I thank the Chairman and members of the joint committee. I am acutely aware that members are busy consulting with their constituencies and I am delighted and highly honoured that you have found time to allow me to talk to you. I love coming to Dublin — this is my second visit — principally because my education has been very much linked to this city through the Mill Hill Fathers. It is a pleasure to be here.
The issue which brings me here is diagnostics. I have just a few points to leave with the committee for deliberation. The public health landscape in developing countries is changing substantially. Life saving medicines are beginning to reach people in the developing world, for tuberculosis, HIV/AIDS, malaria and other diseases. This is a tremendous achievement, but more can be done, especially in enabling the marginalised populations in rural areas who suffer a disproportionate burden of those diseases. We need to enable them to access these benefits and services.
While I thank the Government and people of Ireland for their generosity in contributing to the global fund to fight these diseases, in fact we could have greater impact if those drugs were properly utilised. A critical factor for their rational utilisation is diagnostics. Today the method of diagnosis for TB and malaria is microscopic examination of sputum or blood. It is a 100-year-old technology which was used to discover those very diseases. It is terribly inefficient but in the developing world it is the tool used for diagnosis. In the case of TB, for instance, globally we invest more than $1 billion in diagnostics, but we get a raw deal because only one quarter of patients are actually diagnosed.
Looking at the performance of microscopy, in the best case scenario under research conditions with good supervision, one would be lucky to get 50% of sputum positive patients picked up by microscopy. This used to be so before the onset of HIV/AIDS. In co-infections between TB and HIV, the sputum does not have the bacillae because they are not secreted in the sputum when patients are co-infected with HIV. They are in the blood, in the bones and elsewhere, but not in the sputum. Therefore, microscopy does not work. In children, microscopy cannot work because children do not cough out the sputum — they swallow it. We need better and easier point of care diagnostics. It is a problem to get them because the discovery has not been upfront in the case of TB to give us the right choice of protein molecules to put in the diagnostic tests. Some 50% to 80% of patients treated for malaria episodes actually do not have malaria. That is a waste of drugs because these children have other conditions.
We have to improve diagnostics, which is the case I want to make here. It is possible to improve them and that is what FIND is all about. FIND is doing so in partnership with industry and with academia in both developed and developing countries. It is working closely with the national disease control programmes of the endemic countries. The business model is a public private partnership which picks up ideas from proof of concept and drives the idea through the development of products, evaluation for efficacy trials and registration and goes a step further, which currently industry does not do. Industry will develop and register a product and that is it. We do not think that is the way to get into the public health sector. The best way to get into that sector is to introduce those products in selected national disease control programmes and generate evidence of their cost effectiveness, potential impact and ease of use in order to persuade the public health sector to utilise those technologies. That is what FIND does.
We have been assisted in doing this by the Bill and Melinda Gates Foundation. Our initial grant for TB was for $23 million, which we were supposed to spend in five years. We have spent it in three years but we achieved all the targets. We have a number of tantalising candidate diagnostic products in our pipeline and the dossier on the performance of three of them in national disease control programmes has already been submitted to the World Health Organisation. The WHO can offer guidelines to countries to use these technologies.
We have teamed up with the Clinton Global Initiative in looking at another aspect. We may have nice diagnostics but getting them used in the public sector is not a simple matter. The diagnostic services, just like the health sector infrastructure, has gone down over the last two decades and we need to address that. We are looking at methodologies and mechanisms for building the infrastructure to accept these new technologies when they arrive.
FIND is a public private partnership. Most of the funding is from the Gates foundation. We have got $23 million for TB, $10 million for malaria, $10 million for sleeping sickness. We are expecting another $50 million or so shortly as a renewal of the TB grant. We have got money from the Dutch Government, close to €8 million. It is important that we get public partners to contribute to this partnership. This is what brings me here. Part of my responsibility is to explain to donor countries, to beg — I am in charge of resource mobilisation. I have been talking to the Swiss Government, and those in the USA and Canada. It is a pleasure to address you in the same vein.