How to save 400,000 babies a year

If the year 2025 has had a message for developing countries, it’s this: “You’re on your own.” Most notably, the Trump administration began with an unprecedented and ongoing assault on foreign aid, including global health programs. But there have been further ill omens. Other rich countries, including the UK and France, followed the US example by cutting their own aid programs as well. Meanwhile, President Donald Trump’s tariff campaign has hit poor countries that had been achieving export-driven growth, like Bangladesh, especially hard. If there’s a silver lining for the Global South, it’s that being on their own in 2025 means something very different than what it meant in, say, 1990. Countries where poverty was once near-universal, like India or Indonesia, are now considered middle-income. Some populous countries in sub-Saharan Africa, like Kenya or Nigeria, are, if not completely politically stable, now possessed of enough real state capacity to try ambitious projects like universal health coverage. The resources available to these nations are still highly limited by rich-world standards. But they’re still enough to achieve very impressive feats, and I recently heard of an intriguing project that could serve as a perfect test case. If it works, it could show that major international health projects, saving hundreds of thousands of lives, can be funded largely by the countries they’re meant to help, rather than by forces of philanthropy and foreign aid that have suddenly become unreliable. Neonatal sepsis: When babies’ infections go very, very badly It’s called NeoTest. The program targets an extremely common and preventable cause of death in young infants: neonatal sepsis. Sepsis is a catch-all term for infections that provoke an overwhelming immune response, damaging internal organs, and in the worst cases, leading to death. Sepsis can in principle be caused by anything — a virus, a fungus, a protozoa — but in practice, most infants who get it get it from a bacterial infection. In one way, that’s good: We have antibiotics! In another way, it’s bad: The risk of antibiotic resistance means you don’t want to overuse them. The challenge, then, is to match antibiotics to the babies who need them the most. The tests we have now for bacterial sepsis in infants are slow and expensive. The main technique is “blood culturing,” which involves taking blood from the patient, putting it in a liquid “culture” that reacts if bacteria are present, and waiting to see the reaction show up. This is expensive and often takes two to three days, potentially delaying life-saving treatment. It also has very high “false negative” rates, with studies showing that a large share of neonatal sepsis cases occur in babies who test negative. --- This story was first featured in the Future Perfect newsletter. Sign up here to explore the big, complicated problems the world faces and the most efficient ways to solve them. Sent twice a week. --- So our targeting of antibiotics to babies is currently bad, with the result that hundreds of thousands of babies die every year from sepsis. The estimates we have on the toll of neonatal sepsis aren’t precise, but the best figure I’ve seen, from the World Health Organization (WHO), is a range of 400,000 to 700,000 deaths a year. That’s in the same ballpark as malaria (600 to 700,000 a year) and HIV/AIDS (630,000 deaths in 2023). Other studies go lower (more like 200,000) but, because they exclude infant deaths from pneumonia-caused sepsis, underestimate the number of deaths that could be saved by better targeting antibiotics to babies. The team behind NeoTest — which includes physician and global health research Akhil Bansal, Center for Global Development head Rachel Glennerster, economist and House of Lords member Jim O’Neill, and Nobel-winning economist Michael Kremer — aims to improve that targeting by getting a better test, one that gives results within minutes and is cheap to produce. If you fund it, they will come The NeoTest team does not, itself, consist of medical test manufacturers. But in Glennerster and Kremer, it includes two of the inventors of a tool called an “advance market commitment” (AMC). AMCs are a way to communicate to companies that there’s a big market for a product which doesn’t yet exist. The participants, which can include governments or other businesses or philanthropists, commit to buying a set amount of the new product, at a set price, from any manufacturers who meet the deal’s specifications. The hope is that this provides an incentive for manufacturers to develop the product, because they know for a fact there will be demand for it. It’s worked before. The first AMC, for better vaccines against pneumococcal bacteria at a time when that disease was killing as many as 1 million children a year, resulted in three new vaccines being developed, and in the number of vaccine doses growing from just 3 million in 2010 to around 150 million in 2016. By one estimate from Kremer and co-authors, the new vaccines enabled by the AMC saved some 700,000 lives between 2010 and 2020. More famously, Operation Warp Speed, the US effort that got effective vaccines against Covid-19 on the market less than a year after the pandemic began, used a purchasing mechanism that worked quite a bit like an AMC. The government purchased hundreds of millions of doses from vaccine manufacturers months before the vaccines were in fact approved — giving the pharma firms confidence to start producing doses in large numbers, and encouraging them to keep up their R&D work. NeoTest is an attempt to put together funds — about $120 million in total — for an advance market commitment for a better neonatal sepsis test. Test manufacturers who are willing to sell for $8 per test ($5 funded by the AMC, $3 by the government of the country receiving the tests) would be guaranteed at least 24 million subsidized orders. Ideally, the test will settle at around $3 as a final price, with the initial subsidy helping fund initial costs associated with developing the tests and setting up manufacturing. A rapid test is not some outlandish dream. Neonatal sepsis experts have been saying we need better diagnostics for years; there’s a whole Neonatal Sepsis Diagnosis Working Group that puts out papers explaining the problem. The WHO has put together a detailed description of what a useful rapid test for sepsis might look like, including elements like the size of the blood draw required and the ideal wait for results. Rapid, point-of-care tests that can give answers in minutes are common at this point for viruses like Covid and the flu, and already exist for some bacterial infections like syphilis. But in part because neonatal sepsis is so concentrated in poor countries, developing a test for it hasn’t been a priority for profit-driven firms to date. Dangling $120 million in front of them might change that. This is a problem developing countries could solve as a group One of the most intriguing aspects of NeoTest to me is that Akhil Bansal, the physician who first devised the idea, is pitching it first to governments of middle- income countries (India, Kenya, South Africa, etc.) that might actually use the test in large numbers. $120 million is a decent sum, but not enormous for a global health project. The pneumococcal AMC, by contrast, was for $1.5 billion. And it’s totally within the budgets of some middle-income countries to contribute a portion of that $120 million, especially when the result is a product that will save the lives of thousands of babies every year in their country. Of course, money is money, and if any foreign aid professionals in upper-income countries or philanthropists reading this piece want to support NeoTest, they should — they’re still actively fundraising and are in need of support. The most important thing is that the problem gets solved. But I found the approach of going first to countries directly benefiting for funding intriguing, and surprisingly heartening at what is otherwise a dark time for global health For one thing, it’s remarkable and encouraging that enough middle-income countries have gotten to the point where funding an initiative like this is within their budgets. That wasn’t true 20 years ago. More importantly, though, it serves as a reminder that the work of development will continue with or without Western governments’ support. That support is invaluable, and I hope it returns. But the Global South is resilient, and increasingly shows an ability to solve big problems for itself. A version of this story originally appeared in the Future Perfect newsletter. Sign up here!

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How to save 400,000 babies a year