Trends in TB R&D investment: Where is funding most needed? Lindsey Wu Policy Analyst Policy Cures

ABOUT POLICY CURES An independent not-for-profit research group Innovative ideas and accurate analysis to accelerate development and uptake of new products for neglected diseases of the developing world Previously at the London School of Economics and the George Institute for International Health Global Funding of Innovation for Neglected Diseases (G-FINDER) Project funded by the Gates Foundation Tracks global investments into R&D of new products for neglected diseases 31 neglected diseases (including TB) 134 products areas, including drugs, vaccines, diagnostics, microbicides, vector control products and platform technologies Includes analysis of funding trends for TB R&D since 2007

TB R&D funding,  Increase of $113m (25.4%) from 2008 to 2009  Increase share of global neglected disease R&D funding from 15.1% in 2008 to 17.6% in 2009

TB R&D funding by product,  Basic research investments increased in 2009 (up $63m, 47%)  Drug investments increased in 2009 (up $33m, 22%)  Moderate increase in diagnostics (up $7.5m, 17%), and vaccine investment remained steady

TB R&D funding by funder type, 2009  90% of TB R&D funding provided by only 12 funders  Public funding comprised over half of TB R&D funding (~60%)  BUT.. Substantial private sector involvement ($123m 22% in 2009)  Shift towards public funding  Public (up $108.5m from 2008) – mostly US NIH  Philanthropic (down $30.6m from 2008) – mostly Gates  Industry (up $36m from 2008)

Fund received by TB PDPs,  Substantial share of total TB R&D funding (20% or $109m in 2009)  Decrease of 12% ($15m) since 2008, despite overall increase in TB funding = =

W HERE IS TB R&D INVESTMENT MOST NEEDED ?

Global Plan to Stop TB  $9.8bn estimated to be needed from  Published by the Stop TB Partnership  Even though figures have been contested, this is the only benchmark currently available  Consensus on figures important so funders to know that funding for TB is not a blank check – it is results oriented

Global Plan to Stop TB targets, yearly projections Basic research need Improved characterisation of human TB Address key molecular features of host/pathogen interactions Allowing discovery of new biomarkers and new drug and vaccine candidates Drug product needs New four-month TB regimen for drug-susceptible TB Nine-month regimen for MDR-TB, including new drugs for MDR-TB Safer, shorter, higher efficacy treatment for latent TB infection Basic research $200m in 2009 Increase of $200m needed by 2011 Drugs $180m in 2009 Increase of over $400m needed by 2011 (in US$ millions)

P ROJECTIONS CONT Vaccine product needs Safe and effective vaccine Assay to determine biomarkers and correlates of immunity Diagnostic product needs Detection of TB in all age groups Detection of MDR-TB and latent TB Detecting latent TB infection at risk of progression to active TB Rapid and reliable diagnosis of TB for use at peripheral level of health systems Vaccines $113.4m in 2009 Increase of $100m needed initially by 2011, then up another $200m by 2013 Diagnostics $52m in 2009 Increase of $250m needed by 2011 (in US$ millions)

Key messages  Impact of the global financial crisis  Risk of funding cutbacks ARRA programme ($19m for TB)  Public focus on funding for domestic researchers  Shift in focus from product development to basic research  Basic research funding up 47% from  Product development funding up 14% from

Looking forward  TB R&D funding needs a solid investment strategies  More funding is both vital and welcome, BUT  Funding must be strategically targeted  Funding must be coordinated and diversified across a larger number of organisations and sectors  Funding for product development should be protected and prioritised – PDPs can be a good vehicle to achieve that

Thank you