Davis

Seattle’s global health organization PATH announced today that Steve Davis has been appointed president and CEO.

In his new position Davis will oversee PATH’s annual budget of $305 million, a staff of nearly 1,200, and a portfolio of projects based in PATH offices in 22 countries.

PATH projects include the development of an affordable meningitis vaccine, improved screening and treatment for HIV/AIDS and tuberculosis, and low-cost filters for safe drinking water.

Davis comes to PATH  from McKinsey & Company, where he was global director of social innovation.

In that position, Davis led a global team that consults for nongovernmental organizations (NGOs), governments, and the private sector, with a focus on global health and development, research and development, and Asia and Africa.

Previously, Davis was a long-term CEO of Corbis, a global digital media leader, and served as interim CEO of the Infectious Disease Research Institute, a nonprofit biotech working on vaccines, diagnostics, and drug discovery for infectious diseases of poverty.

His previous experiences also include serving as interim director of PATH’s India program, practicing law with K&L Gates, and working on refugee and human rights issues.

Mr. Davis earned his bachelor’s degree from Princeton University, his master’s degree from the University of Washington, and his juris doctor from Columbia University.

Davis will join PATH on June 11 and be based at PATH’s Seattle headquarters.

He succeeds former president and CEO Dr. Christopher J. Elias, who led PATH through significant growth for ten years.

Dr. Elias left PATH in January to become president of the Global Development Program at the Bill & Melinda Gates Foundation.

The malaria parasite

A malaria vaccine developed by the pharmaceutical company GSK and Seattle’s PATH has been shown to halve the risk of severe malaria in African children.

Malaria strikes an estimated 225 million people worldwide each year, killing more than 780,000 — most of whom are African children.

Currently, there is no approved vaccine for the prevention of the  disease, which is caused by the parasite Plasmodium falciparum.

The new results, which have been published online in the New England Journal of Medicine, were announced today in Seattle at a Malaria Forum hosted by the Bill & Melinda Gates Foundation, which provided major funding for the trial.

The study, which was conducted in seven countries in sub-Saharan Africa, found that three doses of the vaccine, called RTS,S, reduced the risk of a child developing high fever and chills by 56 percent and of severe malaria by 47 percent.

In the study ,the researchers looked at malaria rates among the first 6,000 children, aged 5 to 17 months, in the 12 months after they had received the third dose of the three-dose vaccine regimen.

All together, a total of 15,460 children are enrolled in the study in two age groups–a younger group, 6 to 12 weeks-old and a slightly older group 5 to 17 months-old.

The trial is ongoing, and results of the vaccine’s efficacy in infants 6 to 12 weeks-old are expected by the end of 2012, but a interim analysis of all of the infants and children enrolled in the trial 6 weeks to 17 months finds that at an average of about one year the vaccine reduced the risk of of severe malaria by a third, 34.8 percent.

In a commentary that accompanied the article, Dr. Nicholas White, professor of Tropical Medicine at Mahidol University in Thailand, writes that if all goes well, the RTS,S vaccine should become available in just over 3 years. “It’s been a long time coming, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans.”

But, he adds, questions remain: how long, for example, will the vaccine remain protective, how much will the vaccine cost, and, will the recent drop in malaria deaths due to other interventions, such as the increased use of insecticide-treated bed nets, cause a loss of support for expensive anti-malaria initiatives.

“How,” he asks, “will the necessary funding be sustained in the face of a global economic downturn, along with a reduction in political pressure associated with declining mortality form malaria?”

The report, Financing Global Health 2010, found that funding for global health worldwide has risen markedly over the past two decades, from $5.66 billion in 1990 to $26.87 billion in 2010 — a 375 percent increase.

The fastest growth was seen between 2004 and 2008, when funding rose 13 percent a year on average, the report found, but that rate has since slowed to 6 percent a year between 2008 and 2010.

The U.S. government and private U.S. donors had made substantial contributions, making up one-half of all global health funding in 2008, the report found.

Total overseas health expenditures channeled through US NGOs by funding source, 1990-2010 (Graphic IHME)

BMGF = Gates Foundation

However, in general, the recent increases in funding were driven by government donations as the recession led to a fall in private donations to non-governmental organizations (NGOs), the report found. Funding from U.S. NGOs, for instance, fell 24 percent from 2009 to 2010.

In many cases, funds did not necessarily go where the need was greatest, the report said. For example, countries such as  Bangladesh, the Democratic Republic of the Congo and Brazil, rank high on the “burden of disease list” but received much less aid than would be expected if aid was based purely on disease burden, the report said.

At the same time, countries such as Tanzania, Ethiopia, Uganda, Kenya, and Mozambique received more funds in proportion to their disease burden, in part because all received health aid from the U.S.-funded President’s Emergency Plan for AIDS Relief (PEPFAR) from 2004 to 2008 to help combat HIV/AIDS in these countries, the report said.

When viewed in the context of specific health focus areas, the contrast between need and funding can be even more apparent. For example, 16 of the 20 countries with the highest maternal mortality ratios in 2008 do not appear among the 20 countries that received the most DAH (development assistance for health) between 2003 and 2008.

In fact, 11 of the 30 countries with the highest disease burdens do not appear in among the 30 countries that receive the most assistance, the report found.

Other findings from the report:

• Spending on HIV/AIDS programs has continued to rise at a strong rate to $6.16 billion in 2008, making HIV/AIDS the most funded of all health focus areas.

• Funding for maternal, newborn, and child health, in contrast, received $3.17 billion, about half as much funding as HIV/AIDS as of 2008.

• Malaria and tuberculosis are often included with AIDS as top priorities in combatting infectious diseases, but both receive far less funding: $1.19 billion for malaria in 2008 and $0.83 billion for tuberculosis.

• Aid for malaria and tuberculosis also appears to go to countries that do not have large groups at risk for these diseases. For example, of the 30 countries that receive the most malaria health funding adjusted for disease burden, only three – Eritrea, Sao Tome and Principe, and Swaziland – are located in sub-Saharan Africa, where malaria is most acute.

• Despite much discussion about the need for to build health systems in developing world countries, only $1 billion went to health sector support in 2008, low compared to other health focus areas.

• Funding for noncommunicable diseases, such as cancer, diabetes and cardiovascular disease, which are growing problems in the developing world as these areas grow more prosperous, was $121.25 million in 2008, just 0.5% of all development assistance for health.

The imbalances identified by the report will need to be addressed, said Dr. Christopher Murray, director of the institute and lead author of the report.

“More than 300,000 mothers still die every year, and more than 7 million children die before the age of 5. Chronic diseases need more attention, and countries need better health care infrastructure,” Dr. Murray said. “All of these pressing health issues require funding, and it is becoming increasingly difficult to balance competing needs.”

To learn more:

• Read the report: Financing Global Health 2010

• Visit the Institute of Health Metrics and Evaluation’s website

Malaria parasites in red blood cells

Three years ago, the Bill & Melinda Gates Foundation called for the eradication of malaria, a goal that some experts believe is impossible.

In today’s Seattle Times science reporter Sandi Doughton writes about new developments in the Foundation’s controversial initiative.

“Chief among the new priorities is a vaccine that would prevent mosquitoes from spreading the disease. People who are inoculated could still get malaria, but mosquitoes that bite them would not be able to infect anyone else.”

But, she notes,”some experts fear its emphasis on eradication will divert too much money and energy away from efforts to treat the disease and toward a far-off goal,” Doughton writes.

“The increased focus on the future means the Gates Foundation is ending its support for some efforts to lessen the disease’s current toll. Those include research to improve treatment of the severe infections that strike children and pregnant women, and that are responsible for most of the estimated 850,000 annual deaths from malaria.”

Dr. David Brandling-Bennett, leader of the foundation’s malaria programs, admitted that eradication may be decades away but said that it’s important to start working on the necessary drugs and vaccines, which can take a decade or more to develop, now.

To learn more:

• Read Doughton’s article Gates Foundation shakes up science with goal to end malaria

You can view a two-hour webcast of the event online here.

(LocalHealthGuide covered the event and will provide an summary of the discussion over the weekend.)

The forum focused on a recent report by the Center for Strategic and International Studies’ (CSIS) Commission on a Smart Global Health Policy.

The Washington, D.C.-based, CSIS is a bipartisan, nonprofit organization founded in 1962 to find ways for America “to sustain its prominence and prosperity as a force for good in the world.”

In the report, the commission’s 25-member expert panel argues that a “smart, strategic, long-term global health policy will advance America’s core interests” and “enhance America’s influence, credibility, and reservoir of global goodwill” while at the same time “save and lift the lives of millions worldwide.”

The panel recommends the U.S. adopt a five-point agenda for global health:

Maintain the commitment to the fight against HIV/AIDS, malaria, and tuberculosis

Funding for initiatives targeting these diseases is under threat due to the recession and concerns that money might be better spent on other efforts, such as child and maternal health and health systems strengthening.

U.S. leadership can ensure that “immediate budgetary woes do not derail our efforts,” the commission says and argues that by leveraging these “disease-focused investments” it will be possible to create “lasting health systems” and provide “long-term solutions.”

Prioritize women and children in U.S. global health efforts

The U.S. should double its annual investment in child and maternal health to $2 billion to expand models of care that have been proven effective, the commission says.

These investments should focus on a few core countries in Africa and South Asia, the commission says.

“Affordable tools exist to reduce infant deaths in the first month of life; expanded immunizations can improve child survival; and expanded access to contraceptives can bolster women’s health,” the commission says.

Strengthen prevention and capabilities to manage health emergencies

“Disease prevention offers the best long-run return on investment,” the commission concludes. Emerging health threats, such as infections disease outbreaks, require “long-range collaborative investments”, including making it possible for poor countries to have access to affordable vaccines and medications needed to combat pandemics.

Ensure the United States has the capacity to match our global health ambitions

In order to meet its potential, the U.S. needs a predictable, long-term global health plan, the commission argues. “An essential step is to forge a global health strategy, organized around a forward-looking commitment of about 15 years, careful planning, and long-term funding tied to performance targets,” the commission says.

Among its recommendations, the  commission recommends that a deputy adviser at the National Security Council be charged with formulating a global health policy and promoting coordination and collaboration between government agencies involved in implementing global health programs.

In addition, the commission recommends the creation of an Interagency Council on Global Health to report to this deputy adviser as well as a senior global health coordinator to be located in the Office of the Secretary of State to coordinate day-to-day operations.

Make smart investments in multilateral institutions

While the U.S. will continue to put a strong focus on its own direct investments in global health, The commission urges the U.S. to “bolster its collaborations” with the World Health Organizations, the World Bank, the Global Fund to Fight AIDS, Tuberculosis, and Malaria and other international agencies.

“By pooling resources and efforts with others, the United States is better able to build health systems, extend the reach of vaccine and infectious disease programs beyond U.S. partner countries, devise alliances to meet trans-sovereign challenges, and mobilize resources and leadership among our partners.”

“If we pursue these steps,we can accomplish great things in the next 15 years,” the commission concludes, including:

• Cut the rate of new HIV infection by two-thirds

• End the threat of drug-resistant tuberculosis

• Eliminate malaria deaths

• Significantly expand access to contraceptives.

• Reduce by three-quarters of the 500,000 mothers who die each year in pregnancy

• Save over 2.6 million newborns from dying in the first month of life.

• And significantly reduce the more than 2 million deaths of children under five years of age caused by vaccine-preventable diseases.

The panel for the Seattle conference included:

• Governor Christine Gregoire
• Anne-Marie Slaughter, Director of Policy Planning, U.S. Department of State
• Dana Hyde, Senior Adviser to Deputy Secretary of State Jacob Lew
• Dr. Tadataka (Tachi) Yamada, President, Global Health Program, Gates Foundation
• Dr. Rajeev Venkayya, Director, Global Health Delivery, Gates Foundation
• Dr. Chris Elias, President and CEO, PATH
• Admiral William J. Fallon, US Navy (Retired)
• Dr. Helene Gayle, President and CEO, CARE
• Dr. John Hamre, President and CEO, Center for Strategic and International Studies