Stepping Up Harvard's Leadership in Global Health

Global inequalities in health are among the greatest injustices facing our generation. Seven of the 10 leading causes of death in sub-Saharan Africa are treatable illnesses that have been largely curtailed in the developed world. Additionally, many diseases in the developing world currently lack safe, affordable interventions. Two of the greatest challenges to resolving these inequalities—developing new treatments and ways of administering them—are problems which research universities are uniquely suited to address.

By comparison with funding for the illnesses that confront the developed world, research into disease endemic in the developing world is starved for resources. The World Health Organization estimates that 90 percent of the world’s health-related research addresses only 10 percent of global disease burden, leaving many diseases neglected by the modern research enterprise. These “neglected tropical diseases” (NTDs) include schistosomiasis, trypanosomiasis, hookworm, cholera, and malaria, and account for nearly a million and a half deaths per year.

Considering that the lack of purchasing power of NTD patients results in insufficient market incentive for private investment in those areas and an over-reliance on public funds. Indeed, all 13 technologies approved by the Food and Drug Administration specifically for NTDs between 1975 and 1999 were developed exclusively through public avenues of funding. Universities, the originators of 50 of the 100 most important therapeutic interventions in use today, are the institutions best suited to combine the disciplinary scope in basic and social sciences with the international scale in research capacity to effectively meet the challenges posed by NTDs.

Most developing countries also lack the capacity to administer effective care. Coverage rates of the vaccine for dipheria, tetanus, and pertussis—despite costing less than a dollar per dose and only having to be administered once—have stagnated at around 50 percent in sub-Saharan Africa since its introduction in the 1970s. Efforts to introduce more complex treatments, including AIDS treatment, encountered the same implementation bottlenecks: a lack of human resources, physical infrastructure, supply chain capacity and managerial oversight.

More than 50 billion dollars in new funding has been made available this decade for health delivery programs in AIDS and other diseases; however, in order for these efforts to succeed in developing effective health systems that are accessible by the poor, universities must continue to support the quantitative and qualitative research that establishes decision-making principles in global health delivery. Universities must also commit to training a generation of future leaders, especially those from developing nations, in the multi-disciplinary field of global health delivery. Just as medical schools require two years of hands-on training through clinical rotations, so must research universities establish research and experiential learning opportunities overseas for future practitioners in global health delivery.

Harvard University, as a leader among research universities, should take significant steps to scale up both NTD research and global health delivery science. New, multi-million dollar, multi-disciplinary centers for research in both areas should be established, complete with administrative capacity for inter-disciplinary collaboration, funding for junior researchers, support for tenure-track positions, and formation of overseas capacity for research and training. Because of the lack of traditional research funds in this field, the university must be proactive in seeking non-traditional sources of financial support, including philanthropic foundations and alumni champions. Although the challenges to each field are distinct—NTD research necessitates significant contributions from basic science, while global health delivery science is rooted in the social sciences—the opportunities for productive synergies between NTD and delivery research initiatives are numerous, including collaborations in the development of research capacity overseas. Many Harvard professors, including Jim Kim, Bruce Walker, Dyann Wirth, Sue Goldie and Paul Farmer have made extensive contributions to these fields.

On April 12, 2008, Harvard professors and their colleagues will be discussing research and delivery challenges in global neglected diseases at the conference “Missing Medicines: Harvard’s Response to the Challenge of Global Neglected Diseases.” It is important that the University Strategic Planning Committees within the Office of the President, Harvard Medical School and Harvard School of Public Health support the proposals of these researchers to continue their pioneering work, as well as train the future generations who will take their place. Research universities have a substantial role to play in these areas of global health, the crisis of our generation. We hope that Harvard will step into its role as a leader among research universities in confronting the key challenges in global health, from basic to delivery science.

Matthew F. Basilico ’08, a social studies concentrator in Mather House, is a member of Harvard College Global Health and AIDS Coalition. Jason Zhang is a first year MD-PhD Student at Harvard Medical School.