Successful Collaboration and Preparedness in Global Governance

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1 United States Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response Successful Collaboration and Preparedness in Global Governance ISARIC meeting London, UK November 30, 2015 Dr. Robin Robinson BARDA Director ASPR Deputy Assistant Secretary ASPR: Resilient People. Healthy Communities. A Nation Prepared. 0

2 Some Threats Are Very Large: Pandemic Influenza 1918: Spanish Flu 1957: Asian Flu 1968: Hong Kong Flu A(H1N1) A(H2N2) A(H3N2) m deaths ~500,000 in US 1-4 m deaths 60-80,000 in US 1-4 m deaths ~30,000 in US 1976 Swine Flu The No-Show Pandemic 2009 H1N1 Pandemic 1

3 Other Threats Are Ominous: High Pathogenic Avian Influenza Viruses H5N present 2013 H5N1 2

4 Ebola is both a biothreat and an emerging infectious disease MERS-CoV H5N1 3

5 Human Coronaviruses continue as emerging infectious diseases SARS-CoV MERS-CoV MERS-CoV H5N1 4

6 5 CBRN Material Threats Radiological and Nuclear agents Bacillus anthracis (anthrax) Bacillus anthracis Multi-drug resistant (MDR anthrax) Botulinum toxins (botulism) Variola virus (smallpox) Yersinia pestis (plague) Franciscella tularensis (tularemia) Hemorrhagic Fever Viruses - Ebola, Marburg Burkholderia mallei (glanders) Burkholderia pseudomallei (melioidosis) Rickettsia prowazekii (typhus) Low volatility and volatile nerve agents Hydrogen, potassium, and sodium cyanide Pillar 1 Identify and Assess CBRN Threats

7 6 Threat-Based Preparedness & Response

8 7

9 8 All-Hazards Principle Seasonal & Pandemic Influenza Preparedness All Hazards Preparedness CBRN Preparedness Emerging Diseases Preparedness

10 Medical Countermeasures 9

11 10 Medical Countermeasures Medical Devices Antimicrobials Diagnostics Vaccines Therapeutics

12 Vaccine & Drug Development is still Expensive, Risky and Lengthy 11 PHASES Preclinical Development IND NDA/BLA Discovery Phase I Phase II Phase III Licensure Production & Delivery PRODUCT PIPELINE NIH NIH & ($11.8B) DoD MERS-COV MCMs Valley of Death Ebola MCMs BARDA ARD ($540M) Project BioShield ($5.6B) Licensed Product 1-3% 5-17% 10-25% 18-35% 45-70% 90% PROBABILITY OF SUCCESS TO LICENSURE TIME PIPELINE PHASE COST 3-7 yr yr 1-2 yr yr yr 1-2 yrs $100M -130M $60-70M $70M-100M $130M-160M $190M-220M $18M-20M

13 Statutory Authorities 12

14 13 Biodefense MCM History Project BioShield Act (2004) Pandemic & All-Hazards Preparedness Act (2006) Medical Countermeasure Review (2010) Pandemic & All-Hazards Preparedness Reauthorization Act (2013) PHEMCE Strategic & Implementation Plan (2014) Mid-1950 s on: DoD bio and chem defense programs 9/11 terrorist attacks and anthrax letters Project BioShield (Jul 2004) PREP Act (Dec 2005) PAHPA (Dec 2006) BARDA (Apr 2007) 2009-H1N1 Pandemic (Apr 2009 Aug 2010) PAHPRA st Gulf War Iraqi BW, CW & nuke programs NPS founded (1999) Animal Rule (May 2002) National Strategy for Pandemic Influenza (Nov 2005) PHEMCE Strategy (Mar 2007) Integrated Portfolio (Mar 2008) PHEMCE Review (Aug 2010) PHEMCE SIP 2014

15 Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Governance 14 ASPR/ NIH ASPR/ BARDA CDC/SNS CDC and CDC OPP BARDA CDC/SNS BARDA ASPR/OPEO ASPR Requirements R & D Advanced Development FDA FDA Acquisition & Stockpiling Storage/ Maintenance Deployment Evaluation PHEMCE COORDINATED PLANNING & EXECUTION Other Members:

16 15 DHS : PHEMCE CBRN Medical Countermeasure Process Pillar 1 Identify and Assess Threats BARDA Pillar 2 Evaluate Medical and Public Health Consequences ASPR/OPP Pillar 3 Establish Medical Countermeasure Requirements NIH BARDA CDC Pillar 4 Implement SIP for MCM Development & Acquisition

17 BARDA MCM Story 16 ASPR: Resilient People. Healthy Communities. A Nation Prepared.

18 BARDA s Mission Support advanced development of and make available medical countermeasures for CBRN threats, pandemic influenza, and emerging infectious diseases by transitioning MCM candidates from early development across the Valley of Death into advanced development to regulatory approval O Neil Building, Washington, DC ASPR: Resilient People. Healthy Communities. A Nation Prepared.

19 BARDA Strategic Goals Goal 1: An advanced development pipeline replete with medical countermeasures and platforms to address unmet public health needs, emphasizing innovation, flexibility, multipurpose and broad spectrum application, and long-term sustainability Goal 2: A capability base to provide enabling core services to medical countermeasure innovators Goal 3: Agile, robust and sustainable U.S. manufacturing infrastructure capable of rapidly producing vaccines and other biologics against pandemic influenza and other emerging threats Goal 4: Responsive and nimble programs and capabilities to address novel and emerging threats Goal 5: A ready capability to develop, manufacture and facilitate distribution of medical countermeasures during public health emergencies 18 ASPR: Resilient People. Healthy Communities. A Nation Prepared.

20 BARDA Key Element #1: Create Robust & Innovative MCM Development Pipeline ~ 200 MCM product candidates in development 250 PBS H5N1 PAHPA H1N1 BARDA ERA MCM Review PAHPRA H7N9 Ebola MERS-CoV EID FLU CBRN ASPR: Resilient People. Healthy Communities. A Nation Prepared. 19

21 BARDA Key Element #2: Stockpile CBRN MCMs under Project BioShield Smallpox Radiation Anthrax Thermal Burns 2015 Chemical Botulism ASPR: Resilient People. Healthy Communities. A Nation Prepared. 20

22 BARDA Success Key #3: Seek FDA Approval Cell-based Influenza Vaccine Influenza IV Antiviral Drug Novartis Recombinant-based Influenza Vaccine Protein Sciences Corp. Anthrax Antitoxins H1N1 & H5N1 Vaccines w/ Adjuvant Botulinum Antitoxin HGS/GSK Emergent GlaxoSmithKline Next-Generation Portable Ventilators Covidian Flu/RSV POC Diagnostic Cangene 3M/Focus Amgen ASPR: Resilient People. Healthy Communities. A Nation Prepared. 21

23 BARDA Key Element #4: Establish & Nurture Partnerships ASPR: Resilient People. Healthy Communities. A Nation Prepared

24 BARDA Key Element #5: Establish Robust Manufacturing Capacity Expanding Existing Capacity by Retrofitting Vaccine Manufacturing Infrastructure New Vaccine Mfg. Facilities 2013 ISPE Facility of the Year sanofi pasteur Swiftwater, PA Novartis Holly Springs, NC ASPR: Resilient People. Healthy Communities. A Nation Prepared. 23

25 BARDA Key Element #6: Help MCM Developers for Preparedness & Response CIADMs 2012 Regulatory & Quality Affairs 2006 Fill Finish Mfg. Network 2013 ADS Modeling Hub 2009 Nonclinical Development Network 2011 Clinical Studies Network 2014 ASPR: Resilient People. Healthy Communities. A Nation Prepared. 24

26 BARDA Key Element #7: Have the Best Technical, Clinical, & Regulatory Staff ASPR: Resilient People. Healthy Communities. A Nation Prepared. 25

27 Global Biopreparedness State of Affairs 26 ASPR: Resilient People. Healthy Communities. A Nation Prepared.

28 Key MCM R&D Challenges Ebola Licensure of vaccines(s), Rx clinical studies, & Survivor transmission Pandemic and Seasoanl Influenza Antigenic drift & and seasonal influenza vaccine mismatch Antibiotic Drug Ressitance New drug R&D: conventional & unconventional Global networks for clinical studies MERS-CoV Complete the MERS-CoV basic and translational R&D towards MCM development & approval & clinical study infrastructure in Middle East Rx & vaccine licensure pathways? Mass vaccination campaigns occur? Stockpiles? What about camel vaccines? ASPR: Resilient People. Healthy Communities. A Nation Prepared. 27

29 Global Biopreparedness Amidst Uncertainties Will emergency R&D for EIDs become the new norm? Will bioterrorism fatigue, disbelief, & denial persist? Global biopreparedness IOM, GloPID, ISARIC, Grand Convergence, & WHO consultations: Who is steering the ship and where are we going? ASPR: Resilient People. Healthy Communities. A Nation Prepared. 28

30 Contact Us BARDA: URL: BARDA Upcoming Events PHEMCE Strategy and Implementation Plan CBRN and Pan Flu Programs Business Toolkit Tech Watch program Federally-sponsored conferences Funding opportunities Resources 7 core service programs Regulatory guidance Federal strategies and reports ASPR: Resilient People. Healthy Communities. A Nation Prepared.

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