Decades of pharmaceutical innovation and an array of treatment and prevention options mean that many people living with HIV can now expect to live long and full lives.Gone are the days when people diagnosed with HIV had to take so many pills that they needed to set multiple alarm clocks. A daily pill is now most common, but even that paradigm is changing as the industry investigates longer-acting medicines that don’t have to be taken every day.Some of this progress has been reached through direct engagement and collaboration with the HIV community — people who live with the disease and those who treat and support them.&ldquo;No one wants to be talked at — we want to be talked with,&rdquo; says Warren O’Meara-Dates, a US-based HIV community leader and founder of the <a href='https://www.warrendates.com/menu-details' target='_blank'>6:52 Project</a>. &ldquo;We want to be partners in this, because we’re the ones most impacted by the medicines that are provided for our longevity and opportunity for life.&rdquo;

This patient-centred approach is taken by GSK, through ViiV Healthcare, a specialist HIV company of which it owns the majority share. As a pharmaceutical company solely dedicated to HIV, ViiV bases much of its research and development (R&D) strategy on patient perspectives generated by advisory boards, community events and insights from clinical trials.&ldquo;Our mission is that we leave no one with HIV behind. And to do that, we must listen to the voices of people who are living with HIV,&rdquo; says Dr Kimberly Smith, head of R&D at ViiV Healthcare. &ldquo;A powerful example of this is our Positive Perspectives 2 study, one of the largest HIV patient-reported outcomes studies to date, which included nearly 2,400 people from 25 countries.&rdquo;<h2>Turning talk into treatment</h2>The HIV community has advocated for action from the pharmaceutical industry since the early days of the epidemic. With grassroots groups such as ACT UP leading the way, HIV activists and advocates have had great success working towards the shared goals of better medicines and access to testing and treatment.&ldquo;Historically, the HIV community has had a huge impact on how drugs get developed and the acceleration of drug approvals,&rdquo; says Smith. &ldquo;This is an activist community. They deserve our attention, and we absolutely need to hear what they have to say.&rdquo;O’Meara-Dates has been a key part of the shift towards meaningful conversations as an activist and HIV community advisor to ViiV, as well as a number of public health bodies.&ldquo;For 30 years, without the inclusion of community at this level, the wheel just kept turning,&rdquo; he says. &ldquo;We weren't getting to the place where we needed to, in part because some communities were left out of initial conversations about what innovations we wanted and needed.&rdquo;

One breakthrough came in response to the community’s calls to lift the burden of daily treatment. Hearing these concerns, ViiV became the first company to develop modern two-drug regimens that can reduce the number of medicines taken over a lifetime. Further community insight has helped progress research that is leading to new options for treatment and prevention.<h2>Research that reflects diversity</h2>This is progress, but there is still room for improvement in clinical trial diversity to ensure individuals from the communities and countries where HIV is growing and more prevalent are included. For example, women account for 52 per cent of the global HIV population, but only 19 per cent of those included in HIV treatment and prevention studies.This has long been a concern for the HIV community. &ldquo;Human beings are diverse — no single regimen will have the same outcome from person to person,&rdquo; says O’Meara-Dates. &ldquo;Including the communities most affected by the development of treatments is an integral part of HIV eradication and prevention.&rdquo;In response to calls for representation, the US Food and Drug Administration is requiring pharmaceutical companies to improve diversity in biomedical research. Independently, many pharmaceutical developers, including ViiV, are setting targets for representative demographics in clinical trials.For GSK and ViiV, their forward progress will leverage insights from a 17-year retrospective study of their US clinical trials, which was recently published in Clinical Trials: Journal of the Society of Clinical Trials.<h2>The road ahead</h2>Empowering the HIV community with more options for treatment and prevention is essential to tackling healthcare inequity. To this end, ViiV’s researchers are now investigating the possibility of ‘ultra-long-acting’ medicines with the hope that they could be taken every three months or longer, as well as self-administered medicines that could be taken at home. Many people living with HIV say this would reduce the emotional toll and stigma of a lifetime of treatment.

&ldquo;ViiV is giving options to folks like me who have had to take several medications every day over many years,&rdquo; says O’Meara-Dates. &ldquo;Having more choices to fit my needs is one thing that helps reduce the feeling of stigma associated with HIV treatment.&rdquo;Steps like these, says Smith, show how pharmaceutical companies can be more &ldquo;open and responsive&rdquo; to the people they seek to help. Finding a cure for HIV is the ultimate goal – but in the meantime, collaboration between the HIV community and pharmaceutical companies can help make HIV a smaller part of people’s lives.&ldquo;We are making strides, particularly with ViiV,&rdquo; O’Meara-Dates says. &ldquo;Many of us have spoken up to say, ‘nothing for us without us’, and pharma is listening. Nothing can truly be helpful if our voices are not part of developing new medicines.&rdquo;

As we age, our immune system weakens. With older people more prone to infection, a friendly handshake or a hug between a grandchild and grandparent could potentially lead to serious consequences.&nbsp;To help protect older populations from these health risks, scientists around the world are laser focused on unearthing medical discoveries that can bolster immune strength.&nbsp;Respiratory infectious diseases are a particular concern for the ageing population. These common infections, such as the ones caused by the flu virus or pneumococcus bacteria, are easily spread and can often lead to serious health complications in the elderly. One of these diseases is caused by respiratory syncytial virus (RSV), which leads to an estimated&nbsp;160,000 deaths globally each year,1 and is one of the few major infectious diseases currently without a vaccine for prevention. In fact, solutions for RSV have evaded scientists for generations leaving millions of older adults exposed globally each year.2RSV is just one of the major pathogens on the hit list of GSK&rsquo;s scientists. As one of the leading innovators in the pharmaceutical industry, it has a broad portfolio of vaccine platform technologies and a long heritage in vaccines, dating back to the early 1900s. To date, the company has created vaccines for 23 of the 32 diseases recognised by WHO and Centers for Disease Control and Prevention (CDC) to be preventable by vaccination.3,4,5&nbsp;Now, GSK aims to lead a new generation of vaccine development, with its belief that innovation drives disease prevention. It recently acquired Affinivax, Inc, a clinical-stage biopharmaceutical company based in Cambridge (Boston, Massachusetts). Phil Dormitzer, GSK&rsquo;s senior vice president and global head of vaccines R&amp;D based in Boston, says: &ldquo;The integration of Affinivax&rsquo;s disruptive technology and scientific talent into GSK, alongside our own scientists, will help us expand our portfolio, with many potential applications against infectious diseases.&rdquo;Global attention on the role of vaccines during the past few years has reshaped public awareness around combating infectious diseases. Rather than being viewed solely as a tool to protect children, vaccines are now also considered a preventative tool in healthcare from infancy through adulthood. &ldquo;The world has a greater and renewed understanding of the value of vaccines, &rdquo; says Dr Jamila Louahed, vice president, vaccines R&amp;D, GSK.6She adds: &rdquo;It&rsquo;s more clear than ever that innovative technologies paired with a deep understanding of life sciences can have a major impact on disease prevention and will help unlock effective vaccines to tackle the world&rsquo;s biggest health challenges.&ldquo;

<h2>Vaccine innovation is an opportunity to impact health around the globe</h2>The global vaccines market is projected to surge from $61bn in 2021 to $125bn in 2028,7 spurred by several new vaccines including those focusing on respiratory infectious diseases, meningococcal meningitis and other pathogens. This acceleration in investment and attention couldn&rsquo;t be timelier. As our healthcare systems expand resources to support people living healthier lives, vaccines are set to become an essential part of healthy living by helping to prevent disease.&nbsp;The number of people aged 60 and above is expected to rise to 2.1bn individuals by 2050, up from 1.4bn in 2030.8 As we get older, our immune strength often begins to fade,9 bringing the threat of more frequent infections and, in some cases, more severe health outcomes.10&nbsp;In the US alone, the annual healthcare costs of treating four vaccine-preventable diseases &ndash; influenza, pertussis, herpes zoster, and pneumococcal disease &ndash; are projected to increase from approximately $35bn to $49bn in the next 30 years.11Vaccines will play a critical role in reducing that burden on healthcare systems.<h2>R&amp;D innovation empowering society to age in a healthier way</h2>Waning strength of the immune system may be an inevitable aspect of getting older, but thanks to breakthroughs in vaccine research and development and the use of disruptive technologies, scientists are identifying new tactics to fight infectious diseases from birth through to adulthood.Uniting vaccine science with new adjuvant technologies is one approach GSK deploys to be at the forefront of vaccine innovation. Adjuvants help boost a body&rsquo;s immune response leading to stronger and longer-lasting immunity, improving protection against infections.The advancement of adjuvants are revolutionising vaccines that target pathogens for which vaccines previously were not effective or available. The successful combination of the right adjuvant and antigen can lead to a faster, more potent, and more durable immune response. This can bring particular benefits to the elderly or immunocompromised, who are vulnerable to infection.&nbsp;Other new technologies have enabled researchers to deliver a host of new benefits &ndash; mRNA vaccines initially developed to combat influenza led to the first licensed mRNA vaccines for Covid-19. Another example of a novel technology that is not yet widely known and has the potential to disrupt the landscape is Multiple Antigen Presenting System (MAPS) platform technology. This technology, key to GSK&rsquo;s Affinivax acquisition, has initially been directed toward preventing pneumococcal disease caused by a number of different strains of the bacteria.<h2>Living well for longer</h2>These leaps forward in vaccine development are granting scientists the tools to target and get ahead of infectious diseases that have previously escaped prevention solutions.The importance of such innovations will only intensify in the years to come. As the global population continues to age and knowledge of infectious diseaseincreases, continued investment and research into vaccine innovation will be essential to helping protect as many people as possible &ndash; from infancy to old age, and with a focus on those most at risk. There is reason to believe a new era for vaccines is upon us and together we can look ahead with hope for longer, healthier lives.

1&nbsp;&nbsp;<a href='http://www.niaid.nih.gov/diseases-conditions/respiratory-syncytial-virus-rsv' target='_blank'>www.niaid.nih.gov/diseases-conditions/respiratory-syncytial-virus-rsv&nbsp;</a>2&nbsp;&nbsp;<a href='http://www.niaid.nih.gov/diseases-conditions/respiratory-syncytial-virus-rsv' target='_blank'>www.niaid.nih.gov/diseases-conditions/respiratory-syncytial-virus-rsv&nbsp;</a>3 <a href='http://www.who.int/teams/immunization-vaccines-and-biologicals/diseases' target='_blank'>www.who.int/teams/immunization-vaccines-and-biologicals/diseases</a>4 <a href='https://www.cdc.gov/vaccines/vpd/vaccines-list.html' target='_blank'>https://www.cdc.gov/vaccines/vpd/vaccines-list.html</a>5 <a href='https://www.ecdc.europa.eu/en/vaccine-preventable-diseases' target='_blank'>https://www.ecdc.europa.eu/en/vaccine-preventable-diseases</a>6 <a href='https://www.ecdc.europa.eu/en/vaccine-preventable-diseases' target='_blank'>www.gsk.com/en-gb/behind-the-science-magazine/how-adjuvants-boost-our-immune-response/#_edn1</a>7&nbsp;<a href='https://www.ecdc.europa.eu/en/vaccine-preventable-diseases' target='_blank'>www.fortunebusinessinsights.com/industry-reports/vaccines-market-101769</a>8 <a href='http://www.who.int/news-room/fact-sheets/detail/ageing-and-health' target='_blank'>www.who.int/news-room/fact-sheets/detail/ageing-and-health</a>9 <a href='http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270427/' target='_blank'>www.ncbi.nlm.nih.gov/pmc/articles/PMC7270427/</a>10 <a href='http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death' target='_blank'>www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death</a>11 <a href='https://pubmed.ncbi.nlm.nih.gov/32758069/' target='_blank'>https://pubmed.ncbi.nlm.nih.gov/32758069/</a>

Scientists are combining genetic research, patient data and predictive AI technology to find new ways to solve some of medicine&rsquo;s greatest mysteries. At the new Institute of Molecular and Computational Medicine (IMCM) at the University of Oxford&rsquo;s Nuffield Department of Medicine, scientists and clinicians are joining forces with researchers from GSK to improve the speed and development of treatments for complex neurological diseases such as Parkinson&rsquo;s, Alzheimer&rsquo;s and ALS. This approach brings together biopharma researchers and world-class medical institutions to forge a new path in drug discovery.<h2>A key role for the patient&nbsp;</h2>Central to this approach is a crucial third partner: the patient.&nbsp;&ldquo;Technology is allowing us to bring the patient into R&amp;D like never before,&rdquo; says Tony Wood, Chief Scientific Officer, GSK. &ldquo;Today we can measure the patient experience at many levels: from wearables that track changes in movement to devices that monitor sleep patterns and now even genomics which looks on a cellular level. All that creates a massive amount of data &ndash; GSK generated 20 billion datapoints last year and we have an AI team in-house making sense of that data. And this is all for the purpose of getting ahead of disease, together.&rdquo;&nbsp;Another way to think of it is a totally new research model. &ldquo;Imagine a laboratory for Parkinson's disease with all the pieces finally integrated: one-third of the contribution comes from patients and their families, one third from GSK researchers and another third from Oxford scientists. Patients and their families play a foundational role in the institute and that makes this collaboration and institute unique,&rdquo; says John Todd, Director of the IMCM and Professor of Precision Medicine at the University of Oxford.

<h2>The UK is fertile ground for research</h2>With current medical technologies, the reality is that the complex nature of neurodegenerative diseases is not well understood. That means the search for more effective treatments requires&nbsp;novel&nbsp;ways to identify, describe&nbsp;and interpret the relevance&nbsp;of subtle yet critical differences in a person&rsquo;s genetic and biological make up. Putting the patient at the forefront of R&amp;D will deepen our understanding of disease sub-types and enable us to target treatments more precisely, increasing the probability of success.Enter the UK which is known for its robust life sciences ecosystem and longstanding investments in genetics and genomics that serve as an accelerator for research. GSK complements this with a number of genetically informed drug targets and insights generated from collaborations such as 23andMe, UK Biobank &ndash; and more to come from a new UK initiative called Our Future Health. Approximately 70% of GSK targets in research are genetically validated, and published scientific research shows that genetically validated targets are at least twice as likely to become medicines.

<h2>Tech drives better predictions</h2>Technology is the glue that brings these puzzle pieces together. By using AI models to search for connections across available patient data sets, scientists can unravel layers of information about the building blocks of disease and discover how to combat it early on.This begins with identifying genetic factors which raise the probability that an individual will develop a disease and then building on those clues to determine whether, when and how their disease will progress.&nbsp;These early indicators or predictors of disease help to accelerate drug discovery and development, explains Victoria Higgins, GSK&rsquo;s Senior Director of UK Academic Alliance Management. &ldquo;We have a wealth of disparate data&mdash;from the patients&rsquo; medical history to their DNA and biological samples. If we apply machine learning, we can define patterns to help us to distinguish subtle differences between patient groups.&rdquo;&nbsp;Researchers looking into those groups can identify chemical or molecular signals that indicate how the disease develops and progresses. These techniques enable scientists to match potential drug targets with those groups of patients most likely to respond to treatment. By understanding disease more deeply, researchers can prioritise the most promising leads. They can establish proof of concept much earlier in the R&amp;D process and reach conclusions in fewer steps, using AI to check data and fill in the gaps.

&nbsp;&ldquo;It's about applying these new technologies to identify how disease signatures vary between patients so we can select which patient is more likely to respond to treatment &mdash; so-called precision medicine, get earlier reads on clinical trials and get that medicine out quicker&rdquo;&nbsp;says Higgins.The implications for patient care are significant &mdash; particularly in cases of serious neurodegenerative diseases with patients who often wait years for a definitive diagnosis, by which point their condition may have deteriorated.<h2>More than the sum of its parts</h2>The IMCM recently announced its first research projects focused on Alzheimer&rsquo;s, Parkinson&rsquo;s and ALS.&ldquo;There's never been a time when the ability to bring a range of technologies together with science has been as advanced as it is right now,&rdquo; says Tony Wood. &ldquo;We realised that there was an opportunity to bring it all together to be more ambitious, to be more integrated, and give ourselves an opportunity to really make a difference more quickly. So now we have GSK scientists working side by side with University of Oxford scientists, geneticists and computational biologists &mdash; different disciplines working together to think differently about science, tech and talent so we can get ahead of disease.&rdquo;

<h2>The pharma and biomedical sectors turn to data</h2>In spring 2022, Longitude, a Financial Times company, surveyed 300 academics, biomedical and pharmaceutical executives in the UK and US to better understand the landscape of research and development in the sector.

say AI modelling techniques are key to meeting R&D goals, ranking this among the most important factors for successful research.

stress the importance of access to a wide range of digital health data, which suggests that genetic databases may become even more valuable

agree with the importance of having access to patient-driven data early in the process, underscoring the vital role of patient contributions to research.

&nbsp;Metered-dose inhalers (MDI) occupy a paradoxical place in respiratory health. On the one hand, for more than 50 years they have helped millions of people manage their respiratory conditions &ndash; some of which are exacerbated by climate change &ndash; and provide relief when symptoms get worse. On the other hand, they are <a href='https://www.thelancet.com/cms/10.1016/S2542-5196(20)30271-0/attachment/05b82333-98c3-49b2-b809-0b6e23738f66/mmc1.pdf' target='_blank'>one of the biggest causes of greenhouse gas emissions</a> for healthcare systems. And they are now being targeted for carbon-cutting efforts as health systems strive to reach net zero goals. The culprit is not the inhaled medicine itself. Rather, the emissions come from a greenhouse gas propellant that is currently used in metered-dose inhalers to push the medicine into the user&rsquo;s airways.

There are inhalers which have already been developed that are propellant-free and <a href='https://www.mdpi.com/2071-1050/14/12/7106' target='_blank'>have a much lower carbon footprint</a> compared to MDIs, known as dry powder inhalers (DPI). Where clinically appropriate, patients can be prescribed a DPI with the double benefit of maintaining respiratory symptom control and cutting carbon emissions. &ldquo;We have part of the solution available already,&rdquo; says Christer Janson, Professor in the Department of Medical Sciences at Uppsala University in Sweden

<h2>An existing low-carbon alternative</h2>Janson led a study which found that the mix of MDI and DPI use <a href='https://www.resmedjournal.com/article/S0954-6111(11)00100-4/fulltext' target='_blank'>varies enormously between countries</a>, suggesting that some countries could increase the proportion of patients using DPIs, instead of MDIs, without compromising on patient care. According to a <a href='https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf' target='_blank'>report by NHS England</a>, if 30 per cent of patients changed to non-propellant inhalers and achieved equivalent or better health outcomes, almost half of the carbon footprint of MDIs would be eliminated.&nbsp;In some countries, physicians are encouraged to discuss these kinds of changes with patients. &ldquo;We always want to empower patients to take responsibility for their own treatment,&rdquo; says Janson. &ldquo;At the same time, we don&rsquo;t want to green-shame them into feeling they are doing something that&rsquo;s bad for the environment. The important thing is that they treat their respiratory conditions in the best way.&rdquo;&nbsp;The Global Initiative for Asthma (GINA) recommends that physicians <a href='https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Full-report-23_07_06-WMS.pdf' target='_blank'>first consider the best medicine and inhaler type to achieve the best symptom control for a given individual</a>. If that yields a choice of inhaler, they and the patient should then consider environmental impact. GINA notes that good asthma control, regardless of inhaler type, is associated with lower carbon emissions because it reduces reliance on the carbon-intensive activities that come with hospitalisation and emergency healthcare. Janson points out that, in many cases, symptom control and emission reductions go hand in hand.&nbsp;<h2>Towards sustainable MDIs</h2>Although increasing the proportion of DPIs could make a big dent in carbon emissions from inhaler use, MDIs cannot be eliminated completely. Some patients, such as children, the elderly or those with low inspiratory capacity, need the propellant to deliver the correct dose of medicine to their airways. Some patients also feel more secure using an MDI during asthma attacks or other exacerbations. For these patients, a number of manufacturers are reformulating their MDIs. Among them is GSK, which has been testing a low-carbon technology for the past two years that, if successful, could reduce the carbon emissions of their MDI by approximately 90 per cent.&nbsp;

Developing a low-carbon MDI is a complex process, says Laura Clow, Medicine Development Leader at GSK. In addition to reducing carbon emissions, it must be suitable for patients to take, it must be stable, and it needs to have a shelf life that is long enough to make it practical for patient use. &ldquo;A lot of early development in the chemistry and formulation space looked at all of those things,&rdquo; she says. Now, GSK is going ahead with several clinical trials to test whether an inhaler using its chosen low-carbon technology performs as well for patients as existing inhalers.&nbsp;A major part of the challenge, says Clow, is that developing low-carbon MDIs is uncharted territory. &ldquo;Without having set regulatory pathways to develop low-carbon medicines, it makes it very challenging,&rdquo; she says.

As part of goals to reduce its impact on the environment and nature, GSK has pledged that its carbon emissions in 2030 will be 80 per cent lower than they were in 2020 and net zero by 2045. &ldquo;Delivery of low-carbon MDIs is critical for that,&rdquo; says Clow, noting that MDIs are responsible for around half of the company&rsquo;s total emissions.

Lower-carbon inhalers will also be key for the 75 health systems that have so far <a href='https://www.who.int/initiatives/alliance-for-transformative-action-on-climate-and-health/country-commitments' target='_blank'>committed to lowering their carbon footprint</a>, with 30 of those setting targets for net zero emissions by 2050 or earlier. The NHS England report on delivering net zero says that a transition to lower-carbon MDIs, after increasing DPI use, would eliminate most of the remainder of the emissions from inhalers.&nbsp;

Governments can take action now to encourage the use of propellant-free DPI inhalers where appropriate. And, with low-carbon propellant inhalers on their way to being available by the second half of this decade, should clinical trials and regulatory processes be successful, governments should consider preparing the ground for a swift and smooth transition that helps both people and the planet.

Advances in healthcare have helped transform the way we live, and have contributed to average life expectancy at birth increasing <a href='https://data.worldbank.org/indicator/SP.DYN.LE00.IN' target='_blank'>by 20 years since 1960</a>. But those benefits are not distributed evenly, with health inequities persisting between and within countries and even cities. In England, <a href='https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/lifeexpectancyforlocalareasoftheuk/between2001to2003and2018to2020' target='_blank'>life expectancy in the south-east of the country is three years higher than in the north-east</a>.

Differences in outcomes could worsen as already overstretched health systems contend with the challenge of ageing populations and changing disease patterns, with chronic conditions like heart disease and cancer on the rise. In the face of these challenges, health experts and decision-makers are looking to the potential of earlier intervention and prevention.

As well as the potential to improve individual health outcomes, investing in prevention can also bring social and economic dividends. “There’s an enormously higher return on investment in prevention,” adds Hartenstein.Based on the McKinsey Global Institute and the McKinsey Health Institute’s modelling, as much as <a href='https://www.mckinsey.com/industries/healthcare/our-insights/prioritizing-health-a-prescription-for-prosperity' target='_blank'>$12 trillion could be added to global GDP by 2040</a> “just by scaling up the health interventions that we know work and 70% of that potential is through prevention and promotion”. Known interventions include creating cleaner and safer environments, enabling healthier behaviours and broadening access to vaccines and preventative medicines. Around half of the annual economic benefits would come from a larger and healthier workforce.

<h2>Getting ahead of HIV</h2>HIV is a prime example of the power of prevention and timely treatment in action. Access to HIV prevention, diagnosis, treatment and care means that HIV has become a manageable condition. “A disease that was once almost uniformly fatal is now a disease that can be controlled with treatment,” says Kimberly Smith, head of R&D for ViiV Healthcare – a global specialist HIV company majority owned by GSK.Treatment not only helps control the virus in individuals living with HIV, but also prevents transmission of the virus through sex. “That’s what we call treatment as prevention,” Smith explains. “Treatment itself is preventing people from transmitting sexually and that’s really quite revolutionary.” Another option for HIV prevention is the use of antiretroviral therapy in individuals who are not living with HIV. This is called PrEP, for which there are several different options for people living with HIV to choose from, to best suit their needs.Getting ahead of HIV is one instance of how innovation is needed to help prevent and change the course of a disease. This is why prevention is a focus for GSK beyond HIV too, from supplying vaccines to help protect people from illnesses across their lifetime to researching medicines that could help stop chronic conditions progressing to more severe complications.But if the global community is to meet its goal of ending the HIV epidemic by 2030, more action is needed to address the stigma and discrimination that precludes people from accessing testing, prevention and treatment when they need it – and perpetuates inequities in health. One example is in South Africa where HIV incidence among women <a href='https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30404-8/fulltext' target='_blank'>remains stubbornly high</a>. “We aren’t going to treat our way out of this epidemic. We have to somehow get to these populations and protect them from HIV acquisition,” says Linda-Gail Bekker, Chief Executive of the Desmond Tutu Health Foundation in Cape Town.One way to do this is by increasing the prevention options for these vulnerable populations, including young women and girls in Sub-Saharan Africa at high risk of HIV acquisition. For example, for some women in South Africa, certain prevention and treatment options are too visible and could make them vulnerable to violence and stigma from their partners and communities. That’s why alternative tools such as long-lasting options, and more choice about where to access these tools, such as in mobile clinics, is important. “We now are beginning to invoke choice and we think this is going to make a big difference,” says Bekker.<h2>Raising the voice of communities</h2>The ambition to end HIV is a case study of the need for the right levels of investment as well as engagement of community and other stakeholders in strengthening prevention and timely treatment to improve outcomes and shrink inequities.

The involvement of communities has been central in helping to test innovations and ensure they meet people’s needs. This degree of engagement is key to reducing discrimination, enabling access, and addressing inequities in health outcomes. “We tailor our drug development pipeline to the needs of individuals – we want to hear their voices in order to do that,” says Smith. GSK and ViiV last year committed $7.5 million to the Global Fund’s Gender Equality Fund to support the influence of women, girls and gender-diverse communities in national strategy, policy and programming relating to gender equality and health, with a particular focus on HIV, TB and malaria.Harnessing the voices of individuals and communities to improve health outcomes and reduce inequities goes beyond HIV and can be applied to preventative healthcare more broadly. “The conventional health system alone cannot solve prevention and promotion,” says Hartenstein. Only around 5% of health budgets in the wealthiest countries goes towards prevention. “Yes, that should be higher,” he adds. “But there is an opportunity to bring in a much broader set of stakeholders that are influencing the drivers of health – including businesses, civil society and philanthropists.”

Preventative healthcare is a powerful tool for improving the health of populations and closing gaps in health outcomes. But it will require the right mix of innovations, policies and behaviours to unlock the value of prevention and promote shared health and prosperity.

The health of the planet has a deep impact on human health. Our health relies on the fundamentals of nature: clean air, fresh water, natural food sources and contact with the natural world. But nature and biodiversity are declining at an alarming rate; global wildlife populations plummeted by 69 per cent on average from 1970 to 2022, according to the <a href='https://livingplanet.panda.org/en-GB/#:~:text=The%20Living%20Planet%20Report%202022,are%20to%20reverse%20nature%20loss.'>WWF</a>.&nbsp;&ldquo;There are countless, multiple ways in which ecological destruction can affect human health,&rdquo; says Peninah Murage, an Assistant Professor at the London School of Hygiene and Tropical Medicine. &ldquo;The health benefits [of the natural world] are phenomenal.&rdquo; One example from her own research: in London, temperatures and deaths related to heat exposure over a nine-year period <a href='https://www.sciencedirect.com/science/article/pii/S0160412019323360?via%3Dihub'>were highest in the areas with the lowest levels of urban vegetation</a>. Nature loss has also been<a href='https://www.nature.com/articles/nature09575/tables/1'> linked to the increased transmission of infectious diseases</a> including malaria, Lyme disease and West Nile fever, either because it increases the abundance of hosts or vectors, or changes their behaviours.Nature is also an important source of many raw materials for life-saving drugs and vaccines. For example, a molecule sourced from the soapbark tree is used as a key ingredient in vaccines. And the <a href='https://www.nhm.ac.uk/discover/horseshoe-crab-blood-miracle-vaccine-ingredient.html'>blood of the horseshoe crab</a> is used during the manufacture of many drugs because it contains an agent that helps to detect bacterial contamination.&nbsp;<h2>The role of healthcare organisations</h2>Health leaders are beginning to recognise the urgency of dealing with nature loss. Some 200 health journals <a href='https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02289-4/fulltext'>have called on</a> the UN, political leaders and health professionals to recognise that climate change and nature loss are part of the same environmental crisis, and must be tackled together to protect human health.&nbsp;Yet, as things stand, health systems are almost entirely focused on carbon emission targets. While 75 health systems around the world have <a href='https://www.who.int/initiatives/alliance-for-transformative-action-on-climate-and-health/country-commitments'>committed to lowering their carbon footprints</a>, no similar targets exist for reversing nature loss. &ldquo;Climate and nature are two sides of the same coin,&rdquo; says Eva Zabey, Chief Executive of Business for Nature, a coalition of businesses and conservation organisations calling for action to reverse nature loss. &ldquo;We need nature to tackle climate change and we can&rsquo;t halt and reverse nature loss without a stable climate.&rdquo;

More than 115 nations <a href='https://www.hacfornatureandpeople.org/'>have agreed</a> to designate 30 per cent of the Earth&rsquo;s land and ocean area as protected areas by 2030, and the business world is catching up, too: 320 organisations have <a href='https://tnfd.global/engage/inaugural-tnfd-early-adopters/'>committed</a> to disclose their nature-related dependencies, risks and opportunities, and a pilot group of 17 global companies <a href='https://sciencebasedtargetsnetwork.org/how-it-works/the-first-science-based-targets-for-nature/'>has committed to</a> setting science-based targets for nature. &ldquo;It&rsquo;s a strategic blind spot if a company doesn&rsquo;t understand how it both impacts and depends on nature,&rdquo; says Zabey.So healthcare companies must also address the impacts they have on nature. Drug manufacture, for example, often depends on nature for raw materials, and can put pressure on water supplies in water-stressed regions and produce waste materials that could pollute the local water.Among the companies committed to action on nature is GSK, which has set twin climate and nature goals for 2030. Its nature-positive goal means it is seeking to avoid or reduce its impact on nature and to protect and restore ecosystems where its operations take a toll. Those measures include sustainably sourcing natural materials used in drug production, ensuring that all of its sites have a positive impact on biodiversity, reducing waste from its products, supply chains and operations, and prioritising water usage and quality near manufacturing sites.&nbsp;<h2>Multidimensional goals</h2>Unlike the well-defined metric of carbon emissions in relation to climate goals, assessing progress against nature goals is multidimensional, with no single unit of measurement. But Claire Lund, Vice President for Sustainability at GSK, says the urgent need to protect nature has spurred the company to take action in parallel with its work on defining specific science-based targets. &ldquo;This isn&rsquo;t about getting it perfectly right. It&rsquo;s about getting on with taking action on nature or it could be a big foe in climate adaptation and mitigation and business resilience,&rdquo; she says.&nbsp;One of the company&rsquo;s first projects involved working to replenish the local water supply and improve local access to water near its manufacturing site in the Indian state of Maharashtra. &ldquo;On top of helping to meet our water targets, that one project aims to also support climate mitigation, biodiversity improvements and the health of local people and communities,&rdquo; says Lund. &ldquo;To protect human health and to get ahead of human disease, we must protect nature,&rdquo; she adds.&nbsp;

Although companies such as GSK, as well as H&amp;M Group, Nestl&eacute;, LVMH and Tesco, are making progress in this area, they are still in a minority. While 83 per cent of Fortune 500 companies have set targets relating to climate change, only 25 per cent are taking action on freshwater consumption, 20 per cent on chemical and plastic pollution, and 5 per cent on biodiversity loss, <a href='https://www.mckinsey.com/capabilities/sustainability/our-insights/where-the-worlds-largest-companies-stand-on-nature'>according to McKinsey research</a>.&nbsp;Setting science-based targets for nature is complex compared with measuring carbon emissions, but that must not stop health systems and companies from trying. &ldquo;If companies and financial institutions [can put] nature higher up on the agenda, that is absolutely going to trigger a shift in the whole system, economic and regulatory, that we operate in,&rdquo; says Zabey.&nbsp;Human health and the global economy depend on services that nature provides for free. Reversing the loss of those services is as urgent as acting on climate change for the future of the planet and human health.&nbsp;

Drug-resistant superbugs pose a serious threat to humanity. In 2019, 4.95mn deaths globally were associated with bacterial resistance, and they may cause 10mn deaths annually and around 6.9mn extra days in hospitals by 2050. Antimicrobial resistance, or AMR, occurs because bacteria and other microbes can evolve to outsmart the tools that we use to fight them, such as antibiotics. Drug-resistant infections weigh on the lives of patients, as well as the health systems that care for them and the wider economy.&nbsp;Yet innovations that could slow the march of AMR are few. &ldquo;The pipeline has become thinner, not because we can&rsquo;t make new drugs but because there&rsquo;s no investment to make new drugs,&rdquo; says Henry Skinner, Chief Executive of the AMR Action Fund, an initiative that aims to support the development of two to four novel antibiotics by 2030. &ldquo;The market is substantially broken.&rdquo;The way drug development is incentivised doesn&rsquo;t work with antibiotics. Bringing any medical breakthrough from invention to market costs pharmaceutical companies billions of dollars, which can usually be recouped through sales over time. This model works well in other areas such as oncology and specialty medicines. However, an important aspect of AMR control is curbing the overuse of antibiotics, which hastens the development of resistance. Rightly, new antibiotics are therefore used sparingly, and so struggle to break even, let alone turn a profit.&nbsp;The spate of bankruptcies among companies attempting to develop new antibiotics, even when they have promising results, highlights the gravity of the issue. &ldquo;It&rsquo;s a societal problem and a patient-level problem,&rdquo; says Len Friedland, who leads scientific affairs and public health in the vaccines division of GSK, one of the few large pharmaceutical companies that remains active in the space. When working as a paediatrician in hospitals in the US, Friedland remembers caring for children dealing with complex health needs that were compounded by drug-resistant infections. &ldquo;The children are so resilient, they&rsquo;re doing really well &ndash; but then a multi-drug resistant infection comes along, and they are devastated. They dread this.&rdquo;&nbsp;Older people are disproportionately affected, owning to their weaker immune system, accounting for two thirds of AMR-related deaths. 'We need to have ways to prevent these infections to start with,&rdquo; says Friedland, &ldquo;including through increasing uptake of existing vaccines to prevent disease and reduce demand for antibiotics.&rdquo;&nbsp;

<h2>Slowing the spread through vaccination</h2>AMR can&rsquo;t be stopped, but it can be slowed down. Every infection provides microbes with new opportunities to mutate, so strategies to slow the spread of diseases &ndash; such as improved sanitation and vaccination &ndash; are key. Vaccines can be powerful countermeasures against superbugs. For instance, a new typhoid shot successfully curtailed an outbreak of a dangerous drug-resistant strain among children in Pakistan.&nbsp;Despite their potential to tackle drug-resistant pathogens, few vaccines are being developed for this purpose. &ldquo;One of the problems that developers face is that AMR infections often have very high fatality rates, but &ndash; for now &ndash; are only a small proportion of overall infections. This makes AMR-specific vaccines a smaller market compared to diseases that affect many people,&rdquo; says William Hausdorff, Lead, Vaccines Public Health Value Proposition at PATH&rsquo;s Center for Vaccine Innovation and Access. &ldquo;In particular, the commercial incentive to develop vaccines against such diseases is limited because the added value of slowing AMR is not considered in traditional vaccine assessment frameworks. &lsquo;If I make a vaccine against AMR pathogen, are you going to use it, prioritise it, pay for it?&rsquo;,&rdquo; says Hausdorff.&nbsp;&ldquo;We&rsquo;ve seen amazing innovations in recent years, which have transformed vaccine science,&rdquo; says Friedland. But to make the most of this potential, he notes, regulators and others must encourage innovative approaches to the development and licensing of vaccines targeting AMR-related pathogens. Encouragingly, the role of vaccines as important tools against AMR is gaining more recognition, says Hausdorff. The World Health Organization is developing a new approach for valuing AMR-relevant vaccines that aims to capture the broad benefits of averting infection in the first place.&nbsp;<h2>Reframing the value of novel antibiotics</h2>Some countries are already adopting new approaches to valuing antibiotics. The UK government recently launched a subscription model that proposes to pay up to &pound;20mn a year for the most efficacious novel antibiotics targeting the highest priority resistant pathogens. The aim is to provide a stable incentive to those investing in this high-risk space, encouraging much-needed innovation while also fostering responsible stewardship of antibiotics. Importantly, the value assessment framework underpinning this model captures the wider benefits of novel antibiotics, such as enabling chemotherapy and major surgery to go ahead.Similar models are under consideration elsewhere. In the US, the proposed Pasteur Act would introduce a subscription-style payment model for novel antibiotics. In Canada, an expert panel recommended a subscription model that would pay C$14.5mn&ndash;C$18mn per year for access to new antibiotics. In the EU, new legislation proposes a transferable exclusivity voucher for priority novel antimicrobials, which would reward innovators with extension of data protection for other products.These initiatives are important to address the growing threat of antimicrobial resistance. The global community needs to continue working together to find solutions that mitigate the AMR threat. Organisations such as CARB-X, AMR Action Fund, GARDP, One Health Trust and the Fleming Fund are making great progress on advancing the science of tackling AMR and highlighting the urgent need for policy changes. The pay-off for these efforts will be immense.&nbsp;As many experts have warned, AMR could turn back the clock on a century of medical advances, making it extremely risky to perform many life-saving procedures that are taken for granted today. There is still time to change course before it&rsquo;s too late. The UN High-Level Meeting on AMR in 2024 offers an opportunity for government- and non-government stakeholders alike to commit to clear targets and actionable steps to get ahead of AMR once and for all.&nbsp;

In clinical research, every data point comes from a person – and it matters who that person is. In fact, each person who enters a clinical trial contributes hundreds of data points to study. Large-scale clinical trials involving hundreds or even thousands of individuals are pivotal to the development of new drugs. But individuals respond to drugs differently. The more closely the test group represents the population affected by the disease in question, the more generalisable the results of the study are to the actual population who will receive the treatment once the product is approved.Medicines have historically been tested on disproportionately White populations. Only after some drugs have been approved does it become clear that some of them, work less well for certain minority ethnic groups, such as drugs for high blood pressure.The US government passed legislation in late 2022 requiring drug developers to devise clinical trial diversity plans for medicines under investigation, and some are already doing so. The European Medicines Agency has also updated its guidance to promote clinical trial diversity. But creating those plans is only the first step in achieving clinical trial diversity. Unconscious bias by clinicians and staff at trial sites, a lack of trust in the healthcare system and inadequate communications must also be addressed to achieve the aims of clinical diversity plans.

“Building trust within communities is a known driver of success in recruiting under-represented patients to clinical research; and if people feel seen, heard, and treated as important partners in research in their community, they’re more likely to be more trusting of clinical trials,” says Leslie Henderson-Williams, Director, Global Diversity & Inclusion for Clinical Trials, at health data and analytics specialist IQVIA.<h2>Getting the details right</h2>“Racial and ethnic diversity goals are more complex to set than the more established diversity metrics such as age and sex,” says Michel Reid, Senior Director and Head, Global Demographics and Diversity, at GSK. No two clinical trial diversity plans will look the same. Diseases affect different races and ethnicities differently. Heart disease, colorectal cancer and asthma, for instance, affect Black people in the US at higher rates than others. In the UK, people of South Asian heritage are at higher risk of cardiovascular disease than people from other ethnicities. In New Zealand, the prevalence of type 2 diabetes is around three times higher in Maori and Pacific populations than in their White counterparts. Many clinical trials run at sites around the world, and what counts as a diverse example in a place with a relatively homogenous population, such as Japan, will look very different from one in a more mixed country such as the UK. “We’re thinking down at a much more granular level,” says Reid.Reid led an in-depth study of the racial and ethnic diversity of US-based participants in GSK and ViiV clinical trials reaching back almost two decades. That analysis helped identify disease areas and trial types that needed the most work in achieving diversity. The study also revealed that, in some cases, a trial could reflect the local census population but still fall short of representing the population affected by a disease, highlighting the importance of using disease-specific metrics to measure trial diversity. All of GSK’s phase three trials – the large-scale studies that are pivotal to a drug or vaccine’s approval – have a diversity plan in place.To enrol in a clinical trial, a patient must first know about it. The first barrier to clinical trial diversity is bias that can affect clinicians’ choice of whom to invite to consider participation. Analysis of a US clinical trial examining bronchiolitis in children found that clinicians were less likely to invite Hispanic children into the trial than those of White ethnic backgrounds. A separate study has found that Hispanic children are at higher risk of severe bronchiolitis than White children. A survey of cancer clinical trial specialists in Australia revealed that language barriers during time-pressured consultations commonly meant that people from non-White backgrounds were not invited to participate in research.<h2>Building trust</h2>Trust is also central to participation: a patient must be certain they will receive good care and careful monitoring if they are to be among the first people to try a new drug or vaccine. Building trust is a multifaceted process. One way is through better communication about the benefits and risks of participating in clinical research. Another is by ensuring that the clinics, medical centres and other places that run clinical trials are staffed by relatable people. Clinical trial sites with a greater racial and ethnic mix in their workforces are also the most successful at attracting a diverse range of clinical trial participants.Reid says GSK is working on all these fronts to smooth the way for more diverse clinical trial participation. The company takes diversity of staff into consideration when selecting clinical trial locations. It provides training on overcoming unconscious bias for the people who will be recruiting patients for studies. It also trains clinicians at trial sites in how to use language to make people feel respected. “You can’t just build these plans and hope people show up,” says Reid. “We have to do the work.”

New drug trials wouldn’t happen without scientific breakthroughs, and efforts are also under way to diversify the scientists who work on medical innovations. Black and Hispanic people, women and those from socioeconomically disadvantaged backgrounds are among groups that are under-represented in the scientific workforce, and yet research shows that scientific papers with more diverse groups of authors produce higher-impact findings. “There’s no point in innovating for just one part of society,” says Anne-Marie Imafidon, Chief Executive of Stemettes, a UK organisation that works to increase the participation of girls and young women, especially those from minority ethnic backgrounds, in science. “We're talking about data sets, but also talking about who is making decisions on priorities,” she adds.Clinical trials that properly represent the people who will ultimately benefit from a drug are not just more inclusive, they are better science. They will enable drug developers to gain a better overall picture of how well their treatments work, as well as identify side effects that might affect only some groups. Diversity goals are only the first step, and it will take time to achieve their aims, but the result will be better healthcare for more people.

Climate change is giving infectious disease the upper hand. Shifting weather patterns are expanding the habitats of disease carriers such as mosquitoes, bringing malaria and other serious illnesses to previously unexposed populations. Rising temperatures are also leading to increasingly frequent catastrophic weather events that create hotbeds for infectious disease and then fuel their spread further through the mass displacement of affected populations. Hotter conditions and natural disasters also accelerate the spread of drug-resistant superbugs, intensifying the fight against antimicrobial resistance. Scientists estimate that almost 60 per cent of all infectious diseases are aggravated by a hotter planet and the extreme weather events that come with it.&nbsp;Many parts of the world are already experiencing the health impacts of climate change. In Africa, the arrival of the Anopheles stephensi mosquito from South Asia is causing resurgences of malaria in cities. Outbreaks of cholera are becoming more frequent as the cyclones, floods and droughts that facilitate its spread become more common. Dengue and chikungunya outbreaks are now more intense, and are spreading to new regions because of rising global temperatures. &ldquo;The impact of the climate crisis is going to be counted in human lives,&rdquo; says Githinji Gitahi, group CEO of Amref Health Africa.&nbsp;<h2>Hope in innovation</h2>As climate change complicates the fight against infectious diseases, scientists are finding new ammunition to treat them, and prevent them from occurring in the first place. Martin Edlund, Chief Executive of Malaria No More, an advocacy organisation, believes the eradication of malaria remains possible, despite the new challenges posed by climate change, largely thanks to the pace of innovation in the field. &ldquo;There&rsquo;s never been a moment of greater peril in terms of the challenges, and simultaneously greater promise in terms of the pipeline of new tools,&rdquo; he says.The world&rsquo;s first malaria vaccine, RTS,S, developed by GSK and its partners for use in malaria-endemic countries, is being rolled out across more countries in sub-Saharan Africa, having already reached 2mn children in Ghana, Kenya and Malawi by the end of 2023 through the Malaria Vaccine Implementation Programme. A second vaccine was recently recommended by the World Health Organization, and dozens more are in early development. New antimalarial treatments are also under development. Beyond drugs and vaccines, scientists are finding new ways to control the disease, targeting its carriers, mosquitoes. Researchers at GSK recently discovered a naturally occurring bacterium, Delftia TC1, that could be used to stop infected mosquitoes from spreading malaria.The fight against tuberculosis, or TB, is also showing promising progress. TB is the world&rsquo;s second deadliest infectious disease after Covid-19, and climate change is making it harder to tackle, as the mass displacement of people fleeing natural disasters or unbearable climates exacerbates its spread. &ldquo;There are TB drugs out there, but there is ample opportunity for improvement,&rdquo; says Thomas Breuer, Chief Global Health Officer at GSK, whose scientists are among those hoping to transform how TB is prevented and treated.&nbsp;Some of those potential new treatments are novel antibiotics that researchers hope will tackle multi-drug resistant strains of TB. Clinical trials are also under way for several new vaccines against tuberculosis that aim to prevent its spread (the existing vaccine protects against severe disease, but has limited impact on how it spreads). Breuer says that over half of GSK&rsquo;s global health pipeline is dedicated to diseases that are affected by climate change, including new vaccines for typhoid and shigellosis. &ldquo;We are essentially trying to change the trajectory of high-burden infectious diseases in lower income countries,&rdquo; he says.<h2>Building resilient health systems</h2>Building climate resilience also means making the most effective use of existing tools. Being able to predict extreme weather events such as flooding would enable health systems to deploy oral cholera vaccines ahead of time, to ward off an outbreak. Tracking the movement of malarial mosquitoes could guide the roll-out of vaccines and other preventative measures. High-tech &ldquo;biological weather stations&rdquo; to remotely monitor insect species, such as those set up in Nepal by GSK, the Centre for Health and Disease Studies Nepal and Microsoft, can help prevent, plan and prepare for outbreaks of vector-borne diseases.

&ldquo;That has been demonstrated by so many of the extreme weather events that become extreme health events weeks later,&rdquo;&nbsp;says Edlund.&nbsp;Early warning systems needn&rsquo;t all be technologically advanced. Training community health workers to report unusual cases of illness to a national surveillance system can ensure that severe public health threats are quickly quelled. An outbreak of Marburg virus in Tanzania in early 2023 was contained to nine cases thanks to speedy reporting by community health workers. The worst health effects of climate change will strike those in the countries that are least contributing to the climate crisis, and those with the least resources to counter it. Africa is responsible for around 4 per cent of global greenhouse gas emissions, yet its vulnerability to climate-aggravated disease is far greater than the world&rsquo;s highest emitters. &ldquo;There will be no 96 per cent discount on the impact of global warming,&rdquo; says Amref&rsquo;s Gitahi.&nbsp;There is cause for hope. Scientists and healthcare leaders are developing ever more sophisticated ways of countering infectious diseases with new treatments, vaccines and public health strategies. Political leaders are increasingly recognising the profound impact of climate change on human health, and the private sector, including GSK, is committed to tackling the joint challenge of climate change and infectious diseases.&nbsp;

Now, more than ever, it is important for those groups to work together to shape the climate-and-health policy agenda while continuing to innovate to find and scale up the tools needed to fight infectious disease on a hotter planet.&nbsp;

Look behind any effective campaign to eradicate an infectious disease, and there will be partnerships. Infectious diseases pose serious challenges for populations all over the globe, with young children in lower-income countries the worst affected. Tackling them requires input from governments, biotech companies, non-profits, regulators and many more. Although single organisations can make valuable contributions, they can achieve far more when they work together, driving innovation, access and the strengthening of health systems.Partnerships are at the heart of the fight against malaria, one of humanity&rsquo;s oldest and deadliest diseases. They are vital in increasing vaccination rates among children, and crucial in addressing another global health inequity facing children with HIV, many of whom have limited access to age-appropriate treatment options.<h2>Vaccinating the unvaccinated</h2>Childhood vaccination rates around the world are still recovering from the shock of Covid-19 which caused the first drop in coverage for almost 30 years. Those gaps are showing up in resurgences of vaccine-preventable diseases such as polio, measles and cholera. Low-income nations saw the sharpest drops in coverage levels &ndash; and they are taking longer to recover.&nbsp;No single organisation holds all the expertise and resources required to tackle global health challenges like these. &ldquo;We&rsquo;re big,&rdquo; says Gwen Hines, the UK Chief Executive of Save the Children, one of the world&rsquo;s largest aid organisations.

Most concerning are the zero-dose children, meaning those who have received no vaccines at all. Reaching these children is complicated. They often live in remote places or conflict zones, may not have parents and are likely to suffer from other problems such as malnourishment. Nigeria and Ethiopia have some of the highest levels of zero-dose children in the world, around 3mn in total, and a campaign to reach them draws on the expertise of two very different organisations: Save the Children and GSK.&nbsp;GSK has committed &pound;15mn to the five-year campaign, but the partnership goes well beyond finance, says Hines. She says GSK brings know-how in areas such as the cold chains needed for reliable supply of vaccines and data analytics capabilities that will help pinpoint who is missing out on vaccination and the reasons for that. &ldquo;It&rsquo;s about combining the best of both our skills,&rdquo; says Hines.&nbsp;<h2>Child-centred HIV treatment&nbsp;</h2>Partnership has been crucial in addressing another global health inequity, suffered by children who live with HIV. Only half of these 1.5mn children worldwide are on the life-saving treatments that suppress the virus, compared with three-quarters of adults. As a result, around 15 per cent of Aids-related deaths are in children &ndash; even though under-15s make up only 4 per cent of cases.&nbsp;One reason for the treatment gap is that antiretrovirals were initially designed for adults. Sometimes doctors have to resort to breaking or crushing adult tablets to reach a dose suitable for children and too often the medicines have had such a bitter taste that it makes them unpalatable &ndash; a real challenge when a medicine needs to be taken every day.ViiV Healthcare, the specialist HIV company majority-owned by GSK, with Pfizer and Shionogi as shareholders, partnered with IMPAACT and PENTA, two paediatric HIV clinical trial specialists, to better understand how to optimise antiretrovirals for children. Building on ViiV&rsquo;s voluntary licence partnership with the Medicines Patent Pool, ViiV also partnered with the Clinton Health Access Initiative (CHAI), Unitaid and two generic drug manufacturers to ensure that more affordable versions could be developed and supplied as quickly as possible to reach children in parts of the world where the burden of childhood HIV is highest.&nbsp;ViiV is also working with the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) to integrate its child-friendly formulations with a wider package of interventions, such as newborn HIV testing, with the aim of achieving the UN&rsquo;s goal of ending paediatric Aids by 2030. &ldquo;Because of a whole bunch of partnerships, incredible work by a lot of people, we have optimised testing and optimised treatment options,&rdquo; says Chip Lyons, President and Chief Executive of EGPAF. &ldquo;We&rsquo;ve got these optimised tools, now we have to optimise the availability and utility of those tools to those children.&rdquo;<h2>The world&rsquo;s first malaria vaccine</h2>Partnership is key to the fight against malaria. Despite significant progress, the disease still kills more than half a million people each year, mostly children under five living in sub-Saharan Africa. Recently, a new tool has been added to the armoury: a malaria vaccine called RTS,S, for young children in lower-income countries, which can reduce the risk of severe disease. Its decades-long journey of development and distribution depended on partnerships between GSK, where it was discovered, and many other organisations.One key area of collaboration was GSK&rsquo;s work with PATH, a global health organisation. Both sides of the partnership contributed their respective strengths &ndash; GSK&rsquo;s scientific expertise and PATH&rsquo;s network of African researchers &ndash; to achieve something that had never been done before: a major clinical trial in young children in sub-Saharan Africa. More than 10,000 children received the vaccine in the pivotal Phase 3 trial conducted across seven countries in the region, leading to its recommendation by the World Health Organization.&nbsp;After an implementation pilot in Kenya, Ghana and Malawi, the vaccine will soon be rolled out across more malaria-endemic countries in sub-Saharan Africa. &ldquo;This vaccine was designed for African children from the ground up,&rdquo; says Ashley Birkett, Global Head of Malaria at the PATH Center for Vaccine Innovation and Access.

Infectious diseases are troublesome foes, with a disproportionate toll on children in lower-income countries. Combating them requires a huge amount of work but, by pooling expertise and resources, organisations from every corner of society are making great strides in lessening their impact. If humankind is to continue getting closer to the goal of a healthy life for all, partnership will play an essential role.

Making an impact: Science. Partnership. Scale.