Troy Media – By Amyn B. Sajoo
A strange meeting took place in Toronto in 2001, when the Human Genome Project was maturing into a remarkable milestone of modern science by mapping the entire DNA “life code.” The two authors of The Grandest Challenge – leading medical experts at the University of Toronto – hosted scientists from the World Health Organization (WHO)’s genetics program to ask how the Human Genome Project might be harnessed to benefit of the 90 per cent of people living in the developing world. What a great opportunity for the WHO to explore how the new advances could boost vaccines, drugs and diagnostic tools for Africa and Asia, right?
But the visiting scientists dismissed the very idea that First World genetics could have anything to do with Third World diseases. Tackling one disease at a time, over decades if necessary, was the only way medical science made headway in Africa and Asia. Besides, they asked, what did these Toronto doctors actually know about those places? Shaken but not stirred, one of the doctors, Abdallah Daar, waved his Tanzanian passport and, with his colleague Peter Singer, took the disastrous meeting as a dare to prove there was “room for the poor” in the brave new world of biotechnology. Singer, the child of Jewish immigrants from Hungary’s 1956 revolution, and Daar, of Arab descent and one of the world’s top organ transplant surgeons who lost a sister to malaria in 1997, were off on a grand challenge.
The path from lab to community a formidable obstacle
The Grandest Challenge is a bracing account of their journey to crack a pile of urban myths about public health in our time. For one, we think of scientific breakthroughs – like the polio vaccine or the Human Genome Project – as the watershed event in tackling a disease. Yet time and again it is the path from the laboratory to the community that has proven even more formidable. Long after we had good treatments for malaria and tuberculosis, the former kills over three-quarters of a million people each year, and the latter 1.7 million. The reasons are wide-ranging, and often involve the prohibitive cost of First World solutions. From removing cataracts to delivering the vaccine for meningitis, western doctors and companies often charge 100 times what their southern counterparts do – a difference not easily explained by the mantra of “development” costs that we constantly hear from pharmaceuticals.
Is this yet another plea for charity from First World entrepreneurs to the benighted rest of mankind? That’s another myth, say Daar and Singer, which twists the issue: recognizing the talent and motivation that drives indigenous health innovators in Asia and Africa. A dramatic example is how an Indian company, Shantha Biotechnics, found an ingenious way to tackle hepatitis B, a major cause of liver disease that kills widely in the poorer world. The result: a vaccine sold at less than $1, as against the $20 imported version. Or consider how Moses Musaazi in Uganda created a prototype of an incinerator of medical waste, fuelled by the waste itself. This vital innovation that would cleanly dispose of the huge waste from vaccination campaigns and assorted medical procedures simply failed to get to the market, because it lacked support and funding.
And what of the home-grown demand for genetically modified foods that would counter the perilous single-staple reliance in so much of Africa and Asia, leaving millions acutely short of nutrients like vitamin A, iron and zinc? From rice in China and India to corn, sorghum and sweet potatoes in East Africa, local innovators have sought to enhance foods – against European activism that paints all GM foods as flawed. Earlier resistance by the governments of South Africa and Zambia is giving way to better informed choices that balance the risks with the enormous gains in the fight against hunger and all manner of ailments (including blindness) that stem from poor nutrition. Yes, companies like Monsanto have a terrible record of abusing corporate control of GM seeds and rice. But lessons are rapidly being learned on both sides on that score.
Not surprisingly, there is a bitter undertone in The Grandest Challenge when it comes to the ethics of biomedicine. Individual autonomy and “doing no harm” are prime concerns, to offset the power of both health establishments and free markets. But we seem untroubled by the ethics of spending 90 per cent of all health research funding on the 10 per cent of the world’s population in the First World. “If you were an impotent, depressed, rich adult man living in the West, science delivered for you, in the form of Viagra and Prozac . . . If you were a poor person in Tanzania, you likely died long before you had to worry about the onset of midlife health concerns.”
Yet the answer for Daar and Singer is to engage intelligently with the private sector as well as scientists and governments in “integrated innovation.” Without business and social creativity – as well as more accountable attitudes among scientific innovators – no amount of government action will turn the tide on the onslaught of global health issues. This in not just about giant infectious killers like HIV-Aids, malaria and tuberculosis, but also non-communicable ones like cancer, heart disease, type 2 diabetes and chronic respiratory problems. Add to this the frighteningly high mortality rate of infants and mothers immediately before and after delivery, along with the massive global impact of malnutrition, and we have our work cut out – especially amidst the current economic shrinkage.
The book’s title draws on the authors’ fruitful work with the Bill and Melinda Gates Foundation starting in 2003, identifying the obstacles that attend our most pressing global health problems, and investing serious money in solutions such as vaccines. This in turn was to inspire the launch in 2010 of “Grand Challenges Canada,” a $225 million venture over five years that involves the government and a host of leading medical experts – with robust numbers from Asia and Africa – to spur and support effective solutions. Of special interest are point-of-care tools, on-site diagnostics which act “like the cellphone of global health.” Daar notes that such a tool could have saved his sister when she succumbed to malarial symptoms that went unrecognized in a remote Tanzanian town. Yet such gaps also plague far-flung Canadian communities, especially among First Nations. Our stake in the grandest challenge of “lab to village” is both practical and moral.
The Grandest Challenge: Taking Life-Saving Science from Lab to Village. By Abdallah Daar and Peter Singer. Doubleday Canada.
Amyn B. Sajoo is a research Scholar and Lecturer in the Faculty of Social Sciences & Humanities, Simon Fraser University.