[Ip-health] Dr. Soumya Swaminathan in Nature: How to shape research to advance global health

Thiru Balasubramaniam thiru at keionline.org
Fri Apr 26 10:00:55 PDT 2019



How to shape research to advance global health

Soumya Swaminathan explains how the World Health Organization’s new
science division can promote universal health coverage in all

For seven decades, the World Health Organization (WHO) has been
trusted to set the norms and standards for global health. Over the
past year, the organization has been critically appraising its
processes in light of technological and societal progress, and has
restructured itself to focus on building up health-systems capacities.
The WHO science division, which I lead, was established last month. It
brings together existing research groups focused on reproductive
health, infectious diseases and health-care systems. It is also
charged with strengthening the WHO’s capacity to promote and establish
guidelines on public health, preventive care, clinical medicine and
ethical research, and ensuring that emerging technologies improve
safety and well-being.

In my past roles at the WHO and in India’s health ministry, I have
often been struck by the high expectations that governments have for
WHO advice. Many countries, especially lower-income ones, are
reluctant to implement policies without WHO guidance. Billions of
people rely on official lists of essential medicines and diagnostics:
highly vetted, evidence-based recommendations for tracking disease and
prioritizing which health services should be provided.

It’s a similar story with data. Although government officials might
not like health statistics that show, for example, low vaccination
rates or poor prenatal care, such information can motivate them to
take action. The WHO is committed to making access to and transparency
of health data a public good. That will improve understanding of
health needs and disease burden, but countries will be reluctant to
share their data unless they see real public-health benefits and feel
that groups that provide data are treated fairly. Although we expect
difficulties, we plan to transform the ways in which we collect,
archive, manage, analyse and share data.

The science division will also help to catalyse innovation that
industry and academia frequently neglect. After the 2014 Ebola
outbreak, the WHO developed a list of high-priority pathogens, along
with target product profiles for interventions (for instance, that a
vaccine for Lassa fever should provide provide protection for five
years after a single dose). Having clear guidelines encouraged
researchers to take on these challenges, including the creation of
CEPI, a coalition for epidemic preparedness, which is making progress
on vaccines for Lassa fever, Nipah and Middle East respiratory
syndrome (MERS).

A few weeks ago, the WHO convened stakeholders to strategize ways to
advance a tuberculosis vaccine candidate, which will probably require
innovative development approaches, such as public–private
partnerships. The ‘ring-vaccination’ design used in clinical trials of
the rVSV-ZEBOV Ebola vaccine in West Africa came from a collaboration
of trial methodologists, virologists, statisticians and public-health
experts. It delivered more than anybody thought possible: an
efficacious vaccine amid a terrible outbreak.

The WHO also hopes to convene global experts to help research leaders
and policymakers fill knowledge gaps on issues in their nations that
will have broad practical impact. For example, cost-effective
interventions for non-communicable diseases would promote health and
address leading causes of death. What policies increase the
consumption of fruits and vegetables by people in poverty? Where
physicians are scarce, can nurses help people with diabetes to manage
their condition, using decision-support systems on mobile phones? The
goal is for scientists from the global south to truly take the
driver’s seat, so that questions and insights will address countries’
needs and deliver tangible results.

We anticipate that this research will generalize to help strengthen
health systems. For example, how best can digital-health tools assist
front-line workers in providing quality services? Can real-time data
visualization in a capital city recognize a hepatitis outbreak in one
province, or a shortage of malaria bednets in another? How can
countries learn to use their data to improve health systems?

Another task is to ensure that advances in technology are matched with
the most pressing needs. For example, mobile phones allow information
to flow rapidly to remote settings, and so enable the provision of
certain health services without face-to-face visits. Artificial
intelligence might do the same, but will require a regulatory
framework. Medicines and diagnostics are not rolled out until their
relative risks and benefits have been assessed. Health-care software
should have similar requirements.

The WHO has two unique advantages for helping to decide which
frameworks should be applied to emerging technology: its high
credibility and its convening power. New technologies offer endless
possibilities, from machine learning for disease prediction to gene
drives in mosquitoes to stop malaria. They also demand broad societal
discussion of ethics, equity, justice, risks, benefits and appropriate
limits, especially when technologies could harm the most vulnerable.
Several experts have called for the WHO to set up an observatory or
registry to record ongoing clinical studies involving therapeutic gene
editing of human cells or embryos, and to collect input from the
public and diverse experts to propose a global regulatory framework.

Achieving these goals for the science division will be challenging.
The WHO has a surprisingly small budget for its outsized role, and
must work hard to secure consensus and cooperation from funders and
member countries. However, all agree on the urgency of these tasks,
and the need to come together and realize them. Greater coordination
of science activities within the WHO will help to make that happen.

Nature 569, 7 (2019)

doi: 10.1038/d41586-019-01235-1

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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