Priya Shetty discusses why biomedical research is vital in steering progress towards the Millennium Development Goals.
Following this week's UN summit in New York to discuss progress towards the Millennium Development Goals (MDGs) – the deadline is now just five years away – the focus must shift to practical improvements in healthcare delivery.
The targets set in 2000 were ambitious, and progress has been mixed, with some areas showing hard-won improvements and others demonstrating an appalling lack of momentum. In particular, we are still a long way from meeting the key health targets set for 2015: a two-thirds reduction in child mortality; a three-quarters reduction in maternal mortality; and success in combating HIV, malaria and other major global diseases.
Inadequate funding is partly to blame, and many countries are still feeling the effects of the economic crash, which hit both foreign aid and domestic budgets. Crippled health systems have meant that the products of biomedical research, such as medicines, fail to reach those who need them, and a shortage of healthcare workers means there is often no one to administer treatments even when they are available.
Despite these challenges, political will and public pressure have contributed in crucial ways to efforts to meet the MDGs. So too has biomedical research. Over the past decade, medical advances have resulted in better diagnostic tools and more effective treatments for diseases of the poor. Yet the role of biomedicine in meeting the MDGs is far from over.
Overall, Africa is still the region finding it hardest to meet the MDGs. Under-five mortality is highest in Western and Central Africa, where one in six children die before their fifth birthday (169 deaths per 1,000 live births). Asia has seen some success: between 1990 and 2008, for example, India's under-five mortality rate fell from 117 to 72, although it is still unacceptably high.
Progress in halting the spread of HIV has been patchy at best. Between 2003 and 2008, the number of people receiving antiretroviral therapy increased from 400,000 to 4 million, which is 42 per cent of the 8.8 million people who need it. Yet the rate of new infections is currently outstripping supply. For every two individuals who start treatment each year, five people become newly infected with HIV.
Nevertheless, research has shown which strategies are likely to be most effective in reaching specific health goals. For instance, treating HIV-positive pregnant women with antiretrovirals substantially prevents transmission of the virus to their babies. In 2008, 45 per cent of such women were given this treatment, a 10 per cent rise on the previous year.
Malaria is one disease for which the goal — stopping the spread and starting to reverse the incidence — may actually be met. Data on more than a third of the 108 countries at risk of malaria (nine of them African and 29 non-African) show that malaria cases were cut by more than half between 2000 and 2008.
The most effective antimalarial treatments, known as artemisinin combination therapies, were rolled out halfway through this period, in 2005. Zambia recorded a 53 per cent drop in malaria prevalence between 2006 and 2008. In Limpopo, South Africa, the number of malaria cases dropped from about 6,000 in 2006 to less than 3,000 in 2007.
The road ahead
Well-thought-out research strategies could help countries come closer to meeting the MDGs in the next five years, but they must be directed to specific areas of need. In a statement on 13 September, UN Secretary-General Ban Ki-moon said he would outline a Global Strategy for Women's and Children's Health: "No area has more potential to set off a ripple effect — a virtuous cycle — across the Goals than women's health and empowerment," he said.
In maternal health there is still a large disparity of access between rich and poor women, and urban and rural areas. Ensuring that women with little money and poor transport can access skilled birth attendants, for example, remains a challenge.
It is vital that research is focused on improving health systems in ways appropriate for the unique problems of developing nations. At the moment, poor women cannot reach clinics and hospitals, so improving these systems in a way that benefits poor rural women should improve maternal health overall.
Targeting resources effectively is just as important in the fight against disease. In 2008, pneumonia, diarrhoea, malaria and AIDS were collectively responsible for 43 per cent of worldwide deaths in children under five. Using newly developed vaccines against pneumococcal pneumonia and rotaviral diarrhoea could bring enormous gains. But HIV treatment strategies specifically designed for children are still desperately needed.
Funding such gaps in research is likely to be one of the biggest bottlenecks. Convincing countries to find even more money when they are still suffering from the economic recession will not be easy. But more money is undoubtedly needed.
"To achieve the health MDGs in the 49 lowest-income countries alone, we must invest an additional $26 billion in 2011 — by next year — and build to an additional $42 billion in 2015," says Ban Ki-moon.
National strategies that link research into diseases that coexist in the same patient, such as HIV and tuberculosis, rather than letting them run on parallel lines, could offer more effective ways of tackling both diseases. Integrating individual disease programmes into approaches to strengthen health systems will also be vital given the limited funding available.
The MDGs were too ambitious to ever be achievable, but they have created an unprecedented worldwide impetus to improve the health of the poor. For many developing nations, meeting the goals even partly will have enormous benefits.
Now is the ideal opportunity for developing countries to identify gaps in research. They can then better align their research priorities with their health needs — and indeed their broad development goals — over the next five years as the deadline for achieving the MDGs draws closer.