Innovation in a changing global health landscape Peter Piot
Institute for Global Health Imperial College
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A Major Unfinished agenda Infectious diseases Maternal
mortality Child health Reproductive health Malnutrition Access to
primary health care
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A new Global Health landscape Unfinished agenda persisting
Chronic diseases, mental health, ageing Urbanization, climate
change, water, population New prevention& treatment
technologies New actors
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Beaglehole & Bonita,Lancet 2008; 372: 1988
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Lancet 2010; 375:408-18
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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
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Improve quality of care and prevention Increase access to care
and prevention Address crisis in human resources for health Reduce
costs
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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
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Communications/IT technology Figures from C Toumazou 2007
Institute of Biomedical Engineering, Imperial College London
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Simulation/robotics Figures from GZ Yang, The Helen Hamlyn
Centre for Robotic Surgery
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Biotechnology & Genomics Vaccines: new diseases, new
delivery systems, thermo stability Drugs Point of care diagnostics
Tissues Biomarkers Food
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Cardiovascular polypill 2 o prevention trials coordinated by
George Inst, Sydney (A. Rodgers, A. Patel) & Imperial College
London (S. Thom, N. Poulter) UK-Ireland- Nlands China India S.
Africa Oz New Z Canada Brazil 4 drugs in 1 pill: the Red Heart Pill
c/o Dr Reddys (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
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Miniaturization & Nanotechnology Simple imaging instruments
Point of care diagnostics Lab on a chip Pharmaceuticals delivery
Water disinfection
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..with more information Tomorrows e Patient Record Yike Guo
BODY SYSTEMS ORGANS TISSUES CELLS MOLECULES GENES genetic molecular
cellular Patient X MRI ECG CT
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Business Innovation
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Wellcome Trust-Merck vaccine initiative, India
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Innovation of Delivery Delivery of Innovation
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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)
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Lost in translation?
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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
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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
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People receiving ART in low- and middle income countries
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[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 19862007 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
969798990001020304051986878889909192939495 Less than US$ 1 million
59 212 World Bank MAP launch Global Fund PEPFAR 257 UNAIDS Gates
Foundation 062007 10 000 8.9 billion 10 billion
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AIDS-related deaths with and without antiretroviral therapy 2.5
2.0 1.5 0.5 1.0 3.0 0 Number (millions) Year
1996199820002002200420062008199719992001200320052007 Figure V No
antiretroviral therapy At current levels of antiretroviral
prophylaxis