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CHHS-MARCE Public Health Preparedness Conference Laboratory Safety, Security and Preparedness in the
Evolving Era of Dual Use Research of Concern (DURC) February 10, 2014
Universities at Shady Grove Conference Center
Towards a Global Governance Structure for Infectious Diseases
Harvey Rubin, MD, PhDUniversity of PennsylvaniaPhiladelphia, Pennsylvania
H5N1? No Official Governing Body…
“Most of us are unequivocal about the value of the research. But deciding what to do with these types of studies is complicated. At the moment, there are no official governing bodies to regulate such decisions. They rely on the good will of the researcher”
Anthony S. Fauci, Chief, Institute of Allergy and Infectious Disease, NIH.Quoted in The Deadliest Virus by Michael Specter. The New Yorker. March 12,
2012
The Big Question: Is there a crisis?
UK House of Lords
The Global Burden of Disease Study
infectious diseases accounts for 22% of all deaths and 27% of disability adjusted life years (DALYs)
disproportionate impact on the developing world where
infectious diseases account for 52% of deaths and 50% DALYs in sub-Saharan Africa and only 11% of deaths and 5% of DALYs in established market economies
(Globalization and Infectious Diseases: A review of the linkages. found at http://www.who.int/tdr/cd_publications/pdf/seb_topic3.pdf).
The overall situation in controlling infectious diseases has deteriorated for a number of interrelated reasons: 1
Biological: 1) increase in antibiotic resistant bacterial infections, 2) increase in zoonotic and foodborne infections
Preventing the Spread of Multidrug-Resistant Gram-Negative Pathogens: Recommendations of an Expert Panel of the German Society for Hygiene and MicrobiologyDtsch Arztebl Int 2012; 109(3): 39-45; DOI: 10.3238/arztebl.2012.0039
H. Rubin House of Lords testimony May 2008
Governmental/policy/infrastructure: 1)absence of harmonized regulatory processes hinders rapid development of anti-infective agents
2) disparities in distribution of anti-infective agents to clinics and to patients
3) inadequate rapid and accurate diagnostic testing in the developing world
4) insufficient number of well-trained medical workers
5) unsafe/poorly secured containment and storage facilities
The overall situation in controlling infectious diseases has deteriorated for a number of interrelated reasons: 2
Governmental/policy/infrastructure:
5) national insurgencies and failed states worsen the global communicable disease situation
6) globalization and environmental/climate changes alter patterns of communicable diseases
8) agencies that work for increased access to anti-infective agents must coordinate goals and policies with agencies that work to limit the emergence of resistance to anti-infective agents
The overall situation in controlling infectious diseases has deteriorated for a number of interrelated reasons: 3
Corporate/financial: 1) sparse pipeline of new molecular entities that lead to effective anti-infective agents
2) global financial crises divert scarce resources from health related issues
Research/information: 1) underfunded research to develop antibacterial, anti-fungal and anti-parasitic
agents 2) global infectious disease surveillance and reporting are generally incomplete,
not shared, not interoperable, and not real-time 3) new research in synthetic biology forms an entirely new threat space--
creation of new infectious agents reintroduction of infectious agents that no longer exist in nature generation of infectious agents that exist in nature but are hard to isolate
The overall situation in controlling infectious diseases has deteriorated for a number of interrelated reasons: 4
Illegal activities: 1) Increase in counterfeit drugs contribute substantially to the spread and emergence
of drug resistance of communicable diseases
Social unrest: 1) social disruptions hinder or completely prevent adequate response and mitigation
of an an infectious disease outbreak
The overall situation in controlling infectious diseases has deteriorated for a number of interrelated reasons: 5
“Therefore it is not an exaggeration to speak of a crisis; on the contrary it is a moral, medical, economic and political imperative to raise these issues at the highest level of government.”
H. Rubin: House of Lords testimony May 2008
The Answer to The Big Question: Is there a crisis?
How Should the International Community Respond to the Crisis?
Current Science. 96, 658-663, 2009.
Think BIG Specific Implementation Plans
International Compact for Infectious Diseases: Four Interconnected Components
Big Problems Can Be Solved in Small Bits:The Specific Problem of Vaccine Distribution in the Context of
Global Preparedness
The Problem
19
• Save 9 million deaths each year
• Reduce disease, disability, death and inequality worldwide
• Improve public health & productivity (GDP per capita)
• Eradicate century old diseases like Polio
Vaccines are the single most cost-effective global health program (WHO)
Yet…2-4 million people STILL die each year from
vaccine-preventable diseases19
Cold Chain
No power to keep vaccines cold?---WRONG!
• Background– Mobiles cover over 75% of the world– 2/3 by developing countries– Cell towers are the only type of
infastructure in many rural areas– Research shows these towers may
generate up to 10 kWh of excess electricity daily
• Application– Harness electricity from rural cell towers
to provide stable power for co-located vaccine refrigerators and freezers
Our Solution
http://www.energizethechain.org/
Energy Accessibility• The International Energy Agency
estimated in 2011 that 1.3 billion people lack access to electricity.– More than 95% of these people are in sub-
Saharan African or developing Asia and 84% are in rural areas
Power Stability in Rural India (Samant, 2007):
90% of local health centers suffered frequent power failures45% of local centers had back-up generators50% of sub-centers 71-90 km away are compliant
Using Remote Monitoring System (RMS) to track site location, usage, the number/times fridge door opens, and open durations
Energize the Chain - Rerouting power, Reshaping lives
http://vimeo.com/65549347
ETC + UNICEF: Energy & Connectivity for Health
New York, 12 June 2013“UNICEF is intensifying all our efforts, in every country, to reach the hardest to reach, most isolated communities. This approach, in turn, is not only consistent with, but a vital element in our immunization efforts… We cannot rest until we reach these children – in time to prevent the deaths of the nearly two million children who die every year for simple want of a simple vaccine.” Tony Lake, Executive Director, UNICEF
Strategies for Success:Health worker motivationCommunity participation and ownershipPublic-private partnershipsGovernment ownership and commitmentGovernment Energy policies and operations (e.g., resource mapping)Corporate social responsibilityTechnologies must be user-focused and locally manageable
ETC has working partnerships with nonprofits & private
telecom companies
31
http://www.istar.upenn.edu
International staff
Established on solid base of research and
practice Promote knowledge of
justice/law peace, security, social and
economic developmentSynthesize national and international knowledge
Convene across disciplines: science,
policy, law
Cultivate inclusive vision of issues
Located amid treaty organisations devoted to international law
Endorse the need for a Global Governance
Structure for Infectious Diseases
GLOBAL GOVERNANCE STRUCTURE FOR INFECTIOUS DISEASES Implementation Matrix
OTHER
Example 2 The UN
Special Consultative Status
1) provide expert analysis on issues directly from our experience in the field 2) monitor and implement international agreements 3) play a major role in advancing United Nations' goals and objectives4) attend and participate in UN meetings and conferences 5) submit written and oral statements relevant to the work of the Economic and Social Council (ECOSOC) and its subsidiary bodies 6) organize our own events at UN locations7) maintain five annual grounds passes for our staff to United Nations' premises in New York, Geneva, Vienna, and Nairobi
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