Innovation in Science and Technology A critical path to addressing global health inequities

11

Innovation in Science and Innovation in Science and TechnologyTechnology A critical path to addressing global A critical path to addressing global health inequitieshealth inequities

May 2008

22

• Global health inequity – the problem

• Global access is the target – partnerships can drive solutions

• Innovations in science and technology can create better tools – the Grand Challenges in Global Health

• Many challenges remain – more innovation is needed

3

Leadership

Bill and Melinda GatesCo-chairs

Patty Stonesifer

CEO

Bill Gates Sr.Co-chair

Warren Buffett

Future Trustee

44

Bill and Melinda Gates Foundation (as of Feb. 2008)

>$ 37.3B in assets Additional Warren Buffett gift

in 2006

Have awarded $16.5B in grants

Grantees in 50 states, 100 countries

Foundation staff >550

More information at www.gatesfoundation.org

55

All lives—no matter where they are lived—have equal value. All lives—no matter where they are lived—have equal value.

Science and technology can save livesScience and technology can save lives

Our focus - reducing inequitiesOur focus - reducing inequities

Where does the inequity lie?

With the 2/3 of the world’s 6 billion people that live in the developing world. The greatest need is among the 1 in 6 that

live on less than $1 per day

Gates Foundation Values & Principles

66

The Problem

2/3 of the world’s 6 billion people live in the developing world. More than 1 in 6 live on less than $1 per day

Millions die unnecessarily each year from diseases that are currently treatable or preventable

» AIDS, TB and malaria alone kill 6 million people annually

» Vaccine-preventable diseases kill more than 2 million children annually

Access to existing, effective health interventions is severely limited for most of those in need

» Systems for delivery of vaccines don’t regularly reach all of those in need

» Vaccines available for many years in wealthy countries,

but are not used widely in the developing world

The Result: a global health problem that undermines economic development, social and political stability

77

Priority Diseases and Conditions

• Infectious Diseases• Acute Diarrheal Illness

• Acute Lower Respiratory Infections

• HIV/AIDS

• Malaria

• Tuberculosis

• Vaccine-Preventable Diseases

• Other Infectious Diseases

• Nutrition• Micronutrient deficiencies

• Nutrition for children under the age of 2

• Maternal, Neonatal, Child, and Reproductive Health

Diseases and Diseases and conditions conditions addressed addressed by the by the Foundation – Foundation – 38% of the 38% of the global health global health burden burden

Injuries – 12%

Communicable diseasesnot addressedby the foundation – 3%

Non-communicableconditions – 47%

Total Global Health BurdenTotal Global Health BurdenDisability-Adjusted Life-Years LostDisability-Adjusted Life-Years Lost

Foundation FocusFoundation Focus

8

Accelerate Access & Drive Innovation

Accelerate access to existing health interventions

› Financial commitments have to match the scale of the crisis

› Existing health interventions (vaccines, pre-natal care, HIV prevention) must be delivered to those who need them

The world’s greatest health challenges are solvable –

Drive research on new tools to fight disease

› Focus on solutions that are appropriate for use in the areas of greatest need

99

Global access is the target – partnerships can drive

solutions

1010

GAVI Alliance: Bringing more vaccines to more people

Estimated 2.6 million deaths prevented since 2000 – WHO, 2007 » Immunizations in 2006 averted estimated 600,000 future deaths – WHO,

2007

Coverage has improved» 2005 coverage with hepatitis B vaccine in GAVI-eligible countries: 45%

(20% in 2000) –WHO/UNICEF, Aug 2006

» 28 million more children have been protected against diphtheria, tetanus, and pertussis – immunization rates increased 63 percent in 1999 to 77 percent in 2006

» 138 million more children received new and under-used vaccines ( hepatitis B, Hib, yellow fever).  Hepatitis B vaccine provided in 15 developing countries in 1999, 61 developing countries in 2006

» 1.2 billion auto-disable syringes delivered – GAVI Alliance Secretariat

1111

Success, yes, but more to doIn 2005: An estimated 28 million children in

developing countries were not immunized

2.5 million children died of vaccine-preventable diseases.

Still needed: WHO and UNICEF estimate that an

additional US$10-15 billion will be needed for immunization programmes over the next decade.

More funding needed to introduce vaccines currently in the development pipeline.

More and better vaccines are needed (HIV, TB, malaria, …)

1212

Global Health Opportunities for the Private Sector

Creating platform technologies

Reducing costs and risks through partnerships

Capturing market opportunities

Bringing innovation to health care delivery

1313

Reducing Development Costs and Risks: Product Development Partnerships

The Problem: Despite urgent and significant need for new tools, private and public product development players neglect diseases of the poor because the risks and uncertainties well exceed expected return on investment

A solution: Dedicated, not-for-profit, virtual R&D organizations that accelerate the development and introduction of new products through a portfolio of product partnerships, engaging with industry and academia

The foundation contribution: Over $1.3 billion to more than 14 entities Other donors: UK, Netherlands, Ireland, Rockefeller Foundation, Wellcome

Trust, World Bank, USAID, Switzerland, Norway, Sweden, Canada, MSF, Germany, EU

1414

Product Development Partnerships (PDPs)

Source: BMGF, Q1 2006

  Disease/Product

Year Founded Capital Raised ($M) est. Q1 2006

% BMGF

FIND Diagnostics 2003 33.2 100%

MMV Malaria Drugs 1999 263 63%

MVI Malaria vaccines 1999 268.4 96%

GATB TB Drugs 2000 175 74%

IOWH Neglected Diseases 2000 147.5 98%

AERAS TB Vaccines 1997 111.2 97%

IAVI HIV Vaccines 1996 436.5 29%

IPM Microbicides 2002 164.3 37%

PDVI Dengue Vaccines 2003 56.8 97%

MVP Meningitis Vaccines 2001 70 100%

CVP-JEP Japanese Encephalitis Vaccine 2003 27 100%

IVI Vaccines for Neglected Diseases 1995 181.2 34%

IDRI Infectious Diseases 1993 18.5 81%

PVS Pneumococcal Vaccines 2004 84 100%

Total     2036.6 66%

1515

Clarifying Markets – P

rice

AMC

$x billionPost-AMC market

GuaranteedAMC price

Years

0

2

4

6

8

10

12

1 2 3 4 5 6 7 8 9 10 11 12 13 14

The Advanced Market Commitments would guarantee, in advance, a reasonable price for the vaccine. The donor subsidy would add to the small country co-pay and would ensure firms could make a return on investment – if they develop and supply the product.

Defining Existing Markets

TB Vaccines - $0.5-$1B (BVGH)

Creating Markets

1616

• Innovations in science and technology can create better tools – the Grand Challenges in Global Health

1717

Origins of GCGH:

Yr. 1900:Yr. 1900: David Hilbert, at the International Congress of Mathematicians, David Hilbert, at the International Congress of Mathematicians, proposed that twentieth-century mathematicians should devote themselves to proposed that twentieth-century mathematicians should devote themselves to solving 23 outstanding problems in mathematics. solving 23 outstanding problems in mathematics.

Yr. 2002:Yr. 2002: Bill Gates was inspired to establish the "grand challenges" in global Bill Gates was inspired to establish the "grand challenges" in global health initiative because he was familiar with the way that Hilbert's problems health initiative because he was familiar with the way that Hilbert's problems galvanized and focused the mathematics community.galvanized and focused the mathematics community.

Yr. 2003:Yr. 2003: Partnership with the Foundation for the National Institute of Health Partnership with the Foundation for the National Institute of Health established; scientific board assembled; issued call for ideasestablished; scientific board assembled; issued call for ideas

Grand Challenges in Global Health is not meant to be an exact replica of Grand Challenges in Global Health is not meant to be an exact replica of Hilbert’s approach. The Foundation’s hope is that by identifying a small Hilbert’s approach. The Foundation’s hope is that by identifying a small number of critical problems in global health, and then funding research to number of critical problems in global health, and then funding research to solve these problems, it can help draw attention to and promote more research solve these problems, it can help draw attention to and promote more research on these scientific challenges. on these scientific challenges.

Innovations in science and technology can create better tools- the Grand Challenges in

Global Health (GCGH)

1818

THE 14 GRAND CHALLENGES IN GLOBAL HEALTH SERVE 7 LONG-TERM GOALS

OngoingImprove Childhood VaccinesGC#1: Create Effective Single-Dose Vaccines  GC#2: Prepare Vaccines that Do Not Require RefrigerationGC#3: Develop Needle-Free Vaccine Delivery Systems

Create New VaccinesGC#4: Devise Testing Systems for New VaccinesGC#5: Design Antigens for Protective ImmunityGC#6: Learn About Immunological Responses 

Control Insects that Transmit Agents of DiseaseGC#7: Develop Genetic Strategy to Control Insects GC#8: Develop Chemical Strategy to Control Insects

Improve Nutrition to Promote Health         GC#9: Create a Nutrient-Rich Staple Plant Species

Improve Drug Treatment of Infectious DiseasesGC#10: Find Drugs and Delivery Systems to Limit Drug Resistance

Cure Latent and Chronic InfectionGC#11: Create Therapies that Can Cure Latent Infection GC#12: Create Immunological Methods to Cure Latent Infection

Measure Health Status Accurately and EconomicallyGC#13: Develop Technologies to Assess Population HealthGC#14: Develop Versatile Diagnostic Tools  

Example Vaccine Projects

Needle-Free Vaccination Via Nanoparticle Aerosols (David Edwards)

Development of Novel Mouse Models for

HIV and HCV Infection using hES cells (Hongkui Deng)

Targeting Dendritic Cells with Modified Antibodies (Ralph Steinman)

Genetically Attenuated Sporozoite Vaccine (Stefan Kappe)

Engineering Immunity Against HIV (David Baltimore)

Biomarkers of Protective Immunity For TB (Stefan Kauffman)

26 Vaccine Projects Funded Total

1919

Approaches to Meeting the Grand Challenges

Stimulate revolutionary innovations and bring cutting edge approaches to solving the critical health challenges of the poorest of the world

Create clear paths to maturing innovations into available products/solutions

Ensure that the innovations are appropriate for the settings and problems that need to be reached and can be made accessible (Global Access Strategy)

Engage all those who may have solutions (“Best possible” teams)» Global participation» Diversity of sectors (academia, industry, non-profit, government)» Range of disciplines

2020

THE NEED» To achieve breakthroughs in

global health, we must encourage risk-taking on creative, unorthodox ideas

THE INITIATIVE» US$100 million fast-track grants

initiative of the Gates Foundation

» Will support hundreds of early-stage research projects on creative concepts for new global health solutions

» Initial grants of $100,000; opportunities for future funding

2121

KEY GOAL: To support paradigm-changing ideas » Involve scientists around the world, including those who

don’t typically work in global health

» This includes innovators in the developing world, from complementary disciplines, and in the private sector, as well as young investigators

FAST-TRACK GRANTS

New fast-track grantmaking to make it easy for scientists to apply:

» Relatively short funding proposals, preliminary data not necessarily required

» Fast proposal review (approximately three months)

» Multiple calls for proposals, each funding round will address a few specific topics or themes

2222

GETTING INVOLVED» Sign up at www.gcgh.org for email updates about Explorations funding

opportunities

» First call for grant proposals was posted in early 2008

» Spread the word to colleagues, and encourage them to sign up on gcgh.org

2323

• Many challenges remain – more innovation is needed

2424

The Vision

"There is no bigger test for humanity than the crisis of global health. Solving it will require the full commitment of our hearts and minds. We need both. Without compassion, we won’t do anything. Without science, we can’t do anything. So far, we have not applied all we have of either."

Bill Gates, World Health Assembly, May 2005

www.gatesfoundation.org