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Global Infectious Disease

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

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  1. Global Infectious Disease Dr. Cynthia Schneider Life Science Seminar October 21, 2004

  2. The Facts

  3. The Facts

  4. The Facts

  5. Infectious Disease and the Developing World

  6. 90/10 • 90% of global health care focus on 10% of the population • 90% of global population receives 10% of health care

  7. Malaria: a Case Study in Infectious Disease

  8. Malaria: the “Silent Holocaust”

  9. 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

  10. Poverty and Malaria

  11. Malaria-endemic Countries in Africa, the Middle East, Asia, and the South Pacific, 2002 www.cdc.gov

  12. Malaria-endemic Countries in the Americas, 2002

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. “Low Tech” Weapons Against Malaria • Artemisinin • Mosquito nets • DDT

  21. 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

  22. 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

  23. 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?

  24. 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

  25. 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.

  26. 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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