Strengthening the global health product innovation ecosystem
Each year, millions of people around the world die of preventable diseases because they lack access to vaccines, treatments, and diagnostic tools. Most live in low- and middle-income countries, where businesses are not incentivized to develop or produce affordable health products due to communities’ lack of purchasing power, incomplete information, conflicting regulatory standards, and discrepancies in regulatory requirements.
As the world’s largest producer of active pharmaceutical ingredients and second-largest consumer of pharmaceutical products, China has the potential to become a major supplier of safe, reliable global public goods for health. By pooling resources and expertise from the public and private sectors, our foundation fosters critical international collaboration to make high-quality, affordable medical and health products from China available to those most in need worldwide.
In the area of basic research, we launched the Global Health Drug Discovery Institute (GHDDI) in 2016, in partnership with the Beijing municipal government and Tsinghua University. GHDDI was the first scientific research organization in China funded by a public-private partnership. Equipped with world-class, innovative drug discovery and translational research capabilities, GHDDI is looking for new drugs for infectious diseases, such as malaria and tuberculosis (TB), that disproportionately affect people in low- and middle-income countries. GHDDI researchers have also made progress in discovering potential breakthrough COVID-19 treatment.
We also partner with R&D-funding agencies in China on joint research programs that support scientists in developing innovative solutions to major public health challenges in low- and middle-income countries.
To develop, produce, and deliver lifesaving tools in these regions, we work with the private sector in China on vaccines for Japanese encephalitis, polio, cervical cancer, and other deadly diseases, as well as cold-chain equipment for regions with poor infrastructure, artemisinin-based combination treatments for malaria, and long-acting contraceptive implants. Our global partner network allows us to help the private sector understand the demand for health products in these markets and provide technical support in areas such as R&D, manufacturing, clinical studies, market access, compliance, and commercialization. These efforts help bring high-quality, affordable Chinese-made health products to those who urgently need them.
Supporting China’s effort in bringing its medical products regulatory system up to international standards
A global health innovation ecosystem depends on the regulation of medical products. If China can increase its regulatory capacity and bring its system up to international standards, aid agencies can bring more high-quality, affordable Chinese-made health products to people in need in low-income countries. Likewise, global pharmaceutical innovations can reach China more quickly and improve the health of its people.
We collaborate with regulatory bodies and organizations around the world to expand access to innovative health products for low- and middle-income countries. Since 2016, we have worked with the World Health Organization (WHO) and other international partners to support China’s efforts to align its regulations and standards with international norms and boost its regulatory capacity.
In the area of capacity building, we work with China’s National Medical Products Administration (NMPA), universities, and research institutes to enhance the country’s ability to navigate challenges with multidisciplinary drug review, including by providing expert and technical support for drug review and approval reform. We also encourage the establishment of a comprehensive drug-review training system, including a curriculum and online training. To help NMPA boost its Good Manufacturing Practice inspection capacity, we established a performance index system at the provincial level and helped expand the capacity of quality inspection institutions and personnel, laying the foundation for a highly skilled and professional team of drug reviewers and inspectors.
To facilitate collaboration between Chinese regulatory bodies and international organizations, we supported NMPA in joining the International Council for Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) in 2017. This ensures the implementation of globally accepted technical standards and guidelines for pharmaceutical market access in China. In 2018 and 2021, NMPA was elected as a member of the ICH Management Committee; this helps advance the reform of China’s drug review and approval system and improve drug access and global cooperation. We also supported NMPA’s application for pre-accession to the Pharmaceutical Inspection Co-operation Scheme (PIC/S) in 2021. Membership in the PIC/S community will help China modernize its regulatory system and participate more fully in efforts to coordinate international norms. In August 2022, we supported NMPA in maintaining WHO’s National Regulatory Authority Maturity Level 3 for vaccine regulation. This has laid a foundation for more vaccines produced in China to be eligible for WHO prequalification and for speeding up the export of Chinese-made vaccines to other parts of the world.
Accelerating global efforts to eradicate malaria
Over the past few decades, global efforts to eliminate malaria have been remarkably successful, but the rate of decline in new malaria cases is slowing. WHO’s 2021 World Malaria Report estimated that there were 241 million malaria cases in 2020, 95% of them in Africa, and over 600,000 deaths, mostly children under age 5. Drug and insecticide resistance have also increased in some regions, and emergent infectious diseases, including COVID-19, have posed new challenges for the global prevention and control of malaria.
Worldwide malaria eradication is a top priority of our foundation. For two decades, we have supported expanded use of existing tools and the development of new anti-malarial drugs and innovative models for prevention and control. China was certified malaria-free by WHO in 2021, and we believe that the innovations, production capacity, and expertise that China accumulated in its successful domestic fight against the disease can have a huge impact if applied in places where malaria remains a problem.
To achieve this goal, we are working with WHO; the Global Fund to Fight AIDS, Tuberculosis and Malaria; China’s National Health Commission (NHC); the China International Development Cooperation Agency; China’s Ministry of Commerce; and other partners to introduce high-quality, low-cost Chinese-made anti-malarial products to the global market. We ensure the widest application of existing tools by working bilaterally and multilaterally to fill funding and technology gaps. We also work with Chinese research institutes that are working on new treatments and tools that proactively address drug resistance.
We also support the adaptation of China’s proven prevention and control models for regions of Africa that suffer from high malaria burden. With our support, China’s “1-3-7” model has been included in the WHO guidelines for malaria. We also launched a malaria-control pilot project in Tanzania with Chinese and African experts to adapt this model to the local context; the pilot has helped to significantly reduce malaria prevalence in those communities. Based on the results, WHO plans to launch additional pilot projects that apply this model to other African countries, including Zambia, Senegal, and Burkina Faso.
Successful malaria prevention and control measures depend on a robust disease surveillance and response network. We facilitate cooperation between the Chinese Center for Disease Control and Prevention (China CDC) and the Africa Centres for Disease Control and Prevention to allow China to share its experience and technology. This collaboration helps African countries improve their surveillance capabilities as part of efforts to prevent and control diseases.
Strengthening China’s National Immunization Program
China’s National Immunization Program (NIP) has achieved remarkable success since its launch in 1978, maintaining a vaccination rate of more than 90% in recent years for routine vaccinations, which are provided for free. However, an opportunity exists for further expansion because the program does not include key vaccines recommended by WHO for high-burden diseases caused by streptococcus pneumoniae, human papillomavirus (HPV), rotavirus, and Haemophilus influenzae type b (Hib). Because supplies of these vaccines are generally low in China and they are not covered by the free immunization program, overall vaccination rates for these diseases are low, resulting in huge disparities across China.
Vaccines are among the world’s most cost-effective public health tools, and ensuring equitable access, especially for children and other vulnerable groups, has been one of our foundation’s top priorities since its inception. We work with China CDC, National Immunization Advisory Committee (NIAC) Technical Working Groups (TWGs), and other partners to improve China’s vaccine ecosystem in areas including immunization strategy, vaccine supply, immunization services, and financing and reimbursement methods.
To help improve China’s immunization strategy, we support domestic and international collaborative research platforms for studying vaccine delivery and administration, and we fund new approaches to addressing supply and demand challenges. We also support research team capacity building and industry-wide dissemination of research findings. We help NIAC TWGs devise and update their technical guidelines, and we support evidence-based decision-making on NIP expansion.
To help expand China’s vaccine supply, we support the development and production of NIP priority vaccines and help Chinese manufacturers reduce costs, boost capacity, and elevate quality.
With a view to exploring different service delivery pathways, we conduct pilot programs with technical partners to introduce new vaccines into regional immunization programs. We also support the introduction of strategies, delivery models, and solutions that target regions with varying levels of economic development, vaccine delivery toolkits, and measurement and evaluation systems.
In addition, we carry out research on financing, reimbursement, and procurement mechanisms in China and abroad to address the economic burden of immunization and ensure sustainable development of the NIP.
Working with our partners, we have developed health economic models and related estimates for pneumococcal conjugate vaccine (PCV), HPV vaccine, rotavirus vaccine, and Hib vaccine, and we have conducted free HPV immunization pilot programs in multiple Chinese provinces and cities. Two high-quality, affordable Chinese-made HPV vaccines are already playing a crucial role in regional immunization programs. PCV pilot programs for children are also underway.
Reducing the disease burden of tuberculosis
China has made tremendous progress in tackling TB since 2000, meeting its TB-related United Nations Millennium Development Goal—reducing TB prevalence and mortality by half—five years ahead of the target date. However, according to WHO, China still has the world’s third-highest TB burden, with over 780,000 new cases each year. Many of these cases involve multidrug-resistant TB (MDR-TB), which is especially difficult and costly to treat.
China is an important partner in WHO’s work to end the global TB epidemic by 2035. Since 2009, we have provided technical and funding support to a joint TB prevention and control program in China, in partnership with the NHC, focusing particularly on MDR-TB.
The program has brought together designated hospitals, centers for disease control and prevention, and primary health care (PHC) units to explore new diagnosis and treatment models and improve treatment quality. A comprehensive model that integrates diagnostics, treatment, management, and financing was launched in Zhejiang, Jilin, and Ningxia, increasing the proportion of MDR-TB patients with access to proper treatment from one-third to almost 100% over the past decade. Thanks to new technologies such as rapid molecular diagnostics, the time required to confirm an MDR-TB case has been reduced from two months to two hours, enabling earlier discovery and treatment and further containment of the disease.
The program has also upgraded China’s TB medicine protocol, boosting medication compliance by reducing the treatment regimen from 13 pills to three or four pills per day. New medicines, meanwhile, have increased prevention rates of MDR-TB and raised the recovery rate from 50% to 85%. An electronic pill box developed and produced by Chinese companies with our support records medication use and alerts patients when it’s time to take their medicine. A cluster randomized trial in China using the device showed that it greatly improved medication compliance and provided evidence to support WHO’s update of its TB treatment guidelines.
The program also works with local governments, health insurance providers, and civil affairs departments to explore new payment models that bring down the cost of TB diagnosis and treatment. At the start of the program, MDR-TB inpatient treatment typically cost patients more than 40% of their family’s annual income. In pilot regions, this figure was cut to 10%. We also supported policy research by the National Healthcare Security Administration and Healthcare Insurance Research Institute to increase the reimbursement rate for TB diagnosis and treatment while reducing medical expenses for patients, especially those with MDR-TB.
In addition, we support public education and advocacy on TB prevention and treatment through a long-term partnership with the Chinese Association of STD and AIDS Prevention and Control and Peking University.
Since 2020, we have worked with the Chinese Preventive Medicine Association and other partners to call on China to strengthen its TB prevention and control policy; increase investment in diagnosis, treatment, and vaccine R&D; scale up innovative TB prevention and control models; and improve screening and treatment quality. These efforts aim to contain and eventually eliminate TB in China.
Preventing and controlling HIV/AIDS
In the four decades since HIV was discovered, major progress has been made in the diagnosis, treatment, and prevention of the virus. However, the world—including China—needs to do more if it is to end the epidemic of HIV/AIDS by 2030. The disease remains a serious public health challenge: As of the end of 2020, according China CDC, more than a million people in the country were living with HIV.
Soon after we opened our foundation’s Beijing office in 2007, we initiated an HIV/AIDS prevention and control program in partnership with what was then China’s Ministry of Health (now the NHC). Through collaboration among the government, health care providers, and social organizations, the program expanded access to testing services, reduced the spread of HIV, and produced a wealth of information about how to support social organizations in HIV/AIDS initiatives. These efforts contributed to the establishment in 2015 of the China AIDS Fund for Non-Governmental Organizations (supported by the NHC, Ministry of Finance, and Ministry of Civil Affairs), which provides RMB 50 million in annual funding to social organizations working in the field.
Since 2016, we have also worked with partners to raise awareness of HIV/AIDS and fight stigma around those with the disease. We have also supported programs to reduce mother-to-child HIV transmission in Liangshan Yi Autonomous Prefecture in Sichuan Province. These efforts have helped China slow the spread of HIV and reduce the health and economic burdens that it places on people.
Accelerating the innovation and commercialization of sanitation technologies
An estimated 3.6 billion people around the world lack access to safely managed sanitation. As a result, nearly 500,000 children under age 5 die every year from diarrhea, cholera, typhoid fever, and other resulting illnesses. Developing and scaling up affordable and safe sanitation facilities is essential to the health and sustainable development of low- and middle-income countries.
We collaborate with governments, the private sector, R&D institutions, and international organizations to improve sanitation for the world’s poorest people by funding innovative new toilet technologies, waste treatment solutions, and service delivery models and by cultivating markets. Since 2013, we have helped our Chinese partners use their expertise in technological innovation, mass production, and commercialization to create new solutions for China and the world.
Together with the University of Science and Technology Beijing, we launched the Reinvent the Toilet Challenge to fund research on and testing of low-cost inventions, including low-water or waterless toilets that require no sewer connection or electricity. We have also transferred new sanitation technologies to China through free patents and provided technical and financial support for Chinese partners to adapt, test, and pilot these technologies. With our help, for example, a Chinese company began manufacturing the Omni Processor, a new integrated human waste treatment technology, and adapting it to low-resource settings. The company now has two processors in trial operations in Bengbu City, Anhui Province, and in Dakar, the capital of Senegal. The data and experience generated from these pilots have already laid a solid foundation for commercialization and scale-up of the technology.
We also work with the Ministry of Agriculture and Rural Affairs and the private sector on a demonstration platform to study non-sewered toilet technologies in settings that lack sewage networks, such as rural areas and high-speed trains. In collaboration with the China Primary Health Care Foundation, we support research into these technologies, advocate for their use in health care systems, and raise awareness of environmental protection and infectious disease control in remote areas by promoting the use of non-sewered sanitation facilities.
Improving health for all
The Healthy China 2030 blueprint, which aims to improve the health of all Chinese people, notes the new challenges posed by a host of factors such as industrialization and urbanization, an aging population, continual changes in the types of diseases affecting people, ecological conditions, and lifestyles. Drawing on our experience and expertise in global health, we work with China’s health authorities to improve people’s health and well-being and address gaps in health equity.
Improving primary health care in rural areas to combat illness-induced poverty
One of the greatest challenges faced by people in China and all over the world is the prospect of slipping back into poverty after an illness. Enhancing PHC systems in rural areas is a proven way to address this challenge and will be critical to China’s efforts to further reduce poverty.
Since 2017, we have worked with the NHC to launch pilot programs in 13 impoverished counties in Shanxi, Henan, Hubei, and Sichuan provinces. These pilots aim to improve PHC service capacity, prevent catastrophic health expenditure, and reduce the incidence of illness-induced poverty. Drawing on lessons from international and domestic health reform efforts, they also aim to develop and improve integrated health management models for people at high risk of poverty and make PHC services more effective and efficient. After these pilots showed improvement in PHC service use and reductions in unnecessary hospitalizations in some regions, the policies and policy implementation tools were applied beyond the demonstration areas. The knowledge and evidence generated from the pilots will also facilitate further health system reforms in China.
Advocating breastfeeding and improving child nutrition
Another challenge is early childhood malnutrition, which causes irreversible damage to the brain and body. Although China has made tremendous progress in reducing malnutrition, it still has the world’s third-largest population of children under age 5 with stunting. One contributing factor is imbalances in economic development across the country. Tackling this challenge requires focusing on the 1,000-day window from the onset of pregnancy to a child’s second birthday.
Breast milk provides rich nutrition that fuels growth in the first six months of life; breastfeeding longer than six months benefits both mother and child. However, these benefits are not widely known, and the breastfeeding rate in China remains low. In 2017, with our support, the China Development Research Foundation began surveying the public’s knowledge of breastfeeding and laid the scientific foundation for policies and initiatives to encourage the practice. By forming alliances with partners across different sectors, organizing policy discussions, shaping a supportive social environment, and strengthening public scrutiny, this project has increased breastfeeding rates in its pilot area.
Apart from low breastfeeding rates, many children in low-income regions of China also have no access to nutritious food after age 6 months. This, too, leads to physical and mental impairments. The Chinese government has undertaken a major initiative to distribute free nutrition packs to children ages 6 to 24 months in impoverished regions. We have worked with China CDC and UNICEF to evaluate the effectiveness of this initiative by conducting a randomized double-blind experiment. The results have provided scientific evidence on childhood nutrition intervention, support for the scale-up of nutrition packs, and suggestions for other developing countries facing similar challenges.
Reducing the financial burden and health risks of tobacco use
Smoking is another major health issue. China is the world’s largest producer and consumer of tobacco and has the highest burden of tobacco-related diseases. According to the NHC’s China Report on the Health Hazards of Smoking 2020, the country is home to more than 300 million smokers and over 1 million people die each year from tobacco-related causes, including respiratory diseases, cancer, cardiovascular diseases, and diabetes. If no effective measures are taken to significantly reduce smoking, this number will rise to 2 million deaths per year by 2030 and 3 million by 2050.
As a signatory of the WHO Framework Convention on Tobacco Control (FCTC), China has put tobacco control on its national agenda. According to WHO research, effective policy interventions are the best way to control tobacco use. To help China make progress on FCTC compliance and meet its goal of reducing the smoking rate for people ages 15 and older to 20% by 2030, we work with partners to advocate for proven policies and tools such as tobacco taxes, laws that strengthen public education, and smoking bans in public places.
