Global Health Group H

Global Health Global Health Group HGroup H

Foronda, Fortune, Gerlach, Gicca, GomezForonda, Fortune, Gerlach, Gicca, Gomez

What is Global Health? What is Global Health? • The Institute of Medicine refers to The Institute of Medicine refers to

global health as "health problems, global health as "health problems, issues, and concerns that transcend issues, and concerns that transcend national boundaries, may be national boundaries, may be influenced by circumstances or influenced by circumstances or experiences in other countries, and experiences in other countries, and are best addressed by cooperative are best addressed by cooperative actions and solutions." actions and solutions."

Beginnings of Global Health Beginnings of Global Health and the United Statesand the United States

• United States involvement begins with United States involvement begins with the Malaria Control in War Areas the Malaria Control in War Areas (MCWA) in 1942(MCWA) in 1942• Established to control malaria on military Established to control malaria on military

bases. Also, protecting civilian populations bases. Also, protecting civilian populations from malaria from returning soldiers. from malaria from returning soldiers.

• Training of state and local health officials in Training of state and local health officials in malaria control.malaria control.

• Later renamed Centers for Disease Control Later renamed Centers for Disease Control and Preventionand Prevention


• 1948 – Member states of United 1948 – Member states of United Nations create the World Health Nations create the World Health Organization Organization • Spurred by a cholera epidemic in Egypt Spurred by a cholera epidemic in Egypt

that took 20,000 livesthat took 20,000 lives• Headquartered in Geneva, SwitzerlandHeadquartered in Geneva, Switzerland• Mission - “is the attainment by all peoples Mission - “is the attainment by all peoples

of the highest possible level of health”of the highest possible level of health”


• Beginning in 1967, the WHO and Beginning in 1967, the WHO and international health communities international health communities decided to take on Smallpoxdecided to take on Smallpox

• By 1979 WHO declared that the By 1979 WHO declared that the disease had been eradicated. The first disease had been eradicated. The first disease in history to be eliminated by disease in history to be eliminated by deliberate human design.deliberate human design.

• Nearing success in developing vaccines Nearing success in developing vaccines against malaria and “snail fever”against malaria and “snail fever”

Different Views of Global Different Views of Global HealthHealth

Disease Specific Disease Specific ApproachApproach

• Has been used Has been used effectively in the pasteffectively in the past

• E.g. Successful E.g. Successful campaign to eradicate campaign to eradicate smallpoxsmallpox

Broad Approach across Broad Approach across several Disciplinesseveral Disciplines

• Feel that it’s needed to Feel that it’s needed to make lasting progress in make lasting progress in public health public health

• E.g.. Emphasize the E.g.. Emphasize the need to establish need to establish primary health care primary health care clinics--that treat as well clinics--that treat as well as immunize against the as immunize against the routine diseases of routine diseases of childhood, provide childhood, provide maternal health care, maternal health care, and family planning and family planning

Brain Drain….Fact or Brain Drain….Fact or Fiction? Fiction?

• The migration of health workers from poor countries to The migration of health workers from poor countries to richer countries.richer countries.

• The current global situation reveals a significant shortage The current global situation reveals a significant shortage of healthcare in much of the world – the most severe of healthcare in much of the world – the most severe cases occurring in sub-Saharan Africa.cases occurring in sub-Saharan Africa.

• WHO estimates that sub-Saharan Africa is suffering a WHO estimates that sub-Saharan Africa is suffering a shortage of more than 800,000 doctors, nurses, and shortage of more than 800,000 doctors, nurses, and midwives, and an overall shortfall of nearly 1.5 million midwives, and an overall shortfall of nearly 1.5 million health workers. health workers.

• This translates into a mere 3% of the world’s health This translates into a mere 3% of the world’s health workers struggling to combat 24% of the global disease workers struggling to combat 24% of the global disease burden. burden.

What’s Being Done?What’s Being Done?• World Health Organization: World Health Organization:

– Objective is the attainment of the highest level of health by all the Objective is the attainment of the highest level of health by all the world’s populations. Millennium Development Goals: 1) poverty; 2) world’s populations. Millennium Development Goals: 1) poverty; 2) primary education; 3) gender equity; 4) child mortality; 5) maternal primary education; 3) gender equity; 4) child mortality; 5) maternal health; 6) HIV/AIDS, malaria and other diseases; 7) environmental health; 6) HIV/AIDS, malaria and other diseases; 7) environmental sustainability; and 8) global partnerships for development.sustainability; and 8) global partnerships for development.

• Health Volunteers Overseas:Health Volunteers Overseas:– An organization that works to increase health care access An organization that works to increase health care access

and sustainability in developing countries through clinical and sustainability in developing countries through clinical training and education programs in child health, primary training and education programs in child health, primary care, trauma and rehabilitation, essential surgical care, oral care, trauma and rehabilitation, essential surgical care, oral health, infectious disease, nursing education and burn health, infectious disease, nursing education and burn management.management.

Global Health InitiativesGlobal Health Initiatives• NutritionNutrition• HIV/AIDSHIV/AIDS• Children’s Health Children’s Health • Sanitation Sanitation • VaccinationVaccination• MalariaMalaria• Women’s Health Women’s Health • Infectious DiseasesInfectious Diseases

www.globalhealth.orgwww.globalhealth.org





U.S. Government Agencies and Global Health

• The Department of State is the lead institution for is the lead institution for the conduct of U.S. diplomacy. the conduct of U.S. diplomacy.

• The U.S. Agency for International Development is is an independent federal agency responsible for U.S. an independent federal agency responsible for U.S. foreign assistance; the agency takes overall foreign foreign assistance; the agency takes overall foreign policy guidance from the Secretary of State. policy guidance from the Secretary of State.

• Some of the other U.S. Government agencies that Some of the other U.S. Government agencies that are working in specific areas of health globally are working in specific areas of health globally include the include the Department of Health and Human Services, the , the Peace Corps, the , the Department of Defense, and the , and the Department of Agriculture. .

http://www.state.gov/

http://www.usaid.gov/

http://www.dhhs.gov/

http://www.peacecorps.gov/

http://www.globalhealth.gov/bumper.shtml?http://www.defenselink.mil/

http://www.usda.gov/

Office of Global Health Affairs Office of Global Health Affairs (OGHA)(OGHA)

• Mission Statement:Mission Statement: To promote the health of the people of the To promote the health of the people of the

world by advancing the Department of Health world by advancing the Department of Health and Human Services‘ global strategies and and Human Services‘ global strategies and partnerships, thus serving the health and well-partnerships, thus serving the health and well-being of the people of the United States.being of the people of the United States.

OGHA cont.OGHA cont.

• Represents the Department to other governments, Represents the Department to other governments, other Federal Departments and agencies, other Federal Departments and agencies, international organizations, and the private sector on international organizations, and the private sector on international and refugee health issues.international and refugee health issues.

• Develops U.S. policy and strategy positions related to Develops U.S. policy and strategy positions related to health issues and facilitating involvement of the health issues and facilitating involvement of the Public Health Service in support of these positions Public Health Service in support of these positions and in collaboration with other agencies and and in collaboration with other agencies and organizationsorganizations

• Provides leadership and coordination for bilateral Provides leadership and coordination for bilateral programs with selected countries, such as the U.S-programs with selected countries, such as the U.S-Russian and U.S. South Africa Health Committee, in Russian and U.S. South Africa Health Committee, in support of Presidential and Vice Presidential support of Presidential and Vice Presidential initiativesinitiatives

How Much Is Spent on Global How Much Is Spent on Global Health Initiatives?Health Initiatives?

• Health and Human Services: $272.3 million in FY 1999 Health and Human Services: $272.3 million in FY 1999 • CDC: $226.8 million in FY 2001 CDC: $226.8 million in FY 2001 • U.S. Agency for International Development: $1.494 U.S. Agency for International Development: $1.494

billion for FY 2001 billion for FY 2001 • President's budget for FY 2002 includes an additional President's budget for FY 2002 includes an additional

$212 million over the $480 already committed for $212 million over the $480 already committed for HIV/AIDS, tuberculosis, and malaria alone. HIV/AIDS, tuberculosis, and malaria alone.

**Even with these large commitments, the United States **Even with these large commitments, the United States spends only 0.1% of its gross national product (GNP) spends only 0.1% of its gross national product (GNP) on foreign assistance, a relatively low percentage on foreign assistance, a relatively low percentage compared with other developed countries** compared with other developed countries**

Other Organizations at Work Other Organizations at Work • World Health Organization• Pan American Health Organization• World Bank• UNICEF• UN High Commissioner for Refugees• UN Foundation• Bill and Melinda Gates Foundation• CARE InternationalCARE International• Global Health CouncilGlobal Health Council

http://www.globalhealth.gov/bumper.shtml?http://www.who.int

http://www.globalhealth.gov/bumper.shtml?http://www.paho.org

http://www.globalhealth.gov/bumper.shtml?http://www.worldbank.org

http://www.globalhealth.gov/bumper.shtml?http://www.unicef.org

http://www.globalhealth.gov/bumper.shtml?http://www.unhcr.ch

http://www.globalhealth.gov/bumper.shtml?http://www.unfoundation.org

http://www.globalhealth.gov/bumper.shtml?http://www.gatesfoundation.org

Current WHO InitiativesCurrent WHO Initiatives• Focus on health workersFocus on health workers

• Shortage of 4.3 Million doctors, nurses, and Shortage of 4.3 Million doctors, nurses, and support servicessupport services

• Preparing the workforce that is in placePreparing the workforce that is in place• Limiting exits from the workforceLimiting exits from the workforce• Formulating national health workforce Formulating national health workforce

strategiesstrategies• Working together, across nationsWorking together, across nations

Current WHO InitiativesCurrent WHO Initiatives• Water Sanitation and HealthWater Sanitation and Health

• Lack of basic sanitation education is one Lack of basic sanitation education is one of the leading causes of death. Typhoid of the leading causes of death. Typhoid and chronic dysentery can be drastically and chronic dysentery can be drastically reduced with safe access to clean waterreduced with safe access to clean water

• PHASEPHASE• Personal Hygiene and Sanitation Personal Hygiene and Sanitation

Education Education

New Traditions in Global New Traditions in Global HealthHealth

• Bill and Melinda Gates FoundationBill and Melinda Gates Foundation• Access to existing vaccines, drugs, and Access to existing vaccines, drugs, and

other tools to fight diseases common in other tools to fight diseases common in developing countriesdeveloping countries

• Research to develop health solutions that Research to develop health solutions that are effective, affordable, and practicalare effective, affordable, and practical

• Large focus on HIV an TB in developing Large focus on HIV an TB in developing countriescountries• TB is leading cause of death for people with TB is leading cause of death for people with

HIVHIV


• International AIDS conferenceInternational AIDS conference• ““Battle against AIDS cannot be won unless we Battle against AIDS cannot be won unless we

also fight TB” –Nelson Mandela also fight TB” –Nelson Mandela • International Labor OrganizationInternational Labor Organization

• UN specialized agency which seeks social justice UN specialized agency which seeks social justice and internationally recognized human rightsand internationally recognized human rights

• Health Volunteers OverseasHealth Volunteers Overseas• Works to increase healthcare access in Works to increase healthcare access in

developing developing


• Physicians for Human RightsPhysicians for Human Rights• Investigate and expose violations of human Investigate and expose violations of human

rights worldwide and educate the health rights worldwide and educate the health professionalsprofessionals

• International Center of Equal Healthcare International Center of Equal Healthcare AccessAccess• Allows healthcare professionals to teach their Allows healthcare professionals to teach their

expertise on HIV care and other infectious expertise on HIV care and other infectious disease through clinical mentoring disease through clinical mentoring

Key Issues and Efforts by Key Issues and Efforts by Republicans for Global Republicans for Global

HealthHealth• Foreign Operations, Export Financing, and Foreign Operations, Export Financing, and

Related Programs Appropriations Act, 2007 Related Programs Appropriations Act, 2007 • Fiscal appropriations for foreign operations and Fiscal appropriations for foreign operations and

the Department of Statethe Department of State• Has been enacted Has been enacted

• Global Pathogen Surveillance Act of 2005 Global Pathogen Surveillance Act of 2005 • Global pathogen surveillance and responseGlobal pathogen surveillance and response

• Bill Frist Jr. – Part of Frist family that owns Hospital Bill Frist Jr. – Part of Frist family that owns Hospital Corporation of America (HCA) Corporation of America (HCA)

• Not yet enactedNot yet enacted


HealthHealth• Microbicide Development Act of 2005Microbicide Development Act of 2005

• Intended to facilitate the development of Intended to facilitate the development of microbicides for the prevention of HIV microbicides for the prevention of HIV and other diseases through the and other diseases through the establishment of a Microbicide Research establishment of a Microbicide Research and Development Unit and through the and Development Unit and through the concurrent strengthening of microbicide concurrent strengthening of microbicide activity at CDC. activity at CDC.



HealthHealth• Global Health Corps Act of 2005 Global Health Corps Act of 2005

• Would mobilize U.S. health care workers Would mobilize U.S. health care workers abroad abroad

• Send doctors as federal employees and Send doctors as federal employees and private-sector professionals as private-sector professionals as volunteers to developing countries volunteers to developing countries


Key Issues and Efforts by Key Issues and Efforts by Democrats for Global HealthDemocrats for Global Health

• Rep. Juanita Millender-McDonald (D-CA) Rep. Juanita Millender-McDonald (D-CA) – H.R. 164 – International Pediatric HIV/AIDS H.R. 164 – International Pediatric HIV/AIDS

Network Act of 2005Network Act of 2005• To amend the Foreign Assistance Act of 1961 to To amend the Foreign Assistance Act of 1961 to

provide for the establishment of a network of provide for the establishment of a network of pediatric centers in certain developing countries to pediatric centers in certain developing countries to provide treatment and care for children with provide treatment and care for children with HIV/AIDS, and for other purposesHIV/AIDS, and for other purposes

– Fiscal ImplicationsFiscal Implications• For fiscal years 2006 through 2010 – no less than For fiscal years 2006 through 2010 – no less than

$10,000,000 annually$10,000,000 annually– This bill never became lawThis bill never became law

Key Issues and Efforts by Key Issues and Efforts by Democrats for Global HealthDemocrats for Global Health• Rep. Barbara Lee (D-CA) Rep. Barbara Lee (D-CA)

– H.R. 945 – New Partnership for Haiti Act of 2005H.R. 945 – New Partnership for Haiti Act of 2005• To provide assistance to combat infectious diseases in To provide assistance to combat infectious diseases in

Haiti and to establish a comprehensive health Haiti and to establish a comprehensive health infrastructure in Haiti, and for other purposesinfrastructure in Haiti, and for other purposes

– Fiscal ImplicationsFiscal Implications• Such sums as may be necessary for each of the fiscal Such sums as may be necessary for each of the fiscal

years 2006 and 2007years 2006 and 2007• Authorized to remain available until expendedAuthorized to remain available until expended

– This bill never became lawThis bill never became law

Global Health Issues - Global Health Issues - DemocratsDemocrats

• Rep. Carolyn Maloney (D-NY)Rep. Carolyn Maloney (D-NY)– H.R. 1011 – Women, Children and Infant H.R. 1011 – Women, Children and Infant

Tsunami Victim Relief Act of 2005Tsunami Victim Relief Act of 2005•To provide financial assistance to the United To provide financial assistance to the United

Nations Population Fund to provide urgent Nations Population Fund to provide urgent medical and health care to tsunami victims in medical and health care to tsunami victims in Indonesia, the Maldives, and Sri LankaIndonesia, the Maldives, and Sri Lanka

– Fiscal ImplicationsFiscal Implications•$3,000,000 to provide assistance$3,000,000 to provide assistance



• Sen. Jon Corzine (D-NJ)Sen. Jon Corzine (D-NJ)– S. 674 – A bill to provide assistance to combat HIV/AIDS in S. 674 – A bill to provide assistance to combat HIV/AIDS in

India, and for other purposesIndia, and for other purposes• Rep. Barbara Lee (D-CA)Rep. Barbara Lee (D-CA)

– H.R. 1408 – A bill to provide assistance to combat HIV/AIDS H.R. 1408 – A bill to provide assistance to combat HIV/AIDS in India, and for other purposes in India, and for other purposes

• Amends the State Department Basic Authorities Act Amends the State Department Basic Authorities Act of 1956 to provide assistance to combat HIV/AIDS in of 1956 to provide assistance to combat HIV/AIDS in IndiaIndia

• Fiscal ImplicationsFiscal Implications– Any amounts otherwise available for such purposeAny amounts otherwise available for such purpose– Such sums as may be necessary for fiscal years 2006 Such sums as may be necessary for fiscal years 2006

through 2008 to provide assistance pursuant to the United through 2008 to provide assistance pursuant to the United States Leadership Against HIV/AIDS, Tuberculosis, and States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003Malaria Act of 2003

• This bill never became lawThis bill never became law


• Sen. John Kerry (D-MA)Sen. John Kerry (D-MA)– S. 1698 – Vaccines for the New Millennium Act of 2005S. 1698 – Vaccines for the New Millennium Act of 2005

• Rep. Peter Visclosky (D-IN)Rep. Peter Visclosky (D-IN)– H.R. 3781 – Vaccines for the New Millennium Act of 2005H.R. 3781 – Vaccines for the New Millennium Act of 2005

• A bill to accelerate efforts to develop vaccines for A bill to accelerate efforts to develop vaccines for diseases primarily affecting developing countries diseases primarily affecting developing countries and for other purposesand for other purposes

• Fiscal ImplicationsFiscal Implications– The Secretary determines that a vaccine to combat a The Secretary determines that a vaccine to combat a

neglected disease is available for purchaseneglected disease is available for purchase– For each fiscal year – any funds in the Treasury not For each fiscal year – any funds in the Treasury not

otherwise appropriated as may be necessaryotherwise appropriated as may be necessary– Amounts shall remain available until expended without Amounts shall remain available until expended without

fiscal year limitationfiscal year limitation• This bill never became lawThis bill never became law


• Rep. Betty McCollum (D-MN)Rep. Betty McCollum (D-MN)– H.R. 4188 – Focus on Family Health Worldwide H.R. 4188 – Focus on Family Health Worldwide

Act of 2005Act of 2005• To Amend the Foreign Assistance Act of 1961 to To Amend the Foreign Assistance Act of 1961 to

improve voluntary family planning programs in improve voluntary family planning programs in developing countries, and for other purposesdeveloping countries, and for other purposes

– Fiscal ImplicationsFiscal Implications• $600,000,000 for fiscal year 2007; $700,000,000 for $600,000,000 for fiscal year 2007; $700,000,000 for

fiscal year 2008; $800,000,000 for fiscal year 2009; fiscal year 2008; $800,000,000 for fiscal year 2009; $900,000,000 for fiscal year 2010; and $900,000,000 for fiscal year 2010; and $1,000,000,000 for fiscal year 2011$1,000,000,000 for fiscal year 2011



• Sen. Barbara Boxer (D-CA)Sen. Barbara Boxer (D-CA)– S. 2564 – Stop Tuberculosis (TB) Now Act of 2006S. 2564 – Stop Tuberculosis (TB) Now Act of 2006

• Rep. Sherrod Brown, (D-OH)Rep. Sherrod Brown, (D-OH)– H.R. 5022 – Stop Tuberculosis (TB) Now Act of 2006H.R. 5022 – Stop Tuberculosis (TB) Now Act of 2006

• To amend the Foreign Assistance Act of 1961 to provide To amend the Foreign Assistance Act of 1961 to provide increased assistance for the prevention, treatment, and increased assistance for the prevention, treatment, and control of tuberculosis control of tuberculosis

• Fiscal ImplicationsFiscal Implications– Assistance to combat TBAssistance to combat TB

• Not less than $225,000,000 for fiscal year 2007 and $260,000,000 Not less than $225,000,000 for fiscal year 2007 and $260,000,000 for fiscal year 2008 to carry out the Foreign Assistance Act of 1961 for fiscal year 2008 to carry out the Foreign Assistance Act of 1961

– Global TB activities though the Centers for Disease Control and Global TB activities though the Centers for Disease Control and Prevention Prevention

• $30,000,000 for fiscal year 2007 and such sums as may be $30,000,000 for fiscal year 2007 and such sums as may be necessary for fiscal year 2008. necessary for fiscal year 2008.

• Amounts shall remain available until expendedAmounts shall remain available until expended• This bill never became lawThis bill never became law


• Sen. Christopher Dodd (D-CT)Sen. Christopher Dodd (D-CT)– S. 2765 – Child Health Investment for Long-term S. 2765 – Child Health Investment for Long-term

Development (CHILD and Newborn) Act of 2006Development (CHILD and Newborn) Act of 2006• Rep. Betty McCollum (D-MN)Rep. Betty McCollum (D-MN)

– H.R. 4222 – Child Health Investment for Long-term H.R. 4222 – Child Health Investment for Long-term Development (CHILD and Newborn) Act of 2006 Development (CHILD and Newborn) Act of 2006

• To provide assistance to improve the health of To provide assistance to improve the health of newborns, children, and mothers in developing newborns, children, and mothers in developing countriescountries

• Fiscal ImplicationsFiscal Implications– $660,000,000 for fiscal year 2007 and $1,200,000,000 for $660,000,000 for fiscal year 2007 and $1,200,000,000 for

each of the fiscal years 2008 through 2011each of the fiscal years 2008 through 2011– Amounts are authorized to remain available until expendedAmounts are authorized to remain available until expended

• This bill never became lawThis bill never became law


• Rep. Rep. Barbara LeeBarbara Lee (D-CA) (D-CA)• H.R. 5674 – Protection Against Transmission of HIV for H.R. 5674 – Protection Against Transmission of HIV for

Women and Youth Act of 2006Women and Youth Act of 2006– To require the President and the Office of the Global AIDS To require the President and the Office of the Global AIDS

Coordinator to establish a comprehensive and integrated HIV Coordinator to establish a comprehensive and integrated HIV prevention strategy to address the vulnerabilities of women prevention strategy to address the vulnerabilities of women and girls in countries for which the United States provides and girls in countries for which the United States provides assistance to combat HIV/AIDS assistance to combat HIV/AIDS

• Fiscal ImplicationsFiscal Implications– Provide flexibility to support the implementation of culturally Provide flexibility to support the implementation of culturally

appropriate HIV prevention programsappropriate HIV prevention programs– Ensure onerous requirements are not imposed with respect to Ensure onerous requirements are not imposed with respect to

how funds can be obligated and expendedhow funds can be obligated and expended– Prevent unnecessary reduction in funding for effective HIV Prevent unnecessary reduction in funding for effective HIV

programs in order to meet such onerous requirementsprograms in order to meet such onerous requirements• This bill never became lawThis bill never became law


• Democratic Presidential Candidate – John EdwardsDemocratic Presidential Candidate – John Edwards– Proposed the U.S. spend $5 billion annually to lead a Proposed the U.S. spend $5 billion annually to lead a

worldwide effort to end global poverty through education worldwide effort to end global poverty through education and and health care initiativeshealth care initiatives

– Fiscal ImplicationsFiscal Implications• Commit $600 million for overseas health-related initiativesCommit $600 million for overseas health-related initiatives

– Programs for clean waterPrograms for clean water• ““If, and I'm not saying at this moment I'm going to do it, but If, and I'm not saying at this moment I'm going to do it, but

if there has to be another revenue source, it can't come from if there has to be another revenue source, it can't come from middle or low-income taxpayers.”middle or low-income taxpayers.”

• Create a new Cabinet post to oversee efforts to fight global Create a new Cabinet post to oversee efforts to fight global povertypoverty

– Currently – more than 50 separate agencies working on foreign Currently – more than 50 separate agencies working on foreign assistanceassistance

• Convene a worldwide summit on "low-cost investment in Convene a worldwide summit on "low-cost investment in clean drinking water and sanitation" and support preventive clean drinking water and sanitation" and support preventive health carehealth care John Distaso, Senior Political Reporter, The New Hampshire Union Leader,

3/16/2007

HIV/AIDS Around the WorldHIV/AIDS Around the World

Proposed Legislation: Proposed Legislation: Pharmaceutical Incentive for Pharmaceutical Incentive for

HIV/AIDS Vaccine 2007HIV/AIDS Vaccine 2007• Establish economic incentives that would increase the participation of Establish economic incentives that would increase the participation of

pharmaceutical companies in the Research and Development of an pharmaceutical companies in the Research and Development of an HIV/AIDS vaccineHIV/AIDS vaccine

• A recurring grant in the amount of $125 million dollars to be used in A recurring grant in the amount of $125 million dollars to be used in the R&D division towards the creation of a vaccinethe R&D division towards the creation of a vaccine

• Tax credit for any costs associated with any phase of the development Tax credit for any costs associated with any phase of the development of the vaccineof the vaccine

• Establish affiliations and partnerships with Universities/Organizations Establish affiliations and partnerships with Universities/Organizations to increase efforts in the development of a vaccineto increase efforts in the development of a vaccine

RationaleRationale• Approximately 40 million individuals are living Approximately 40 million individuals are living

with HIV/AIDS and 5 million are infected with the with HIV/AIDS and 5 million are infected with the virus each yearvirus each year

• The prevalence levels for this virus will continue The prevalence levels for this virus will continue to rise globallyto rise globally

• High mortality and morbidity rates associated High mortality and morbidity rates associated with HIV/AIDSwith HIV/AIDS

• High economic costs in lost productivity and High economic costs in lost productivity and pensions resulting from absenteeism, sickness, pensions resulting from absenteeism, sickness, and deaths from AIDSand deaths from AIDS

Rationale Cont.Rationale Cont.• Immunization is an inexpensive and effective public Immunization is an inexpensive and effective public

health intervention that has had a profound life-saving health intervention that has had a profound life-saving impact around the world.impact around the world.

• The devastating impact of neglected diseases in The devastating impact of neglected diseases in developing countries threatens the political and developing countries threatens the political and economic stability of these countries and constitutes a economic stability of these countries and constitutes a threat to the United States economic and security threat to the United States economic and security interests.interests.

• Despite the devastating impact that AIDS and other Despite the devastating impact that AIDS and other diseases have on developing countries, it is estimated diseases have on developing countries, it is estimated that only 10 percent of the world’s research and that only 10 percent of the world’s research and development on health is targeted on diseases development on health is targeted on diseases affecting 90 percent of the world’s population.affecting 90 percent of the world’s population.

Target GroupsTarget Groups• Pharmaceutical Companies Pharmaceutical Companies • Individuals at high risk of becoming Individuals at high risk of becoming

infected with HIV/AIDSinfected with HIV/AIDS• Institutions such as Universities and Institutions such as Universities and

teaching hospitals as well as IAVI teaching hospitals as well as IAVI (International AIDS Vaccine Initiative) and (International AIDS Vaccine Initiative) and NIH to assist in our efforts to the NIH to assist in our efforts to the development of a vaccine in order to reach development of a vaccine in order to reach our target populationour target population

Pharmaceutical CompaniesPharmaceutical Companies• Lack of funding (financial support) to private and public Lack of funding (financial support) to private and public

sector organizations to development of the vaccinesector organizations to development of the vaccine• Because the developing country market is small and Because the developing country market is small and

unpredictable, there is an insufficient private sector unpredictable, there is an insufficient private sector investment in research for vaccines for neglected investment in research for vaccines for neglected diseases that disproportionately affect populations in diseases that disproportionately affect populations in developing countriesdeveloping countries

• Of more than $100,000,000,000 spent on health Of more than $100,000,000,000 spent on health research and development across the world, only research and development across the world, only $6,000,000,000 is spent each year on diseases that are $6,000,000,000 is spent each year on diseases that are specific to developing countries, most of which is from specific to developing countries, most of which is from public and philanthropic sources. public and philanthropic sources.

PartnershipsPartnerships• Partnerships between governments and private sector are Partnerships between governments and private sector are

playing a critical role in the area of global health, particularly playing a critical role in the area of global health, particularly in the fight against neglected diseases, including HIV/AIDS.in the fight against neglected diseases, including HIV/AIDS.

• These public-private partnerships improve the delivery of These public-private partnerships improve the delivery of health services in developing countries and accelerate health services in developing countries and accelerate research and development of vaccines and other preventive research and development of vaccines and other preventive medical technologies medical technologies essentialessential to combating infectious to combating infectious diseases that disproportionately kill people in developing diseases that disproportionately kill people in developing countries.countries.

• These public-private partnerships maximize the unique These public-private partnerships maximize the unique capabilities of each sector while combining financial and capabilities of each sector while combining financial and other resources, scientific knowledge, and expertise toward other resources, scientific knowledge, and expertise toward common goals which cannot be achieved by either sector common goals which cannot be achieved by either sector alonealone

Partnerships Cont.Partnerships Cont.• Public-private partnerships serve as incentives to the Public-private partnerships serve as incentives to the

research and development of vaccines for the research and development of vaccines for the neglected diseases by providing biotechnology neglected diseases by providing biotechnology companies, which often have no experience in companies, which often have no experience in developing countries, with technical assistance and on developing countries, with technical assistance and on the ground support for clinical trials of the vaccine the ground support for clinical trials of the vaccine through the various stages of development.through the various stages of development.

• Sustaining existing public-private partnerships and Sustaining existing public-private partnerships and building new ones where needed essential to the building new ones where needed essential to the success of the efforts by the United States and others in success of the efforts by the United States and others in the international community to find a cure for these the international community to find a cure for these and other neglected diseasesand other neglected diseases

MechanismMechanism• Interested pharmaceutical companies would Interested pharmaceutical companies would

apply for the grant and the IAVI and the OGHA apply for the grant and the IAVI and the OGHA would be responsible in selecting the recipientwould be responsible in selecting the recipient

• Recipient selection based on quality of Recipient selection based on quality of proposals submitted and grading criteria will be proposals submitted and grading criteria will be established (i.e. advance laboratory established (i.e. advance laboratory technology, past HIV/AIDS research conducted, technology, past HIV/AIDS research conducted, etc.) etc.)

• One (1) Pharmaceutical Company will be One (1) Pharmaceutical Company will be selected to receive the grant each yearselected to receive the grant each year

• Company must submit quarterly reports on Company must submit quarterly reports on status of vaccine developmentstatus of vaccine development

IAVI Mission StatementIAVI Mission Statement• To ensure the development of safe, effective, accessible, To ensure the development of safe, effective, accessible,

preventive HIV vaccines for use throughout the world. IAVI is a preventive HIV vaccines for use throughout the world. IAVI is a global not-for-profit, public-private partnership working to global not-for-profit, public-private partnership working to accelerate the development of a vaccine to prevent HIV infection accelerate the development of a vaccine to prevent HIV infection and AIDS. Founded in 1996, IAVI and AIDS. Founded in 1996, IAVI researches and developsresearches and develops vaccine candidates, vaccine candidates, conducts policy analysesconducts policy analyses, and serves as an , and serves as an advocate for the field with offices in advocate for the field with offices in AfricaAfrica, , IndiaIndia, and , and EuropeEurope. . IAVI supports a comprehensive approach to HIV and AIDS that IAVI supports a comprehensive approach to HIV and AIDS that balances the expansion and strengthening of existing HIV balances the expansion and strengthening of existing HIV prevention and treatment programs with targeted investments prevention and treatment programs with targeted investments in new AIDS prevention technologies. As the world’s only in new AIDS prevention technologies. As the world’s only organization focused solely on the development of an AIDS organization focused solely on the development of an AIDS vaccine, IAVI also works to ensure a future vaccine will be vaccine, IAVI also works to ensure a future vaccine will be accessible to all who need it.accessible to all who need it.

Mechanism Cont.Mechanism Cont.• Establish partnerships with the Pharmaceutical Establish partnerships with the Pharmaceutical

company selected and Universities through company selected and Universities through providing fellowships/internships to students providing fellowships/internships to students interested in R&D of HIV/AIDS vaccine interested in R&D of HIV/AIDS vaccine

• Intellectual property belongs to pharmaceutical Intellectual property belongs to pharmaceutical company but US government will get company but US government will get discounted/bulk price on vaccines to distribute to discounted/bulk price on vaccines to distribute to individuals at riskindividuals at risk

• Funds must primarily be used in the R&D of an Funds must primarily be used in the R&D of an HIV/AIDS vaccine (including clinical trials to ensure HIV/AIDS vaccine (including clinical trials to ensure safety and efficacy)safety and efficacy)

FinancingFinancing● Up to $125 million in Categorical Grant • $25 million per year • Life of grant will be a maximum of 5 years • Each year the grant would be renewable based on the progression in the development of the vaccine

Financing Cont.Financing Cont.

Tracking Funding for Preventive HIV Vaccine R&D, June 2005 [IAVI]

OutcomesOutcomes• A vaccine might not prevent AIDS in the infected person but A vaccine might not prevent AIDS in the infected person but

could reduce the transmission of HIV to otherscould reduce the transmission of HIV to others• Reduce transmission of HIV to babies from infected mothersReduce transmission of HIV to babies from infected mothers• A vaccine could permit the person to become exposed briefly, A vaccine could permit the person to become exposed briefly,

but would prepare the person's immune system to block but would prepare the person's immune system to block continued infection and eliminate the virus. The childhood continued infection and eliminate the virus. The childhood vaccines against measles, mumps, and polio work in this vaccines against measles, mumps, and polio work in this mannermanner

• A vaccine could delay the onset of AIDS for many years, perhaps A vaccine could delay the onset of AIDS for many years, perhaps by which time a more effective treatment could be availableby which time a more effective treatment could be available

ReferencesReferences• www.globalhealth.orgwww.globalhealth.org• http://www.hhs.gov/ogha/http://www.hhs.gov/ogha/• http://www.who.int/en/http://www.who.int/en/• www.gatesfoundation.org/www.gatesfoundation.org/GlobalHealthGlobalHealth//• http://en.wikipedia.org/wiki/Global_healthhttp://en.wikipedia.org/wiki/Global_health• http://www.globalhealth.org/public_policy/http://www.globalhealth.org/public_policy/

global_health_legislation.phpglobal_health_legislation.php• http://www.who.int/en/http://www.who.int/en/• http://www.gatesfoundation.org/default.htmhttp://www.gatesfoundation.org/default.htm• http://thomas.loc.gov http://thomas.loc.gov • http://www.iavi.org/viewfile.cfm?fid=30892http://www.iavi.org/viewfile.cfm?fid=30892

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