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Vaccines that do not need to be refrigerated, staple crops that contain a wide range of nutrients, and drugs that minimise the likelihood of drug-resistance, are among the top scientific advances that could dramatically improve the condition of the world's poor, according to an international panel of leading health scientists.

A list of 14 such 'grand challenges' published today (17 October) will form the basis of a research initiative funded by the Bill & Melinda Gates Foundation to address critical scientific challenges that, if solved, could lead to important advances against the developing world’s most pressing health problems (see Bill Gates gives US$200 million to health research).

Other challenges identified by the panel include the development of technologies that allow patients to be diagnosed for several conditions simultaneously, and the creation of genetic strategies to control disease-carrying insects (for full list, see box below).

Scientists around the world are now being invited to submit grant proposals for research in the 14 key areas to the US Foundation for the National Institutes of Health – which is running the initiative along with the Gates Foundation. Individual grants will be awarded up to a total of US$20 million for a maximum of five years, and applicants from developing countries are particularly welcomed.

The initiative aims to take a step toward redressing the fact that only a small fraction of biomedical research efforts are currently directed toward health problems that disproportionately affect the two billion poorest people on Earth.

"It's high time that the world's scientific community, which has contributed so much to the medical progress achieved in the past century, turns its creative attention to solving the enormous health problems of the developing world," says Richard Klausner, executive director of the global health programme at the Gates Foundation.

The initiative's 20-member panel, which includes several developing country scientists, formulated the 14 challenges from more than 1,000 ideas submitted by individuals from 75 countries.

The challenges are divided into seven long-range goals: developing childhood vaccines; creating new vaccines; controlling disease-carrying insects; improving nutrition; improving drug treatments; curing latent and chronic infections; and measuring disease and health status accurately and economically.

"If we could solve any one of these grand challenges the impact on health in the developing world could be dramatic," says Harold Varmus, president of Memorial Sloan-Kettering Cancer Center and chair of the scientific panel. "We hope to solve several in the course of [the] initiative".

Link to an article in this week's Science by some members of the scientific panel

The challenges announced today, which are associated with seven broad goals, are:

Improve childhood vaccines:
1. Create effective single-dose vaccines that can be used soon after birth.
2. Prepare vaccines that do not require refrigeration.
3. Develop needle-free delivery systems for vaccines.

Create new vaccines:
4. Devise reliable tests in model systems to evaluate live attenuated vaccines.
5. Solve how to design antigens for effective, protective immunity.
6. Learn which immunological responses provide protective immunity.

Control insects that transmit agents of disease:
7. Develop a genetic strategy to deplete or incapacitate a disease-transmitting insect population.
8. Develop a chemical strategy to deplete or incapacitate a disease-transmitting insect population.

Improve nutrition to promote health
:
9. Create a full range of optimal, bioavailable nutrients in a single staple plant species.

Improve drug treatment of infectious diseases:
10. Discover drugs and delivery systems that minimize the likelihood of drug resistant micro-organisms.

Cure latent and chronic infections:
11. Create therapies that can cure latent infections.
12. Create immunological methods that can cure chronic infections.

Measure disease and health status accurately and economically in developing countries:
13. Develop technologies that permit quantitative assessment of population health status.

14. Develop technologies that allow assessment of individuals for multiple conditions or pathogens at point-of-care.

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