South Africa’s investment in Health Research and Innovation Using innovation to improve the lives of South Africans Glenda Gray President of the South African Medical Research Council 23 rd June, 2014 ESOF 2014

Selected South African Health Indicators South AfricaSub-Saharan Africa Population (2012), millions Average annual population growth rate ( ), % Life expectancy, at birth (2012), years Male Female Gross national income per capita (2012), US$7,4601,350 Child (under 5 yr) mortality rate per 1,000 live births (2012) 41- Neonatal mortality rate1 (<28 days) per live births (2012) 12- Population with access to clean water (2012), % of population 9564

SA’s burden of disease Cause of deathDeaths% HIV/AIDS180, Hypertensive heart disease39, Lower respiratory infections38, Cerebrovascular disease37, Tuberculosis37, Diarrhoeal diseases26, Ischaemic heart disease24, Interpersonal violence20, Road injuries18, Diabetes mellitus13, COPD 11, Nephritis/nephrosis 9, Top 12 causes457, Total615,

HIV South Africa has the highest number of infected individuals In 2012, it is estimated that 12.2% of population (~6.4 million) were HIV positive Increase of 1.2 million over 2008 (10.6% or 5.2 million) South Africa has also the largest antiretroviral (ART) programme with > 2 million patients. Approximately 75% individuals in need of ART received it.

ART roll-out leading to major gains in life expectancy Public sector ART roll-out 60.6 years in years in years in years in 2003 Bor et al. Science 2013

Elimination of HIV infection in infants? South Africa progresses to elimination of HIV infection in children! Prevention of mother to child transmission (PMTCT) prog. with antiretroviral (ART) had reduced the infection rate from 25% (2004) to less than 2% (2013).

Worldwide: – ~450,000 prevalent cases of MDR-TB in 2012 South Africa: – MDR-TB cases (culture-confirmed) – cases Only 6,500 started on treatment in 2012 ~ 10% were culture confirmed XDR-TB Global TB Report, WHO, 2013 & 2012 &2010 South African National Department of Health Report, 2008 NHLS communicable diseases survey bulletin; vol 9; August 2011 Size of the problem TB

Strategic Health Innovation Platform Flagship Projects Training next generation of scientists Focus on both CD & NCD disease  Receive government funding through DOH & DST  Fund intramural & extramural research  Leverage government funding to increase spend on research e.g NIH, BMGF, Wellcome  Investigating disease pathogenesis & drug/vaccine discovery  Validating models for predicting type-2 diabetes  Discovery of links between HLA & clinical TB disease  Prevention of brain injuries during sports  RESEARCH PLATFORMS  Non Human Primate Facilities

TB Drugs Discovery Largest DD projects in the world Paediatric formulations TB Diagnostics PCR with 30 mins readout Urine based diagnostics TB Vaccines Systems biology & bio-informatics Investigating transmission and correlates of protection & disease

HIV microbicides Phase III licensure trial with TNF gel Silver-based microbicide pre-clinical work HIV Vaccines Phase I/II SAAVI DNA & MVA Neutralising Antibodies P5 pox public private partnership (USD100 million) HIV NHP Platform Rhesus macaque immunogenicity SHIV challenge model

Malaria Drug Discovery Largest drug discovery project in Africa Entire lifecycle of parasite Malaria clinical candidate 1 clinical candidate delivered in back up series profiles Insectary Two insectaries in RSA

Blood & Urine Clinical validation Early Diabetes Diagnostic Comprehensive pharmacology evaluation Vivo support model Early Diabetes Drug

Pharmacogenomic: Breast Cancer Pharmacogenomic: Diabetes

Umbiflow = Umbilical Artery Doppler : –Doppler software app –Doppler handheld probe Mobile-connected notebook: –Hosts Umbiflow app –Computer terminal for nurses at clinical level to generate and access EHR, book/refer patients Central database/ health information exchange –Store, filter, access EHR by authenticated users –Allows community health care workers to book patients, facilitate feed-back loop

Tshwane “Mamelodi Khulelwe” Study (CSIR-Tshwane Municipality-UP-MRC) Create evidence for effectiveness of integrated community-based antenatal care to increase the number of pregnant women who attend antenatal care. Create evidence for clinical significance of routine Doppler screening (operated by nurses) at primary antenatal care to reduce the number of unexplained stillbirths. Approx R10m? CHW Patient Nurse

Triage Prototype

Knowledge & Wealth have been recognised as related since ancient times

Scientific Productivity is a much better predictor of economic wealth and human development than any other variables Publications is the index closest to the GDP/capita Jaffe K et, al Plos one, June 2013

Acknowledgements Funders: DOH & DST leveraged BMGF, NIH, British MRC & Wellcome