Download Global Disease Burden & Access Gap

Global Disease Burden
and the
Access Gap
UAEM Introductory Seminar
September 27, 2008
By Goldis Chami
Outline
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Global Disease Burden
Drug Pipeline
Access Gap
Research & Development Gap
Global Disease Burden: World
Health Statistics
Life expectancy at birth:
Country
Males
Females
Canada
78
83
South Africa
50
53
Sierra
Leone
39
42
Global Disease Burden: World
Health Statistics
Life expectancy at birth:
WHO
Region
Males
Females
Americas
72
78
SE Asia
63
65
Africa
50
52
Global Disease Burden:
Average Life Expectancy
Global Disease Burden: Why?
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Poverty
- Basic nutrition and clean water
- Shelter
- Education
- Basic Medical Care (Public Health)
 Essential Medicines
Global Disease Burden: World
Health Statistics
Mortality per 100,000 population
HIV/
AIDS
HIV
Prevalence
TB
Western
Pacific
4
89
16
Europe
9
342
7
SE Asia
17
289
29
Africa
203
4459
56
Global Disease Burden:
The Coverage Gap
HIV/AIDS
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3.6 million living with the disease
worldwide
Most of these individuals in subSaharan Africa
Has killed 25 M
Hepatitis B (HBV)
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Viral, transmitted much the same as
HIV
Cirrhosis of liver & liver cancer
Vaccine available, extremely
effective
Not always available in LMI
countries
In endemic areas, prognosis for HIV
is worsened
Heart Disease
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Deaths have declined by >50% in
industrialized countries
93% of morbidity and mortality from CVD
in LMI countries
Essential Medicines
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Fundamental to basic care
WHO lists 312 essential medicines
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*Cough*
33% of the world has no access
Issues: The Access Gap
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The systematic inability of individuals in
developing countries to obtain existing
and essential medicines
In poorest parts of Africa, nearly 50%
have no access
< 4% in LMI countries get needed antiretrovirals
What Causes the Access Gap?
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PRICE: the consumption of medicines is
sensitive to price, especially in the
poorest countries
Price, in turn, is affected by PATENT
STATUS
The most significant factor in lowering
prices is the introduction of generics into
a country – MSFO
Generic competition the single most
important tool to remedy the access gap Oxfam
From Discovery to Drugs
When the Drug Development
Pipeline Fails to Flow…
Research & Development Gap
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The massive underinvestment in
medicines for neglected diseases, which
primarily impact those in LMI countries
The 10/90 Gap
TB & tropical disease = 11.4% of the
tropical disease burden
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…but only 13 out of 1393 drugs targeted these
Research & Development Gap
Cont’d
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Current system fails to optimize existing
meds & technologies for use in developing
countries
Examples will come later
Diagnostic tools not appropriate
R&D Gap:
African Sleeping Sickness
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Most commonly used drug to treat =
arsenic based, kills 5% of those treated.
New drugs needed, but none have been
developed
Why? R&D system depends on patents &
market-based incentives.
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5-7% of profits from LMI countries
R&D Gap
The patent system leads R&D toward the
most profitable disease and conditions,
rather than toward diseases that cause the
most morbidity and mortality.