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In recent years, the world has witnessed the tragic outcomes of multiple global health crises. From Ebola to high prices to antibiotic resistance, these events highlight the fundamental constraints of the current biomedical research and development (R&D) system in responding to patient needs globally.To mitigate this lack of responsiveness, over 100 self-identified “alternative” R&D initiatives, have emerged in the past 15 years. To begin to make sense of this panoply of initiatives working to overcome the constraints of the current system, UAEM began an extensive, though not comprehensive, mapping of the alternative biomedical R&D landscape. We developed a two phase approach: (1) an investigation, via the RE:Route Mapping, of both existing and proposed initiatives that claim to offer an alternative approach to R&D, and (2) evaluation of those initiatives to determine which are in fact achieving increased access to and innovation in medicines. Through phase 1, the RE:Route Mapping, we examined 81 initiatives that claim to redress the inequity perpetuated by the current system via one of five commonly recognized mechanisms necessary for truly alternative R&D.Preliminary analysis of phase 1 provides the following conclusions:No initiative presents a completely alternative model of biomedical R&D.The majority of initiatives focus on developing incentives for drug discovery.The majority of initiatives focus on rare diseases or diseases of the poor and marginalized.There is an increasing emphasis on the use of push, pull, pool, collaboration and open mechanisms alongside the concept of delinkage in alternative R&D.There is a trend towards public funding and launching of initiatives by the Global South.Given the RE:Route Mapping’s inevitable limitations and the assumptions made in its methodology, it is not intended to be the final word on a constantly evolving and complex field; however, its findings are significant. The Mapping’s value lies in its timely and unique insight into the importance of ongoing efforts to develop a new global framework for biomedical R&D. As we progress to phase 2, an evaluation tool for initiatives focused on identifying which approaches have truly achieved increased innovation and access for patients, we aim to demonstrate that there are a handful of initiatives which represent some, but not all, of the building blocks for a new approach to R&D.Through this mapping and our forthcoming evaluation, UAEM aims to initiate an evidence-based conversation around a truly alternative biomedical R&D model that serves people rather than profits.

Inuit communities can beat COVID-19 and tuberculosisInuit communities are at high risk for respiratory infections and coronavirus disease 2019 (COVID-19) because they are currently fighting another respiratory infection epidemic, tuberculosis. Inuit today are nearly 300 times more likely to get tuberculosis than any Canadian born, non-indigenous person. 1 COVID-19 has been reported in Inuit communities in Nunavik, Canada; however, no case of COVID-19 disease has been reported in Nunavut, Canada. 2 But there is no room for complacency. In Clyde River, Nunavut, the community is already implementing emergency readiness plans for the control of Communities in this area are reachable only by air, have very basic medical care facilities, and have insufficient COVID-19 testing available. If the virus that causes COVID-19 reaches Nunavut, it could have tragic consequences.Defeating infectious diseases requires community-driven responses. Community leadership together with a coordinated public health approach are needed to eliminate tuberculosis in Nunavut. We need the same response for COVID-19. WHO has recognised the need for community-driven responses and encourages implementation of innovative people-centred approaches to tuberculosis during the COVID-19 pandemic. 4 Community organisations, such as Ilisaqsivik Society and SeeChange Initiative, have developed a unique collaborative model: 5 a fundamentally community-first approach that provides control, space, and resources for community members to empower themselves to eliminate tuberculosis. It can do the same for COVID-19.The model includes the development of emergency readiness plans (eg, sourcing hygiene materials for the

The global health crisis in non-communicable diseases (NCDs) reveals a deep global health inequity that lies at the heart of global justice concerns. Mirroring the HIV/AIDS epidemic, NCDs bring into stark relief once more the human consequences of trade policies that reinforce global inequities in treatment access. Recognising distributive justice issues in access to medicines for their populations, World Trade Organisation (WTO) members confirmed the primacy of access to medicines for all in trade and public health in the landmark Doha Declaration on the TRIPS Agreement and Public Health of 2001.