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Innovation in a changing global


health landscape




Peter Piot


Institute for Global Health


Imperial College

A Major Unfinished agenda


Infectious diseases


Maternal mortality


Child health


Reproductive health


Malnutrition


Access to primary health care


A new Global Health landscape


Unfinished agenda persisting


Chronic diseases, mental health, ageing


Urbanization, climate change, water,
population


New prevention& treatment
technologies


New actors



Beaglehole

&
Bonita,Lancet

2008; 372: 1988

Lancet 2010; 375:408
-
18

Chronic disease:

a problem with a solution


Tobacco control



Salt and alcohol reduction


Healthy diet and weight control


Physical activity


Indoor pollution reduction


Secondary prevention and “poly
-
pill”


Improve quality of care and
prevention


Increase access to care and
prevention


Address crisis in human
resources for health


Reduce costs


What is in the pipeline?

IT & Robotics & Virtual Reality & Imaging


IT : mobile phone, social networking,
sensors, mega Wi
-
Fi, GIS, agent based
analysis and modelling, combination
technologies...


Robotics, virtual reality eg surgery


Small user
-
friendly imaging


Communications/IT technology











Figures from C
Toumazou

2007 ©
Institute of Biomedical Engineering, Imperial College London

Simulation/robotics












Figures from GZ Yang, The Helen Hamlyn Centre for Robotic Surgery

Biotechnology & Genomics



Vaccines: new diseases, new
delivery systems, thermo stability


Drugs


Point of care diagnostics


Tissues


Biomarkers


Food





Cardiovascular polypill 2
o

prevention trials

coordinated by George Inst, Sydney (A. Rodgers, A. Patel)

& Imperial College London (S. Thom, N. Poulter)

UK
-
Ireland
-

N’lands

China

India

S. Africa

Oz

New Z

Canada

Brazil

4 drugs in 1 pill: the “Red Heart Pill” c/o Dr Reddy’s (Hyderabad)



UMPIRE: Europe & India, 2000 patients



KANYINI
-
Gap: Australia, 1000 patients



IMPACT: New Zealand, 600 patients



UMPIRE
-
South Africa, 1000 patients



Brazil & China & Canada, 2000 patients

Current

Planned

Miniaturization & Nanotechnology



Simple imaging instruments


Point of care diagnostics


Lab on a chip


Pharmaceuticals delivery


Water disinfection


..with more information

Tomorrow’s e Patient Record

Yike

Guo

BODY

SYSTEMS

ORGANS

TISSUES

CELLS

MOLECULES

GENES

genetic

molecular

cellular

Patient X

MRI

ECG

CT

Business Innovation

Wellcome Trust
-
Merck vaccine
initiative, India

Innovation of Delivery

Delivery of Innovation

Can innovation be delivered in poor countries?

Tanzania


Electricity


Low coverage


Generators


High cost of fuels


Occasional Solar Panel


Communication


All villages have Bar with Television


70%
-

80% Mobile Phone Coverage


3G Mobile Coverage in Large Urban Areas




Data provided by African Space Trust (africanspace.co.uk)



Lost in translation?

Risk and uncertainty


Unclear risks of new technologies


May need new safety norms


Regulatory systems often weak


Risk perception varies culturally (eg
GMO in Europe vs US)


Ethical and human rights issues


Lessons from Aids


Technological innovation can be game changer


Innovation in funding, pricing and delivery


Good politics, bad politics...


Resistance: institutions & experts, not virus


Go beyond traditional health actors


Nothing for the people without the people


Need for long term view

People
receiving ART in low
-

and
middle income
countries

[i]

1996
-
2005 data: Extracted from 2006 Report on the Global AIDS Epidemic (UNAIDS, 2006)

[ii]

1986
-
1993 data:
AIDS in the World II. Edited by Jonathan Mann and Daniel J. M. Tarantola (1996)

Notes
:

[1] 1986
-
2000 figures are for international funds only


[2]
Domestic funds are included from 2001 onwards

Spending on aids in low and middle income countries

1986‒2007

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

US$ million

292

1623

8.3 billion


Signing of Declaration of
Commitment on HIV/AIDS,

UNGASS


‘96


97

‘98

‘99

‘00

‘01

‘02

‘03

‘04


05

1986

‘87

‘88

‘89

‘90

‘91

‘92


93

‘94

‘95

Less than

US$ 1 million

59

212

World Bank

MAP launch

Global Fund

PEPFAR

257

UN
AIDS


Gates
Foundation

‘06

2007

10 000

8.9 billion

10
billion


AIDS
-
related deaths with and

without antiretroviral
therapy

2.5

2.0

1.5

0.5

1.0

3.0

0

Number (millions)

Year

1996

1998

2000

2002

2004

2006

2008

1997

1999

2001

2003

2005

2007

Figure V

No antiretroviral therapy

At current levels of antiretroviral prophylaxis