Meeting global challenges
In times of austerity, should the MRC and other UK funders continue to invest in medical research in developing countries? Director of the London School of Hygiene and Tropical Medicine Peter Piot tells us that as well as a moral responsibility, there are vital scientific, economic and political interests at stake.
The heart of the MRC’s mission is to improve human health through world-class medical research. That mission doesn’t stop at Dover; diseases don’t respect national borders. The history of illness and infection is the history of human development, globalisation and migration. In profound ways – evolutionary, immunological and cultural – we are shaped by our health and illnesses.
At medical school in the early 1970s, my tutors advised me against specialising in infectious disease because, according to them, all the major problems had been solved. But barely a year into my first job in a microbiology lab in Antwerp, we received a battered flask from Zaire containing blood samples from the victims of a lethal outbreak of a mysterious haemorrhagic fever – and succeeded in isolating the Ebola virus. A few years later, the AIDS epidemic forced me to confront the extreme complexities of health and disease, and of the politics and bureaucracies of international cooperation.
Both epidemics show the enormous potential and real limitations of science to solve today’s health problems. Researchers rapidly elucidated the workings of the HIV retrovirus, and developed life-saving drugs. But it required a massive international effort to slow the spread of AIDS and make treatment available to those who most need it – and we still haven’t developed a vaccine.
The world is becoming a ‘global village’, and it is crucial for the health of Britain’s increasingly diverse and widely travelling population that our health services have access to the most up-to-date research on diseases worldwide.
Recently this has been exemplified by headlines on malaria, non communicable diseases such as cancer and diabetes, and preparedness for the London 2012 Olympics. In this context, a global outlook and involvement is vital to sustain the excellence and relevance of the UK’s biomedical research base.
The UK is a world leader in such research, and the MRC is an important and influential funder and driver of research worldwide. The MRC units in The Gambia and Uganda have led efforts to understand and combat diseases from sickle-cell anaemia to HIV . This work has been sustained over many decades, and makes a vital difference on the ground.
Such activity has become multinational in scope and multi-agency in character – for example the MRC is a founding partner of the Global Alliance for Chronic Diseases. Such international research collaborations bring real benefits, both for the UK and for developing countries. They also build capacity and develop skills: for example the MRC/DfID African Research Leader scheme helps strengthen research leadership across sub-Saharan Africa.
I would also argue that a healthier world is in our economic and political interests. The MRC’s international programmes and units are very cost-effective, for example the current MRC/DfID agreement is worth £45m over five years. This sum is tiny in the context of health spending, but vital in funding key projects and sustaining the UK’s position in the global health community. This also brings great – although sometimes intangible – returns in the form of goodwill and influence; ‘health diplomacy’ can be a powerful driver of international cooperation.
But there is a deeper economic and moral argument, which derives as much from religious traditions and modern science as from Adam Smith. In a globalised world, the wellbeing of people and nations is fundamentally interdependent. When war and pestilence rule, everyone suffers: something I have experienced working in countries ruled by dictators and riven with conflict. In contrast, healthy and prosperous populations are not only happier, but make much better trading partners. I think the Government understands this well, and has made a commitment to protecting international development budgets despite the economic climate.
As scientists and clinicians, we feel a strong moral responsibility to help people, and today our responsibility is global. Investment in research is vital to saving lives, alleviating suffering and contributing to peace and prosperity.
But we can’t assume everyone thinks the same, or that anything will happen without communicating the value of global health research and informed advocacy.
My experience at UNAIDS taught me that it takes a lot of energy and dedication to build coalitions that actually get things done on the scale that is needed. At a time of fiscal constraint, it is of course important to invest our funds and effort as wisely as possible. But it is all the more important that we work together to communicate our vision and the value of our work to mobilise the resources required to sustain our achievements so far and meet the serious challenges ahead.
These are global challenges, and the UK has a significant part to play in meeting them. Health is a fundamental human right for all. We must recognise this and sustain our commitment to research beyond our national boundaries.