01 Mar 2012
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How to Close the Health Gap

by Sean Silverthorne

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In developed countries, tuberculosis has been nearly eradicated, thanks to good nutrition and antibiotics. But those remedies are not available to 90 percent of the world’s population, and 1.7 million people die each year from the disease. Malaria and HIV/AIDS are also prevalent killers at much higher rates in poor countries. You’ve heard of the wealth gap. Welcome to the health gap. The people who need the medicines most in the world are the least likely to receive them.

“Now that we have such extraordinary capabilities, what will we use this power to achieve?” ask scientists Abdallah Daar and Peter Singer (AMP 171, 2006) in their new book, The Grandest Challenge: Taking Life-Saving Science from Lab to Village (Doubleday Canada). Daar and Singer are professors at the University of Toronto and directors of the university’s McLaughlin-Rotman Centre for Global Health. To an alarming extent, they argue, life expectancy is determined mostly by where you reside. People in developed economies have a good shot at seeing 80, while life expectancy in some developing countries is half that age, reduced by lack of inexpensive primary care and by poor nutrition.

The Grandest Challenge charts the efforts of scientists, health organizations, businesses, and philanthropists to extend the frontiers of medicine and in particular the science of genomics beyond the Northern Hemisphere and into rural villages the world over. It turns out to be a particularly vexing problem.

Until recently, drug companies largely ignored the world’s poor: few new drugs were created to combat tropical diseases and TB. The needs of the developing world also were neglected by the Human Genome Project, one of the great health-care breakthroughs in history.

The good news, according to Daar and Singer, is that real progress has been made over the last decade, thanks in part to funding from organizations such as the Bill & Melinda Gates Foundation and efforts by pharmaceutical companies and governments to make drugs available at little or no cost. But the biggest advances are being seen at the local level, where innovation is winning the day.

An increasing number of biotech start-ups are setting up shop in developing countries, and VC firms are chasing them. In Hyderabad, India, for example, Shantha Biotechnics created clever culture-growing techniques that dropped the cost of a vaccine dose for hepatitis B from $20 to $1. “Close to consumers, they understand the local market and health-delivery infrastructure,” write Daar and Singer. “They have the potential to invent and develop drugs at far lower cost than northern biotechs can.”

Meanwhile, funded efforts to address “grand challenge” questions are finally focusing on the health-care needs of the poor. Some teams, for example, are working on genetic modifications that would render the mosquito unable to transfer malaria. Those developments make Daar and Singer optimistic. “We contend that if we can answer these questions and overcome these obstacles, we can not only save lives, we can begin to imagine a new world.”

—Sean Silverthorne

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