Access to Medicines For the Developing world

1. Access to Medicines For the Developing world Andrew Gray March 10, 2009 www.ubc-uaem.org

2. Global disease burden: Average life expectancy

3. Global disease burden: Explanations Poverty • Basic nutrition and clean water • Shelter • Education • Basic medical care (public health) • Lack of access to health care workers • Lack of access to health care tools

4. Poverty • Basic nutrition and clean water • Shelter • Education • Basic medical care (public health) • Lack of access to health care workers • Lack of access to health care tools

5. Essential Medicines • Fundamental to basic care • WHO lists 312 essential medicines • 33% of the world has no access *Cough*

6. The problem we’ll be focusing on: • Billions of people around the world don’t have access to the medicines they need in order to survive and thrive. • Why?

7. The Access Gap • The systematic inability of individuals in developing countries to obtain existing and essential medicines

8. Neglected Diseases • Mostly tropical infections • Primarily affect the poor • The top 13 tropical infections currently infect 1 billion people world wide • The research gap: for many of these diseases, safe, effective treatments do not exist

9. Malaria • The #1 cause of death of children under 5 in Africa • Current treatments: • Resistance problems for all drugs except artemisinin • Frequent shortages of artemisinin • Reduced African GNP by 1.3% from 1965 to 1990, for a total reduction of 50%. 1 1Gallup, J. and Sachs, J. American Journal of Tropical Medicine and Hygiene, 2001; 64 (1, 2) S., p.90

10. Visceral Leishmaniasis • ~50,000 deaths worldwide / year. • Main treatments require hospitalization for several weeks • Serious adverse side effects, IV administration • Better treatments available, but expensive • Lack of effective diagnostics: testing is complicated and requires highly experienced staff. Enlarged spleen & liver in VL patient.

11. Neglected Diseases The “big three”: • HIV/AIDS • Malaria • Tuberculosis • “Most neglected” diseases: • African sleeping sickness • Dengue fever • Leishmaniasis • Schistosomiais • Chagas disease • Leprosy & many others

12. Proportion of new drugs, 1975-1999 The research gap Relative contribution to global disease burden (DALYs) Trouiller et al., Lancet 2002, 359:2188-94

13. From discovery to drugs ?

14. The drug development pipeline Identify promising leadsFormulate as a pill (e.g.) RegisterMass-produce Assess safety and effectiveness

15. Where Do Universities Fit In? • University research is vital to the development of new medicines. • 15 of the 21 most important drugs introduced in the US between 1965 and 1992 were developed using knowledge and techniques from federally funded research. 2 2 The benefits of medical research and the role of the NIH. United States Joint Economic Committee, 2000.

16. University Contributions to Drug Discovery Researchers develop new technologies Universities patent these technologies Patent rights are licensed to industry Industry assesses safety and efficacy

17. Stavudine • Antiretroviral used to treat HIV • Discovered at Yale • Licensed to Bristol-Myers Squibb (BMS) • BMS trade name: Zerit

18. Stavudine • Price in 2001: $10,349

19. Price in 2001: $10,349 Price in 2008: $87 (generic production)

20. Addressing the Problem Goals: • Access to essential medicines • Neglected disease research

21. Global access licensing at Ubc • Adopted in 2007 • UBC is committed to: 1. Ensuring the world’s poor get fair access to its technologies 2. Seeking partnerships to provide funding for ND research areas 3. Developing new technologies to benefit the developing world.

22. UBC leads the way • 2007: UBC establishes first GAL module in Canada • Dr. Kishor Wasan’s lab develops a novel formulation of the drug Amphotericin B (Amp B) • Amp B is efficacious in treatment of blood borne fungal infections as well as VL

23. Oral amp b formulation • Why? - Intravenous injection requiring up to 30 days in hospital - Expensive, loss of income during treatment, low availability • Solution: Amp B that can be orally administered - Easily transported and administered, less expensive, accessible even in remote regions with minimal medical facilities.

24. Global access licensing...In action! • iCo Therapeutics will commercialize oral formulation • iCo has global rights to make/sell drug in developed world as a treatment for blood-borne fungal infections • Will ensure availability of drug to developing countries to treat VL through subsidized pricing. • UBC’s University-Industry Liaison Office and the UBC Chapter of Universities Allied for Essential Medicines worked to formalize agreement.

26. Further challenges • Developing global access strategies at other universities • Funding for Neglected Disease research at UBC and elsewhere

27. Take-home points • Join UAEM (or find us on Facebook) • Tell your friends/mom/everyone you know what you learned today. • Your career? • Advocate with us – eg. CAMR reform. • Talk to your professors.

28. Thank you for your time Questions? Comments? Interested in getting involved? info@ubc-uaem.org www.ubc-uaem.org