Improving Global Health through Scientific Development

In late 2005, I traveled to Entebbe, Uganda, to participate in my first of a series of H5N1 influenza regional training workshop for African scientists. At the time, the U.S. Government was engaging the developing world to educate scientists about the pathology, epidemiology and detection of the growing H5 threat. During my presentation on the U.S. international bird flu strategy, I grew concerned that many in the audience looked skeptical. Finally, a doctor from south Sudan stood and asked, “Why is it that the U.S. considers H5 to be a priority for African countries?” I answered with mortality statistics from past influenza pandemics, but the purpose behind the question was clear. Bird flu was important, but it was a Western priority. The workshop participants came from countries with their own health crises, such as endemic disease, famine, drought, poverty and conflict, and wanted to learn how to confront these challenges head-on. They hadn’t come to Entebbe that week to learn about U.S. policies on bird flu – they came to learn about the science.

Strengthening scientific research capacity in low- and middle-income (LMI) countries is the single best way for the U.S. to improve global health over the next fifteen years. Currently, building research infrastructure—including institutional and regulatory frameworks, academic institutes and sufficiently skilled people to conduct and publish research— is overlooked by a majority of global health programs.¹ Most programs in LMI countries are planned and operated by developed nations, and reflect the donor country’s priorities, values and politics. Programs that develop local research capacity and scientific infrastructure are desperately needed, and over fifteen years can create a powerful, sustainable weapon against global disease.

The benefits of scientific development have been widely acknowledged.^{2, 3} Increased science capacity will, for example, strengthen neglected disease research and drug development, boost human capital and infrastructure, build up disease surveillance capabilities and develop scientifically sound healthcare policies. Significantly, increased science capacity also allows developing countries to determine their own health priorities. While the past decade has seen an increase in funding of a few specific diseases — most notably HIV/AIDS, tuberculosis and malaria — these initiatives left traditional health indicators such as maternal and child health and vaccination coverage underfunded and understaffed.⁴ As new health challenges emerge due to factors like overpopulation and climate change, a local, educated infrastructure, in coordination with established global health authorities, can help countries identify their own funding priorities and increase the impact of their global health programs.

But critically, a long term investment in science capacity within developing countries will also help address the root causes of global health disparities. Research programs can build a developing nation’s economy by driving social and technological innovation. The diplomatic effects of cross-border research programs have been shown to strengthen international ties and help mitigate regional conflict. Developing a strong science program will help retain a nation’s best thinkers, adding to the next generation of social advocates and political leaders. These advantages extend from the collaborative and thesis-driven nature fundamental to scientific research. Scientific development addresses both the immediate challenges in global health, as well as the underlying conditions in which those challenges emerged.

There are signs that many developing countries are making deeper investments in national science, but progress is mixed.⁵ Countries such as Cuba, India and China have seen notable growth in national research programs over the past ten years with impressive results, yet most developing countries invest less than 1% of their GDP in R&D (versus 2.5% in the U.S.). While the number of researchers in developing countries has increased by 45% over the past decade, per capita this number is only one-tenth that of developed nations. Universities in countries such as Nigeria and Kenya are struggling to keep talented scientists from immigrating to developed nations, and often faculty vacancies can reach as high as 40%. Sustaining a science program capable of impacting health issues is near impossible under these conditions.

At the end of the Entebbe workshop, a Nigerian scientist shocked me by mentioning that her research department could not afford access to many important science and medical journals. As a former geneticist, I knew that access to scientific literature is crucial, and barriers could cripple research through academic isolation. The U.S. has made some contribution to building science overseas, but more must be done. Developing scientific capacity requires long-term political commitment, national research strategies, budget lines, skills development, incentives for private investment, the ability to use external knowledge, and a culture of inquiry. Genuine partnerships between the U.S. and LMI countries can train young researchers, build basic and applied research institutes and link developing countries to the global medical, scientific, and public health communities. But through significant, sustained investment by the U.S., in-country scientific research programs will emerge as the single most effective tool in global health.

Sources

1. Coloma J, Harris E (2009) From Construction Workers to Architects: Developing Scientific Research Capacityin Low-Income Countries. PLoS Bio. 7: 1-4.
2. See United Nations Educational, Scientific and Cultural Organization [UNESCO] (1999) Declaration onScience and the Use of Scientific Knowledge, available at http://www.unesco.org/science/wcs/eng/declaration_e.htm. Accessed 19 Nov. 2009.
3. Annan K (2003) A challenge to the world scientists. Science 299: 1485.
4. Piller C, Smith D (2007) Unintended victims of Gates Foundation generosity. Los Angeles Times, Available: http://www.latimes.com/news/nationworld/nation/la-na-gates16dec16,0,3743924.story. Accessed 16 Nov.
5. UNESCO (2009) A Global Perspective on Research and Development, available at: http://www.uis.unesco.org/template/pdf/S&T/Factsheet_No2_ST_2009_EN.pdf. Accessed 20 Nov. 2009.