TreatmentAction Group

Update on Global TB Research

By Claire Wingfield

Treatment Action Group

Advisory Council for the Elimination of Tuberculosis

Centers for Disease Control and Prevention (CDC)

March 20-21, 2007

Atlanta, Georgia

Who is TAG?

• Treatment Action Group (TAG) was founded in January, 1992, and is the first and only AIDS organization dedicated solely to advocating for larger and more efficient research efforts, both public and private, towards finding a cure for AIDS.

• The TB/HIV Project works to combat TB/HIV co-infection through a combination of community-based advocacy, education and mobilization efforts involving AIDS advocates in developed and developing countries. The TB/HIV Project is supported by a grant from the Bill & Melinda Gates Foundation.

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TB Research

• The 1940’s and 50’s were the heyday of TB drug discovery.

• Between the 1940’s and 1980 there was dramatic decline in global TB disease, and as a result there was a stall in TB R&D.

• But TB made a dramatic comeback with the dawn of the HIV pandemic.

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Methodology

• Objective was to highlight gaps in spending as well as in areas of scientific study in TB R&D.

• Funding data were collected largely from original-source donors.

• Data were collected from public and private sector sources and were supplemented by interviews.

• Most of the data is based on self-reporting by recipients and representatives of funding sources.

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1 NIAID / NIH

2 Gates Foundation

3 Medical Research Council (UK)

4 Other Institutes & Centers / NIH

5 Centers for Disease Control

6 Company X

7 Wellcome Trust

8 NHLBI / NIH

9 European Commission 6th Framework

10 Otsuka

TOP 10 Donors to TB Research (2005)

Who Are the Funders?

TreatmentAction Group Feuer C. Tuberculosis Research & Development: A Critical Analysis. Treatment Action Group (TAG); 2006

TB Research: 2005 Investment by CategoryTotal: $392,713,089

Operational Research$49,629,397

13%

Vaccines$69,611,048

18%

Basic Science$93,661,494

24%

Applied / Preclinical / Infrastructure / Unspecified

$43,594,59611%

Diagnostics$16,449,619

4%Drugs

$119,766,93530%

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Feuer C. Tuberculosis Research & Development: A Critical Analysis. Treatment Action Group (TAG); 2006

Overall TB R&D Investment (2005 = $392.7M)

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? ? ?

Feuer C. Tuberculosis Research & Development: A Critical Analysis. Treatment Action Group (TAG); 2006

Investment in TB ResearchActual vs. Need

(2005)

Basic Science$93,661,494

NIAID54.5%

CIHR1.3%

Max Planck1.1%

India MoST0.5%

Wellcome Trust7.6%

MRC9.6%

NHLBI16.2%

EC 6th Framework4.4%

Gates Foundation2.8%

Other NIH ICs1.7%

NWO0.2%

Brazil0.04%

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2005 Spending

Diagnostics Research$16,449,619

Sequella4.9%

USAID5.2%

DFID5.6%

Gates Foundation41.5%

All India Institute0.02%

CIHR0.1%

Inserm0.1%

NIAID36.5%

Company Y3.0%

India MoST3.0%

CDC0.2%

TreatmentAction Group

2005 Spending

Drug Research$119,766,935

Otsuka10.3%

CDC9.2%

NL MoFA (DGIS)2.3%

DC Ireland0.3%

CIHR0.4%

FDA0.4%

Inserm0.5%Sequella

0.5%India MoST0.6%

Rockfeller Foundation1.5%

AstraZeneca7.7%

Wellcome Trust4.4%

USAID3.2%

EC 6th Framework2.2%

Novartis2.9%

Gates Foundation8.5%

DFID0.03%

Other NIH ICs0.1%

All India Institute0.1%

NIAID33.6%

Company X16.6%

TreatmentAction Group

2005 Spending

Vaccine Research$69,611,048

Gates Foundation41.2%

Danida0.2%

FDA0.3%

Other NIH ICs0.3%

CIHR0.3%

Inserm1.1%

India MoST1.1%

Wellcome Trust5.7%

Ellison Foundation2.4%

CDC1.4%

Max Planck2.2%

NIAID34.5%

EC 6th Framework9.4%

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2005 Spending

Operational Research$49,629,397

KNCV0.3%

Swiss ADC0.4%

Thai MoPH0.6%Inserm

0.6%NL MoFA-DGIS

0.9%CIHR0.9%

USAID3.8%

Wellcome Trust3.4%

GFATM3.3%

NHLBI3.2%

DFID2.1%

Swedish IDA1.0%

Gates Foundation20.7%

Other NIH ICs4.5%

All India Institute0.1%

Lilly0.2%

Brazil0.2%

France MoFA0.3%

MRC37.5%

CDC15.9%

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2005 Spending

3. The GP2 Gap by Research Area($ millions)

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

TB diag

nosti

cs*

TB drug

s**

TB vacc

ines*

**

Subtot

al

Basic

rese

arch

Applie

d/inf

rastr

uctur

e

Opera

tiona

l rese

arch

Subtot

al

Diagno

stics

, dru

gs &

vacc

ines s

ubtot

al

Basic,

infra

stru

cture

& op

erati

onal

subto

tal Total

FY 2005 actual GP 2006 est. GP 10 year est. 10 year actual based on 05

TreatmentAction Group

The Funding Gap: Who Should Pay?($ millions)

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

FY 2005 actual 10 year actual based on 05 TAG 10 year recommendation

Public Philanthropic Industry Multilateral Total

TreatmentAction Group

NIH Investment: TB vs. HIV (2005)

0

500

1000

1500

2000

2500

3000

Total Basic Science Drugs Vaccines

$ M

illio

ns

TB HIV

TreatmentAction Group

NIH Infectious Disease SpendingFY05 Actual (dollars in millions )

2,921

252 187 183 164 158 154 121 104

0

500

1,000

1,500

2,000

2,500

3,000

3,500

TreatmentAction Group

2. Global TB R&D Spending for 2005: Top 27 Investors ($1 million or more)

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

NIAID

/ NIH

Gates F

oundation

Medica

l Rese

arch C

ouncil (U

K)

Other I

nstitu

tes &

Cente

rs / N

IH

Centers

for D

isease

Contro

l

Company X

Wellc

ome T

rust

NHLBI / NIH

European C

omm

issio

n 6th

Fra

mework

Otsuka

Insti

tut P

asteur

AstraZeneca

USAID

Inse

rm

TB Rese

arch C

enter (

ICM

R), In

dia

Min

istry

of S

cience

and Te

chnolo

gy, In

dia

Netherla

nds Min

istry

of F

oreig

n Affa

irs (D

GIS)

Max P

lanck

Insti

tute

Canadian In

st. o

f Health

Rese

arch

Novarti

s

Dept. for I

ntern

ational D

evelo

pment (

DFID)

Russia

n TB In

stitu

tes

Rockefe

ller F

oundation

Ellison M

edical F

oundation

Global F

und

Researc

h Inst.

for T

B, Japan A

nti-TB A

ssn.

Sequella

Basic Science Applied / Preclinical / Infrastructure /Unspecified Diagnostics Drugs Vaccines Operational Research

TreatmentAction Group

2005 Spending

FY05 GP 2006 base 5-fold GP2 TAG 10 yr Actual estimate increase 2015

recBy new tool category

TB diagnostics 16 59 80 516 900

TB drugs 120 418 600 4800 6000

TB vaccines 70 291 350 3641 3600New tools sub. 206 768 1030 8957 10500

Basic research 94 0 470 0 4800Applied/Infrastructure 44 0 220 0 2200Operational research 50 0 250 0 2500Subtotal 188 0 940 0 9500

Total TB R&D 394 768 1970 8957 20000

How Much TB R&D Funding is Really Needed (Dollars in Millions)

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Why are the Global Plan Numbers Insufficient?

Action Points

• A comprehensive global TB R&D agenda is urgently needed.• TB R&D needs better global/national coordination.• Industry needs to be more transparent about TB R&D

investments.• Reporting consistency is needed to better track and annually

update TB R&D. Need greater involvement from all funders in TB R&D.

• Emerging countries such as Brazil, China, India, Russia, South Africa and Thailand should play a bigger role.

• A five-fold (400%) increase in annual TB R&D expenditures is the minimum necessary to achieve the goals set out in The Global Plan II.

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THANKS

• Javid Syed, TAG

• Mark Harrington, TAG

• Eric Goemaere, MSF