Impact of Diseases

• AIDS : 40 Million persons around the world Infectious Diseases in the Era of are HIV-positive, out of which 28 millions Globalisation in sub-Saharan Africa • TB : 1.7 million people die every year of TB, 84 % in DCs Philippe KOURILSKY • Malaria : more than 1 Million deaths a year, Institut Pasteur an African child dies of malaria every 30 seconds

Malaria’s cost: loss of economic growth from parity per person, at purchasing -power parity 1987 $, 1980-95 1,290 Neglected Diseases 600 • Some infectious diseases receive hardly any 400 public attention and no investment, as there 200 is no « market »

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Impact of those diseases Global impact of Diseases

• HIV-Aids has caused in some countries a • Why has globalisation changed the picture ? fall on 50% in agricultural production • World wide travelling of people and wide • Malaria has slowed down economic growth circulation of goods has radically changed in Africa by 1.3% a year the patterns • TB has equally caused a 1.5 % slow down. • Nobody nowhere can be considered safe from any infectious disease

Biomedical research Epidemiological surveillance

• Better understanding of the mechanisms of • Man as a main cause of development of transmission (sequencing and analysis of pathogens (urbanisation, deforestation, …) genomes) • Changes in health related issues due to • Improved diagnostics tests climatic change or evolution of our • Studies on resistance to antibiotics and environment (Dengue, West Nile, etc) other types of resistance • Hygiene and environment • Elaboration of vaccines and therapeutical • Bioterrorism and civil strifes treatments • Epidemiology

Protection by vaccines and new Relation size of the population and drug drugs market, 1999 • Development of new, massive campaigns in immunisation such as GAVI • Efficient vaccines exist against diseases 11% Africa + Asia such as tetanus, diphtheria, whooping Latin America N. America cough, measles, polio, etc. Europe 72% Japan • Research in new vaccines and drugs needs to be encouraged on the 3 diseases and other neglected diseases : research must be World Population Drugs Market globalised Source: IMS-Health/UNDP, 1999 Need to support a more • Only 11 new molecules against tropical diseases have been developed between 1975 and 1999 : globalised research – Malaria: halofantrine, méfloquine, artémether, atovaquone – Chagas disease: benznidazole et nifurtimox • Advocacy and development of new – Helminths: albendazole strategies : WHO, NGOs, etc. – Schistosomiasis : oxamniquine et praziquantel – Onchocerciasis: ivermectine • Funding : bilateral and multilateral donors, – African Trypanosomiasis: éflornithine such as the European Union (EDCTP), the • 2 reformulations: Global Fund, etc. – African Trypanosomiasis: pentamidine – Leishmaniasis: amphotéricine B in lipid formulation • Public-private partnerships Less than 1% of total (n=1393) drugs licensed during • but a financing gap remains and the this period situation requires urgent attention

Need to support the outcome of Affordability and availability of research vaccines and drugs • Encourage researchers by allowing • Even when vaccines or drugs exist, they are development of drugs, including for not affordable or available (Meningitis, for neglected diseases, where no « market » example) exists • When new vaccines or drugs are elaborated • Need for a reflexion on new modes of drug by scientists, there is no guarantee on development, new approach to standards development and commercialisation • Reflexions about the encouragement of (shighellas, for example) local drug or vaccine production in DCs.

Meningitis The example of AIDS

• New particularly lethal variant of nesseria • Why is the current situation so disastrous ? meningitidis, W 135 • Some countries have refused to face the • Availability of vaccine : limited to reality of the epidemics developed countries markets • Cultural and religious reasons have been a • Cost of quadrivalent vaccine (A, C, W 135, major hurdle Y) too expensive for developing countries • Technical difficulty in developing a vaccine • Need to unite efforts (WHO, research • Regulatory problems teams, Industry, NGOs) for a solution

The various issues associated with infectious diseases, particularly in the Are developed countries prepared to do developing countries, raise huge technical, more and faster to cope with bioterrorism industrial and political problems, with an than they did with AIDS ? immense humanitarian and political worldwide impact.