path ic2030 innovation matters

8/11/2019 PATH Ic2030 Innovation Matters

1/20

Innovationmatters Amie Batson

Seth Berkley

Balram BhargavaAgnes Binagwaho

Brge Brende

Steve Davis

Haitham El-noush

Anthony Fauci

Craig Friderichs

Tore Godal

Glenda Gray

Felix OlaleAllan Pamba

Rajiv Shah

Peter Singer

Gavin Yamey

With a messagefrom UN Secretary-General Ban Ki-moon


2/20

Smart phone-readable andstandardized QRcodes to trackmedicines?

A eld-based test for water

safety that quanties risk?

Simulationprograms tohelp healthworkers

manageemergencyobstetric andneonatal care? A highly efficacious

HIV vaccine?

Diagnostic and

screening tools

for malaria and TB,

tailored specically for

low-resource settings?


3/20

Since the launch of the Every Woman Every Child movement in 2010, leadersfrom government, civil society, multilateral organizations, and the private sectorhave worked hand-in-hand to improve health and save lives around the world.Building on earlier work, our collective efforts have achieved much progress:Maternal and child deaths have been cut by almost half since 1990. Remarkabletechnological advances in recent years, such as low-cost vaccines, new drugs,diagnostic tools, and innovative health policies, have driven this unprecedentedreduction in maternal and child mortality.

The innovative Every Woman Every Child partnership model has proven tobe a game-changer for womens and childrens health, demonstrating theimmense value of bringing all relevant actors to the table. Many otherinnovations, including more efficient distribution networks, the use of mobiletechnologies to reach women in rural areas, and local vaccine production, havealso played an important role in generating new progress for womens andchildrens health.

As we acknowledge these achievements, we must recognize that much moreneeds to be done to meet the Millennium Development Goals (MDGs) focusedon health. Each year, 289,000 women die while giving life, and each day, almost18,000 children die, mostly from preventable causes.

As we accelerate efforts to achieve the MDGs by the 2015 deadline andcreate the best possible foundation for implementing the post-2015development agenda, innovation will be critical. These innovations may betechnological, social, business, or nancial. Many lifesaving innovations alreadyexist, and an increasing number are coming from low- and middle-incomecountries. We need to determine which have the greatest potential and how totake them to scale.

The Innovation Countdown 2030 initiative seeks to help the world meetthis challenge. By working across sectors to identify and analyze promisinginnovations, the initiative will highlight new pathways for ensuring that everywoman and every child have the opportunity for a healthier, happier life.Together, with new innovations at the forefront, we can reach our shared goal ofending all preventable maternal and child deaths within a generation.

ByBan Ki-moonSecretary-General

of the United Nations


4/20

We are pleased to welcome you to Innovation Matters, the rst product of theInnovation Countdown 2030 initiative.

As sponsors of the initiative, PATH and the Government of Norway are deeplymotivated by the impact that innovation has had on global health in the past15 years. From 2002 to 2012, for example, innovations in child survivalincludingimmunization as well as malaria prevention and control, improved nutrition,access to clean water and sanitation, and educationhave reduced the numberof deaths among children under age ve by 3 million per year. When we seeremarkable results like this, we know that we can do much, much more to improvethe effectiveness, safety, accessibility, and cost of todays health interventions.

As we set our sights on harnessing the potential of innovation for the next15 years, we acknowledge a few key insights. First, we recognize that manyinnovations that have contributed to progress toward the MillenniumDevelopment Goals were already in the pipeline when the goals were launchedin 2000. Second, we see that innovation is no longer the sole purview of white-coated scientists working in well-funded labs. Increasingly, innovation happensat the intersections of disciplines, sectors, and countries. Third, we recognizethat taking bright ideas to scaled-up reality is a long, hard road with manypitfalls. Development, large-scale production, introduction, and use are seldom

linear or sequential.We conclude that if we can be more deliberate about identifying high-potentialinnovations, we can strategically focus resources for the greatest possibleimpact. We can enlist governments and new investors who seek to channeltheir resources most effectively. And we can develop new ways to surface andaccelerate the ideas that will one daywithin our lifetimesachieve game-changing impact.

We live in a dynamic world, and we know that the innovation landscape willchange. New innovations will emerge, and existing innovations will advanceor drop off. Innovation Countdown 2030 therefore seeks to not only createa formal process for identifying innovations but to track those innovationsover timecapturing new ideas, sharing provocative insights, and creating anenvironment that drives change. And it seeks to foster the cross-talk thatcan provide the essential ingredientwhether thats knowledge, resources,or partnershipsin a formula that has the power to improve millions of livesaround the world.

By Amie BatsonChief Strategy Officer

PATH

and Tore GodalSpecial Adviser on

Global HealthMinistry of Foreign Affairs

Norway


5/20

Child deaths dropped48% between 1990 and

2013, from 12.2 million

to 6.3 million.

0

6

12

1990 2013


6/20

72% of the drop in

child deaths was dueto health innovations

and better systems

for delivering them.


7/20

A window ofopportunity totransform the future

of global healthBy Brge Brende

s were adopted in 2000, a growing global health community,spanning researchers and innovators on the one hand topoliticians on the other, has proven effective in working forhealth and development. This successful cooperation nowneeds to be widened both in scope and depth as we looktoward 2030.

Bending the curve of child mortalitylowering it from12.6 million in 1990 to fewer than 6.6 million in 2012 was only part ly due to new vaccines, drugs, diagnostics,health devices, and digital tools. Politicians were alsocalled to action, as the very nature of the MDGs forced themto think more smar tly about how states should addresschild mortality.

The MDGs acted as a scorecard for measuring development,an empirical basis for drawing up policy. Systematic

measurement and accountability were no longerrequirements for the technical community alone, butfor politicians worldwide. They needed to ensure that breakthroughs in the eld of health actually trickled downto the people who needed them.

There are various ways of doing this, such as creatingmarket-shaping mechanisms, establishing publicprivatepartnerships, or the successful conclusion of regional andglobal trade negotiations.

We must make use of the lessons learned from theMDGs as we draw up the new agenda. The new SustainableDevelopment Goals (SDGs) should be limited in number,

clearly understandable, and measurable, but at thesame time achievable. If they are not, they will not winpolitical support. Purse strings will be tightened, andthe vision will be harder to sell. This is why simplicityis paramount. The simplicity of the MDGs is one of thereasons they were effective.

At the same time, the new agenda needs to be broadened intwo important ways.

First, health needs to be seen in the context of other areas,such as nutrition, education, climate, and governance.

We therefore need to ask ourselves how we can develop atrans-sectoral and sustainable approach that is effective onthe ground. The Norwegian government is looking closelyat the links between education and health. There is strongevidence that education improves the chances of a healthylife, just as good health is a key factor in education andfor subsequent employment. This is particularly true forgirls. Educated girls make educated choices. They becomepregnant later, and they are thus more likely to be able tofeed their children properly and support them throughschool. Educated girls are less likely to be infected by HIVand less likely to infect others. The list goes on.

Norway intends to work with various partners to identifyand promote innovative approaches that create synergies between health and girls education at all levels.

Second, the SDGs need to be universal. This means thatthey will apply just as much to Norway as to the rest ofthe world. We are already developing plans to reduceour greatest health burden: noncommunicable diseases,including mental health problems. At the same time, we

can see interesting links between global and nationaldevelopment agendas.

For example, we believe that homegrown solutions canoften be applied elsewhere. We are convinced that high-quality medical care and preventive medicine need not only be for the rich. Prices can be drastically reduced if we ndsmart solutions. It has been done many times and can ofcourse be done again.

It is not easy to predict what innovations will be developedin the period up to 2030. But there are already good ideasout there. This is why we have launched InnovationCountdown 2030, which will systematically identify and

assess curve-bending innovations, engage and inspirestakeholders, raise awareness about opportunities for theglobal health community, andmost importantlybringinvestments on board in support of the SDGs.

We now have a window of opportunity to transform thefuture of global health through the new developmentframeworkif we put our minds together.

Brge Brende is the Minister of Foreign Affairsof Norway.


8/20

Innovation is crucialto achieving agrand convergence

in global healthBy Gavin Yamey and Agnes Binagwaho

transformation is now at our ngertips.

If we make the right health investmentsto scale up existinghealth interventions and delivery systems and to develop

and deliver new toolswe could see a grand convergencein global health within our lifetimes. Within one generation, we could reduce the rates of infectious, maternal, and childdeaths in nearly all low- and lower-middle-income countriesdown to the low levels seen today in richer countries likeTurkey, Chile, and Costa Rica (Figure 1).

One in ten children in poor countries dies before his or herfth birthday; by 2035, we could reduce that rate down toone in fty. We could prevent 10 mill ion maternal, child,and adult deaths each year from 2035 onward. But thisgrand convergence cannot be achieved without innovationto discover tomorrows disease control tools.

We had the privilege of serving as members of The LancetCommission on Investing in Health, chaired by LawrenceSummers and Dean Jamison. The commission published anambitious yet feasible road map for achieving convergence,called Global Health 2035 (www.globalhealth2035.org). Theroad map has three key components.

The rst is mobilizing nancing . The price tag for low- andlower-middle-income countries to achieve convergence is anadditional $70 billion per year from now to 2035. Fortunately,these countries are on course to add $10 trillion per year totheir GDP over that time period. Public investment of lessthan 1% of this GDP growth could therefore fund the grandconvergence. Some countries, of course, will still needexternal assistance to nance their health programs.

The second is targeting this nancing toward the mostcost-effective health interventions . Early investmentin scaling up modern methods of family planning,antiretroviral medication, and childhood vaccinations would have a particularly large and rapid payoff.

The third is increasing funding for R&D . Our modelingfound that even with aggressive scale-up of todays toolsto 90% coverage levels, convergence would not be achieved.Low-income countries would get only about two-thirds ofthe way. To close the gap, new technologies will be needed.Countries that adopt new tools experience an additional 2% per year decline in their child mortality rate over countries that do

notan acceleration that is crucial for reaching convergence.The most important way that the international communitycan support the grand convergence is by funding the discovery,development, and delivery of the next generation of medicines, vaccines, diagnostics, and devices. International funding forR&D targeted at diseases that disproportionately affect poorcountries should be doubled from current levels (US$3 billionper year) to $6 billion per year by 2020. Game-changingtechnologies that could help achieve convergence include asingle-dose radical cure for vivax and falciparum malaria andhighly efficacious malaria, tuberculosis, and HIV vaccines.

The public health and economic benets of achieving

convergence would be profound. Every $1 invested from2015 to 2035 would return $9 to $20, an extraordinary returnon investment.

We have at our ngertips one of the greatest opportunitiesavailable to improve human welfare. The question is: Will we seize it?

Gavin Yamey, MD, MPH, MA, MRCP, isa physician and Associate Professor ofEpidemiology and Biostatistics in the Schoolof Medicine at the University of California, SanFrancisco (UCSF), where he teaches globalhealth policy. He leads the Evidence to PolicyInitiative (http://e2pi.org) in the UCSF GlobalHealth Group.

Agnes Binagwaho, MD, MPed, PhD, is apediatrician and the Minister of Health ofRwanda. She was previously PermanentSecretary of the Ministry of Health andExecutive Secretary of Rwandas National AIDSControl Commission. She co-chaired the MDGProject Task Force on HIV/AIDS and Access toEssential Medicines.

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m o r t a

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( d e a t h s p e r

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b i r t h s )

Advanced investment scenarios

Low-income countries

Lower-middle-income countries

UNDER 5 MORTALITY RATE

100

80

60

40

20

2011 2025 2035

CONVERGENCETARGET

0

Estimated decline in child mortality rates fromenhanced health-sector investments. The convergence targetis 20 deaths per 1,000 live births, similar to the current childmortality rates in high-performing middle-income countries.


9/20

The changing worldof global healthinnovationsNew approaches to accelerating impact

By Rajiv Shah

, a newborn before administering immunizations againstpneumonia and diarrhea. In Haiti, a skilled birth attendantuses a simple bag and mask to save an infant who isstruggling to take her rst breath. In India, a Ministry ofHealth official reviews scorecards with district-level data toevaluate nationwide progress.

Today, we are pioneering a child survival revolution driven by the power of innovation to realize a world where allchildren survive and thrive. By equipping communityhealth workers with simple, affordable technologies, wecan deliver essential health services right to the doorstepof vulnerable familiesenabling countries to leapfrogslower, more traditional paths to improving the health oftheir children. This approach has helped cut child mortalityin half in two decades. Each day this year, 17,000 morechildren will live, laugh, play, and learn compared to

20 years ago.New technologies, however, still take too long to reachthose who need them most. Health facilities remainunderfunded and understaffed. And poor monitoring andevaluation means we do not often know what is and is not working. This year, in fact, more than 6 million children will die before their fth birthday from causes we knowhow to prevent.

That is why, two years ago, we helped host a globalcall to action to rally the world behind a new approachand a single, comprehensive goal: ending preventablechild deaths by 2035. Together, we agreed to prioritizeevidence-based solutions and redirect resources to reachthe poorest of the poor, who are the most likely to die frompreventable causes.

This past year, we reconvened the global communityat Acting on the Call: Ending Preventable Child andMaternal Deaths to take stock of our progress. With agreater emphasis on science, business, and innovation,developing countries themselves have stepped forwardto lead with energy and focus. Sixteen countries havelaunched their own calls to action, set national targets, andcreated evidence-based report cards and action plans to

focus resources and lifesaving interventions in the most vulnerable regions.

These leaps forward are catalyzing new solutions alongthe continuum of carefrom reproductive and maternalhealth to newborn and child health. In Zambia, a public-private partnership called Saving Mothers, Giving Life isusing geospatial technology to map travel time to clinicsand establishing a eet of motorcycle ambulances to

reach women in an emergency. In just one year, maternalmortality declined by roughly one-third in the districtscovered by the partnership.

In Nepal, we supported randomized control trials andfeasibility studies demonstrating that the antisepticchlorhexidine cuts infant mortality by 23% for penniesper dose. We also partnered with a local company to takethis solution to scale. Through Saving Lives at Birth:A Grand Challenge for Development, we are investing inat least 59 global health game-changing innovations justlike chlorhexidine.

In the past two State of the Union addresses, PresidentObama called upon the US to join the world in endingextreme poverty and its most devastating consequenceschild hunger and child deathin the next two decades. Weknow we can get this done, and we know the impact it willhave. Ending child death is the rst step in ensuring morechildren learn, get good jobs, and grow their economies.While accomplishing this mission would be a great moral victory, it is also critical to our own nations stability,security, and prosperity. With a smart, focused, innovativeapproach, we know we can save millions of livesandcreate ripples of change that transform the future offamilies and countries.

Dr. Rajiv Shah serves as the Administrator ofthe US Agency for International Development(USAID) and leads more than 9,600professionals in 80 missions around the world.

With a smart, focused,

innovative approach, weknow we can save millions

of lives.


10/20

Lets reinvent thewheelA homegrown approach to transforming healthcare innovation in Africa

By Felix Olale

a university campus housing one of the most advancedresearch facilities in the world. Launched in November 2013,this facility is the location for IBMs 12th global researchand innovation lab dedicated to solving Africas biggestchallenges. It is the result of a partnership with the Kenyan

government, with IBM committed to investingUS$10 million in the rst two years and the Kenyangovernment contributing a similar amount over the nextve years.

With these funds, IBM is building one of Africas mostadvanced cloud-enabled computing hubs with the abilityto collect and analyze large amounts of data to buildsustainable solutions for Africas most pressing challenges.The ambitious and highly localized research agendaincludes areas such as agriculture, energy, nancial

inclusion, health care, public safety, transportation,and water.

To tackle these challenges, IBM has hired a research staffthat is somewhat unique in its composition. IBM pairsseasoned researchers with more than 20 young Africans,many holding PhDs from universities abroad. These youngAfrican scientists are part of the large diaspora beginningto return home to participate in Africas newfoundeconomic growth. I should know. I am one of them.

The UNs Department of Economic and Social Affairsestimates that there are 3 million tertiary-educated

migrants from sub-Saharan Africa living in membercountries of the Organisation for Economic Co-operationand Development. Africas highly educated diasporais a vastly underutilized resource in the quest to buildhomegrown innovation that is fundamental to solvingAfricas health care challenges.

As the global health community moves toward the post-2015agenda, Africas health care challenges remain formidable.

Despite recent improvements, the health of the vastmajority of Africans is still at risk. Sub-Saharan Africa has11% of the global population but carries 24% of the worldsdisease burden. On the basic indicators of health, thecontinent compares poorly with other developing regions.One in six children born in the region today will die beforeage ve. African women face more than 100 times the riskof maternal mortality than women in the developed world.The average life expectancy in sub-Saharan Africa is a mere52 years. And sadly, most of the countries will not meet theUNs Millennium Development Goals for health by 2015, letalone address the signicant threat of noncommunicablediseases now on the horizon.

This can change. I believe that the principal way totransform Africas health systems is to deliberately investin and partner with African institutions in order to buildlocal capacity focused on local African problems. Theingredients for success already exist. What remains is forthe global community to reinvent its approach.

We must ask the right questions in order to better utilizethe window of opportunity that exists today: How can weentice more Africans in the diaspora to return home? Howcan we take advantage of ubiquitous data and technology?How do we better partner with local enterprise andgovernments to create innovation hubs and ecosystems?How do we move from todays siloed approaches towarda holistic approach that builds more sustainable Africanhealth systems?

Africas health systems are at an inection point. As wemove toward the post-2015 agenda and the UNs agendafor the Sustainable Development Goals, the global healthcommunity has a rare opportunity to reinvent its approachto innovation and transform the health of Africa.

Felix A. Olale, MD, PhD, is the CEO ofWellness Group, a medical diagnostics andimaging company focused on delivering high-quality and affordable health care across Africa.He also sits as Chairman of the Board for theExcelsior Group and is on the board of directorsfor PATH.

The principal way to

transform Africas health

systems is to deliberatelyinvest in and partner with

African institutions in order tobuild local capacity focused

on local African problems.


11/20

Reaching every child throughimmunization

innovationBy Seth Berkley

pioneering work, vaccines continue to be one of themost innovative and cost-effective health interventionsthe world has ever seen. They have already paved the way for dramatic reductions in life-threatening anddebilitating diseases in wealthy and many developingcountries. But now, thanks to the accelerated developmentof new vaccines and new ways of improving access toimmunization, we have the opportunity to reach everychild, no matter where they live.

This is critical because, despite the great strides that have been made in increasing immunization rates, globalcoverage is still much lower than most people realize. Atrst glance, coverage has been on the rise, with the numberof children receiving all doses of diphtheria-tetanus-pertussiscontaining (DTP) vaccines (the traditional yardstick of immunization coverage) increasing from 73%to 83% in the last decade. However, a look at the numberof children receiving all 11 vaccines recommended by theWorld Health Organization for universal usagediphtheria,pertussis, tetanus, polio, Haemophilus inuenzae type b,hepatitis B, measles, rubella, BCG (against tuberculosis),pneumococcal, and rotavirusreveals a very differentpicture, with just 5% of the worlds children ful lyimmunized. Its little wonder that 1.5 million children stilldie from vaccine-preventable diseases every year.

Increasing the number of children who are fullyimmunized could make a huge impact on this gure, notleast because some of these new, powerful vaccines targetmajor killers. Rotavirus and pneumococcal vaccines, forexample, protect against some of the main causes ofdiarrhea and pneumonia, the two biggest causes of deathamong children under age ve.

Innovative efforts by Gavi, the Vaccine All iance, have

helped accelerate access to new and powerful vaccines.This year, we will support the introduction of one new vaccine in a Gavi-eligible country every week on average.However, introducing these vaccines is just the rst step.The bigger challenge is ensuring they reach every singlechild, including the most remote and marginalized. This will require new tools such as digital and geographicalinformation systems so we know where those childrenare and who is being missed, innovative supply chainequipment and practices so we can get vaccines everywherethey are needed, and better human resource management.Together, these can enable countr ies to leapfrog into muchhigher-performing health systems and dramaticallyincrease access to vaccines as well as other vital healthinterventions.

Newer vaccines have also moved us from preventionof traditional infectious diseases to infectious causesof chronic diseases, such as cancer. Today we alreadyhave vaccines to protect against two common cancers:liver cancer (hepatitis B) and cervical cancer (humanpapillomavirus), and there are others in the pipeline.Given that today more than 30% of cancers in Africa haveknown infectious antecedents, as opposed to less than 10%in industrialized countries, this kind of innovation willprove vital.

In the long term, the trend of innovation in R&D canalso lead to vaccines for many more pathogens, such asHIV, hepatitis C, malaria, and tuberculosis, all of whichhave thus far challenged traditional vaccinology. In themeantime, if we continue to invest in immunizationinnovation, by 2020 we should be able to dramaticallyincrease the number of children who are fully immunizedand come signicantly closer to reaching every child.

Seth Berkley, MD, is the CEO of Gavi, theVaccine Alliance.

Innovation can enable

countries to leapfrog into

much higher-performing

health systems anddramatically increase access

to vaccines.


12/20

Ending AIDSToward an HIV vaccine and cure

By Anthony Fauci

was recognized and its etiologic agent, HIV, wasdiscovered. Extraordinary scientic progress has beenmade in understanding, diagnosing, treating, andpreventing HIV/AIDS. Globally, new HIV infections anddeaths from AIDS fell by more than one-third over thepast decade.

While continued scale-up of existing HIV treatmentand prevention tools will likely continue to reduce newHIV infections and AIDS deaths, further innovation isneeded if we are to realize the goal of a world without AIDSand sustain that landmark success. In this regard, twoareas loom large: developing a vaccine to prevent HIVinfection, and nding a therapeutic regimen that inducespermanent or at least prolonged suppression of viremia,thereby sparing HIV-infected individuals a lifetime ofantiretroviral therapy (ART).

The history of HIV vaccine development has been marked by disappointments, but recent research advances haveprovided reason for optimism. Notably, candidate vaccineshave proven protective in various animal models of HIVinfection, and modest efficacy was seen in a large humanHIV vaccine trial conducted in Thailand. Ongoinganalyses of the data from the Thai trial have identiedpossible leads for improved vaccines, and clinical trialsare planned to build on the results. Furthermore, agrowing array of potent, broadly neutralizing monoclonalantibodies targeting at least ve structures on theHIV envelope protein have been identied. Alone or incombination, these antibodies can neutralize most HIVstrains circulating globally. Scientists are working tocharacterize these antibodies and the viral structuresto which they bind and to trace antibody developmentin the bodies of HIV-infected individuals, with an eye to

eliciting such broadly neutralizing antibodies in uninfectedindividuals.

A second key area of innovation in HIV science is ndinga cure for AIDS. The stunning successes achieved withART for HIV-infected individuals is tempered by the factthat these lifesaving drugs are not curative; the viruspersists in a latent form in cellular reservoirs even whena patient responds well to treatment. Although medicines

can suppress HIV to very low levels in the blood, the virusin these reservoirs of latently infected cells resurges iftreatment is stopped.

Two strategies emerge when the concept of a cure isconsidered: viral eradication, in which HIV is no longerpresent in the body, and sustained virologic remission,in which viral replication is completely suppressed orkept at very low levels in the absence of daily ART. Thelatter approach is likely the more feasible of the two. Theextended virologic remission seen in an HIV-infectedinfant called the Mississippi child treated very soon after birth suggests that therapy, if initiated early enough in HIV

infection, can perhaps preempt formation of a sustained viral reservoir. Furthermore, a cohort of patients in France was identied who started treatment early in the course ofinfection and later discontinued ART without viral rebound.Since very early therapeutic intervention is not alwaysfeasible, other approaches are being pursued in the questfor a cure, including activating and eliminating latentlyinfected cells, immunotoxic therapy directed at the HIVreservoir, gene therapy, and other novel strategies includinga therapeutic vaccine.

In summary, although both an HIV vaccine and a cureremain within the uncertain realm of discovery, recentadvances give cause for hope that both can be achieved with further innovation. Added to our existing HIVtreatment and prevention tools, an HIV vaccine and cure would help bring us closer to our goal of ending AIDS.

Anthony S. Fauci, MD, is Director of theNational Institute of Allergy and InfectiousDiseases (NIAID) at the US National Institutesof Health. Dr. Fauci also is Chief of the NIAIDLaboratory of Immunoregulation and was oneof the principal architects of the US PresidentsEmergency Plan for AIDS Relief (PEPFAR).

Recent advances give

cause for hope that both

an HIV vaccine and a cure

can be achieved withfurther innovation.


13/20

Nurturinginnovators andinnovationsA new model for frugal innovation today forimpact tomorrow

By Balram Bhargava

- landscape ranges from needs reminiscent of developedcountries to infectious diseases prevalent in low-incomecountries. The vast majority of Indians cannot access orafford the medical technologies they need. More than 80%of the medical technology in India is imported, making itprohibitively expensive. Of course, Indias challenges arenot unique; the vast majority of low- and middle-incomecountries face them.

Indias aspiration to become an advanced nation ispredicated upon the nations ability to provide high-quality health care to its people at an affordable cost.Need-appropriate innovation that leapfrogs signicantconstraints is the key to solving this urgent challenge.What is required is a new paradigm in innovationthat leverages the deep understanding of Indias needsand context by local innovators who are steeped in afrugal mind-set.

The Stanford-India Biodesign program and the newSchool of International Biodesign (SIB) are rooted in

this new paradigm. The SIB program is a Departmentof Biotechnology, Government of Indiafunded programmanaged by Biotech Consortium India Limited at theAll India Institute of Medical Sciences and the IndianInstitute of Technology Delhi, with Stanford University asan international partner. The program brings together aninterdisciplinary team of physicians, engineers, doctors,and researchers in its fellowship program. SIB fellows gothrough experiential learning and hands-on training inmedicine, design, engineering, and business development.They identify unmet clinical needs through direct

observation and intensive research of disease processes thatare screened based on parameters such as potential impact.Potential solutions for high-impact needs are screened based on technical feasibility, competitive landscape, andstakeholder analysis.

Training innovation leaders today who will createtechnologies to heal humanity tomorrow has been atthe core of SIBs mission. Over the past seven years, the

program has trained more than 100 innovators who have become the anchors of the medical technology ecosystemin the country. These innovators have invented more thanten technologies that are in active development and clinicalevaluation. These three are representative of the range ofSIBs innovations:

Consure is a novel fecal catheter that solves challengesassociated with a serious and underestimated problemfecal incontinence. The star t-up founded by innovatorshas completed product development, established scalableoperations, successfully completed safety and efficacystudies, obtained patent grants in key jurisdictions, and

recently received US Food and Drug Administrationclearance for commercialization. Consure is a wonderfulexample of frugal innovation that will not only address aserious health problem in India but also bring down thecosts of managing fecal incontinence in the developed world.

HiCARE LIMO is an affordable, cardboard-based,environmentally friendly immobilizer for lower-limbfractures. Similar in performance and superior inusability to more expensive metal immobilizers, ithas been licensed to public-sector manufacturing anddistribution company HLL Lifecare Limited, which isnow introducing the technology to health care systems inIndia and internationally.

BRUN is an electronic feto-maternal wellness monitoringsystem in development that simplies monitoring duringlabor and helps in objective decision-making, improvingfeto-maternal outcomes in resource-limited settings. Theinnovation has the potential to serve pregnant women inmuch of the developing world.

Collectively, the innovations from the SIB program willlikely help tens of millions of people worldwide. Even morecritically, the program has become a model for a countrythat produces an abundance of high-caliber physicians,

engineers, designers, and researchers, leading to amultitude of SIB-inspired incubators across India.

Balram Bhargava, MBBS, MD, DM, FRCP(Glasg),FRCP(Edin), FACC, FAHA, FIACS, FAMS, FNASc, is Professor at the Department of Cardiology,Cardiothoracic Sciences Centre, and ExecutiveDirector, Stanford-India Biodesign at the AllIndia Institute of Medical Sciences. ProfessorBhargava is decorated with Padma Shri, one ofIndias highest civilian honors.

The key is need-appropriate

innovation that leapfrogssignicant constraints.


14/20

Taking a boldstep forward:innovation

in AfricaBy Glenda Gray

is lacking. How wrong this view is! Africa is the land ofopportunity, and innovation is a key factor driving this.Whether countries are pioneering mobile health or healthsystems research, Africa can often be seen on the forefrontof innovation. Our challenge is translating such innovationto scale and impact.

Nowhere is innovation in Africa more critical than in theeld of health care. Whether it equips us to diagnose apatient at the most remote clinic, or whether it ensures thequality and integrity of medicines, innovation is central todriving better patient care toward 2030.

The rst thing to realize about Africa is that we are differentfrom the rest of the world. Compared to other regions, we have unique needs, a genetically diverse population,different diets, and a very different disease burden prole.Taking these differences into account, one soon learns that

innovation and impact are measured quite differently herethan they are in the northern hemisphere. Impact factorsand citation rates are important to us. But saving lives andimpact are most important.

At the Medical Research Council in South Africa, we seekto focus on the impact of innovation to save lives. We areapproaching this goal in partnership and with a focus onthe key disease burdens of our continent. One such exampleis our exciting partnership with PATH to develop criticalinterventions focusing on maternal and child health bytaking projects to scale. These interventions include a

low-cost Doppler device to measure umbilical function inthe last trimester of pregnancy, which could reduce infantmortality in an environment where an ultrasound is athree-hour drive away.

In Africa, waiting times at rural clinics can often be morethan 12 hours. As a result, many sick people are sent homeuntreated, even though many cant afford the fare to returnto clinic the following day. These individuals are lost tothe system. To overcome this challenge, we are focusingon developing an electronic triage device that seeks toradically reduce patient waiting times and help those ingreatest need rst. Our rst study in this domain showeda radical improvement of triage times, a vast reduction oferrors, and improved patient outcomes. Building on thismomentum, we will next seek to address the challenge ofdeveloping electronic records of patients.

None of these examples required the latest technologythis is not always Africas need in health care. Rather, theyinvolved a new way of approaching enduring problems,rethinking the possibilities in light of Afr icas unique needsas well as our unique capabilities.

Glenda Gray, MBBCH, FCPaeds (SA), DSc(honoris causa), a National ResearchFoundation A-rated scientist, is President ofthe Medical Research Council of South Africa.

Africa can often be seen

on the forefront of innovation.

Our challenge is translating

such innovation to scaleand impact.

Were rethinking the

possibilities in light of Africasunique needs and capabilities.


15/20

Peter A. Singer, OC, MD, MPH, FRSC,is CEO of Grand Challenges Canada.

Scaling innovationsto save lives ofwomen and children

pre- and post-2015By Haitham El-noush, Allan Pamba, and Peter A. Singer

, - - the Every Woman Every Child (EWEC) initiative tomobilize and intensify global action to improve the healthof women and children around the world. The EWECinitiative hosted the Accountability Commission, theindependent Expert Review Group, the UN Commissionon Life-Saving Commodities for Womens and ChildrensHealth, and the Innovation Working Group (IWG).

The IWG was established to advocate for, identify, andsupport innovations to accelerate progress on the healthtargets included in the Millennium Development Goals.Through its exible structure and extensive networkof more than 180 members representing more than80 institutions, the IWG has made the case for innovationas game-changer for maternal, newborn, and child health(MNCH), whether science and technology, social, business,nancial, or some combination of these.

In addition, the IWG has produced useful reports onsustainable business models for delivering health care,engagement guides for companies, and checklists forimproved health care, the deployment of innovativemedical devices in low-resource settings, nutrition foradolescent girls, mHealth and telemedicine, and innovativenancial models. Importantly, the IWG is the primaryplatform for private-sector engagement in the EWECinitiative. Thanks are due to the support of the Governmentof Norway and the visionary leadership of Tore Godal.

Meanwhile, global partners were developing a pipeline ofinnovations in MNCH that did not previously exist. Forexample, the Bill & Melinda Gates Foundation, GrandChallenges Canada, the US Agency for InternationalDevelopment, the Norwegian Agency for DevelopmentCooperation, and UK Aid par tnered on Saving Lives at Birth, which has supported 91 innovations, including 77 at the proof-of-concept stage and 14 transitioning to scale. These partnersand others have supported hundreds of MNCH innovations.

While most of these innovations are stil l at the proof-of-concept stage, there are some examples of innovationsalready transitioning to scale, such as the Odon device(innovation in assisted vaginal delivery) being scaled by BD

and the Linda Jamii program (health care micro-insurance)developed by Changamka, Safaricom, and Britam.

The challenge now is to turn up the tap on this robustpipeline of MNCH innovations, unleash the social capitaland expertise needed for scaling, and turn the trickle ofinnovations transitioning to scale into a torrent.

There are strong links and exciting complementarities between the IWG and the Innovation Countdown 2030initiative, which will help to identify these promisingMNCH innovations. While the IWG follows the EWECinitiatives timeframe and focuses on MNCH, InnovationCountdown 2030 targets additional health domainsincluding reproductive health and infectious andnoncommunicable diseases, as well as MNCH. Theoutcomes of the Innovation Countdown 2030 initiative will greatly benet efforts to scale innovation as theproject looks to provide insights into which innovations will have the highest impact and to develop an innovationassessment framework.

A key strategy of the IWG going forward will be tocontribute to a global marketplace for MNCH innovations, where innovations meet investors to help them transitionto scale in a sustainable manner and achieve widespreadimpact. The IWG is uniquely positioned to contributeto such a platform. Its comparative advantage is theability to bring its member network to invest in themost promising innovations in the MNCH pipeline. This will prove crucial in achieving the target set in the IWGstrategy of demonstrating several scaling and scaled MNCHinnovations within the coming two years.

Haitham El-noush, MSc, BSc, is Senior Adviser,Innovation in Health and Development,The Norwegian Agency for DevelopmentCooperation, and project manager for theInnovation Working Group.

Allan Pamba, MD, MSc, is Vice President ofPharmaceuticals, East Africa and GovernmentAffairs, Africa, for GlaxoSmithKline, andco-chair of the Innovation Working Group.


16/20

The next frontierDigital health for scaled impact

By Craig Friderichs

communications technology to support behavior change,supply chain improvements, health nancing, health worker enablement, and other critical health serviceshas been well-documented. However, mHealth has yetto demonstrate signicant scale and integration intothe health system. Mobile is dependent on volume todrive economies of scale, but fragmentation, inadequatepartnership brokerage, and an inability to access business-to-business (B2B) payment mechanisms have largely

prevented mHealth services from reaching signicant scale.

With more than 85% of total health care expendituresexisting in a B2B or reimbursive payment environment,mHealth stakeholders have to be able to demonstrate strongeconomic evidence of mHealths cost impact on specichealth interventions.

We have been tracking the growth in mHealth since2010, looking for evidence to support the sustainable B2Bintegration of mobile into the scal budgets of national orregional health providers. Our rst literature review helpedus understand that out of more than 800 peer-reviewedpublications, less than 1% demonstrated a cost implicationto the health intervention and/or health system.

Four years later, we are now tracking more than 1,300mHealth services being deployed across emerging markets.The phenomenal growth in the number of new services hasnot, unfortunately, seen a parallel growth in the evidence base of these services, particularly economic or cost proofpoints. Some 90% of services rely on donor funding and/or aconsumer payment model, both of which we would argueare unsustainable given the short-term nature of fundingand the inability of consumers at the bottom of the pyramidto contribute signicantly to out-of-pocket health expenses.

Building toward scale and sustainability, we need to beconscious of the fact that mobile services are built around ahigh-volume, low-margin business model. Most of the mHealthservices we analyze are not able to achieve this tipping pointof active users that allows for economies of scale.

The vast majority of sustainability models are designedfor thousands or tens of thousands of users. When wepresented an opportunity from one of our GSMA members,

Samsung, to pre-embed health services onto 80 millionmobile devices across Africa over the next two years, onlya handful of service providers were able to adjust theiroffering to take advantage of this opportunity to support upto 80 million potential users across Africa.

We also have to consider how to better leverage the mobileecosystem to drive scale and sustainability. Internet.org was able to secure zero-rated connectivity agreements withAirtel in Zambia recently with a strong brand value andproduct offering. MTN and Airtel Group have committedto similar offerings across their portfolio of operations ifmHealth stakeholders can demonstrate a win-win value

proposition.Gemalto, the largest SIM card manufacturer, has about 350million SIMs in circulation across sub-Saharan Africa andhas committed to distr ibute health content and enablecivil registration. Samsung, in addition to pre-embeddingSmart Health onto 80 million devices, has committed tomake its Samsung ecosystem available. It is hoped thatnancial and nonnancial incentives will drive demand forhealth services. For example, users might receive a weeksfree access to the Samsung music store for completing animmunization schedule.

Realizing the potential of mHealth will depend on creating

sustainable, low-margin, high-volume business models.This volume is dependent on strong demand from endusers. Demand can be catalyzed through an ecosystem ofdelivery partners aiming to drive down the prohibitive costof handsets and connectivity; leverage strong marketing,distribution, and public relations campaigns; andaggregate the multitude of mHealth services onto a singleuser interface.

Craig Friderichs, MD, MBA, is Director ofHealth at GSMA and has pioneered the GSMAecosystem partnership and the Pan-AfricanmHealth Initiative.

Realizing the potential of

mHealth will depend oncreating sustainable,

low-margin, high-volume

business models.


17/20

Why innovationmattersBy Steve Davis

lives and improve health, including in the worlds most vulnerable communities. By harnessing the power of newideas and channeling the expertise of a diverse ecosystemof partners, networks, and systems, innovation is fuelinghealth solutions that are more effective, more accessible,and less expensive than ever before.

Researchers have started to quantify just how profoundthe impact of innovation can be. The Institute for Health

Metrics and Evaluation, for example, determined that new vaccines, drugs, diagnostics, public health campaigns,and related innovations resulted in 4.2 mil lion fewer childdeaths in 2013, compared to 1990. 1 Progress like this isfundamentally changing the landscape of human healthand opportunity.

Yet the truth is we have only begun to tap innovationsradical potential.

Today, game-changing breakthroughs are coming fromevery corner of the globe. Innovation comes from scrappystart-ups in India and entrepreneurs in South Africainspired by rsthand knowledge of their communitiesneeds. It comes from cross-sector partnerships andenterprising, underfunded inventors. Sometimes, itcomes from the most unlikely of sources. Right now, theWorld Health Organization and BD, a medical technologycompany, are testing and developing a prototype devicethat could help babies make their way through the birthcanalan idea conceived by a car mechanic in Argentinainspired by an online video on how to extract a cork froman empty wine bottle.

The nature of innovation itself is changing in ways thatcould exponentially accelerate our progress. As a globalcommunity, we must break down the barriers and silosthat choke the ow of innovation through the developmentpipeline. We must create new ways to connect our brightest

minds, greatest ideas, and common aspirations acrosssectors, disciplines, and borders.

At PATH, we know that nding creative ways to connectinnovation and impact can drive massive improvementsin health. For example, our work with partners in Chinaturned an effective vaccine that was virtually unknownoutside the country into an internationally approved toolto ght Japanese encephalitis, a disease that kills three

in ten people it infects. We used an innovative systemsapproach to make it happenstrengthening diseasesurveillance, negotiating affordable pricing, and providingtechnical expertise to help the manufacturer in China meetinternational regulatory standards. The vaccine is now being rolled out to millions of children across Asia.

Greater investments in research and development arecritical to accelerating progress. The Lancet Commissionon Investing in Health has called for the doubling by 2020of funding for international R&D that targets diseasesdisproportionately affecting low- and middle-incomecountries. 2 Focusing our efforts on the most promising

innovations will yield tremendous returns on investmentin both lives and resources saved.

Now is the time to reach higher and br ing togetherthe worlds leading innovatorsfrom experts in theglobal health community to social and impact investors,entrepreneurs, technology and business leaders,policymakers, and partners from the Global South.How much more could we do together by harnessingour collective exper tise, resources, networks, andcommitment? How dramatically could we accelerateinnovation and reach the millions of women and childrenstill waiting to share in the gains?

References

1 Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels ofneonatal, infant, and under-5 mortality during 19902013: a systematic analysisfor the Global Burden of Disease Study 2013. The Lancet. 2014; doi:10.1016/S0140-6736(14)60497-9.

2 Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a worldconverging within a generation. The Lancet. 2013;382(9908):18981955.

The nature of innovation

itself is changing in ways thatcould exponentially accelerate

our progress.

Steve Davis is President and CEO of PATH,an international nonprot organizationdriving transformative innovation to save livesand improve health, especially among womenand children.


18/20

Innovation Countdown 2030 is reimaginingwhats possible in global health. Led byPATH, the initiative is identifying andshowcasing technologies and interventionswith great promise to accelerate progress

toward solving the worlds most urgent health issues. The initiative is supportedby the Government of Norway.

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

Our approach

To identify innovations with great potential for global health impact by 2030,PATH is conducting a survey to gather innovations identied by a broad range ofmultidisciplinary experts in global health, technology, investment, the nonprotsector, academia, and government from around the world.

The survey is available at: www.ic2030.org/engage/

Survey responses received by October 10, 2014, will be evaluated using anassessment methodology developed with the input and guidance of anindependent expert advisory group. An independent panel of experts will rankselected innovations, taking into account their potential for impact based ontheir affordability, accessibility, effectiveness, and other factors.

The Innovation Countdown 2030 report

The nal set of selected health technologies and interventions will be featuredin the Innovation Countdown 2030 report planned for release in 2015.

Photos: inside front cover (starting at top left): PATH/Laura Newman, PATH/Gabe Bienczycki, PATH/Lesley Reed, PATH/Gabe Bienczycki,PATH/Dunia Faulx; inside back cover (starting at top right): Heng Chivoan, CDC/James Gathany, PATH/Laura Newman, Umit Kartoglu.


19/20

Therapeutic regimens that induceprolonged suppression of viremiain HIV-positive patients?

Geospatial

technology

to map

travel times

to clinics?

Financingmechanisms for

smallholder farmersto improve foodsecurity?

A mosquito-repellentpatch?


20/20

Whats your idea for transforming global health?

Which technologies and interventions do you believe will drive dramaticimprovements in health over the next 15 years and beyond?

Take the Innovation Countdown 2030 survey

Nominate the innovations you believe have great potential for health impactby taking our short survey, available at: www.ic2030.org/engage/

Survey responses received by October 10, 2014, will be evaluated usingan assessment methodology developed with input from an independentexpert advisory group. An independent panel of experts will rank selectedinnovations, with high-potential innovations to be showcased in theInnovation Countdown 2030 report planned for release in 2015.

Survey responses received after October 10, 2014, will be part of a pool ofinnovations considered for future editions of the report.

Join the conversation

www.ic2030.org

#ic2030

[email protected]

path ic2030 innovation matters

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