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Global Disease Burden and the Access Gap UAEM Introductory Seminar September 27, 2008 By Goldis Chami Outline 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? 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 3.6 million living with the disease worldwide Most of these individuals in subSaharan Africa Has killed 25 M Hepatitis B (HBV) 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 Deaths have declined by >50% in industrialized countries 93% of morbidity and mortality from CVD in LMI countries Essential Medicines Fundamental to basic care WHO lists 312 essential medicines *Cough* 33% of the world has no access Issues: The Access Gap 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? 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 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 …but only 13 out of 1393 drugs targeted these Research & Development Gap Cont’d 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 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. 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.