THE IMPORTANCE OF INNOVATION IN ADDRESSING GLOBAL …€¦ · 2012 grant payments . DO WE NEED...

© 2014 Bill & Melinda Gates Foundation

THE IMPORTANCE OF INNOVATION IN ADDRESSING GLOBAL HEALTH GAPS IN THE DEVELOPING WORLD Global Vaccine and Immunization Research Forum

DR. TREVOR MUNDEL

PRESIDENT, GLOBAL HEALTH

March 6, 2014

© Bill & Melinda Gates Foundation | 3

WHAT WE DO

GLOBAL HEALTH GLOBAL DEVELOPMENT UNITED STATES PROGRAM


OUR GLOBAL REACH AND PRESENCE

Ethiopia

London

Beijing Washington DC

New Delhi

Nigeria

South Africa

Seattle

1,200 1,198 1,096 1,092 1,003 940 881 792 735 680 612 553 475 402 343 260 185 123 61

1,116 1,114 1,110 1,100 982 944 887 764 662 602 543 484 411 365 307 238 180 127 64

$3.4B $3.3B $3.2B $3.1B $3B $2.8B $2.4B $2.1B $1.6B $1.1B $943M $684M $401M $215M $122M $81M $1.2M $533K $10K

2012 active grantees

2012 employees worldwide

2012 grant payments

DO WE NEED

INNOVATION IN

GLOBAL HEALTH …beyond better delivery of existing simple solutions?

PROGRESS IN REDUCTION

1990 2012 2015

Under-five 90

48

MDG 4

target: 30

Infant

35

63

Neonatal

21

33

Deaths/1,000

live births

of under-five, infant and neonatal mortality rates

Pneumonia ~1.1M 17% of all U5 child deaths

Diarrhea ~594,000 9% of all U5 child deaths

Malaria ~627,000 7% of all U5 child deaths

MAJOR PREVENTABLE CAUSES

2012

of under-five (U5) child deaths from infectious diseases

TECHNICAL HURDLES TO

IMPACT ARE HIGHER IN

GLOBAL HEALTH …due to environmental factors and broken delivery systems.

WHAT IS INNOVATION

IN GLOBAL HEALTH?

DOUBLED

MANUFACTURERS supplying GAVI-funded vaccines

2011

2001

>TWO THIRDS of children worldwide get vaccines from DCVMs

>50% of GAVI’s vaccine suppliers are DCVMs

2001

2012

370M ADDITIONAL CHILDREN IMMUNIZED with GAVI support:

DROP IN COST to fully

immunize a child with pentavalent, pneumococcal, and rotavirus vaccines.

36%

2010

$35.19

2011

$32.97

2012

$22.63

In 2009 rotavirus

vaccines were

per dose. $7.50

In 2012 rotavirus vaccines

dropped to

per dose. $2.50

In 2015 rotavirus vaccines

will drop to

per dose. $1.00

CHALLENGES

IN INNOVATION FOR

GLOBAL HEALTH

Innovating for the developing world

poses a unique set of difficulties,

including developing:

Solutions for weakened immune

systems

Novel ways to boost vaccine responses

Single-shot vaccines and long-lasting

antiretroviral drugs

Combination vaccines to target multiple

diseases

SCIENTIFIC CHALLENGES

Uses messenger RNA (mRNA) to test

novel vaccines or vaccine concepts (e.g.

influenza and non-live Rotavirus

vaccines)

• Efficient development - a very fast

manufacturing process

• Relatively streamlined - one

manufacturing process for all product

candidates

• High stability

• Self adjuvantation

• Absence of any protein immunogen

purification

CUREVAC®

1. RNA Modification Modified mRNA increases antigen expression

RNActive® Vaccine

2. Complexation of modified mRNA with protamine Complexed modified mRNA enhances adjuvanticity

3. A combination of modified mRNA

and complexed modified mRNA Leads to enhanced expression and adjuvanticity

Protamine

Limited cold chain storage and weak

health systems intensify the need for:

Heat-resistant vaccines

Innovative packaging/multi-dose vials to

reduce volume in cold chain

Reducing wastage - preservatives for

multi-dose vials

Battery-operated, rapid diagnostic tools

Tracking mechanisms and efficient

supply chains to avoid stock-outs

INFRASTRUCTURE LIMITATIONS

Results of VillageReach’s work to

overcome infrastructure limitations in

Mozambique include:

Reduction in incidence of vaccine

stockouts in rural health centers from

80% to 1%

Increase in the amount of time the cold

chain is working from 40% to 96%

Increase in the percentage of children

receiving basic vaccines from

69% to 95%

VILLAGE REACH - MOZAMBIQUE

Overcoming Infrastructure Limitations

Sanofi-BMGF price support mechanism

will enable US$1/dose pricing for IPV

IPV is necessary to achieve a polio-free

world by 2018

UNICEF will procure up to 300 million

doses of IPV per year

The GAVI Alliance will make IPV

available for inclusion in routine

immunization in 73 of the poorest

countries

AFFORDABILITY

We provide financial support to industry

through a variety of financial

instruments to de-risk investments in

global health products, including:

Advanced Market Commitments

Volume Guarantees

Product-Related Investments

Equity Investments

OVERCOMING MARKET FAILURES

An innovative approach to funding

promising global health technologies

A $108 million social impact fund

composed of individual and institutional

investors

Focused on development of drugs,

vaccines, diagnostics, and other

interventions for low-income countries

New technologies will target malaria,

TB, HIV/AIDS, and maternal and

infant mortality

26

GLOBAL HEALTH INVESTMENT FUND

© Bill & Melinda Gates Foundation |

Overcoming Market Failures

IMPORTANCE OF

DATA ANALYTICS

AND MEASUREMENT

Using GIS mapping and GPS tracking

of vaccination workers in Northern

Nigeria yields data useful in improving

microplanning and identifying

communities missed during polio

campaigns.

TRACKING POLIO VACCINATION IN NORTHERN NIGERIA

Vaccination Days

Mop-up (day 5)

Not Visited

Hamlet areas

Legend

Dec. 14–23, 2013

Dalawa Ward

Mop-up (day 10)

GBD 2010 was the first standardized,

comprehensive platform to quantify

global health data by geography, age,

and sex

Greater accessibility and improved

access to data

We are investing heavily in

Global Burden of Disease 2.0

The goal is to inform decision-making

and maximize health system impact

However, we still have a fundamental

issue with primary data quality

GLOBAL BURDEN OF DISEASE

Source: IHME


COMMUNICABLE, MATERNAL, NEONATAL AND NUTRITIONAL DISORDERS

Sub-Saharan Africa, DALYs - both sexes, all ages

LRI Diarrhea Preterm N Sepsis Malaria Iron

N Enceph Other Neo

HIV TB

PEM

Meningitis

Other Inf Syphilis Maternal

LRI Diarrhea Preterm N Sepsis Malaria Iron

N Enceph Other Neo

HIV TB

PEM

Meningitis

Other Inf Syphilis Maternal

Measles

Wh

oo

pin

g

Te

tan

us

Latin America and Caribbean, DALYs - both sexes, all ages

LRI Diarrhea Preterm

N S

epsis

Iron

N Enceph Other Neo

HIV TB

PEM

Meningitis Syphilis

LRI Diarrhea Preterm N Sepsis Iron N Enceph

HIV TB

1990 2010


GUIDING OUR INVESTMENTS IN GLOBAL HEALTH

Probability of Technical and Regulatory Success (PTRS) %

Do

llars

per

Dis

abili

ty A

dju

ste

d L

ife

Ye

ar

(DA

LY

) A

ve

rte

d

10

$1M

$100K

$10K

$1K

$100

$10

$1

20 30 40 50 60 70 80 90 100

Bed Nets

Benchmark

Surgical Male Circumcision

Bubble size is

equivalent to

the amount of

DALYs averted

100M DALYs Averted

HIV/AIDS

Malaria

TB

Pneumonia

EDD

NID

HIV/AIDS

Malaria

TB

Pneumonia

EDD

NID

Passive

Immunizations

TMC278LA

Dapivirine

Ring

Pox Protein

HIV/AIDS

Malaria

TB

Pneumonia

EDD

NID

RTS,s

RTS,s 2nd Gen

GNF 156 Tafenoquine

NITD 609

OZ 439

Probability of Technical and Regulatory Success (PTRS) %

Do

llars

per

Dis

abili

ty A

dju

ste

d L

ife

Ye

ar

(DA

LY

) A

ve

rte

d

10

$1M

$100K

$10K

$1K

$100

$10

$1

20 30 40 50 60 70 80 90 100


GUIDING OUR INVESTMENTS IN GLOBAL HEALTH

Passive

Immunizations

TMC278LA

Dapivirine

Ring

Pox Protein

Aeras402

M72

Aeras485

PaMZ DS REMox Novel-2

PaMZ MDR

RTS,s

RTS,s 2nd Gen

GNF 156 Tafenoquine

NITD 609

OZ 439

NRRV

116E Liquid

Anti-Secretory

Shigella CP

Leish F3

Hookworm

Flubendazole

Anti-Wolbachia

HPV Vx

PCV (SII)

LIQ

WC

CP

Bed Nets

Benchmark

Surgical Male Circumcision

Bubble size is

equivalent to

the amount of

DALYs averted

100M DALYs Averted

HIV/AIDS

Malaria

TB

Pneumonia

EDD

NID

IMPORTANCE OF

PARTNERSHIPS


SOME OF OUR PARTNERS

Institute of Medical Biology,

Kunming

THE IMPORTANCE OF INNOVATION IN ADDRESSING GLOBAL …€¦ · 2012 grant payments . DO WE NEED...

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