The Grandest Challenge

Author Essay

In 1990, one study revealed that only 10 percent of global spending on health research was used to study conditions in developing countries, even though people there suffered 90 percent of the global disease burden. This became known as the 10/90 gap. Citizens in the United States, Canada and Western Europe were getting the lion’s share of health research dollars even though their people suffered only a small fraction of the world’s diseases. In other words, if you were an impotent, depressed, rich adult man living in the West, science delivered for you, in the form of Viagra and Prozac and a host of other remedies. If you were a poor person in Tanzania, you likely died long before you had to worry about the onset of midlife health concerns.
 
One big problem I started to see was that drug companies in the late 1990s felt the world’s poor weren’t a viable market because they couldn’t ever pay back the cost of discovering, testing and bringing to market new drugs, a burden that the major companies claimed cost them up to a billion dollars for each new drug. In the last quarter of the twentieth century, pharmaceutical companies developed 1,393 new drugs, but only 16 of them were created to combat tropical diseases and TB.
 
Even when scientists discovered a remedy for a disease that affected both rich and poor, it took a long time to get it to the poor. When the hepatitis B vaccine was developed in the late 1960s,34 for instance, it quickly became widely available in the rich world, and today is routinely given to schoolchildren. In the developing world, however, where most of the world’s hepatitis resides and where the virus is a common cause of primary liver cancer, the vaccine is still not widely available. In other words, the people who need the vaccine the most are the least likely to get it.
 
I became determined to change this, and in 1998, a year after my sister’s death, I left my high-powered post as chief of surgery in Oman to begin an uncharted journey into the world of global public health. My move coincided with the extraordinary acceleration of the genetic revolution that had been building for a century, ever since Gregor Mendel conducted his meticulous pea-growing experiments to show how traits – or genes, as we now know them – are inherited. I knew that genetic science was still largely confined to the most sophisticated labs in the rich world, but I also saw that this revolution could offer hope to developing nations.
 
In 1998, I began working with my colleague Jean-François Mattei on a report for the World Health Organization. Together, we explored the ethical, scientific, social and legal implications of medical genetics and biotechnology, and how these might apply to global health.