Making the most of the Arab Spring

April 26, 2012

Kathryn Strachan

Kathryn Strachan

Freelance health and development journalist working in Johannesburg

 Research for health has traditionally received little attention in the Arab world. And the extent to which the situation that has followed last year’s ‘Arab spring’ is influencing the region’s agenda for health research was discussed in a session at the Forum 2012 meeting.

In particular, several speakers pointed out that people in the Arab world now have a voice – and that this presents an opportunity to change the way decisions about both health research and development are made.

According to Hassen Ghannem, professor of medicine at the university hospital Farhat Hached in Sousse, Tunisia, people in his country were now asking about issues that had been accepted without questions in the past.

“The main message from Tunisia is to listen to the population,” he said. People were now demanding answers from policymakers. This created an opportunity to change that way decisions were made, and to place research at the centre of those decisions.

Fouad M Fouad, co-ordinator of the Syrian Centre for Tobacco Studies, said that in an emergency situation, where there was no food or proper sanitation, the place of research was not always clear.

Virtually no research had been carried out in Syria in peaceful times, he said. But the current conflict in the country had brought a renewed need for research on questions such as why vaccination rates had fallen over the past year.

“This should keep us motivated to work harder for research. We should keep going, even when we are in such a shaky position, and work together for change,” he said.

Francisco Becerra, the head of projects at the Council on Health Research for Development (COHRED), said change in Egypt had to be about more than replacing one group of leaders with another.

Political leaders had to listen to the voice of the people. Otherwise the previous neglect of the needs of the population would be repeated, and the opportunity for changing society would be lost.

Other speakers pointed out that the changes sweeping across the Arab world had brought opportunities at every level. But there was a danger that previous hard-won gains – such as progress in women‘s rights – could be lost if they were not adequately protected.

“We have achieved a lot in the past in the areas such as reproductive health, informed choice, and family law, but now the old language is reappearing again,” Hoda Rashad, director of the Social Research Centre at the American University of Cairo, Egypt told the meeting.

“In people’s excitement with the new revolution, they want to cut all ties to the past, and this includes throwing out all the achievements that have been made over the past few years.”

It was essential for researchers to remain aware of the complexities of the issues that they faced, and to have informed debates about them. Otherwise there was a risk that progress made in women’s rights and in health equity would be lost.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

A paradigm shift that promises a better future

April 25, 2012

David Dickson

David Dickson
Editor, SciDev.Net

Can the governments of both developed and developing countries be persuaded to back a paradigm shift in the way that research into novel treatments for the diseases of the developing world is funded?

Eye on the future: keeping vaccines affordable is the challenge ahead (Credit: Gates Foundation)

This is the challenge being thrown down by supporters of a proposed international convention on the funding and co-ordination of health research that is being proposed to the World Health Assembly next month (see my recent editorial).

As described to a session of Forum 2012 devoted to the proposal, the case for change is clear. Carlos Corea, a member of the WHO’s Consultative Expert Working Group on Research and Development (CEWG) which draw up the proposal, outlined three reasons that change was needed.

Firstly, he said, although investment by pharmaceutical companies has increased significantly in recent years, product innovation – measured by the number of new drugs emerging – has gone down.

Secondly, despite increased investment in research and development for diseases in developing countries, a lack of incentives means that this remains insufficient. And thirdly, “there is little co-ordination [in drug research]. Global efficiency is not very high.”

Michelle Childs, of Medecins sans Frontieres, put it more pragmatically. “We are interested in the proposed convention because of the frustration of our medical teams that many of the tools that they need are unavailable, un-affordable, or ill-adapted to the situations they face on the ground.”

The reason, she suggested, was that drug industry relies on recouping the costs of research and development through high prices on the resulting products, which it is able to charge through the exercise of patent rights.

At the core of the proposed treaty would lie a fundamental break with this principle. Namely, the costs of R&D on new drugs would be de-linked from the costs of providing the drugs to patients.

James Love of Knowledge Ecology International, one of the original architects of this novel approach, described the challenge. “How do you change the paradigm and come up with something new that reconciles the needs for innovation and access.”

Why was this controversial? “Because it challenges current thinking about how R&D is financed”. Furthermore, the principles on which it is based “are seen as a threat to existing business models”.

But Love argued that the treaty model “should not be considered that controversial, since it focusses on areas where the market is not working, and where the access issues are particularly acute”.

The fate of the proposal at next month’s meeting of the WHA is uncertain. “Some people may try to delay the decision for a year,” says Love.  “But you don’t want this report to sit on the shelf.

“What is needed is for the WHO to create an intergovernmental body to move this thing forward. We need to open the door that allows people to start discussing this proposal.”

Francisco Songane, the chair of the Forum 2012 steering committee, warned that for even this to happen, it was important that delegates to the WHA should be fully informed about the proposals.

Otherwise there might be last-minute attempts to block progress not out of disagreement, but out of a lack of knowledge.

Others added that it was not just health ministries that needed to be involved, but other ministries with a stake in the outcome. In particular this included finance ministries, since the treaty has potentially significant financial implications.

Despite the challenges in generating the necessary paradigm change, there was an air of optimism in the discussion in the Forum 2012 session.

“The world we live in today is different from the world in which we will live in 20 years’ time,” said Love. “You have to find a path to change things. The R&D treaty is an attempt to build a different future.”

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012.

Can poor countries produce their own drugs?

April 25, 2012

Lia Labuschagne

Lia Labuschagne
Freelance journalist working in Cape Town

Can lower and middle income countries (LMICs) engage in producing the drugs needed to combat neglected tropical diseases? And to what extent do their governments hold the key that will allow them to do so?

Where next? Drug production is the next step after research for low and medium countries (Source: ANDDI)

These questions led to a lively round-table discussion at Forum 2012 chaired by Elizabeth Ponder, associate director for scientific affairs at BVGH in the United States.

Ponder pointed out that neglected diseases affect more than 1 billion people around the world.

Millions of people in resource-poor countries die from these diseases, she said, because life-saving drugs, vaccines, and diagnostics are inaccessible, outdated, unsafe, ineffective – or not yet created.

The challenge was put to a panel representing a wide range of interested government bodies, NGOs, funders, and research laboratories, as well as the private biopharmaceutical sector .

Most panelists agreed that capacity was not the problem; many lower and middle income countries had the scientists and technologies needed to develop the relevant products.

The main problem lay in raising the funding needed to get the drugs into production, and to ensure that they were distributed to where they were required. And this frequently required a political – as well as a financial – commitment.

Jean-Pierre Paccaud, director of business development at Drugs for Neglected Diseases initiative in Switzerland, said that it was important to understand the specific needs of the areas in which diseases occurred, and then to focus on leveraging local capacities.

Konji Sebati, director of the department of traditional knowledge and global challenges at the World Intellectual Property Organization in Switzerland, said that lobbying governments was important since “without political will nothing will change”.

According to David Walwyn, chief commercialisation officer with the company iThemba Pharmaceuticals in South Africa, “it is important to articulate clearly to governments what we want, and to set clear targets.”  Universally-accepted goals were needed so that progress could be monitored.

And Alex Ochem, of the African Network for Drugs and Diagnostics Innovation, agreed that the research capacity exists in Africa. But he stressed the sobering truth that “no matter how much research we carry out and articles we publish, if we do not get the product – the medicines – to the market, then we have failed.”

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

Health research funding is no gambling matter

April 25, 2012

Kathryn Strachan

Kathryn Strachan

While many country representatives described to the Forum 2012 meeting their battles to create a flow of financing for health research, an unusual problem has come up in Colombia: how to make it stop.

Mery Barragan Avila, head of the research division at Columbia’s Department of Science, Technology and Innovation’s research division, told a session at the meeting that being selected as a recipient for the funds derived from a tax on gambling had created its own share of problems.

Health research funding should not be left to chance (Credit: Flickr/sincerelyhiten)

“It was like winning the lottery,” she said of the unexpected windfall. But problems followed, as the department lacked the capacity to manage the funding.

In addition, the stipulation that royalties remained in the regions in which gambling took place had also created conflicts – and the potential for unequal treatment – between the regions.

Her example reflected the need for health research to retain government support at its core. Other forms of funding were often erratic, and based on a shorter timescale than that required for effective in-depth health research.

An example from Panama, on the other hand, showed the importance of advocacy, as the research community had made a strong case to government, to donors and to the pharmaceutical industry, emphasising the value of research.

Partnerships with pharmaceutical companies are widely quoted as one way forward, for example by the UK Medical Research Council (MRC), but this route has to be navigated with care.

“We have to ensure that we all understand each other, because we all have different aims,” said Catherine Elliot, the MRC’s head of clinical research support. It could take 40 years of research to develop a major breakthrough. But pharmaceutical companies needed research to be translated into results in three to four years, she said.

Kathryn Strachan is a freelance health and development journalist working in Johannesburg.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

How to help Africa rise to the challenge of innovation

April 25, 2012

Lia Labuschagne

Lia Labuschagne
Freelance journalist working in Cape Town

Turning research into innovation is a complex issue. It requires considerable human, financial and other resources. And these must be drawn together by strategies that work within specific local contexts.

At a session at Forum 2012 examining investments that have been made in Africa to address outstanding issues of research and innovation for health and development, Hannah Akuffo, deputy head of the Research Cooperation Unit at the Swedish International Development Cooperation Agency, proposed the creation of a global facility to fund and monitor innovation on the continent.

Anti-malaria bednets in Tanzania: an example of successful African innovation (Credit: Flickr/Prashant Panjiar)

“Governments need to invest innovation, not only in their own countries but also into the continent,” said Akuffo, who believes such a facility could combine practice with training, and both conduct studies on and monitor the evolution of innovation systems.

It would also formulate medium-term strategies and tactics for supporting innovation, and attract partners for collaborative efforts to increase both quantity and quality of innovations, focussing on the need for inclusive development.

Akuffo suggested an international host for such an initiative – ideally an intergovernmental organisation such as UNESO or UNDO – but that there should be a gradual shift of responsibility for specific programmes to the national level.

Partners for regional organisations could come from high-income countries and NGOs. Funding might be drawn from a combination of multinational donors, development banks, donors and international aid organisations involved in science and technology. Partner countries would provide funding out of their regular budgets.

The session was chaired by Peter Ndumbe, responsible for research, publication and library services at the WHO Regional Office for Africa, and included a review of South Africa’s Strategic Management Framework, created to stimulate local health innovation, by Glaudina Loots, director of health innovation at the Department of Science and Technology.

Case studies of successful programmes supporting innovation were presented by Budzanani Tacheba, of the Botswana Innovation Hub, and Hassan Mshinda of the Tanzanian Commission for Science and Technology.

Tacheba, quoting Steve Jobs’ comment that “innovation distinguishes between a leader and a follower,”  described how the Botswana initiative is aimed at helping the country to compete in global markets, providing a home for knowledge-intensive, technology-driven businesses.

In Tanzania, Mshinda said that research into the way that insecticide-treated nets contribute to the fight against malaria had led to the creation of a successful manufacturing industry that was currently producing 50% of the global output of bednets.

Research had earlier shown that the nets reduce malaria parasitaemia and anaemia by 60%, and improve child survival rates by 27%. A well-planned programme had led to Tanzania’s doubling the value of its export of nets, from US$50 million in 2008 to US$100 million in 2010, and to an industry that now employs employing 7,000 people.

 Innovation is far from dead on the African continent.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

Lia Labuschagne is a freelance journalist based in Cape Town

Women in science: some progress, but challenges remain

April 24, 2012

Lia Labuschagne

Lia Labuschagne
Freelance journalist working in Cape Town

Women researchers have long explored the frontiers of knowledge, and have in the process made major contributions towards meeting health and development challenges, according to the moderator of a panel discussion at Forum 2012 on the role of women in science in the developing world.

Yet Jill Farrant, professor of molecular and cell biology at the University of Cape Town, and an expert on resurrection plants – plants that can ‘come back to life’ from a desiccated state when rehydrated – pointed out that women have not necessarily received recognition for their achievements.

Jill Farrant: women scientists are often not acknowledged (Credit: UNESCO/L'Oreal Foundation)

For example, said Farrant, one of the 2012 winners of the L’Oréal-UNESCO Awards for Women in Science, only 16 Nobel Prizes have been awarded to women, compared to more than 500 men.

Nashima  Badsha, an advisor to the South African Minister of Science and Technology, said that gender equality was protected by the country’s constitution, and that, especially in higher education, the statistics were encouraging. Women made up most enrolments and graduates in universities, and at PhD level, the number of women was fast approaching that of men.

But these figures masked less encouraging details. For example, women still only accounted for a third of publishing scientists in South Africa, while black women were under-represented in science, and the overall employment of women in higher education was under 18% – below that in other BRICS countries.

In Brazil, according to Claude Pirmez, vice president for research at the Oswaldo Cruz Foundation in Rio de Janeiro, the number of women holding PhDs was growing strongly. But the highest positions in science were still dominated by men – the Brazilian Academy of Science, for example, remained 90% male.

Javie Ssozi, a digital media consultant from Uganda, described how information and communication technologies were giving women access to opportunities and information sharing. For example, rural women farmers could be given information about new agricultural skills or ways to deal with climate change.

But he added that policies were often not gender sensitive, and that projects could be influenced by cultural issues. For example, men often tried to decide when and how women used their mobile phones.

Finally, for Devaki Nambiar, a postdoctoral research fellow in the Public Health Foundation of India, a key issue was the personal safety of women in society. “If you can’t leave your home in safety, how can you make progress in science and technology?” she asked.

But noticeably, all but one member of the discussion panel were females, and they spoke in front of an audience consisting mainly of women.  Perhaps a case of preaching to the converted?

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

Lia Labuschagne

How the mobile telephone is revolutionising global health

April 24, 2012

Kathryn Strachan

Kathryn Strachan
Freelance health and development journalist working in Johannesburg

The widespread adoption of mobile phones in developing countries is opening up a world of possibilities for the health sector, a session of Forum 2012 devoted to “mobile health” was told.

Expectant mothers in South Africa, Bangladesh and India, for example, are being reached through a mobile phone campaign that sends them health information and continues through to the first year after the birth of a child.

The programme, the Mobile Alliance for Maternal Action (MAMA), is run by the USAid-supported mHealth and the pharmaceutical company Johnson and Johnson, and has in its first two years has already reached half of pregnant women in South Africa.

The project already has several sources of revenue, and the intention is that its initial donors will withdraw after two years, leaving it to stand on its own feet.

The session was also told that telecommunications has not only made it possible to reach people in remote areas, but has allowed people to make informed decisions on their health.

“It has allowed us to target low-income women in hard to reach areas, and has also helped in our goal of promoting gender equity,” said USAid advisor Lauren Marks.

Telecommunications has also come to the aid of health in fighting the US$75-billion market in counterfeit medicine.

A system run by mPedigree, a non-profit organsition based in Ghana, allows customers to scratch a panel on a medicine package and text the code to a central authority, which can then verify in seconds whether the medicine is safe.

mPedigree president Bright Simons told the session that this not only saved lives, but had a wider health impact, as counterfeit medicines had contributed to the growing problem of drug resistance.

The real power, he said, was not in the technology, but in the wide range of partners that had come together to create this system. “It’s about sharing accountability,” he added.

Another example, of “mobile health” came from South Africa, which has 75% mobile phone penetration, and where Vodacom had agreed to support 70,000 volunteer community health care workers through its Nompilo project.

By helping them keep track of patient details, the community workers are able to improve the care that they provide. And based on the success of the project, Vodacom is planning to extend it to Kenya and Tanzania.

These were just some of the ways in which the mobile telephone is revolutionising health-care in the developing world. And the future promises to be even brighter.

Kathryn Strachan is a freelance health and development journalist working in Johannesburg.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

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