1. Innovation in a changing global health landscape Peter Piot Institute for Global Health Imperial College

2. A Major Unfinished agenda Infectious diseases Maternal mortality Child health Reproductive health Malnutrition Access to primary health care

3. A new Global Health landscape Unfinished agenda persisting Chronic diseases, mental health, ageing Urbanization, climate change, water, population New prevention& treatment technologies New actors

5. Beaglehole & Bonita,Lancet 2008; 372: 1988

6. Lancet 2010; 375:408-18

7. 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”

8. Improve quality of care and prevention Increase access to care and prevention Address crisis in human resources for health Reduce costs

9. 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

10. Communications/IT technology Figures from C Toumazou 2007 © Institute of Biomedical Engineering, Imperial College London

11. Simulation/robotics Figures from GZ Yang, The Helen Hamlyn Centre for Robotic Surgery

12. Biotechnology & Genomics Vaccines: new diseases, new delivery systems, thermo stability Drugs Point of care diagnostics Tissues Biomarkers Food

13. Cardiovascular polypill 2 o prevention trials coordinated by George Inst, Sydney (A. Rodgers, A. Patel) & Imperial College London (S. Thom, N. Poulter) UK-Ireland- N’lands China India S. Africa Oz New Z Canada Brazil 4 drugs in 1 pill: the “Red Heart Pill” c/o Dr Reddy’s (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

14. Miniaturization & Nanotechnology Simple imaging instruments Point of care diagnostics Lab on a chip Pharmaceuticals delivery Water disinfection

15. ..with more information Tomorrow’s e Patient Record Yike Guo BODY SYSTEMS ORGANS TISSUES CELLS MOLECULES GENES genetic molecular cellular Patient X MRI ECG CT

16. Business Innovation

17. Wellcome Trust-Merck vaccine initiative, India

21. Innovation of Delivery Delivery of Innovation

25. 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)

27. Lost in translation?

29. 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

30. 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

31. People receiving ART in low- and middle income countries

32. [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 1986‒2007 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 ‘96‘97‘98‘99‘00‘01‘02‘03‘04‘051986‘87‘88‘89‘90‘91‘92‘93‘94‘95 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

34. 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