By: Abdallah Daar and Peter Singer


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Improving health for the poor depends on nurturing local innovations — and learning how to deliver them, argue Abdallah Daar and Peter Singer.

In the 1980s and 1990s the world's life sciences researchers were largely ignoring the poor, with genomics, for example, mostly confined to sophisticated labs in the rich world.

We argue that the life sciences revolution is now ushering in a new era of better and less expensive drugs, vaccines and diagnostics. [1] The prospect of improving health is greatest in low- and middle-income countries (LMICs), and the hope is that a child born in a poor country will have the same life expectancy as a child born in a rich country.

We are already seeing these efforts bear fruit. Take malaria, for example: a vaccine is due to be deployed by 2016. And at a biological level, researchers are studying genetic profiles to understand why some children get cerebral malaria and die while others don't. This is just one of many applications of life sciences in global health.

But there are ethical, social and commercial challenges in taking life-saving science from the lab to the village — to those most in need of these innovations. The sustainable solutions to these obstacles are homegrown, where the lab is closest to the village.

Grand initiatives

The Bill & Melinda Gates Foundation's Grand Challenges in Global Health programme, launched in 2003, began with 14 'critical barriers' to solving (mainly infectious) health problems in the developing world.

Subsequent initiatives for research prioritisation have focused on non-communicable diseases, such as the Grand Challenges in Chronic Non-Communicable Diseases, which led to the creation of the Global Alliance for Chronic Disease (GACD) — an international alliance of funding bodies to coordinate research on heart disease and stroke, some cancers, respiratory conditions and type 2 diabetes — and more recently the Grand Challenges in Global Mental Health initiative.

The latter two identify the role of social determinants of health, and the need to focus on behaviour change and implementation research — how to encourage the uptake of research findings.

Implementation research is desperately needed in LMICs to address issues taken for granted in rich countries. For example, research in urban Tanzania found that 30 per cent of people had high blood pressure but fewer than one in five were aware of their condition, and just 10 per cent of those received sustained treatment.

Research funding for such problems will soon be announced by GACD, in partnership with Grand Challenges Canada and others, including the Canadian Institutes of Health Research and the International Development Research Centre.

Implementation: the challenges

Implementation research has not, until now, been considered a serious science. While randomised controlled trials are the gold standard for testing the safety and efficacy of drugs, schemes to deliver health interventions are less likely to be assessed with the same scientific rigour.

We need to understand how to deliver life-saving medical interventions, improve access to them, make them affordable, and scale them up massively.

And we must remember that identifying and funding research priorities in the life sciences are just the first step towards real change. Technologies need to be made into actual products and disseminated at a low cost to the people who need them.

Many scientific ideas come to nothing, or help far fewer people than intended. In most parts of Africa scientific ideas, even great ones, are never commercialised.

For example, a simple dipstick diagnostic test for schistosomiasis was not commercialised in Ghana because a system to do so simply does not exist. There are many other examples of 'stagnant technologies'. [2]

Other barriers include a culture of scientific research that focuses on publications rather than real-world outcomes; limited flow of knowledge and skills among researchers, business and capital providers, government regulators and policymakers; and almost no venture capital to fund ideas at an early stage.

But Africa is now in a position to begin solving its own health and economic problems. In Tanzania, a company called A to Z Textile Mills has become the continent's biggest manufacturer of long-lasting insecticide impregnated bed nets, while employing around 6,000 workers, improving health directly and indirectly.

Supporting local enterprise

Looking ahead to the next ten years, we believe innovation will fuel advances in global health and problems will be addressed in a holistic way. And implementation research will become more important as we gather deeper insights into disease risk and biology.

Nurturing local innovations and finding ways to get them to the people who need them is the sustainable answer to the health problems of the developing world.

What can we do to support innovative enterprises? Grand Challenges Canada is investing in research to integrate business, science and social innovation — something we call 'Integrated Innovation'. This will be key to taking scientific insight from the lab to the village.

And with its Global Health Rising Stars programme, Grand Challenges Canada provides funding for young researchers in developing countries to uncover truly innovative ideas likely to have a major impact.

There is little doubt we will see innovations from the developing world increasingly flowing to rich countries, turning the traditional notion of technology transfer on its head.

Abdallah Daar is chief scientist and Peter Singer is CEO of Grand Challenges Canada. Both are also professors at the University of Toronto and University Health Network, Canada. Their book, The Grandest Challenge, was published by Doubleday Canada.


[1] Daar, A.S, and Singer, P.A. The Grandest Challenge (Random House 2011)
[2] Simiyu, K., Daar, A.S., and Singer, P.A., Stagnant Health Technologies in Africa. Science 330, 6010 (2010)