Beyond investing: Making global health a reality for all

Post authored by Liza Gross

At what point is it no longer acceptable for the richest nations in the world to let millions of children in the developing world die from preventable diseases before they reach age five?

That question lay at the heart of a World Bank report on global health – the first of its kind – over two decades ago, and remains the inspiration for a new cross-journal PLOS collection, Grand Convergence: Aligning Technologies and Realities in Global Health, launched today to coincide with PLOS’s participation in the International Congress on Infectious Diseases in India, March 2-5.

One could argue that nations with the resources to reduce the global burden of disease have a moral duty to do so, but as the authors of the 1993 World Bank report argued, improving global health outcomes also makes economic sense, in part by reducing production losses due to worker illness and freeing resources otherwise needed for treating disease.

The Lancet Commission on Investing in Health, a group of leading economists and global health experts, bolstered this economic argument in a 2013 report with an ambitious investment plan to reduce the global burden of disease by 2035. It’s possible to achieve a “grand convergence in global health,” the report authors argued, through a strategic investment plan aimed at reducing mortality rates from some of the most devastating preventable diseases in lower-income countries to universally low levels.

The commissioners also noted that such an effort could not be accomplished without substantial investments in new research to develop and, perhaps most importantly, deliver new health technologies. Identifying the most promising tools to close the global health gap is the focus of the Grand Convergence collection, published today in three PLOS journals: PLOS Biology, PLOS Medicine, and PLOS Neglected Tropical Diseases.

The collection was commissioned by Gavin Yamey, professor of the practice of global health at the Duke Global Health Institute and lead author of The Lancet report, and Carlos Morel, director of the National Institute of Science and Technology for Innovation in Neglected Diseases in Brazil.

Yamey and Morel focused on five conditions that disproportionately affect the world’s poorest people: HIV/AIDS, tuberculosis, malaria, maternal and child mortality, and neglected tropical diseases. The articles, written by experts who are directing global disease control campaigns or international research efforts, explore the diverse array of innovations that will be needed not just to prevent and treat disease but also to successfully ramp-up the delivery of health tools and services to those most in need.

In their paper on ending AIDS, Glenda Gray et al. argue that although widespread elimination of HIV will require the development of new, more potent prevention tools, true containment will depend on the creation of what has proven frustratingly elusive: a highly effective vaccine.

Development of a safe, effective vaccine will also be needed to end the global tuberculosis epidemic, argue Christian Lienhardt et al., along with better treatment protocols and rapid point-of-care diagnostics.

Janet Hemingway et al. offer cautious optimism in the fight to eliminate malaria. “The product development pipeline for malaria has never been stronger,” they argue, “with promising new tools to detect, treat, and prevent malaria, including innovative diagnostics, medicines, vaccines, vector control products and improved mechanisms for surveillance and response.” Yet successful development and adoption of these tools will require better systems for information management, and surveillance and response, they note, which in turn depend on continued financial and political commitment to support eradication programs.

Highlighting the problem of delivering health care to those in need, Margaret Kruk et al. argue that gains in health will require major investment in what they call “policy and implementation research,” which can be defined as the “systematic and rigorous analysis of which delivery approaches worked across a variety of health needs and which did not.”

Substantial gains in reducing the burden of neglected tropical diseases, which continue to rank among the world’s biggest health problems, will require new drugs, vaccines, diagnostics, and vector control agents and strategies, Peter Hotez et al. argue. But to eliminate these ancient scourges, they say, it is especially important to build up local capacity in research and development in the affected countries.

The innovations that could have the most impact in reducing maternal and infant mortality, Cyril Engmann et al. say, will be those that tackle stillbirth, adolescent health and preconception care, mental health, integrated early childhood development, and especially target vulnerable populations such as the urban poor and those displaced by emergencies.

Such ambitious global health goals cannot be reached unless the two vastly different worlds of innovation and public health can be brought together, argues Mary Moran. “This convergence, and the R&D underpinning it, will first require an even more fundamental convergence of the different worlds of public health and innovation, where a largely historical gap between global health experts and innovation experts is hindering achievement of the grand convergence in health.”
So far, global health funders have mostly succeeded in mobilizing resources when the need is clear and imminent, argues Trevor Mundel, who directs global health research for the Bill and Melinda Gates Foundation. But maximizing the impact of global health funding remains a major challenge and will demand a serious reconsideration of the ways foundations fund and organize health research and development worldwide. A more strategic, data-driven approach to investment is still needed, he says.

The prospect of achieving a grand convergence in global health within a generation can only be realized through a serious, renewed effort to step up investments in R&D to tackle the health conditions of poverty, argue Yamey and Morel. Closing the global health gap would prevent some 10 million deaths a year from 2035 onwards.

We hope this collection inspires the international health community to contribute to what Yamey and Morel call an “unprecedented opportunity to boost human development worldwide.”

Liza Gross is Senior Editor and Science Writer for PLOS Biology.