Explore New Solutions in Global Health Priority Areas (Round 17)

The Opportunity

At this time, we are only accepting proposals for this topic on the five (5) specific challenges listed below. When you apply, you will see the list of challenges from this call; please select the appropriate challenge for your proposal.

This call for ideas is part of the 17^th round of Grand Challenges Explorations (GCE). Over the past eight years of GCE, we have experimented with a mix of topics – broad, open topics that leave much to the innovators’ imaginations, and narrow, focused topics that provide a specific toolset or criteria – covering everything from new therapeutics, vaccines, and diagnostics to financial services for the poor and agricultural tools for smallholder farmers. One consistent lesson we have learned is that the world never seems to run out of great ideas. To elicit more of these great ideas without limiting creativity and boldness, we are continuing to set forth a series of challenges that remain broadly unsolved in the areas where we work. Here we provide a bit of guidance around what we will and will not fund, but leave the solution itself open to your imagination.

Above all, our goal is to harness advances in science and technology to save lives, and all of our investments are driven by the need to develop and apply solutions that can be deployed, accepted, and sustained in the developing world.

The challenges laid out below fit squarely within our focus areas and identify gaps in knowledge or technology that, if understood and developed, could launch us forward quickly to save lives and improve the quality of life for the worlds’ poorest.

The Challenge

To encourage innovators around the world to think outside the box and potentially address challenges outside their primary field of work, we are posing a short and concise list of key challenges that remain unmet by the world’s greatest minds. We ask that applicants review our priority funding areas for additional information and consider ideas that can be sufficiently tested within the scope of a GCE Phase I award ($100,000 USD over 18 months). While these are big challenges and we don’t expect complete solutions here, we expect proposals to clearly outline success metrics to help us understand whether the idea will ultimately be transformative. We seek ideas that are "off the beaten track," daring in premise, and clearly different from the approaches currently being developed or employed.

This list is not in order of priority, nor is it an exhaustive list of the challenges we seek to solve; however, for the purposes of this request for proposals, ideas must show clear relevance to one of these specific challenges. More specific information on each challenge and what we will or will not fund can be found after the list.

We’re seeking innovative ideas to assess the burden of disease and to develop new diagnostics, specifically to:

• Develop methods for simple preparation and preservation of stool samples for room-temperature transport and remote-analysis;
• Better understand cause of death from tissue samples;
• Develop point-of-care nucleic acid diagnostics to below $2 per test;
• Enable self-testing for cervical cancer;
• Develop malaria diagnostics to accelerate toward eradication.

Successful proposals will:

• Clearly describe how the idea, if successful, would help solve one of the challenges described in the call;
• Be directly relevant to the developing world (e.g. low-cost, useful across multiple geographical and cultural settings, self-sustaining);
• Have a clear and testable hypothesis and include an associated plan for how the idea would be tested or validated;
• Yield interpretable and unambiguous data in Phase I, in order to be considered for Phase II funding.

We are specifically seeking proposals under these categories. Additional information on each can be found below.

Develop methods for simple preparation and preservation of stool samples for room-temperature transport and remote-analysis

Current corpological methods for the diagnosis of helminth infections require near-immediate analysis due to: a) working with stool as the primary specimen, and b) species-dependent stability of eggs that are counted to determine the presence and intensity of infection. The resource requirements to conduct accurate mapping and surveillance of these diseases could be partially reduced with hub-and-spoke or centralized testing logistics. We seek new methods for the preparation and preservation of stool samples that can be performed at the point-of-collection with minimal training and resources. Methods should preserve stool-derived eggs produced by a diversity of helminth species in a manner that samples can be transported at long distances, under various conditions, and extracted for accurate identification and counting in a remote laboratory using basic equipment. Compatibility with current tools, such as Kato-Katz, McMaster or similar methods, must be addressed.

Better understand cause of death from tissue samples

In order to get the right interventions to the right children in the right place to save lives, particularly in developing countries, we need to better understand what causes morbidity and mortality. To that end, we are seeking better ways to identify pathogens and immune responses in tissue samples collected during minimally invasive autopsy. We welcome bold ideas to enable identification of pathogens and associated pathology in tissue samples that can overcome one or more challenge including improved reproducibility and robustness of results, faster and simpler tissue processing, reduced dependence on specific reagents (e.g. available antibodies), and creative methods to select tissue samples for biopsy. Tissue samples of high interest include lung, liver, and brain biopsy samples. Standard pathology and immunohistochemistry based methods will not be considered for funding.

Develop Point-of-care nucleic acid diagnostics to below $2 per test

There is a need for point-of-care tests for nucleic acid targets that are extremely low cost, yet retain the capability of processing diverse sample types (such as sputum, whole blood, stool, swabs, and urine) and the ability to quantitate targets. We seek new diagnostic platforms or technologies that maximize sample preparation flexibility across specimen types, maintain sensitivity and quantitation, and are very low cost, with an end-to-end test cost target of below $2, including sample collection.  Of particular interest are HIV viral load testing, TB case detection, and HPV screening.

Enable self-testing for cervical cancer

High-throughput and low-cost point-of-care/contact tests are needed by cervical cancer prevention programs that use HPV mobile screening campaigns. Clinically-validated nucleic acid biomarkers offer high sensitivity for diagnosing women with cervical cancer or pre-cancer (histologically confirmed CIN2+ or higher lesions) but suffer from low to medium specificity, resulting in additional resources to identify those who are harboring or at risk of developing cancer. We seek biomarkers that can be measured in simple-to-collect cervical, vaginal and urine specimens to diagnose women with cervical cancer or pre-cancer (histologically confirmed CIN2+ or higher lesions) in a screening population. Preferred biomarkers will have preliminary clinical evidence that targeted biomarkers are non-inferior to current validated biomarkers, and can be reliably measured in less than two hours with minimal instrumentation and operator processing.

Develop malaria diagnostics to accelerate toward eradication

As we drive toward malaria eradication, we need appropriate diagnostic tests designed to support the elimination tactics. To meet that need, we seek new ideas for low cost malaria Point of Care (POC). Specifically:

• More sensitive POC diagnostics. In the control phase, microscopy and commercial rapid diagnostic tests (RDTs) seem to be sufficient to carry out the goals of malaria control programs to reduce morbidity and mortality. However, to move from “Control” to “Elimination”, we need more sensitive tests to identify individuals in the community with lower parasite densities who are not diagnosed with current RDTs but contribute significantly to malaria transmission. We are looking for non-molecular technologies that will lead to an improvement in level of detection of two logs over commercially available RDTs.
• Non-invasive RDTs. As we move toward elimination, we anticipate that it will be difficult to “actively” test the population using finger prick, especially in very low prevalence regions. Therefore, we seek RDTs performed on non-invasive samples such as saliva. To fit the need, these tests must be simple, fully integrated, more sensitive than RDTs performed on blood, and importantly, remain very low cost.

Under this challenge, we will not fund ideas proposing urine sampling as the only innovation, aptamer-based diagnostics, new biomarkers, microscopy, or technologies that only apply to one protein.

We will not fund:

• Ideas that do not address one of the key challenges described in this call;
• Ideas or solutions not aligned with the Gates Foundation’s Global Health priority areas and strategies listed above;
• Ideas without a clearly-articulated and testable hypothesis;
• Ideas not directly relevant to developing countries.
• Ideas for which a relevant indicator of success cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months);
• Approaches that represent incremental improvements to conventional solutions (e.g., research of current methods for vaccine discovery, development and delivery intended to expand, improve or integrate existing technologies or tools);
• Basic research without clear relevance to the goals of this topic;
• Solely behavioral change/educational initiatives (e.g., training programs, scholarships, education programs);
• Solely infrastructure or capacity-building initiatives;
• Approaches that present unacceptable downstream safety risks (e.g., as a barrier to product development);

For more specific information about the foundation’s strategies in the priority Global Health areas, see: http://www.gatesfoundation.org/What-We-Do