At Kavli Prize Science Forum, Focusing on Science for Global Health
Can the developed world’s science – resulting in the best and cheapest vaccines, the most powerful computers and the most effective medications – be more effective at improving global health, particular for developing nations?
This was the central question of the Kavli Prize Science Forum, which was held earlier this month in Oslo, Norway.
This year, the topic was "Science and Global Health," with the discussion covering a variety of items. This includes the need for vaccines developed in the countries where they’re needed; the ability of genomics to track infectious diseases; the promise of "Big Data" computing to more effectively track global health trends and rapidly-emerging crises; the critical value of basics such as clean water and good sanitation; and the challenge of implementing low-tech measures to fight malaria, cholera and other deadly epidemics. You can see the webcast of the forum here.
Participating were Rita Colwell, former director of the U.S. National Science Foundation; Alice Dautry, president of the Institut Pasteur in France; Harvey Fineberg, President of the Institute of Medicine in the United States; and Kiyoshi Kurokawa, chairman of the Health and Global Policy Institute in Japan. Moderated by BBC News science correspondent Pallab Ghosh, the discussion opened with an address by Prime Minister of Norway Jens Stoltenberg, who is also co-chair of the UN Commission on Life-Saving Commodities for Women and Children, which works to improve access to essential health supplies for women and children.
Here are some notes/highlights of the discussion:
Rita Colwell - Colwell cited stark statistics that point to the need for a more unified approach to global health care that recognizes connections between what might seem like independent crises – not just attacking one problem at a time in isolation from others. Among the global health challenges that might be addressed by an interconnected response: 2.6 billion people lack improved sanitation, and approximately 800 million people lack safe drinking water; one billion go to bed hungry, while three billion people are undernourished, one billion are obese and 30% to 50% of the world's food production is wasted. "We really need to understand the link between water, energy, food and global health – a holistic approach to global health."
Discussing the disturbing outbreak of cholera in Haiti, Colwell called for global health initiatives that, while grounded in science, also empower the recipients of care – particularly women – by allowing them to tailor the initiatives to the specific needs, culture and societal structure of their communities.
Science research, applied effectively, can be a powerful weapon against disease, Colwell said. Genomic science, for example, is helping health care professionals better understand and track infectious diseases. Advances in computing that can make sense of huge amounts of data – the so-called trend toward using "Big Data" – will soon improve the ability to track the spread of disease across large populations.
Alice Dautry - Dautry said this kind of rigorous scientific analysis is critically needed during global health crises. "It's not so easy because the pressure is very high – the public pressure (and) pressure on politicians. The pressure on people making decisions is difficult, and sometimes you need to slow down just to make decisions on the basis of science." Drug development for health crises in developing nations also needs to be reconsidered. "We tend to do clinical assays for medical treatment in rich countries, the United States and Europe, and we tend to do them more on men. And then of course you use this treatment in different countries, in a different kind of population in different surroundings (and with) different genetics – and sometimes it doesn't work the way they want. … It's not so simple; you can't just transfer even great results of science."
Dautry also pointed to the challenge of implementing low-tech health care solutions in developing nations. As an example, she talked about mosquito bed nets, which have been extremely effective in preventing the spread of malaria – when they’re used as intended. In some places, where women and children are most vulnerable to contracting the disease, men take all the bed nets for themselves. Some men have used them as fishing nets. Dautry said there are far too few follow-up studies on the effectiveness of health care measures.
Developing countries whose populations are suffering most from disease must be allowed to develop their own solutions, Dautry added. "I think the best solutions can come locally, precisely because local people know better their own context, and they can adapt some of the discoveries that have been made may be in the North."
Harvey Fineberg – Global health should be thought of as "public health with the population of the whole world as the object. This has several implications. It means that you think about health in terms of equity as well as achievement because every life has merit and worth. … It means that you think about global health in a way that breaks down the barrier between domestic and international, because the concept of health … for everyone includes the notion of health at home as well as health abroad.
Science in the service of global health must adhere to the same principles of science in any discipline, Fineberg continued. "We want science that is directed ultimately at solving the most important problems, including the problems of health. We want science that is methodologically sound. We want science that is creative, innovative, imaginative and forward-looking. We want science that is carried out in a highly ethical way. This is always the case." Fineberg added three other goals for science aimed toward global health:
- It should be "aimed at solutions that will be universally applicable, because if we are concerned about health everywhere we want science to help solve the problems of health everywhere."
- "The translation of the science should be affordable, and able to be applied in countries and circumstances where fewer resources are available."
- Implementing scientific solutions should be treated as a scientific challenge itself. "The science of implementation is as equally challenging as the basic knowledge that underlies the (solutions) that need to be implemented."
Fineberg also acknowledged that a tension often exists between those who want to devote more resources toward research and those who want more resources committed to providing immediate care. He suggested reframing the issue. "The way to think about it is not research versus care, it's care today versus better care in the future. It's still a trade-off, but it is a trade-off that is really about the present versus the future – rather than investment in knowledge versus investment in treatment."
Kiyoshi Kurokawa - Kurokawa spoke about new approaches to financing global health initiatives. Government-to-government financing can lead to rigidly controlled programs that create a kind of economic dependency by the country receiving benefits.
Innovative options include micro-financing for community health initiatives, and health care programs financed through private organizations that also create local jobs. Kurokawa also cited the success of innovative financing by the Global Alliance for Vaccines and Immunization (GAVI). The International Finance Facility for Immunisation (IFFIm), which raises funds for GAVI, uses "long-term pledges from donor governments to sell ‘vaccine bonds’ in the capital markets, making large volumes of funds immediately available for GAVI programmes," according to the IFFIm website. "It’s a great opportunity, and it’s very creative financing," Kurakawa said.
As a final note, let me also mention that in closing each of the panelists selected their number one priority for improving global health in developing nations. For Colwell, that was addressing the issue of clean water and good sanitation; for Dautry, the priority was better and more training, so there would be exponential growth of people able to address health issues; for Fineberg, it was empowering the nations themselves to play a stronger role in health care research and delivery; for Kurokawa, it was getting the public to think and behave more globally about health care.
These are my notes, which may be a bit rough in places, so if you are interested in the dialogues, you can watch the webcast directly at www.kavlifoundation.org/kavli-prize-science-forum. You can also learn more about The Kavli Foundation, which is one of the founding partners of the Prizes, and is dedicated to advancing science for the benefit of humanity, promoting public understanding of scientific research, and supporting scientists and their work.
Photo credit: Nyaya Health via Flickr