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Over 70 years ago the United Nations established World Children’s Day, which was to be celebrated every year on 20 November
What is World Children’s Day?
United Nations understood the need to promote international togetherness in improving children’s welfare.
World Children's Day offers each of us an inspirational entry-point to advocate, promote and celebrate children's rights, translating into dialogues and actions that will build a better world for children.
For Unicef, World Children’s Day is a day of action to mark the adoption of the Convention on the Rights of the Child. It is a day to raise awareness of the need to indiscriminately protect and fulfil the rights of every child.
What is CELT Global Health’s work for Children?
Under the co-direction of Professor Andrew Owen and Professor Steve Rannard, CELT Global Health specialise in creating long-acting versions of medications that are already on the market. By working with already existing medicines, we know they’re already safe and effective.
There are lots of illnesses around the world, that are either treatable or preventable, that are not being either prevented or treated. From a behavioural perspective, we can see that some illnesses have a high ‘pill burden’, which means they require a lot of oral medicines over a long period of time, often at specifically-timed intervals. These can be very hard to maintain, especially when the patient is a child.
Our hope is that long-acting medications will help drug adherence through removing the pill burden of certain medicines and we have projects that focus specifically on children.
LONGEVITY project and malaria
The LONGEVITY project is one of CELT Global Health’s largest programmes of research and development. It’s funded by global health agency Unitaid and concentrates on creating either long-acting treatments or preventatives for tuberculosis, hepatitis C virus and malaria.
LONGEVITY is an international consortium making sure the entire journey, from concept to patient, prioritises patients in low- and middle- income countries (LMICs) where these diseases have the largest impact. It includes preclinical and clinical researchers, patent experts, community engagement specialists, policy makers and more.
Our collective malaria work has a large focus on children as, not only is malaria’s mortality rate disproportionately high in LMICs, but the vast majority of deaths from malaria are in children under 5 years of age. From the World Health Organization’s malaria factsheet breakdown, we can see the devastating numbers that around 432,440 children, between birth and five years old in the WHO Africa Region died of malaria in 2023 alone.
Proof of concept
Understandably, something needs to be done about the awful mortality rate of this disease, but developments in malaria research have been stagnating. On the 12 November this year, the first new drug for malaria in decades showed promising results in a clinical trial offering new hope to countless people around the globe . This is a tremendous achievement, and recent progress towards using long-acting technologies to make better use of existing drugs is also offering new hope.
LONGEVITY’s malaria work follows a different path to tuberculosis and hepatitis C virus, due to its paediatric nature. We’re working with Queens University Belfast to see if long-acting malaria preventative medications can be administered to children via a microarray patch rather than an injection.
Microarray patches would mean children receive their long-acting dose of medication via a patch that they wear for a few of hours. After that time, the medicine is within their bodies and releases over a long period of time. The hope is that we’ll have proof of concept for a patch that can be worn once a month for a few hours, rather than children needing to constantly wear a patch or manage regular pills. Unlike injections, the patches are minimally invasive and so may be particularly appropriate for children.
If we can achieve proof of concept, we hope it will open the opportunity to create patches to help eliminate malaria while avoiding pill burdens and the stigma that can come with them.
Community of Practice for long-acting therapeutics for maternal and paediatric health
CELT Global Health head a Community of Practice for long-acting therapeutics for maternal and paediatric health, which is also funded by global health agency Unitaid. Overseen by the Perinatal Pharmacology Group and headed by Dr Adeniyi Olagunju, we’re gathering a global multidisciplined team of motivated organisations, groups and individuals representing a variety of stakeholder groups. We aim to strengthen the approach for the consideration and inclusion of pregnant and lactating patients, and children in clinical trials of long-acting therapeutics.
Often clinicians need to make treatment decisions for pregnant and lactating patients and children with little to no safety data about medications for these populations, and we want to make sure that long-acting therapeutics don’t follow that pattern. Trust in medication starts with science but absolutely requires meaningful and impactful engagement with the communities who can benefit from them.
Dynamic paediatric physiology – affects on pharmacokinetics, pharmacodynamics and development of long-acting therapeutics
The first webinar of the Community of Practice took place in March 2025 and included a talk by Professor Edmund Capparelli from the University of California, San Diego, titled ‘Dynamic paediatric physiology – affects on pharmacokinetics, pharmacodynamics and development of long-acting therapeutics’.
It highlighted the developmental changes in children that impact drug absorption, distribution, metabolism, and excretion. The presentation explained the importance of age-specific dosing strategies and the variability in drug exposure across age groups in children, especially for biologics and monoclonal antibodies.
The data presented reinforced the importance of tailored approaches in paediatric drug development to ensure safety and efficacy for these patients.
Long-acting therapeutics in paediatric health
In July the Community of Practice had its first in-person meeting of members. Over one day there were four sessions that included maternal health, paediatric health, global health and reporting back from specialist breakout sessions.
The second session of the day was ‘Long-acting therapeutics in paediatric health’ and was chaired by Professor Dan Hawcutt, Director of Research at Alder Hey Children's Hospital and recently appointed Founding Director of the new Liverpool Institute of Child Health and Wellbeing.
A full recording of the session can be seen on our YouTube channel.
Paediatric health priorities – Identifying where the need is greatest
The first speaker was Professor Moherndran Archary from the University of Kwa-Zulu Natal. The key takeaways included that:
- Infection in children over 5 years old is a huge burden to health systems globally.
- Children and adolescents account for 57% of communicable diseases across all age groups
- Children who die from infections often have complex causal pathways, and it is uncommon for a single infection to be solely responsible for their death.
- Professor Archary asked us where we as a Community of Practice sit with this?
- He explained that we need to look at alternative formulations that can be produced in low- and middle- income countries to make them more accessible, especially in countries with lower funding for respiratory syncytial virus immunisation programmes.
- Children and adolescents account for 57% of communicable diseases across all age groups
A full recording of Professor Archary’s session can be seen in the YouTube recording of the session.
Pharmacokinetics and safety considerations for long-acting therapeutics: use in children
The second speaker for this session was Professor Edmund Capparelli from the University of California, San Diego. A full recording of Professor Capparelli’s talk can be seen on our YouTube recording, but some key points included:
- Children and young people on long-acting HIV treatment combination, cabotegravir and rilpivirine, reported preferring long-acting injectables to pills, even those who also reported discomfort or pain in the injection site.
- Getting long-acting lenacapavir, a newly approved long-acting HIV pre-exposure prophylactic, into children will be complicated as there are additional steps in the process for that patient group.
If we understood the rate of long-acting therapeutics’ absorption better, it would be easier to move them on to other populations, such as the paediatric population.
Long-acting therapeutic technologies and innovations: potential applications for paediatric health priorities
The last session for the Paediatric Health panel was Prajith Venkatasubramanian from the University of Liverpool’s Perinatal Pharmacology Group. A full recording of this talk can be seen on our YouTube channel, but key points included:
- We must think about the different physiologies of the different stages in childhood, from premature infants through to adolescents.
- Children have a higher bodily water content, which is a major consideration and can be used to help injection site pain as higher water concentrations in the formulations could be used to tackle this.
- Long-acting injectables are not always suitable for paediatrics because of needle phobia:
- Adult injection site pain can be reported up to 7 days afterwards, so we need to know what it is for children
- This must be carefully considered, as it is essential to provide long-acting therapeutics for paediatric populations in a manner that improves quality of life.
Why aren’t long-acting therapeutics widely used in paediatrics?
- A lack of prescribing guidelines and policy
- Manufacturing complexity and scale up challenges
- They offer a low-profit margin to commercially focused stakeholders
Long-acting formulations are not prioritized for regulatory approval in paediatric populations by regulatory authorities.
Potential for long-acting injectables in malaria control and elimination
During the Global Health panel, Andre Tchouatieu from Medicines for Malaria Venture included a key point for consideration within long-acting malaria preventative therapeutics. Long-acting treatments provide us the opportunity to target the children most at risk of seasonal malaria. As it’s seasonal, they don’t require treatment all year round, so if a long-acting malaria preventative lasts three months that’s only two doses a year, one as the season is beginning and one during.
You can see Andre’s talk within the session in our Global Health panel recording from the day, it really helped to highlight the practical application of these paediatric discussions with real world input from the teams working directly with the patients of concern.
Medical research often falls short of representing all patient populations, but we remain committed to doing better. Children and young people are among the most vulnerable and important groups in clinical care. Our work must also consider caregivers' who are responsible for decision making and often administration of medicines. It is important to note that the age children and young people start to make their own decisions related to healthcare varies across counties and cultures.
We understand how important this is, and it’s why children are a focus within large proportions of what we do. We try to advocate for children within our own work, and we will keep working to protect them, wherever they are, from these horrendous diseases that cause them so much harm.
#WorldChildrensDay
The Community of Practice for long-acting therapeutics for maternal and paediatric health is funded by global health agency Unitaid.
