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Designing Strategies for Neglected Disease Designing Strategies for Neglected Disease ResearchResearch
Lecture 1ALecture 1A
Amy KapczynskiAmy Kapczynski
UC Berkeley LawUC Berkeley Law
From MSF Campaign for Access to Essential Medicines, AccessNews (No. 18, Jan 2009)
Female Life Expectancy at Birth (2006)
Sierra Leone - 42
Japan - 86
From http://www.globalhealthfacts.org/ and WHO, World Health Statistics 2008
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
1373
133
othertropical diseasesTB
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
5%1%
1%
11%
4%1%
1%
1%
45%
30%
North America
Europe
Japan
Oceania
CIS
SE Asia
Latin Amer.
Indian subcontinent
africa
middle east
CIPIH Report, data provided by IMS Health
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
0 2 4 6 8 10 12
Africa
Europe
South East Asia
Eastern Mediterranean
Americas
Western Pacific
High income
Death rate per 1000 adults aged 15–59 years
Cardiovascular diseases
Cancers
Other noncommunicable diseases
Injuries
HIVAIDS
Other infectious and parasitic diseases
Maternal and nutritional conditions
Slide taken from http://www.who.int/entity/healthinfo/global_burden_disease/GBD2004ReportFigures.ppt, data from WHO Global Burden of Disease Report 2004
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
Projected deaths by cause and income, 2004 to 2030
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
Deaths (millions)
High income Middle income Low income
HIV, TB, malaria
Other infectious
Maternal/perinatal/nutritional
Cardiovascular disease
Cancers
Other NCD
Road traffic accidents
Other unintentionalIntentional injuries
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)