Designing Strategies for Neglected Disease Research
Lecture 1A
Amy Kapczynski
UC Berkeley Law
From MSF Campaign for Access to Essential Medicines, AccessNews (No. 18, Jan 2009)
Female Life Expectancy at Birth (2006)
Japan - 86
Sierra Leone - 42
From http://www.globalhealthfacts.org/ and WHO, World Health Statistics 2008
From The Lancet Infectious Diseases Vol 2 July 2002
Health System Building Blocks
From WHO, Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes, WHO’s
Framework for Action (2007)
New Chemical Entities Approved,
1975-1999
13
3
other
tropical diseases
TB
1373
Troullier et al, Drug Development for Neglected Diseases…, 359 Lancet 2188 (2002)
From Nwaka & Hudson, Innovative Lead Discovery Strategies for Tropical Diseases, Nature
Reviews Drug Discovery 5, 941-955 (November 2006)
Worldwide Pharmaceutical
Market by Region, 2005
1%
1%
1%
1%
4%
5%
1%
North America
Europe
Japan
Oceania
45%
CIS
SE Asia
11%
Latin Amer.
Indian subcontinent
africa
30%
CIPIH Report, data provided by IMS Health
middle east
Overseas Development Assistance for
Health, 2001-2006
From Global Forum for Health Research, Monitoring Financial Flows (2008)
WHO “Neglected Tropical Diseases”
:: Buruli Ulcer
:: Chagas disease (American trypanosomiasis)
:: Dengue/dengue haemorrhagic fever
:: Dracunculiasis (guinea-worm disease)
:: Fascioliasis
:: Human African trypanosomiasis
:: Leishmaniasis
:: Leprosy
:: Lymphatic filariasis
:: Neglected zoonotic diseases
:: Onchocerciasis
:: Schistosomiasis
:: Soil transmitted helminthiasis
:: Trachoma
:: Yaws
Adult mortality rates by major cause group and region, 2004
Cardiovascular diseases
High income
Cancers
Other noncommunicable diseases
Western Pacific
Injuries
HIVAIDS
Americas
Other infectious and parasitic diseases
Maternal and nutritional conditions
Eastern Mediterranean
South East Asia
Europe
Africa
0
2
4
6
8
10
Death rate per 1000 adults aged 15–59 years
Slide taken from http://www.who.int/entity/healthinfo/global_burden_disease/GBD2004ReportFigures.ppt, data from WHO
Global Burden of Disease Report 2004
12
Type I, II and III Diseases
• Type I: large burdens of disease in rich and
poor countries
– Hepatitis B, measles
– Cardiovascular diseases, tobacco-related illnesses
• Type II: majority of disease burden in poor
countries
– HIV/AIDS, TB
• Type III: overwhelmingly / exclusively in poor
countries
– Sleeping sickness, river blindness, buruli ulcer, Chagas,
leprosy, dengue, leishmaniasis, guinea worm
From Yach et al., The Global Burden of Chronic Diseases, 291 JAMA 2616 (2004).
Projected deaths by cause and income, 2004 to 2030
30
Intentional injuries
Other unintentional
Road traffic accidents
Deaths (millions)
25
Other NCD
20
Cancers
15
Cardiovascular
disease
10
Maternal/perinatal/nutr
itional
5
Other infectious
HIV, TB, malaria
0
2004
2015
2030
High income
2004
2015
2030
Middle income
2004
2015
2030
Low income
Slide taken from http://www.who.int/entity/healthinfo/global_burden_disease/GBD2004ReportFigures.ppt, data from WHO
Global Burden of Disease Report 2004
Why act against neglected diseases?
(GFHR, MCH)
Health is a key determinant of welfare
-- ill health negatively affects income, education
-- each year 100 million families impoverished b/c of
health spending
-- health second biggest expenditure after food - has
implications for other basic needs (nutrition, housing)
Development
-- huge economic returns to investment in health estimated returns of $3 to $10 for every $1 invested
(compared to $1.2-1.5 in other sectors of economy)
Why act against neglected diseases?
(Fisher & Syed)
National self-interest (externalities, national security,
immigration, trade)
Historical equity (colonialism, wealth / labor extraction,
client regimes / institutions, terms of trade - including
contemporary)
Social utility (R&D directed to do greatest good for
greatest number, DALYs)
Distributive justice (equal concern and respect for
persons, human capabilities, right to health)