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Viewpoint: Fighting Global Health Crises at Home

Freier

By Maria C. Freire, Ph.D.
Maria Freire, a former director of the Office of Technology Transfer of the National Institutes of Health, is CEO of the Global Alliance for TB Drug Development; www.tballiance.org.

Today's most urgent global public health crises - the alarming progress of AIDS, tuberculosis, and malaria - confront our medical community with realities and fundamental issues that get to the core of why we chose professions in the biomedical field.

AIDS, TB, and malaria combined take a toll of 6 million lives a year. Tuberculosis alone takes a life every 15 seconds and infects one in three people around the world. In fact, TB is the No. 1 killer of AIDS patients. Therapy does exist, but only a fraction of patients complete the lengthy, six-to-nine month drug-combination treatment, which has resulted in the rapid spread of deadly, multi-drug- resistant strains.

But while Americans appropriately demand the latest tools medical science can deliver for combating cancer and high cholesterol, we have grown complacent about identifying and treating diseases like TB. Diagnosis, for example, is mostly carried out with microscopes and sputum counts while treatment relies on drugs that date back to the mid-1900s.

The fact is that most TB and malaria patients around the world and those suffering from AIDS in sub-Saharan Africa do not have the purchasing power to attract industry investment into the very costly research and development process required for new therapeutics, vaccines, and diagnostics. So, we find ourselves using obsolete tools to attack these devastating diseases.

Global village, global solutions

Doing nothing about this reality simply is not an option. The death toll and devastation call us to action, but so does self-interest: in a global village, we have global infections. We must use the brightest minds and the most advanced tools to defeat these common enemies.

Can the U.S. medical community change market realities? Probably not, but we do have an opportunity to expand the means and ways by which these tools are developed. It will take education, advocacy, and creative business strategies.

Here are a few things we can do:

Spread the Word: We can remind healthcare practitioners of the devastating impact of these diseases and impress upon tomorrow's professionals sensitivity to, and understanding of, their global impact. By encouraging more students to pursue careers in this field, we bring nimble, creative minds to tackle and solve the mysteries of the oldest diseases by using interdisciplinary skills and techniques.

Advocate for More Funding: We need to convey the enormity of these epidemics to the general public and gain the support of decision makers to reverse the infectious trends. These diseases can be conquered. We are in an exciting time in biomedical research where identifying new molecular targets for attack is possible so that new compounds can be designed and formulated. For example, we can support increased funding of the Global Fund for AIDS, TB and Malaria to create a market-pull mechanism that would attract investment by the private sector; and, we can create a market-push mechanism by increasing budgets for basic research to help develop therapeutics, diagnostics and vaccines for these diseases.

Mobilize Technology: Academic institutions spawn inventions that translate into better medical interventions for tomorrow. We have had important successes in technology transfer in recent years. The focus, given market realities, has been on those technologies that are pursued by pharmaceutical and biotechnology companies. While these remain important, let us also identify and create novel avenues for technology transfer with sound public health as the bottom line. One such approach is the business model of the Global Alliance's not-for-profit public-private part-nership. The Alliance enlists researchers and drug developers worldwide to develop faster-acting and affordable drugs. By in-licensing or partnering with experts, we use funds to support the development of compounds that would otherwise not move into the drug development pipeline.

Ultimately, when we use the best medical tools to fight the most pressing global health crises, we will see dividends that go beyond lives saved - we will benefit from a healthier, more secure world and can be satisfied that we have worked proactively for the benefit of those in great need outside our own immediate circles.

We have been reminded, sometimes painfully, that we can never be fully immune from the "outside world," so whether it is affordable medicines for our seniors or defending ourselves against potential bioterrorist threats, as healthcare professionals we can help lead our nation in considering and responding to these challenges.