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’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.
Vaccinating the unvaccinated
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 – and they are taking longer to recover.
No single organisation holds all the expertise and resources required to tackle global health challenges like these. “We’re big,” says Gwen Hines, the UK Chief Executive of Save the Children, one of the world’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.
GSK has committed £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. “It’s about combining the best of both our skills,” says Hines.
Child-centred HIV treatment
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 – even though under-15s make up only 4 per cent of cases.
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 – 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’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.
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’s goal of ending paediatric Aids by 2030. “Because of a whole bunch of partnerships, incredible work by a lot of people, we have optimised testing and optimised treatment options,” says Chip Lyons, President and Chief Executive of EGPAF. “We’ve got these optimised tools, now we have to optimise the availability and utility of those tools to those children.”
The world’s first malaria vaccine
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’s work with PATH, a global health organisation. Both sides of the partnership contributed their respective strengths – GSK’s scientific expertise and PATH’s network of African researchers – 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.
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. “This vaccine was designed for African children from the ground up,” 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.
