1. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 1 Symposium on Vector Biology, Ecology and Control: Celebration of Professor Mir Mulla's 50 Years at Riverside Strategic Considerations for Global Tropical Disease Research: Continued need for innovative vector research Robert Ridley (Director WHO/TDR)

2. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 2 Publications demonstrate need for: Investment in health to alleviate poverty Investment in Research to ensure advances in health and appropriate policy decisions Investment in capacity building so research sustainable and can be driven by DEC's

3. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 3 Critical trends in global research environment DEC's left behind in priority setting Growing regional variation Enhanced research capabilities in DEC's Global research environment for tropical diseases Epidemiological Changes Momentum through new players / initiatives Infectious disease burden remains high Rise in pharmaceutical product development Complexity and fragmentation

4. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 4 Vision An effective global research effort on infectious diseases of poverty in which disease endemic countries play a pivotal role

5. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 5 Implications for TDR  To foster the vision  To focus activity where there is need and where TDR has a comparative advantage

6. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 6 New and improved tools New and improved strategies New knowledge / discoveries New and improved interventions Modelling the system to address TDR's role New and improved interventions New and improved strategies New knowledge / discoveries New and improved tools GAELF Trachoma RBM StopTB Global Fund APOC New and improved tools EDCTP New and improved tools MMV Microbicides DNDi GATB IAVI FIND NIH, Trust, Research councils, etc… Grand Challenges Empowerment, pivotal role … Stewardship, effective global effort..

7. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 7 Implications New knowledge / discoveries New and improved tools New and improved interventions New and improved strategies Foster innovation for products, emphasizing DEC engagement Foster research to develop and evaluate interventions in real-life settings Foster research for access to interventions

8. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 8 Working with all stakeholders to achieve Innovation Interventions Access

9. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 9 Capacity, Empowerment, led by Effective global effort, Stewardship… Empowerment Stewardship BL 4: Innovation for PD in DEC Business Lines and Gaps BL 3: Discovery BL 5: Innovative vector control BL 11: Integrated delivery strategies BL 9: Malaria/fever treatment policy BL 8: Treatment for HIV/TB BL 7: Drugs for helminths BL 6: Diagnostics BL 10: VL elimination

10. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 10 Capacity, Empowerment, led by Effective global effort, Stewardship… Empowerment Stewardship BL 4: Innovation for PD in DEC Business Lines – vector related BL 5: Innovative vector control BL 11: Integrated delivery strategies BL 10: VL elimination

11. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 11 Outline of the presentation Global perspectives, issues and challenges for control of vector-borne diseases TDR contribution to vector-borne disease research Some critical issues for future direction of vector research for tropical diseases

12. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 12 Global perspectives, issues and challenges for control of vector-borne diseases

13. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 13 Vector-borne diseases affect about half of world's population They occur in more than 100 countries, affect nearly half of the world's population, and result in high morbidity and mortality They are responsible for more than 500 million clinical cases per year (nearly one person in ten). Their total burden is about 56 million Disability Adjusted Life Years (DALYs). Malaria remains the dominant disease globally

14. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 14 Climate Change and Human Health. 2002. by A.J. McMichael, D.H. Campbell-Lendrum, C.F. Corvalán, K.L. Ebi, A. Githeko, J.D. Scheraga and A. Woodward, 2003, 322 pages: http://www.who.int/globalchange/publications/climchange.pdf, p. 50http://www.who.int/globalchange/publications/climchange.pdf

15. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 15 http://www.who.int/globalchange/en/

16. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 16 The Economist, 12 May 2007, p. 41

17. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 17 GLOBAL STATUS.Deaths: 1.09 million annually (most deaths occur in children under the age of 5).Cases: 550 million clinical cases annually.Disease burden: 44.99 DALYs). At risk: 40% of the global population (>2.1 bn) Progress in reducing the global burden of malaria has been slow

18. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 18 Continent-wide distribution of malaria burden AfricaAsiaAmericas Estimated proportion of population at risk 66%49%14% Estimated contribution to the global burden of clinical cases 59%38%3% Estimated contribution to the global mortality burden 89%10%<1% http://rbm.who.int/wmr2005

19. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 19

20. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 20 Research Priorities New tools (to address resistance) –Drugs, diagnostics, vaccines, insecticides (IRS, ITN, other) How to use these tools effectively –Dosing, packaging, rotation, combination into packages How to ensure interventions are accessed in poor settings –Distribution mechanisms, community approaches Cost effectiveness of interventions and impact –Health economics, burden of disease measurements etc..,

21. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 21 Dengue: Annual DHF cases

22. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 22

23. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 23 Other Vector-Borne Diseases African trypanosomiasis Chagas disease Leishmaniasis Lymphatic filariasis Onchocerciasis (Schistosomiasis)

24. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 24 Human African Trypanosomiasis (HAT) Control limited by reduced vector control efforts and inadequacy of other existing interventions e.g., drugs are not adequate. Several vector control methods (traps, screens, application of insecticides on traps or livestock, sequential aerial application of insecticides, sterile insect technique, and community-based vector control interventions) were developed over the years, but … –Are they optimised? –Can they be scaled up cost-effectively and sustainably? Opportunities for new tools?

25. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 25 Chagas disease Successful vector control achieved in the Americas based on the application of insecticides to control domestic triatomine populations. However, this approach has been ineffective against the invasion of bugs from peridomestic and sylvatic areas. New tools and approaches needed that prevent re- infestations of triatomine populations. –genetically-engineered bacterial symbionts and biological control agents?

26. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 26 Need for integrated vector management approach Integrates all available resources to achieve a maximum impact on vector- borne disease. Evidence-based requiring capacity to generate local data on disease epidemiology and vector ecology. » Collaboration within the health sector and with other public and private sectors that impact on vectors. » Engagement with local communities and other stakeholders; » A public health regulatory and legislative framework.

27. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 27 Continued need for innovation Environmental management for integrated vector control Tool development (chemical and non-chemical) for vector control –Exploiting advances in biotechnologies for the development of improved vector control tools and strategies –Vector genetic transformation as a potential method for vector control Research on cost-effective delivery Translating research findings into policy and action Building capacity in disease endemic countries for the exploitation of new technologies Need for $$$$$$$$$$$?

28. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 28 Some TDR contributions and future perspectives on Vector Research www.who.int/tdrwww.who.int/tdr for more publications

29. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 29 Some contributions 1982: Onchocerciasis - Bacillus thuringiensis israelensis H-14 in disease control use for blackfly control of onchocerciasis at critical moment to counter pesticide resistance 1989: African trypanosomiasis - Insecticide impregnated tse tse fly traps in disease control use. (biconical and monoconical) 1990: Chagas disease - Fumigant canisters, insecticidal paints and Triatomine detection boxes in disease control use 1991: Onchocerciasis - DNA probes for Onchocerca volvulus (OCP) in control use 1991: Malaria – Tucson meeting initiates activity on genetically modified mosquitoes

30. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 30 Some contributions 1994: Malaria - Insecticide-impregnated bednets in disease control use following results of large-scale trials in Africa showing 20% mortality reduction. 2002: Malaria - Genome sequencing of Anopheles gambiae completed by TDR-fostered consortium and announced simultaneous to the sequencing of Plasmodium falciparum). 2004: African trypanosomiasis -A TDR-led consortium of organizations form the International Glossina Genomics Initiative (IGGI) in an international effort to fully sequence the tsetse fly genome 2005: Methodology to facilitate pupal surveys for dengue 2006: Evidence that community directed provision of bednets can demonstrably enhance uptake

31. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 31 Genetically modified vectors Malaria (since 1994), Dengue (added in 1999) and HAT (added in 2006) Catteruccia, Nature, 2000: A. stephensi transformed using Minos TE Grossman et al., Insect Molec. Bio. 2001: A. gambiae transformed using piggyBac Ito et al., Nature, 2002; Ghosh et al., PNAS, 2001 Mosquitoes refactory to P. berghei

32. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 32 Training Courses and Consultation ICIPE – July 2004

33. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 33 Recent TDR publications on dengue

34. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 34 lPupal and demographic surveys enable assessment of dengue vector densities and threshold levels for Dengue transmission  Pupae serve as proxy for adult mosquitoes  Allows focus on most productive containers making surveys more cost effective  Multi-country study validates hypothesis Achievement – Entomological sampling for Dengue Traditional view: Bottles main source Revised view: Round tanks Tyres main source

35. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 35 House index (% of infested houses) presented as an example from Mexico. Blue bars representing nearby control clusters "benefit" from intervention clusters. Far away external control clusters show unchanged vector densities. Insecticide Treated Curtains Can Reduce Dengue

36. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 36 Elimination of visceral leishmaniasis on Indian sub-continent

37. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 37

38. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 38 Many (APOC) countries familiar with CDT ivermectin –Takes 5 years for APOC to introduce sustainably –Over 100,000 communities engaged –60 million reached –100 million by 2010 Can this CDI be expanded and more broadly utilised? Integrated community directed interventions

39. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 39 Community engagement and ownership of distribution

40. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 40 RBM target P<0.001

41. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 41 APOC target P<0.001

42. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 42 Some critical issues for vector research Impact of climate change and water management Resistance to insecticides Integration of vector control into combined, multi- disease interventions Sustainability of vector control interventions Entomology capabilities, especially in developing countries Managing innovation through multi-disciplinarity of future research Interface between research, control and policy

43. Symposium on VBEC HMI, Riverside, CA May 29-June 1, 2007 43 Vision An effective global research effort on infectious diseases of poverty in which disease endemic countries play a pivotal role