Public-Private Partnerships: Limelight on Diabetes

Renuka Gadde VP, Global Health October 18, 2012

Legal Entities Plant locations Corporate Office

Medical technology company

• $7.5B

• 29,000 employees

Four Areas of Focus

1. Reducing the spread of infection

2. Advancing global health

3. Enhancing therapy

4. Improving disease management Products relevant to Diabetes and Women’s Health

AD Immunization Syringes Blood Collection CD4 Testing TB Diagnostics

About BD (Becton, Dickinson and Company)

Pen Needle

Focus Needed Now More Than Ever Before

“Cancer, diabetes, and heart disease are no longer the diseases of the wealthy. Today, they hamper the people and economies of the poorest populations even more than infectious disease. This represents a public health emergency in slow motion.” Ban Ki-Moon, United Nations Secretary-General

Environment Summary • Non-communicable diseases are a

heavy burden on the progress for global health

• Diabetes disproportionately affects people in developing & emerging countries

• Data reveals the inextricable link of diseases of the poor including those between HIV, TB, and Diabetes

• Healthcare systems must be

strengthened to cope with this burden of chronic disease

• Leading NCD experts are calling for linkages with healthcare systems strengthening efforts associated with funding for infectious diseases

Diabetes Opportunity BD is uniquely positioned to take an industry leadership role in this effort by leveraging our deep competencies in diabetes care and global health experience in immunization, HIV/AIDS, and TB to:

• Advocate for effective use of funding in health systems strengthening efforts

• Partner with other organizations to demonstrate benefits of patient centric care

• Invest in new technologies across the company to improve patient management

Expected Outcome: • Create sustainable markets for our products where

there are tremendous human needs, but insufficient ways to address them

Diabetes is a Huge Developing World Issue

Urbanization and Risk of Diabetes

Move from rural to urban doubles risk Move to “mega-city” (>10MM) raises risk fourfold Sedentary lifestyle, affordable transport, inability to raise food and poor food options all lead to a higher risk Rural areas access to communications that promote “western” food raises risk

Implications Segmentation of markets by urban and rural is insufficient Need socioeconomic segmentation: urban slums Adoption of low-cost innovations developed for RLS will occur within countries and across borders

Key Statistics

80% Diabetics undiagnosed in Africa

500M Number of people with Diabetes in the future

3.5M Annual Deaths from Diabetes in LMIC

4 of 5 Cases in Low/Middle Income Countries

Diabetes NOT Diagnosed 37.7 Million

Diabetes Diagnosed 14 Million

India Diabetes Population 51.7 Million

73% 27%

100

73

10.8

0.5

Start with 100 patients

Diabetes Burden in India

No Insulin 5.6 Million

Insulin 1.4 Million

80% 20%

Treated 7 Million

NOT treated 7 Million

50% 50%

Pens 0.35 Million

Vials 1.05 Million

25% 75% 2

Initiation

Diagnosis

Opt for treatment

Treatment Choice

Device Choice

13.5

Total # patients ‘dropping out’ at

each stage

BD’s History in Diabetes

1897 1924 2000s JDRF and BD Collaborate to Develop More Accurate and Reliable Glucose Monitoring Devices for People with

Type 1 Diabetes

BD™ Insulin Syringes

BD AutoShield™ Duo Pen Needle

BD manufactured its first syringe made specifically for insulin injection.

2010

BD launches the world’s smallest needle – BD Ultra-Fine™ Nano

JDRF and BD Collaborate to Improve Insulin Pump Delivery

2011 2012

Examples of Some of our Programs and Partnerships

BD Diabetes Makeover •Three programs launched over two years (2004-2006) – Nationwide, Washington, D.C., and NYC •14 people total participated in the Diabetes Makeover program •Program helped participants learn how to improve their diabetes management to live healthier lives. •Each participant was made over by the BD Diabetes Dream Team – a team of the nation’s leading diabetes clinical, nutrition and fitness experts, as well as a lifestyle consultant.

India Diabetes Educator Project

• Project HOPE, BD, Lilly and Bayer HealthCare created a four-year collaboration to address the national diabetes crisis in India in 2008.

• BD Developed a training curriculum with Project Hope and IDI and provides long distance learning

• Trained over 4,000 healthcare professionals, including nurses, and dieticians, in diabetes education.

• 60 master trainers trained and 18 collaborative

training centers were set up for onsite patient diabetes education training.

• Expansion of India Diabetes Educators Project with Project HOPE in 2011

• Piloted program at five industry sites with a communication package that promotes • Diabetes prevention education • Motivation and voluntary testing for diabetes • Lifestyle education and linkages to services.

Workplace Wellness Program with CII

• BD is working with CII to deliver an end-to-end six months intervention in two industries.

• Provided this material to MOHFW for their use under their NCD campaign

The Art of Living

• This program is an expansion of the India Diabetes Educators Project.

• It aims to strengthen their existing focus on ‘living well’ to include: • Diabetes prevention education to ‘Yuvacharyas’ • Linkages to labs for voluntary testing for diabetes • Lifestyle education and linkages to appropriate health

care services • The program targets 6,000 slum population across 4 slums

in Bangalore . • Screening followed by intensive follow-up with 500 at risk +

500 diabetics for 18 months to monitor adherence, blood parameters and BMI.

• Demonstrate model for concept of community-based education and management of diabetes through self-motivated behavior change

• First of its kind effort in India to increase clinicians focus on Injection technique, impacting long term patient outcomes.

• 13 Top and most respected KOLs across country signed to be on Advisory Board to develop India guidelines.

• Guidelines developed after review by 75 clinicians from across India and 6 clinicians from India sub continent.

• Guidelines accepted for publication in Indian Journal of Endocrinology and Metabolism – November 2012 Issue.

First India Insulin Injection Technique Guidelines

The Forum for Injection Technique (FIT) was developed to establish and promote best practice in injection technique for all involved in diabetes care.

China Diabetes Education Program

• Since 2008, Project HOPE, BD, Lilly and Roche Diagnostics established diabetes training centers, and developed diabetes education and training materials supported by the Ministry of Health and government.

• Nine Centers of Excellence continue to be referral sites for difficult to treat patients.

• Created a body of 500 Medical Professionals with expertise in the diagnosis and treatment of diabetes care with skills in teaching primary care physicians.

• Developed a “train-the-trainer” model to be replicated in other geographies.

• BD contributed both financial and products donations to this collaborative program.

BD Celebrates World Diabetes Day

• BD associates around the globe demonstrate their support for World Diabetes Day by: – hosting diabetes awareness

activities in their communities, – wearing blue, – walking 366 steps (each step

representing one million people with diabetes) and

– forming the traditional symbolic blue circle.

Diabetes Care Strengthens Global Health Position

HIV & TB HIV Patients 10X

more likely to develop TB

HIV & Diabetes Use of some ART

can increase risk of Diabetes by 3X

TB & Diabetes Diabetes patients 3X

more likely to develop active TB

Need for Patient Management HIV ---- Diabetes ---- TB

Opportunity: BD has deep expertise in all three diseases, combined with a long-standing focus on health systems strengthening that we can further leverage

BD-PEPFAR Collaborations

• BD and PEPFAR collaborate in five areas, which include lab strengthening, wellness centers for healthcare workers, safer blood collection, preventing violence against girls, and addressing breast and cervical cancer in the developing world.

• These collaborations are designed to strengthen healthcare systems and address root causes of the spread of disease in the developing world.

Leveraging Existing HIV/AIDS Platforms: Labs for Life Collaboration

• Labs for Life builds on prior five-year PPP that focused on

improving overall lab systems in sub-Saharan Africa.

• New collaboration will include Uganda, Kenya, Ethiopia and Mozambique and also India will focus on:

– Quality improvement for laboratory services to attain national,

regional, or international accreditation

– Laboratory Human Resources training on pathology, forecasting and optimization

– Curriculum development and training on equipment maintenance

– Collaboration with the ACILT and ASLM to strengthen local capacity and promote country ownership

– Deployment of POC guidelines – Leverage systems and capabilities established for HIV to also

effectively address diabetes

Closing Comments

• Collectively, we can provide a rapid response to this emerging emergency.

• The consequences of not addressing diabetes can simply be stated as costing a life and in many cases over a life time.

• 50% of WW amputations from diabetes; 50,000/yr in India.

• Aravind Eye: Diabetics 25x more likely to suffer blindness.

• Diabetes is the underlying cause for Cardio Vascular deaths.

• We can reverse this condition and manage the condition. At BD, we are committed to this goal.