What is the Newborn Survival Prize?
The idea is to create a prize focused on severely ill neonates being cared for in district level hospitals in lower-and middle-income countries. It will run for 3-5 years and have two strands:
- STRAND 1 will incentivise the development of two diagnostic products designed for neonates (28 days old old or less): A) A triage tool to detect bacterial sepsis; B) a test to assess antibiotic susceptibility with a panel of 10 antibiotics from WHO’s AWaRe list.
- STRAND 2 will incentivise companies to develop equipment or devices to address the acute challenges of neonatal intensive care units (NICUs) in lower-and-middle countries. For example, radiant warmers/phototherapy machines, CPAP (continuous positive airway pressure) and other tools that would have a demonstrable impact on survival rates.
The problem
Globally nearly half of deaths of children under-five are deaths of neonates (within 28 days of birth). Although there has been an impressive decline in under-five mortality in the last 30 years, the decline in neonatal mortality has been slower.
Globally in 2018, 2.5 million children died within the first 28 days of life, and it has been reported that 75% of neonatal deaths occur within the first week of life, with a high proportion dying within the first 24 hours.
Developing countries represent 98% of neonatal mortality worldwide (Bryce et al., 2005), with the highest rates occurring in Sub-Saharan Africa (43% of global deaths, average of 28 deaths per 1,000 live births). Challenges in identifying bacterial pathogens and determining sensitivity to antibiotics leads to over-reliance on empirical therapy recommendations and treatment with oftentimes inappropriate antibiotics.
Recent advances in identifying biomarkers
The science is advancing in terms of identifying biomarkers and algorithms to diagnose sepsis. A prize will create a clear framework so that innovators can transform these scientific advances into diagnostics that save lives. The prize will also create a means of co-creation, bringing together test developers with staff in neonatal intensive care units (NICUs), to develop locally relevant, robust diagnostics and equipment
Market failure
Because neonatal mortality is high in countries with relatively low per capita income, diagnostic tests to identify sepsis in newborns is not an attractive market. A challenge prize would subsidise development and link test makers to procurement paths that will be built into the prize design. These market shaping strategies will motivate test developers that have not addressed this challenge so far because they thought there was no market.
NICU devices that are either out of reach because of price or sub-standard quality
A challenge prize will create a structure to bring together manufacturers and clinicians to create products that can be locally maintained and are robust, affordable and fit for purpose. The co-creation mechanisms will take into consideration the limited bandwidth of LMIC practitioners.
Product validation and evaluation
An open innovation programme will ensure that competing teams have expert input and vetting of their validation studies to ensure that products meet or exceed agreed-upon standards. The prize will also tender for evaluation sites where outputs can be tested in real-world conditions.
Initial idea for eligibility and judging criteria
Eligibility criteria
Teams: Innovators may be academics or companies from anywhere in the world but they must establish relationships with LMIC-based district hospitals. The prize management team will do matchmaking to facilitate these relationships.
Some initial ideas for judging criteria:
- Target product profiles (TPPs) for neonatal diagnostics that are being developed by the World Health Organisation (WHO) will be adapted for this prize.
- The triage tool to diagnose bacterial sepsis will need to have time-to-result of less than two hours.
- Tests to assess antibiotic susceptibility will need to have a time to result of less than 10/12 hours.
- Equipment and devices will need to demonstrate effectiveness according to a set of standards and criteria that will be developed by neonatologists working in LMICs.
Want to get involved or tell us what you think! The best prize ideas are developed through extensive research and engagement with experts, stakeholders and people with lived experience of the problems they are focused on. We start with a first draft like the one above – then work to improve, refine and validate our thinking.
We’re particularly keen to have conversations about this idea with potential funders and organisations working in the field. Get in touch if you’re interested – or if you think you have a better idea – and we’ll schedule a call.