.S. Rao, PhD Institute for Globally Transformative Global Health Investment Fund Department of Biotechnology, Technologies United Kingdom Government of India United States Richard Gordon, PhD India Ann Mei Chang, BS Strategic Health Innovation Partnerships, Junaid Razzak, MBBS, PhD US Global Development Lab, US Agency for South African Medical Research Council Aman Foundation International Development South Africa Pakistan United States Marc Jouan, MD Peter Singer, OC, MD, MPH, FRSC Lucy Chen, MD, MPH Institut Pasteur Grand Challenges Canada Institute for Global Health, Beijing University France Canada China Frederik Kristensen, MD, MBA, MPH Gavin Yamey, MD, MPH, MA, MRCP Tania Douglas, PhD, MBA, MS World Health Organization Evidence to Policy Initiative, University of Faculty of Health Sciences, University of Switzerland California, San Francisco Cape Town Allan Pamba, MD United States South Africa GlaxoSmithKline Kenya The way forward

Imagine the world in 2030 if even a fraction of the promising innovations featured here are 44 introduced, scaled up, and accessible to the people who need them most. How many more lives could we save over the next 15 years by focusing our brightest minds,

o rt collective resources, and shared aspirations on accelerating health innovations with transformative potential? In this first year of the Innovation Countdown 2030 initiative: • We saw how crowdsourcing can tap into an innovation ecosystem and amplify lifesaving solutions from all corners of the globe. • We found gaps in the pipeline of innovation to address key health challenges, especially NCDs. • We were inspired by the potential for crosscutting innovations to drive global progress

T DOWN 2030 rep T ION COUN toward health equity. We aim to continue IC2030 as a multiyear initiative, building on our findings and a database that contains hundreds of compelling health solutions.

the INNOVA By focusing the world’s attention and resources on promising health innovations, we can ensure that the 2030 health targets are met. Together, we can source innovation from around the world, build the evidence base for high-impact innovations, catalyze attention and investment, and advance policies to support and sustain those innovations.

What you can do

Imagine the Join the possibilities conversation Learn more We received many more Share your ideas and Engage with us online intriguing ideas than we thoughts with us: to find out more: could feature in this report. • Email the team at • Visit ic2030.org, where Here are three more to fire [email protected]. more innovation your imagination: submissions we received • Engage in the ongoing • Promotion and farming of will be available over the discussion about insects as an inexpensive coming months. financing and accelerating and sustainable food high-potential health • Read our blog posts on source to reduce innovations at events and accelerating and financing malnutrition. meetings that include innovation by leading • A point-of-care diagnostic the Third International cross-sector experts on test combined with a Conference on Financing ic2030.org. mobile device interface for Development and the • Follow us on Twitter: and GPS to identify spikes United Nations General #ic2030. in disease cases, enabling Assembly in 2015. faster disease outbreak response. • A $1 folding paper microscope that could help bring diagnostics to researchers and clinics in remote areas. Tara Herrick Tom Furtwangler Amie Batson Amy MacIver Greg Zwisler Claire Hudson Claudia Harner-Jay Countdown 2030 Jolayne Houtz John Ballenot Peder Digre Kate Davidson Dave Simpson David McAdams King Peggy project team Innovation initiative

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