The de­vel­op­ing world’s health in­no­va­tors

Financial Mirror (Cyprus) - - FRONT PAGE -

We live in an age of tragic health para­doxes. Mass immunisation cam­paigns have elim­i­nated en­tire dis­eases, but chil­dren in coun­tries like Haiti and Bangladesh con­tinue to die of eas­ily treat­able dis­eases caused by com­mon pathogens. Glob­al­i­sa­tion has lifted mil­lions of peo­ple out of ex­treme poverty, but has left them ex­posed to the non­com­mu­ni­ca­ble dis­eases of the post-in­dus­trial age – from di­a­betes to heart dis­ease – in coun­tries that lack the re­sources to treat them.

Un­der­ly­ing these para­doxes is yet an­other: the vast ma­jor­ity of health re­search is con­ducted in wealthy economies, but the vast ma­jor­ity of the global pub­lic-health bur­den falls on low- and mid­dle-in­come coun­tries. There is some­thing grossly in­ef­fi­cient – even im­moral – about this al­lo­ca­tion of re­sources, which un­der­mines the devel­op­ment of health so­lu­tions for those who need them most.

To be sure, it was pos­si­ble to ad­dress the first gen­er­a­tion of global devel­op­ment prob­lems with straight­for­ward trans­fers of cap­i­tal and so­lu­tions from rich to poor coun­tries. Ex­am­ples in­clude pro­grams to boost pri­mary-school en­roll­ment and, in pub­lic health, mass i mmu­ni­sa­tion cam­paigns. But the new gen­er­a­tion of devel­op­ment prob­lems, from the qual­ity of ed­u­ca­tion to child deaths from treat­able dis­eases, will not be so easy to re­solve. They de­mand long-term ca­pac­ity build­ing and knowl­edge trans­fers from rich to poor coun­tries, with the lat­ter gain­ing far more agency in de­vel­op­ing so­lu­tions.

In other words, the fo­cus of global pub­lic-health strate­gies and in­vest­ments should shift to­ward re­duc­ing the struc­tural dis­par­i­ties be­tween rich and poor coun­tries, in terms of their ca­pac­ity for med­i­cal re­search and pub­lic-health im­ple­men­ta­tion. This mis­sion – which, I would ar­gue, should be the main goal of global pub­lic-health ef­forts to­day – would en­tail a cen­tral role for in­sti­tu­tions like the In­ter­na­tional Cen­tre for Diar­rhoeal Dis­ease Re­search (icddr,b), based in Dhaka, Bangladesh, where I work as a sci­en­tist.

As it stands, most global pub­lic-health ac­tiv­i­ties in­volve re­searchers from ad­vanced coun­tries lead­ing lo­cal teams in de­vel­op­ing coun­tries. While this is bet­ter than im­pos­ing ready-made so­lu­tions on the de­vel­op­ing world, as oc­curred dur­ing the Cold War, it is not good enough. Med­i­cal re­search and pol­icy im­ple­men­ta­tion in the de­vel­op­ing world must be led by re­searchers and spe­cial­ists from low- and mid­dlein­come coun­tries – peo­ple who can com­bine cut­ting-edge sci­en­tific ex­per­tise with an in­ti­mate un­der­stand­ing of lo­cal con­texts. The value of de­vel­op­ing-coun­try-led in­no­va­tion has been demon­strated time and again. Over the last 15 years, sci­en­tific in­no­va­tions spear­headed by de­vel­op­ing coun­tries con­trib­uted sig­nif­i­cantly to progress on the United Na­tions Mil­len­nium Devel­op­ment Goals (MDGs), par­tic­u­larly those re­lated to global health.

The con­tri­bu­tions of icddr,b alone are enough to prove the value of de­vel­op­ing-coun­try health in­no­va­tion. The in­sti­tute’s re­searchers carry out in­no­va­tive and com­plex sci­ence, from clas­sic clin­i­cal tri­als and epi­demi­o­log­i­cal stud­ies to be­hav­ioral-mod­i­fi­ca­tion tri­als aimed at re­duc­ing the spread of in­fec­tious dis­ease – with re­mark­able re­sults.

An iconic ex­am­ple of icddr,b’s work is oral re­hy­dra­tion so­lu­tion (ORS), a sim­ple bal­anced so­lu­tion of sugar and salt ad­min­is­tered orally to peo­ple suf­fer­ing from di­ar­rheal dis­eases like cholera. That so­lu­tion, which icddr,b played a cen­tral role in de­vel­op­ing, has pre­vented an es­ti­mated 40 mil­lion deaths glob­ally since the 1960s, and has been called one of the most im­por­tant med­i­cal in­ven­tions of the twen­ti­eth cen­tury. More re­cently, my team and I de­vel­oped a new low-cost sys­tem for de­liv­er­ing “bub­ble CPAP” (con­tin­u­ous pos­i­tive air­way pres­sure), which keeps air flow­ing dur­ing the process of treating se­vere pneu­mo­nia. Trevor Duke, Di­rec­tor of the Cen­tre for In­ter­na­tional Child Health at the Royal Chil­dren’s Hospi­tal at the Univer­sity of Mel­bourne, also par­tic­i­pated in the pro­ject.

Our ver­sion of bub­ble CPAP, which uses cheap and read­ily avail­able ma­te­ri­als like plas­tic tub­ing and sham­poo bot­tles, proved in tri­als to be more ef­fec­tive than the stan­dard lowflow oxy­gen ther­apy rec­om­mended by the World Health Or­gan­i­sa­tion. Fol­low­ing the trial, the Dhaka Hospi­tal of icddr,b im­ple­mented the new low-cost bub­ble CPAP, in­stead of the WHO-rec­om­mended ther­apy, as part of stan­dard treat­ment of chil­dren with pneu­mo­nia. Since then, the death rate for bub­ble CPAP-treated pa­tients has fallen from 21% to just 6%.

These re­mark­able suc­cesses stem from the fact that icddr,b re­searchers – most of them Bangladeshis who trained abroad – are well ac­quainted with the prob­lems they are try­ing to ad­dress. They un­der­stand what it means to face se­vere – and, to some ex­tent, in­sur­mount­able – re­source con­straints.

The 15-year MDG ex­pe­ri­ence made clear the in­dis­putable po­ten­tial of de­vel­op­ing-coun­try in­no­va­tion to ad­vance pub­lic health. For­tu­nately, world lead­ers seem to have taken that les­son to heart: the Sus­tain­able Devel­op­ment Goals – the am­bi­tious post-2015 devel­op­ment agenda adopted at the UN last Septem­ber – are premised on the idea of lo­cal own­er­ship.

But, de­spite vo­cal sup­port for lo­cally led re­search and devel­op­ment, se­vere con­straints to de­vel­op­ing-coun­try in­no­va­tion re­main – and must ur­gently be re­moved. Un­sur­pris­ingly, the tight­est con­straint is the lack of re­sources, both hu­man and fi­nan­cial. To ease it, de­vel­oped and de­vel­op­ing coun­tries must now work to­gether to en­sure ad­e­quate in­vest­ment to sup­port lo­cal ef­forts re­li­ably and sus­tain­ably. With ad­e­quate sup­port from lo­cal and in­ter­na­tional fi­nanc­ing mech­a­nisms, more in­no­va­tion hubs like icddr,b could emerge and flour­ish in poor coun­tries. By ad­vanc­ing knowl­edge shar­ing and tech­nol­ogy trans­fer, these hubs would en­hance co­op­er­a­tion among de­vel­op­ing coun­tries, and help us fi­nally over­come the per­sis­tent and tragic dis­par­i­ties that plague global health.

Health in­no­va­tions de­vel­oped in the world’s poor coun­tries have passed the test of scal­a­bil­ity and ap­pli­ca­bil­ity in the places that need them most. With the ma­jor­ity of the world’s pop­u­la­tion liv­ing in re­source-chal­lenged set­tings, we must recog­nise – and in­vest in – the ef­forts of those who are push­ing the fron­tiers of med­i­cal sci­ence in the de­vel­op­ing world.

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