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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

Dr. Cynthia Schneider

Life Science Seminar

October 21, 2004






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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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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



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Malaria-endemic Countries in Africa, the Middle East, Asia, and the South Pacific, 2002

www.cdc.gov



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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


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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.


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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


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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


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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


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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


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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


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“Low Tech” Weapons Against Malaria

  • Artemisinin

  • Mosquito nets

  • DDT


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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


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Policy Choices: Whose Standards Are They Anyway? resistance

  • 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


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  • Another approach -- modify the vector resistance

  • 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?


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Role of Department of Defense resistance

  • “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


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Flu Vaccine Crisis Reveals U.S. Vulnerability resistance

Systemic problems with vaccines:

1) high cost of manufacturing and passing regulatory hurdles;

2) limited U.S. and foreign markets;

3) Product liability exposure.


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Towards a Different Model resistance

  • 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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