Total humanitarian funding toward Ebola...Ebola dramatically reduced 2014 growth compared with...
Transcript of Total humanitarian funding toward Ebola...Ebola dramatically reduced 2014 growth compared with...
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Total humanitarian funding toward Ebola
Response plan
funding, $1.42 billion
Other funding,
$1.8 billion
Pledges, not yet
received, $618 million
Source: United Nations.
Total committed or
contributed funding :
$3.22 billion
Outstanding pledges:
$618 million
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Ebola response plans face a funding gap of almost US$1 billion
0.0 0.1 0.3 0.4 0.5 1.1 6.9
20.9
36.1
48.2
55.0 58.5
61.7
0
10
20
30
40
50
60
70
Mar-2014 May-2014 Jul-2014 Sep-2014 Nov-2014 Jan-2015 Mar-2015
Source: United Nations.
Percent of funding requirements met
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Ebola could cost the West African economy up to $32.6 billion
2.2 1.6
7.4
25.2
0
10
20
30
Short-term impact Medium-term impact
$ billions
High Ebola estimate (disease spreading)
Low Ebola estimate (disease containment)
Source: World Bank.
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Ebola dramatically reduced 2014 growth compared with
projections
4.5
5.9
11.3
0.5
2.2
4.0
0
4
8
12
Guinea Liberia Sierra Leone
Percent
Actual
Projected
Source: World Bank.
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Reductions in 2015 growth rates lead to a projected
$1.6 billion in forgone GDP due to Ebola
Source: World Bank.
540
180
920
0
200
400
600
800
1000
Guinea Liberia Sierra Leone
$ millions
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Other diseases, 813 products
registered Neglected diseases, 37
products registered
Source: The Lancet.
Treatments targeted at neglected diseases represented less
than 5% of 850 new therapeutic products registered in 2000-11
* Neglected diseases were defined as malaria, tuberculosis, diarrheal
diseases, neglected tropical diseases, and other diseases of poverty.
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U.S. government funding for emerging infectious diseases
45 58 47
230
45 55 46
211
46 73
n/a
260
46 50
n/a
257
0
50
100
150
200
250
300
CDC Global DiseaseDetection and
Emergency Response
USAID/State Dept.Pandemic Influenza andOther Emerging Threats
DoD Global EmergingInfections Surveillance
and Response
DoD CoorperativeBiological Engagement
$ millions 2012 2013 2014 2015
Sources: U.S. Foreign Assistance Dashboard, Kaiser Family Foundation.
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Sources of funds for R&D on neglected diseases
Public (high-income governments),
62.6%
Public (multilaterals), 0.2%
Public (low- and middle-income
governments), 2.1%
Philanthropic, 18.5%
Private (multinational
pharmaceutical companies), 14.4%
Private (small pharmaceutical and biotech companies),
2.0%
Source: World Health Organization.
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Allocations of R&D for neglected diseases, 2010
HIV/AIDS, 35.0%
TB, 18.8%
Malaria, 17.9%
Dengue, 5.8%
Diarrheal diseases, 5.2%
Kinetoplastids, 4.8%
Bacterial pneumonia and meningitis, 3.0%
Helminths, 2.4% Salmonella
infections, 1.4% Other, 5.7%
Source: World Health Organization.
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Despite progress in treatment, tuberculosis still costs billions
to global economy
Each year, TB results in:
• 8.4 million patients
• A 30% decline in average productivity loss of US$1 billion
• Two million deaths deficit of US$11 billion
The TB death rate dropped 45% between 1990 and 2013.
• 37 million lives saved through effective diagnosis and treatment, 2000-
2013
• US$2 billion needed to fill resource gap to implement existing TB
interventions
Sources: World Health Organization, Science and Society.
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Investment in AIDS treatment generates $19.8 billion in returns Cohort of 3.5 million, cumulative 2011-2020
-14.2
31.8
0.8 1.4
19.8
-20
-10
0
10
20
30
40
Program cost Labor productivity Orphan care costsaverted
End-of-life costsaverted
Net benefit
$ billion
Source: PLOS One.
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Malaria costs Africa $12 billion every year
• Countries with endemic malaria had income levels that were only
33% of those in countries that do not suffer from malaria.
• Countries with a severe malaria burden grew 1.3% less than those
without each year.
• Aggregate loss owing to the disease in 25 countries was more than
15% of GDP.
Sources: Science and Society, Gallup.
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Ebola is a blip on the historical perspective Tuberculosis: Biggest infectious disease killer in human history
Source: Nature / World Health Organization World Tuberculosis Report 2013.
0.0
0.5
1.0
1.5
Ebola Tuberculosis
1.5 million deaths
7,905 deaths
2014: Deaths Ebola vs. Tuberculosis Millions
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Extensively Drug-Resistant Tuberculosis (XDR-TB) “XDR-TB: Ebola with wings.” Coming to a country near you?
• Airborne transmission with mortality similar to Ebola (30-70%)
• Found in 100+ countries
• At least 2x as many cases (43,200) last year as the total number of cases
of Ebola (20,206)
Source: World Health Organization, 2015.
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Vaccines: An Extraordinary Track Record
“Among the most cost-effective health interventions ever developed”
– The Bill & Melinda Gates Foundation
Source: Aeras.
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Vaccine development: expensive and risky
• Risk at every step
• Major outlay of money
toward the end of the
process: Phase 3 and
manufacturing
• “The valley of Death”
• Raising manufacturing
standards and Regulatory
requirements
• Remaining targets are
scientifically challenging
Fact sheet
April 2009
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Vaccine Development is a long process
EXPLORATORY PRECLINICAL CLINICAL DEVELOPMENT REGISTRATION LCM
Many years 1-2 years 4-8 years 3 years
Preclinical PoC File Launch
Phase III
• Large scale safety
+
• Lot to lot consistency
+
• Non inferiority (combos)
or
• Efficacy
Post-marketing
commitments
• Safety
• Effectiveness
Pharmacovigilance
Industrial Investment
done early and at risk
Done mostly outside of
the “Big Pharma”
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Opportunities for improvements are
numerous
EXPLORATORY PRECLINICAL CLINICAL DEVELOPMENT REGISTRATION LCM
Many years 1-2 years 4-8 years 3 years
“Animal Rule” Post-Marketing
Commitments
Standardized CMC
Standardized and modular
manufacturing
Reverse Vaccinology
and other ‘omics
Synthetic Biology
Clinical Trials in a test tube
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Te
chnic
al F
easib
ility
The many remaining vaccine targets are
scientifically challenging
Medical Value/Market Attractiveness
• GBS
Chikungunya
E. coli UTI
E. coli 0157
Enterovirus 71
H. pylori (ther)
Dental carries
S. paratyphi
Leishmaniasis
Norovirus
Otitis Media
Parvo B19
PIV
Schistosomiasis
Shigella (prot)
Rhinovirus
S. aureus
S. CoNS
RSV
Bocavirus
C. jejuni
Cholera
Epstein-Barr Virus
HHV-6
Legionella
M. pneumoniae
Hantavirus
Hep C (ther)
hMPV
HSV 2
hMPV-PIV Combo
CMV
P. acnes
Enterococcus
TB latency
A baumannii
Klebsiella
E. coli nosoc
P. aeruginosa
Periodontal
ETEC
GAS
• N.gonorrhea
• Tryposonomia
sis
Preferred but
empty quadrant
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Is there a crisis in the making in the Industry?
• 2 Vaccine manufacturers have recently exited: Novartis and Baxter
• Another has reduced its product line: J&J
• Most GAVI vaccine are supply constrained, DTP supply crisis for
UNICEF
• Share of vaccine trials among all clinical trials decreasing
(clintrial.gov)
• Asymmetry in the Eco system: “R&D” and “non R&D” producers
• Compete through Innovation vs Compete through Low Cost
• Need for a balanced Ecosystem
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Thanks to BMGF and other donors, HIV, Malaria and TB are
no longer neglected But is enough done for the others?
Source: clintrial.gov
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Framework for health sector response & early recovery from
the Ebola crisis
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Confirmed cases of Ebola in Guinea, Liberia and Sierra
Leone
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Decline of Ebola in Guinea and Sierra Leone
confirmed cases each week
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Guinea, Liberia, Sierra Leone: most infection on West coast
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West Africa epidemic curve
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West Africa epidemic curve
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R&D
Vaccines
• Phase III vaccine trial of Canadian vaccine VSV-EBOV started in
communities in Coyah and Conakry on 23 March 2015
• The trial is sponsored by Guinea with WHO and MSF
• So far about 500 people have been vaccinated in 15 rings. More rings will
be set up as contact tracing continues, with the aim of vaccinating 10 000
people.
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R&D
Drugs
• siRNA (Tekmira) RCT trial in Sierra Leone has enrolled 21 patients, of
which 11 were included in the treatment arm (n = 100)
Diagnostics
• Assessment of the ReEBOV Antigen Rapid Test Kit (Corgenix) by
Partners in Health on 25 blood samples found the test had 100%
sensitivity (cf 92% in the WHO study) and 92% specificity (cf 85% in
WHO study)
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Getting to “zero”: Guinea, Liberia, Sierra Leone
Outbreak ended in any one of the above countries 42 days after last
confirmed case has tested negative twice for the virus
After 42 days, each country should maintain a system of heightened
surveillance for a further 90 days
End of the outbreak in the West African sub-region will be declared when the
42-day period has elapsed in the last affected country
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WHO’s role in fighting Ebola
Information & Data
• Data to quantify the epidemic
• ≈60 technical documents and
guidelines
People
• Rapid deployment >2000 technical
experts, >500 through GOARN, staff
for 26 mobile laboratories, >100
logisticians, 58 foreign medical teams
Hospitals
• Built 5 Ebola Treatment Units (ETUs),
technical support for 70+ ETUs, 150+
community care & holding centres
Equipment
• Delivered > 1.4 million kits Personal
Protective Equipment
Research & Development
• Investigation of vaccines, drugs,
therapies, and diagnostics
Coordination & Partnership
• Coordinated health response to Ebola
across West Africa (3+4+)