Research in infectious diseases and antibiotic resistance : Funding

The French situationPr JF Delfraissy,

Director ITMO I3M and ANRS, Interministerial Coordinator of the fight against Ebola

AMR INTERGOVERNMENTAL WORKSHOP

Paris, November 17, 2015

Medical and Scientific challenges

• Emerging diseases; zoonosis, human ecology, biodiversity

• Resistance : Bacteria, Tuberculosis, (worldwide problem )…

• Transmission of infection and resistance (mechanisms, nosocomial…)

• Infectious agents and non infectious diseases: cancer, cardiovascular, obesity, allergy, inflammation,…

• Vaccination: new vaccines, immunity, SHS…

• The big 3 : HIV, Tuberculosis, Malaria

Deaths from Infectious Diseases

15M/59M. Year (25%)

Death from resistance to antibiotics

US +EU+ thailand > 90.000(WHO 2014)

The rest of the world ????

Microbiology and Infectious DiseasesKey points: France 2015

• Major Institutions : Institut Pasteur, Inserm, CNRS, IRD

• Others : ANRS, CEA, CIRAD, INRA, INVS, Universities

• 12% of French research forces: 300 teams, 2000 Scientists & Technical staff

• 18% of French biomedical publications: 5000 publications per year

• Translational and clinical research: 35 clinical units involved, including HIV and hepatitis

• Network of vaccine research centers

• Large research network in resource limited countries

17 units work in close relation with Resistance to antibioticsNot including clinical research

Main research Institutes in the field

National Institute for Health and Medical ResearchTotal budget*: € 972.2 million (year 2013)

Institut PasteurTotal Budget*: € 282 million (year 2013)

National Center for Scientific ResearchTotal budget*: € 3,415 million for 7 institutes (year 2013)

Institute for Research for DevelopmentTotal budget*: € 234 million (year 2013)

Agricultural Research Center for DevelopmentTotal budget*: € 197 million (year 2014)

Strengths in clinical and

translational research

Rouen

Brest

Saint-

Pierre

Ile de

la

Réuni

on

Cayenne

Pointe-à-Pitre

Fort-de-France

9 CIC-Clinical Epidemiology

Network of CIC in Vaccinology: REIVAC

54 Investigation Clinical Centers (CIC)

Network of ID centers: RENARCI

French Clinical Research Infrastructure Network

The overall coordination

IBEID

ALLEnvi

National alliance for research on environment

Project Funding/year: infectious

diseases and immunology

PHRC: Clinical Research Hospital Programme€ 7 m

National Research Agency€ 9 m

National Research Agency for AIDS & Hepatitis€ 35 m

• National level:

• Regional level: academia, patients associations,foundations ...

AMR: Where does the money come from in France ??

In-kind money (salaries is not included)

- Some money is directly given to support the units working on antibiotics and related topics INSERM, CNRS, ANSES, CEA, INVS Pasteur: Estimate: ≈1.200.000 Euro/year- No specific French Call for the antibiotic resistance and the related microbiology

Other SOURCES: Competitive grants with other thematics: estimate money for

ANR up to 2.000.000 Euro/year(2014-2015)PHRC (Public Clinical research ) up to 300 000 Euro/year FP6/7/JPI-AMR up to 1.000.000/year

Other sources : industries Unknown !

- Funding for Pharmaceutical Clinical trials on antibiotic therapies is not included

• 60 projects whichrelates to AMR

• € 20,1 M

• Laboratories : Anses, CNRS, CEA, INSERM, INRA, ENVT, ENS, University, HospitalsInstitut Pasteur, Institut Curie, Other...

Source Financement (%)

ANR 65,5

PHRC 10,6

Principauté de Monaco 6,5

Fondation R. Follereau 2,9

CEA 2,2

FRM 2,2

INSERM 2,1

Ministères 2,1

OSEO FUI 1,7

ANSES 1,7

INRA-ANSES 1,2

FranceAgriMer 0,9

Fondation infectiopôle sud 0,5

Funding dedicated to AMR 2007- 2014

Some dispersion of the forces working

on the “one health field of AMR” from

clinical research to the fundamental research Is explained by the different bodies in charge

of the research

AMR : A one health priority

Ministry of health : Ministry of research :

Ministry of Ecology, SustainableDevelopment and Energy

INSERMMedical research

PHRC (Clinical research)ANR (fundamental Research; all fields)

ANSES(Antibiotics and animals)

Food, Environmental ; animal Health & Safety ;

Ministry of agriculture

INRA research onAlimentation and Animal-

Agriculture -Environnement

INVS

Epidemioçlogy

Marisol Touraine , Minister for Health, announced in September 2015

the National plan for the preservation of antibiotics

Among others actions it emphasize the need for a better coordination of the actors working in the context the one

health antibiotic resistance

Propositions for the French national plan for preservation of antibiotics (September 2015)

Recommendations1 : National strategy for research on AMR and development of innovative products to fight AMR 2 : Find indicators to follow AMR in all fields and its cost3 : Improve the proper use of antibiotics (professional training ,

specialized call centers)4 : population awareness on antibiotic prescription

Transversal tools for its application 1. Creation of an Interministerial Committee for AMR2. Assign funds for 5 years for interdisciplinary research and

innovation for AMR3. Develop a special status for products raised to fight against AMR4. To declare AMR as one of the 2016 national causes

Four main administrative forces exist which should participate to the fight against AMR in our country and

contribute to the JPI-AMR programmes

- Ministry of research French agency for basicand PPP research (ANR....)

- Ministry of health French program for clinical research (PHRC).

- Ministry of agriculture and Ministry of Ecology, Sustainable Development and Energy research on the Animal and environment.

ConclusionsSince Anti Microbial Resistance belongs to many fields (one health perspective) for cost and efficiency reasons It is not possible to dissociate the differentResearch programmmes according to our respective administrative departments

This is true for developed countries but also less developed countries which are highly impacted by this problem

If we want to tackle this societal problem the tools are:-A mandatory coordination in each country and between countries of the different bodies in responsibility of AMR- The establishment of transversal programmes (from clinic -to fundamental research)

Back Up

IMMI: French Biomedical research Centers

Institut Pasteur ParisPitié SalpétrièreOrsay/Mondor/Bicêtre/CEABichat/St LouisCochin/Cordeliers

BIOPOLE Lyon-Grenoble IRT Lyon/Pasteur

Institut Pasteur Lille

Bordeaux

Strasbourg

INFECTIOPOLE SudMarseille-Montpellier-NiceIHU

Toulouse