Marissa Chmiola

What do an onsite chlorine generator, fingerprint scanning technology for newborns, and temperature-monitoring wristband all have in common? The potential to save the lives of mothers and newborns in some of the poorest, hardest-to-reach communities around the world. These were among the many innovations pitched on July 27 at the DevelopmentXChange—the final stage of competition in the seventh annual Saving Lives at Birth: A Grand Challenge for Development, a prize program sponsored by the US Agency of International Development and other partners to identify and advance transformative, cost-effective solutions to improve maternal and newborn health, particularly during the first 48 hours after birth. Through the challenge, innovators compete for grants to develop, test, and bring their ideas to scale. This year, the challenge received more than 550 applications from across the world, with 53 teams chosen as finalists to compete at this year’s DevelopmentXChange. At the conclusion of the event, 15 winners were selected, with additional grant recipients to be announced later this year in the transition-to-scale category. GHTC members featured among finalists Among the 53 finalists were five promising innovations from GHTC member organizations, profiled below: Validation of an innovative, onsite, easy-to-use chlorine generator for infection prevention and control in labor wards* PATH The chlorine generator for infection prevention and control in labor wards. (Photo: GHTC/Marissa Chmiola)With just salt, water, and a power source, a hospital or clinic can create chlorinated water onsite to disinfect equipment and surfaces to keep mothers and babies healthy. That’s the idea behind the SE Flow Chlorinator—an easy-to-use, cost-effective chlorine generator designed for low-resource settings.  Infections are a leading cause of death for mothers and newborns during childbirth. While chlorine is one of the most widely-used and accepted methods for disinfecting surfaces, getting chlorine to remote health care facilities can be a challenge due to combination of weak supply chains, inconsistent transportation networks, and bureaucratic hurdles. The result: Close to one-third of facilities in low-income countries recently surveyed by the World Health Organization (WHO) did not have chlorine available. PATH and its partner MSR Global Health hope the SE flow will address chlorine supply chain hurdles by enabling facilities to produce consistently chlorinated water on the spot, at the quantity needed. The device also produces an additional benefit: cost savings. Over five years, the SE flow is estimated to save a facility 50 percent over the cost of purchasing chlorine on the market. PATH and MSR Global Health plan to test 50 of the devices next summary to collective evidence, refine the design, and support a broader roll out. Validation of an innovative newborn respiratory package of equipment and training* PATH Respiratory infections are a leading cause of infant mortality, particularly in premature infants whose lungs are not fully formed. Without strong lungs and appropriate oxygen intake, newborns face significant challenges in healthy development, including lifelong neurological damage or blindness. Continuous positive airway pressure (CPAP) therapy helps mitigate these challenges; however, the tools used in high-income nations to administer this therapy have traditionally been too costly to use in low-resource settings overseas.  A low-cost  bCPAP device for newborn health. (Photo: GHTC/Taylor Capizola) PATH and other partners developed a low-cost bubble CPAP (bCPAP) device, combined with an oxygen blender, that is appropriate for low-resource settings and has proven effective in controlling the flow of air to support breathing. To support further uptake and effective use of this intervention, PATH is now partnering with the Massachusetts General Hospital Division of Global Health and Human Rights to package the bCPAP, oxygen blender, nasal prongs, and a pulse oximeter with training and educational materials, including checklists, manuals, and wall charts. The training materials will be essential to expanding newborn access to respiratory therapy, particularly in facilities where no prior intervention existed and medical staff may be uncertain of how to best use these new tools. The team has also partnered with Sinapi biomedical, a South African biomedical manufacturer, to manufacture the package of tools and training materials to greatly expand the number of medical facilities using these interventions by bring the toolkit to scale. They expect that with Saving Lives at Birth support, mortality will drop 25 percent among newborns treated in facilities introducing bCPAP therapy for the first time. Building social accountability structures for respectful maternity care in Kenya: “RMC Virtual Space” Population Council Population Council's virtual space photos. (Photo: GHTC/Marissa Chmiola)The birth of a child can be one of the most moving experiences of a mother’s life, but in many low-income countries, it can also expose a woman to abuse and disrespect. Women who visit a health care facility during childbirth often face mistreatment, whether in the form of physical abuse, non-consent for physical examinations, neglect, or disrespectful comments. Often women are hesitant to report these incidents due to fear of reprisal or distrust that their feedback will be heard. Population Council has designed a low-cost mobile text message reporting platform that they believe will empower women to report their experiences and help providers comprehend the scope of the problem and develop solutions. This intervention works by enrolling women in the platform when they visit a facility for care. Following a visit, the patient is prompted through text message with a series of simple questions to collect information about her experience. The data is then aggregated and presented to the provider or facility in an easy-to-understand, dashboard-style system. Population Council chose to design the platform using text messaging as the basis for collecting feedback because it is ubiquitous across the African continent and provides a level of anonymity that encourages women to report their experience. The project team is at the concept stage and is currently testing the intervention in health facilities in Kenya to solicit feedback and refine its approach. Innovative packaging and pasteurization for donor human milk to improve health outcomes for preterm infants PATH Human milk banks play a critical role in ensuring that safe, high-quality human milk can be made available to infants whose mothers are unable to directly provide their own milk. Current guidelines for human milk pasteurization require temperature control of 62.5 degrees Celsius for 30 minutes to ensure all pathogens and bacteria are killed. Unfortunately, while this temperature kills microorganisms that can make infants sick, it also kills vital nutrients for an infant’s growth and development. No further international guidelines have been established, leaving engineers and scientists with the challenge of delivering safe, yet properly nutritious donor milk to milk banks. To solve this issue, PATH is seeking to improve the two processes involved in transporting human milk to milk banks: Pasteurization and packaging. PATH plans to research and narrow in on the optimal temperature range and timing capable of keeping human milk safe to drink and properly nutritious for infants. As part of this, PATH is also exploring the most effective packaging that help in achieving this temperature range and timing. Currently, the most common packaging for human milk is plastic or glass jars, but PATH researchers have found these jars do not transfer heat well or consistently. PATH plans to test a number of packaging options from stainless steel jars, which are commonly used in countries like India, to sterile plastic bags coated in aluminum—which in early testing have shown to distribute heat evenly and are easy to transport. Once the optimal temperature rage and optimal packaging are discovered, PATH plans to distribute this information widely to milk banks, donor human milk pasteurization equipment manufacturers, and human milk packagers to improve health and survival outcomes for all infants who receive heat-treated donor human milk globally. Advancing a simple, low-cost rapid diagnostic test for urinary adipsin: A promising new biomarker-based test for improving preclampsia screening in low-resource settings* PATH The preeclampsia (PE) test. (Photo: GHTC/Matt Robinson) Preeclampsia (PE) is a dangerous condition that causes organ failure and seizures, and it is one of the leading causes of maternal and newborn deaths worldwide. While diagnostic tests already exist that can provide early warning of risk factors, accurate tests require samples collected over 24 hours, and rapid tests were able to identify only 51 percent to 68 percent of risk cases. Thanks to a Saving Lives at Birth Round 4 Seed Award, PATH has developed an early prototype of a rapid diagnostic test (RDT) that is just as fast as existing RDTs, but is capable of catching 85 percent of risk cases early in the third trimester of pregnancy in plenty of time to take action. It is also temperature stable at 37 to 45 degrees Celsius and can be produced for pennies on the dollar of the cost of previous tests.  With its round seven award, the PATH team will undertake additional activities to bring the new RDT closer to broad scale use. First, the team will further optimize the test to expand its shelf life and determine the feasibility of increasing the test’s accuracy. Second, the team will explore whether the test—which currently requires a strip be dipped into urine in a separate container—can be incorporated into a form similar to at home pregnancy tests, making it easier to use and allowing women to take the test in the comfort of their own homes. Finally, the team will begin negotiations with commercial partners to scale up the product so it becomes widely available worldwide. The transformative power of innovation GHTC congratulates both our members and the other teams who were selected as finalists and award winners. This year’s prize winners will join the growing community of over 100 innovators supported by the Saving Lives at Birth partnership. Many of these innovations are beginning to have an impact as they are brought to scale. To date, the program has supported 1.5 million women and newborns and saved nearly 10,000 lives. The Saving Lives at Birth program proves that through creative partnerships and innovative ideas and interventions, we can create dramatic improvements in the health and well-being of people around the world. *indicates this intervention was among the 15 winners. GHTC staff including Taylor Capizola, program assistant; Matthew Robinson, MA, multilateral advocacy and policy officer; and Courtney Carson; US advocacy and policy officer, contributed to this article.  

GHTC held a Game changers in global health game night on Capitol Hill to educate Congressional staffers about the impact of US leadership in global health research and development (R&D). Our guests ate, drank, played games, and learned a thing or two about how investing in global health R&D saves lives around the world, creates US jobs and economic growth, and protects Americans from disease threats. Here are some of our favorite photos: Playing "ROI: Return on Innovation" claw game to see the impressive rate of return generated by US investments in global health R&D.  I wonder what return this person will get for his dollar.     Discovering that global health R&D is a smart investment. It saves lives around the world, spurs US economic growth, generates cost savings, and protects Americans from disease threats.      Pulling a block from "Agency Jenga" to learn a fun fact about the important and unique contributions made by each US government agency involved in global health R&D.     Each US agency is vital to a strong and stable global health R&D ecosystem. If too many blocks are removed, the system could topple!     Playing "Striking out Disease" bowling to experience how changing funding levels for global health R&D impacts our ability to strike out the world's deadliest diseases. This player experienced funding cuts so was stuck bowling with a tiny tennis ball!       This player received an R&D funding increase, so she was able to bowl with the jumbo ball.       Attendees visit the "Gallery of Game Changers" booth to see, touch, and taste how American investment is generating game-changing global health technologies.     The International Partnership for Microbicides demonstrates how its dapivirine vaginal ring is inserted and can help women protect themselves against HIV and AIDS. The ring, which slowly releases the antiretroviral drug dapivirine, was shown to be effective in late stage clinical trials.     PATH shows off the Nifty Cup. This low-cost device, developed with support from USAID, helps babies born prematurely who struggle to breastfeed.     HarvestPlus shows off its naturally-bred, biofortified Vitamin-A orange corn, allowing attendees a chance to taste orange corn cookies and popcorn. This innovation is a sustainable, cost-effective way to combat malnutrition.     Jhpiego demonstrates how to put on a new Ebola personal protective suit it developed with support from USAID's Ebola Grand Challenges for Development.     This guest agrees. Investing in global health R&D should be an important priority for the US government.     Playing "Race for a Cure" to learn about the global health R&D process. It takes an average of 12-15 years to develop a vaccine. This player is racing to see if she can get her vaccine through all the stages of the product development process before the clock runs out.     Developing treatments, cures, and vaccines for the world’s most devastating diseases is not easy. Many challenges arise along the path from scientific discovery to lifesaving technology. That's just a part of the global health R&D process.     GHTC Director Jamie Bay Nishi talks about GHTC's mission and the critical role of global health R&D in addressing the world's most pressing health challenges.     Jamie Bay Nishi introduces Congressman Albio Sires (D-NJ), a longtime global health R&D champion and lead co-sponsor of the Global Health Innovation Act.     Congressman Albio Sires highlights how US leadership in global health R&D not only saves lives around the world, but also protects Americans from disease threats and generates US jobs and economic growth.     Congressman Albio Sires (D-NJ) checks out Jhpiego's Ebola personal protective suit.     Guests visit the "Does It Exist?" booth with a scenario card they received at registration to discover whether the vaccine, drug, or other health technologies needed to address the scenario exists. Despite tremendous progress in global health, we still don’t have the tools needed to diagnose, prevent, and treat many longstanding and emerging health challenges.     A guest spins the "Wheel of Progress" to receive a trivia question about a US agency involved in global health R&D.     Guests enjoy GHTC's signature color-changing cocktail "The Cure." It takes a drop of American ingenuity, a dash of investment, and a dose of partnership to discover the cure.     Attendees check out Jhpiego's Ebola personal protective suit.     Everyone agrees, game night was a hit!

On February 20, Jamie Bay Nishi joined GHTC as its new coalition director. Marissa Chmiola, GHTC’s communications officer, sat down with Jamie during her third week on the job to find out more about her background, what inspires her, what challenges and opportunities she sees in advocacy for global health research and development (R&D), and what lies ahead for the coalition. What first got you interested in the field of global health and development, and what inspires you about this line of work? Jamie Bay Nishi. Photo: DevexI grew up as overseas as a “diplobrat,” so I consider an interest in international affairs and global development to be in my DNA. As the child of diplomats, I lived in Saudi Arabia, Egypt, France, and Germany, and had the chance to see firsthand the impact of US engagement in diplomacy and global development.I really fell into health as an area of interest after graduating college. I wanted to work overseas, but most of the opportunities available at the time were contractor positions in Iraq as part of the war effort. Because that wasn’t an interest area of mine, I took a job working at the Advisory Board Company where I helped launch their Technology Insights product, advising hospitals in the United States on their clinical technology purchasing needs. While I found the work interesting, I ultimately recognized that domestic health wasn’t my passion, so I pivoted my career trajectory toward the global development field. I earned a Master’s degree in Conflict Resolution and ultimately took a job at then startup-mode Devex, a membership organization and media platform for the development community (basically a Bloomberg for international development). Over a decade later, I am delighted to have landed at an organization that focuses on both health and development, marrying these two interests! What attracted you to the director role at GHTC, and what excites you most about leading this coalition? I joined GHTC after spending nearly nine years growing Devex’s membership, as well as building unique partnerships. When considering the GHTC director position, I was excited about the possibility of diving deeper into a technical area within the global development field, and exploring how my membership-building and media partnership development skills could be applied in the advocacy space. It’s also exciting to take helm of a coalition that has a decade-long track record of effectively mobilizing support for global health R&D. This gives me a strong foundation to build upon, while at the same time offering me the opportunity to consider new approaches to amplify our advocacy for even greater impact.You’ve been on the job for three weeks now. What are your first impressions?In my first few weeks on the job it has been my priority to meet with each of our coalition members. I have been continually impressed by the incredible and impactful work each organization is doing to advance innovation to save and improve lives around the world. It’s truly inspiring.It’s also clear I’ve come into this role at a pivotal time in American political history. The United States has long lead the world in global health and medical innovation, and now more than ever, there is a need for coalitions like GHTC to engage with policymakers to maintain this support and champion continued US leadership in improving health and well-being worldwide. This is especially the case for protecting investments in global heath R&D—forward-looking investments that can sometimes fly under the radar.Your professional background is in stakeholder engagement, strategic partnerships building, and marketing. How does this experience shape your thinking about advocacy and translate into this new role at GHTC? While I am relatively new to the policy and advocacy field, I feel my previous experience in member engagement and communications will be a useful skill set to bring into the advocacy space. I hope to bring a fresh set of eyes to the advocacy challenges we face today and drive forward innovative approaches to build momentum within the coalition and to achieve impact with policymakers.What do you see as some of the biggest opportunities and challenges right now in advocacy for global health R&D? This year has brought dramatic shifts in the US political landscape, which could alter the US government’s historic leadership role in global health R&D. As a coalition and community, we have a lot of work ahead to support continued US, as well as multilateral leadership, and prioritization of global health R&D, which includes efforts to maintain or increase funding. Maintaining bipartisan political support and buy-in will be our biggest priority—and to do this we will have to make sure that as a coalition we articulate both the need for and promise of new global health innovations, in the United States and around the world. Due to the highly nuanced and technical nature of R&D, this can sometimes be challenging to communicate.On the other hand, I am really looking forward to digging-in to expand and deepen GHTC’s relationships with key policymakers and thought leaders in the United States and multilateral space. To really drive the global health R&D agenda forward, it will be critical to broaden GHTC’s constituency to enlist new supporters, and elevate visibility both for the coalition’s advocacy work and the pivotal role R&D plays in the future of global health.Tell us about your vision for GHTC and what you will be focusing on in your first year as director. I look forward to bringing our members together this spring for GHTC’s first ever member summit, where together we will strategize the future of GHTC. I also look forward to adding to GHTC’s core competencies to complement the incredible efforts and activities of my team. I personally want to look at new ways to augment the visibility of the coalition and its members, engage new stakeholders without diluting the core mission and purpose of GHTC, and strategize new communications efforts that will resonate with policymakers.My team as a whole will also be doubling down on engagement with policymakers in Congress, federal agencies, and multilateral entities to promote continued and expanded engagement in global health R&D.What do you enjoy doing in your spare time? I have a lot of hobbies outside of work including being a Zumba instructor, salsa dancer, stand-up paddle boarder and beer/kombucha homebrewer.

It’s that time of year when Americans join together with family and friends and give thanks for the many things in life for which they are most grateful. In the spirit of the Thanksgiving holiday, GHTC asked our members and staff to share what they are most thankful for in global health. Here’s what they had to say: “I am thankful for all patients who take part in clinical trials so that the world will have more effective regimens to end TB, in all its forms.” Willo Brock, Senior Vice President of External Affairs, TB Alliance “I’m thankful there is increasing global interest in the development and production of vaccines for diseases of poverty, like hookworm, schistosomiasis, and Chagas.” Tara Bracken, Communications Associate, Sabin Vaccine Institute “I am thankful that 2016 was a turning point for women’s HIV prevention research—one that brought us hope for one day soon expanding women’s options with a long-acting vaginal ring. I am also grateful for the amazing partners who believe women’s health and empowerment matter!” Zeda Rosenberg, Founder and CEO, International Partnership for Microbicides “I’m thankful for the new generation of emerging R&D leaders who are both generating new knowledge and achieving global health impact.” Dr. Timothy Mastro, Chief Science Officer, FHI 360 “I’m thankful for sustained US government funding to fight emerging epidemics, like Ebola and Zika, through R&D and scientific advancement.” Lindsay Litwin, Jhpiego Innovations “I’m thankful that elimination of sleeping sickness is now a real possibility thanks to new tests being strategically implemented alongside new vector control technologies and improved treatment regimens.” Dr. Joseph Ndung’u, Head of Neglected Tropical Diseases Programme, FIND “I’m thankful that the six antimalarials MMV and partners have brought forward are saving young lives today!” Andrea Lucard, Executive Vice President of External Relations, Medicines for Malaria Venture “I’m thankful for research that has shown promise for an effective six-month regimen to cure XDR-TB [extensively drug-resistant TB].” Rabita Aziz, Policy Research Coordinator, ISDA Global Health “I’m thankful for the inspirational dedication and continued participation of all HIV vaccine clinical trial volunteers. Without you, the important work of finding a safe and effective HIV vaccine would not be possible.” Dr. Fran Priddy, Chief Medical Officer, International AIDS Vaccine Initiative “I’m thankful for the over 200 members of Congress who have co-sponsored the Reach Act to accelerate efforts to end preventable deaths of mothers and children around the world.” Brandon Ball, Policy and Advocacy Officer, PATH "I'm thankful for low-cost interventions like chlorhexidine gel for umbilical cord care being made more accessible to Sub-Saharan Africa to reduce newborn mortality." Assumpta Nantume, Communications Associate/Global Health Corps Fellow, Global Health Council “I'm thankful a new generation of Middle Eastern scientists are advancing the development, production, and characterization of new vaccines to help endemic countries better respond to the threat of infectious diseases like MERS, schistosomiasis, and leishmaniasis.” Chris Bennett, Senior Program Officer, Sabin Vaccine Institute “I’m thankful for pioneering donors such as UNITAID for funding development of new hepatitis C tests for countries where fewer than 1 percent of people living with hepatitis C have been diagnosed.” Catharina Boehme, Chief Executive Officer, FIND “I’m thankful for scientists and researchers who devote their lives to important global infectious disease work to help people around the world and to protect Americans here at home and the funding the US government provides for such important work.” Karen Goraleski, Executive Director, American Society for Tropical Medicine and Hygiene “I’m thankful for the tremendous progress we’ve made in advancing child and maternal survival and excited for the prospect of saving the lives of more than 6 million mothers and children by 2030 if we work together to advance and scale-up 11 promising innovations.” Heather Ignatius, Multilateral, US, and Europe Policy & Advocacy Team Lead, PATH “I’m thankful for researchers across the globe whose efforts have, with unprecedented speed, deepened our scientific understanding of and advanced new tools to prevent, detect, and treat Zika.” Kat Kelley, Senior Program Assistant, GHTC “I'm thankful so many good dengue vaccine candidates are in development that could help curb the growing global dengue epidemic.” Tara Bracken, Communications Associate, Sabin Vaccine Institute "I'm thankful for increased awareness on global antibiotic resistance and WHO's new evidence-based Infection Prevention and Control Guidelines." Danielle Heiberg, Advocacy Manager, Global Health Council “I'm thankful for the lives of mothers and babies that have been saved, sustained, and supported by midwives across the globe.” Shannon Egan, Jhpiego Innovations “I’m thankful that malaria rapid tests have contributed to better malaria control, which in turn has helped fuel a massive decline in childhood mortality over the past decade—and that partners around the world are working together to find innovative new solutions for identifying non-malarial causes of fever. Diagnosis matters!” Dr. Iveth J. González, Head of Malaria and Acute Febrile Syndrome programme, FIND “I’m thankful for the support of MMV’s committed donors and partners that make our work to develop new antimalarials for vulnerable populations possible.” Andrea Lucard, Executive Vice President of External Relations, Medicines for Malaria Venture “I’m thankful to be a part of the #StartStayAIDSFree initiative which aims to end AIDS in children by 2020.” Catherine Connor, Senior Director of Public Policy and Advocacy, Elizabeth Glaser Pediatric AIDS Foundation “I’m thankful that members of both major US political parties have continued to demonstrate strong, bipartisan support for global health research and development and US efforts to save lives around the world.” Marissa Chmiola, Communications Officer, GHTC

A CDC researcher prepares reagents that would be used in a CDC-developed Zika diagnostic test. Photo: CDC/Sue Partridge, CDC- Ft. CollinsOn Wednesday, 26 current and past presidents of the American Society of Tropical Medicine and Hygiene (ASTMH) sent a letter to the leadership of the US Senate and House of Representatives urging policymakers to pass an emergency spending bill to combat the Zika virus as soon as possible, calling failure to do so “imprudent and reckless.”Six months have now passed since the White House first requested US$1.9 billion in emergency funding for the Zika virus response, yet Republicans and Democrats in Congress have failed to reach a compromise position, and last month Congress adjourned for summer recess without passing a funding bill. As a result, US agencies involved in the response, including the US Centers for Disease Control and Prevention and the National Institutes of Health, have been forced to repurpose funds from the Ebola response and other accounts to continue financing efforts to curtail the spread of the Zika virus. But President Obama and agency leaders have voiced mounting concerns that federal funds to fight Zika are quickly running out and lack of funding could delay vaccine research and development.In the letter to congressional leaders, ASTMH’s current and past-presidents note that, “The science is clear, the call to action is clear and yet, political infighting has carried the day while the outbreak continues….Patchwork and inadequate funding will not do the job—plain and simple.”The letter continues: “Without proper funding, researchers cannot sustain surveillance, planning, mosquito control, or research and development efforts to protect our most vulnerable populations, including women and children.” It ends by urging Congress to “get this job done now.” This collective leadership letter is the first of its kind for the Society, which is the largest international scientific organization of experts dedicated to reducing the worldwide burden of tropical infectious diseases and to improving global health.Click here to read the full letter.

USAID's 2015 Health-Related Research and Development Progress Report. Photo: USAIDLast month the US Agency for International Development (USAID) released its annual Health-Related Research and Development Progress Report detailing the agency’s research and development (R&D) activities to address global health challenges.Breakthroughs Blog is joined by Neal Brandes—team leader for USAID’s Health Research Program (HaRP) in the Bureau for Global Health—to learn more about the report and USAID’s ongoing support for global health R&D. The HaRP team coordinates the cross-bureau effort to produce this publication and has been advocating collaborative and coordinated research and research utilization efforts to accelerate the research-to-use process.Q: GHTC is always excited to dig into this great report each year. Can you highlight for our readers what is new in this year’s report with regard to new programmatic developments at USAID or major scientific developments in USAID-supported biomedical R&D? NB: There are many new developments that we’re excited about in this year’s report. To highlight just a few: The Ebola epidemic this past year emphasized the need for processes to solicit new ideas and rapid solutions based on sound evidence. This year’s report highlights the exciting products of the Fighting Ebola Grand Challenge, as well as the ongoing good works to produce innovations through the Saving Lives at Birth Grand Challenge. On the newborn front, we report on the progress on care of newborns with possibly severe infection or sepsis—one of the leading preventable causes of death. The World Health Organization (WHO) recommends that sick newborns be referred to hospitals for in-patient care, but also recognizes there are significant barriers to families in low- and middle-income settings accessing that essential care. A multicountry and multidonor initiative supported research establishing that newborns unable to access hospital care can be treated by a trained health worker in lower-level health facilities. This treatment is provided on an outpatient basis with a shorter course of antibiotics. The WHO has recently updated its guidance based upon this new evidence, and we are already in the midst of implementation research to test, adapt, and support its effective and safe application in real-world health systems. Finally, there was encouraging progress on research to combat the HIV and AIDS epidemic. Findings from two dapivirine ring trials are highlighted. These are landmark studies because they are the first to test the efficacy of a woman-controlled method of HIV prevention that uses a nongel microbicide.  Q: This year’s report marks the end of USAID’s 2011–2015 Health Research Strategy. Looking back at the last five years of USAID-supported biomedical R&D, what are some of the most exciting and impactful developments or innovations that have resulted? Are there disappointments or areas in which not as much progress was made as the agency had hoped? NB: Research operates across a continuum. Fortunately, in recent years we’ve had the opportunity to witness some of these efforts come to fruition. For example, take the chlorhexidine story. Chlorhexidine was an early effort to invest in a promising idea through a managed research-to-use process. We began with a careful assessment and then a modest series of concurrent proof-of-principle studies; research utilization efforts; and collaborative efforts with governments, universities, nongovernmental organizations, and pharmaceutical companies that demonstrated the potential and established a foundation to save lives. Nepal was both an early adopter and a global champion for the results of this work. Today these efforts have led to global engagement, rigorous introduction, and scale-up planning in 10 countries. We also understand that the nature of research involves uncertainty and planning for failure. Because of the commitment of our partners and the agency’s culture of learning, we are able to see setbacks as opportunities to improve our processes and extract value from our missteps that will improve the next efforts to address complex challenges.Q: The report illustrates how USAID is working with other US agencies across the continuum of R&D to develop new tools to combat tuberculosis (TB) as part of the US government TB strategy. Could you tell us more about how USAID is coordinating with other US agencies to advance development of critically needed tools in other health areas?A lab technician test tuberculosis samples at a lab in Bandung's Public Health Laboratory. Photo: USAID IndonesiaNB: We work with many stakeholders, foremost of which are the host governments. Because we are stewards of the public’s money, we collaborate with US government agencies as well as other donor development agencies such as the United Kingdom Department for International Development and philanthropies on almost every area of our portfolio—whether it’s to keep each other informed to ensure our efforts are aligned and coordinated or coordinating cofunding to advance the R&D agenda with a goal of advancing research investments to save lives. For example, our malaria portfolio consists of many operational research projects that are done through the President’s Malaria Initiative—a joint effort between USAID and the US Centers for Disease Control and Prevention (CDC). The Ebola Grand Challenge efforts were based on a coordinated partnership with USAID, the White House Office of Science and Technology, CDC, and the US Department of Defense. To introduce new tools and measurements in behavior science (like Big Data), we are working with the White House Social and Behavior Science team.Q: Why is it important for USAID to continue to play a strong role in health research, and what’s next for USAID in this area? Should we expect a 2016–2021 strategy, and how might it look similar to or different from the current strategy? NB: We still have many health challenges ahead of us, and our success is dependent on garnering strong evidence to inform decision-making and action. USAID has the advantage as a development agency to provide technical leadership and an on-the-ground presence working in conjunction with our partner countries and other stakeholders to accelerate the application and development of science and innovation.We are actively discussing our new research strategy. Like our previous strategies, it will address the unique needs of each of our technical areas. However, we are also working together to articulate a number of broad principles that define our work—placing emphasis on how our work includes implementation science, innovation, and partnerships.