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Global Infectious Disease. Dr. Cynthia Schneider Life Science Seminar October 21, 2004. The Facts. The Facts. The Facts. Infectious Disease and the Developing World . 90/10. 90% of global health care focus on 10% of the population 90% of global population receives 10% of health care.

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global infectious disease

Global Infectious Disease

Dr. Cynthia Schneider

Life Science Seminar

October 21, 2004

90 10
90/10
  • 90% of global health care focus on 10% of the population
  • 90% of global population receives 10% of health care
and it s getting worse
And It’s Getting Worse
  • Average number of cases per year has quadrupled since 1980s
  • Malaria deaths among children in eastern and southern Africa has doubled
  • In some areas rate of increase of malaria deaths as high as 11-fold
  • 95-100% of population of tropical Africa at risk of malaria
  • At present rate of increase, half of the world’s population soon will live in malaria infected areas
history of battling malaria
History of Battling Malaria
  • Malaria eliminated in US by draining swamps
  • Early 20th century, organized malaria control
  • Global eradication campaign 1956-1973 failed
  • Chloroquine - cheap, effective treatment (5 cents per dose) until evolution of chloroquine resistant mosquitoes
  • From 1990 onwards, increasing problem in Africa
  • Multi-pronged approach: vector, prevention (vaccine, spraying, nets) , drugs for treatment
battling malaria today the players
Battling Malaria Today : the Players
  • Gates Foundation, Malaria Vaccine Initiative:
  • Assumptions (source: Gates Foundation web site)
  • A strong foundation of malaria research already exists;
  • Progress along the malaria vaccine development pathway will be measurable;
  • Current market forces requiring a return on investment cannot drive malaria vaccine development alone, requiring a balance of push and pull mechanisms for success; and
  • Effective disease prevention will ultimately require combination vaccines that include several antigens from different stages of the Plasmodium life cycle and elicit a breadth of immune responses.
gates foundation mvi
Gates Foundation MVI
  • Approach
  • Partnerships
  • Vaccine Development, not Discovery
  • Pursues multiple vaccine candidates simultaneously
  • Uses industrial model of management with goal of ensuring that MVI funding results in net increase in funding for vaccine development
gates partners
Gates Partners
  • PATH – international NGO for sustainable, culturally sensitive solutions to health problems in developing world
  • Glaxo Smith Kline (GSK)
  • GAVI Global Alliance for Vaccines and Immunization
  • Mozambique – GSK Biologicals, Mozambique Ministry of Health, Centro de Investigacao em Saude da Manhica (CISM), Hospital Clinic of the University of Barcelona
gates funding for malaria
Gates Funding for Malaria
  • MVI at PATH 50 million over 4 years (4/1/99)
  • 100 million over 4 years (9/21/2003)
  • Other grants, such as to One World Health –1.4 million
  • Compared to total funding for malaria – about 80 million in 2004
the players
The Players

MMV –Medicines for Malaria

  • Swiss Foundation established 1999
  • Public Private Partnership
  • WHO, IFPMA (International Federation of Pharmaceutical Manufacturers Association), Global Forum for Health Research, Rockefeller Foundation, World Bank, Swiss Agency for Development and Cooperation, Association of the British Pharmaceutical Industry, Wellcome Trust
  • Formed as alternative to market mechanisms, which have not led to vaccine development
rbm roll back malaria
RBM –Roll Back Malaria
  • 1998- WHO, UNICEF, UNDP, World Bank, plus 90 other partners
  • Goal to halve malaria by 2010
  • Multi-faceted Strategy, with emphasis on “low tech’ interventions:
    • Preventive treatment during pregnancy
    • Artemisinin-based combination therapy for treatment
    • Vector control
      • Insect-treated nets
      • Indoor residual spraying
low tech weapons against malaria
“Low Tech” Weapons Against Malaria
  • Artemisinin
  • Mosquito nets
  • DDT
artemisinin an organic antidote to chloroquine resistance
Artemisinin – an organic antidote to chloroquine resistance
  • Artemisinin and artesunate come from an herb used in traditional Chinese medicine
  • Combat chloroquine resistance
  • Works best when combined with another anti-malarial
  • Artemisinin in combination with other anti-malarials has cure rate of 90%
  • PROBLEM: Artemisinin currently grown in Tanzania, exported to Europe for processing, re-imported to Africa at prohibitive cost of $5-7 per dose
policy choices whose standards are they anyway
Policy Choices: Whose Standards Are They Anyway?
  • DDT -- arguably readiest, cheapest means to combat malaria
  • Not used in developing world because of regulatory standards in developed world
  • Northern/western driven environmental standards have (inadvertent) impact on health in developing world
  • How to balance environmental safety and human health?
  • Risk evaluation that incorporates risk of doing nothing
slide23
Another approach -- modify the vector
  • Genetically alter mosquito so that it cannot transmit disease (prevents malaria parasite from binding onto mosquito’s gut; interrupts malaria life cycle)
  • Genetically alter mosquito so that it produces more defensin, which kills malaria bacteria (like a vaccine imbedded in mosquito)
  • Problems: How to regulate? How to ensure environmental safety?
role of department of defense
Role of Department of Defense
  • “New” vaccine recently tested in Mozambique was developed at Walter Reed
  • DOD operates largest malaria drug development program in world, emphasis on drug resistance (IOM Emerging Infectious Diseases from the Global to the Local Perspective, 1999)
  • DOD has large network of state-of-art labs all over world -- 700 staff, with 800 in DOD who work with them on infectious diseases
  • Focus on safety of troops has led to comprehensive surveillance/monitoring system
  • Links to WHO and other health agencies
flu vaccine crisis reveals u s vulnerability
Flu Vaccine Crisis Reveals U.S. Vulnerability

Systemic problems with vaccines:

1) high cost of manufacturing and passing regulatory hurdles;

2) limited U.S. and foreign markets;

3) Product liability exposure.

towards a different model
Towards a Different Model
  • Need to create incentives for more private companies to develop vaccines
  • Requires creative rethinking of public/private balance and roles
  • How to create incentives for more public and private entities to tackle infectious diseases in developing world
  • How to balance western/northern regulation standards with needs and capacities of developing world
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