UNAIDS' new leader, rescissions, and breakthroughs for Ebola and TB: This week in development

A health worker fills a syringe with Ebola vaccine before injecting it to a patient, in Goma, Democratic Republic of the Congo. Photo by: REUTERS / Baz Ratner

Winnie Byanyima is selected as the next UNAIDS executive director, and new treatments for Ebola and drug-resistant TB provide breakthroughs: This week in development.

Two new treatments have offered a dash of hope in the Ebola outbreak in Democratic Republic of the Congo. The WHO committee in charge of monitoring the efficacy and safety of the therapeutics recommended moving forward with REGN-EB3 or mAb114, after preliminary data from close to 500 patients showed that those who received these drugs had much higher chances of survival than those given ZMapp and remdesivir. Responders are hopeful the positive results will encourage more people to go to treatment centers and seek early care. Many patients continue to stay in their communities, exposing more people to the virus and delaying their treatment, said Mike Ryan, executive director of the WHO Health Emergencies Program, during a telebriefing on Monday. The Ebola outbreak, which was declared a public health emergency of international concern in July, has lasted more than a year, reached more than 2,600 cases, and killed almost 1,800 people, according to the WHO.

The U.S. Food & Drug Administration approved an anti-tuberculosis drug, called pretomanid, that is meant to treat patients suffering from extensively drug resistant, treatment-intolerant, or treatment non-responsive multidrug resistant pulmonary TB. Treatment for these cases has typically involved multiple daily drugs and injections for over a year, a lengthy regimen that can be too complex and toxic for patients. Global health advocates are hopeful the simplified regimen — which consists of only three drugs and a shorter treatment length of six months — could improve cure rates. A clinical trial of a combination therapy that includes bedaquiline and linezolid, or so-called BPaL, in South Africa showed a success rate of approximately 90%, and a concurrent clinical trial run by Médecins Sans Frontières and the TB Alliance also involves the approved combination therapy. Advocates are now calling for the TB Alliance, the drug’s developer, to ensure the drug is affordable.

Winnie Byanyima will be the next UNAIDS executive director, the United Nations body announced this week. She was the only woman shortlisted for the UNAIDS leadership position and was chosen over four other candidates: Chris Beyrer, Salim Abdool Karim, Bernard Haufiku, and Sani Aliyu. Members of the global health community welcomed the news — but AIDS organizations also presented a tough to-do list for the incoming chief. The list includes tackling some serious internal governance issues at the embattled U.N. body, whose leadership and organizational culture were put under the spotlight after a damning report in December 2018 described how the agency’s leaders failed to prevent and respond to harassment allegations. There are also external challenges, with recent data showing an increase in new HIV infections in several countries and declining donor support for the AIDS response.

More information is expected next week on the Trump administration’s “rescission” attempts, according to USAID Chief of Staff Bill Steiger. “We are engaged in a conversation with the staff and our examiners about where we are, what priority obligations we have yet to make, and what kinds of funds are on the table for global health and a number of other very high-priority programs,” Steiger said at an event on Wednesday. Last week, OMB sent a letter to USAID and the State Department ordering a funding freeze of between an estimated $2 billion to $4 billion that have yet to be obligated to specific projects, in an attempt by the Trump administration to prevent U.S. foreign assistance funds already appropriated by U.S. lawmakers from being spent near the end of the fiscal year. The rescission attempt has been publicly denounced by both Republicans and Democrats, but it is unclear if Congress will be able to stop the administration from refusing to spend the money as appropriated so it can be returned to the U.S. Treasury. This week, the White House also announced that it will shield the signature projects of White House adviser Ivanka Trump and Vice President Mike Pence from the possible cuts.

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