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Expanding the reach of breakthroughs: Raj Shah of USAID presents the 2011 Barmes Global Health Lecture

Following find the transcript of the text of the David E Barmes Global Health Lecture, as presented by Raj Shah of the US Agency for International Development (USAID) on February 15, 2011 at NIH. The transcript was published online by The Lancet on July 4, 2011.

This Comment is a précis of my David E Barmes Global Health Lecture at the National Institutes of Health, Bethesda, MD, USA, on Feb 15, 2011.1

Advancing science, technology, and innovation to improve human welfare is one of the USA’s core competitive advantages. If the global health community can harness that capability for the poorest communities in the world, we can leave an unparalleled legacy in global health in this next decade. But to seize this opportunity, we will need to do things very differently. We need to focus on building country-led health systems instead of donor-driven disease-control programmes.

Here, US President Obama’s Global Health Initiative (GHI) is making real progress in this effort, generating efficiencies while simultaneously extending care. We must target the freed resources provided by the GHI toward the expansion of new scientific breakthroughs, facilitating a continuum of invention and innovation from bench to bush. The most transformative new breakthroughs are vaccines. By expanding the coverage of existing vaccines and introducing new ones, the lives of 4 million children can be saved over the next 5 years.2

USAID recently welcomed a commitment from vaccine manufacturers to reduced prices for the pentavalent vaccine, which protects against five deadly diseases, in addition to a reduction in price for rotavirus and human papillomavirus vaccines.3 These price breakthroughs will dramatically increase vaccine availability and accessibility for those who need it most.

In women’s and children’s health, we must first address the significant unmet need for family planning in the developing world.4 Innovations in products would allow provision of a broad range of family planning options to women to ensure healthy timing and spacing of their pregnancies.

We also need to train health workers to provide life-saving care at birth. By providing them with uterotonics, such as autodisposable injections for oxytocin or oral misoprostol, a substantial proportion of post-partum haemorrhage, the leading cause of death in pregnancy and childbirth, could be prevented.5 And basic resuscitation techniques need to be used in newborn babies to combat birth asphyxia, which accounts for a quarter of deaths at this time.5

Today, we have helped cut malaria cases in half in over 40 countries, reduced childhood malarial deaths by 200 000,6 and even seen a reduction in all-cause childhood mortality by as much as 30% in some countries.7 But more is needed. Community health workers need a point-of-care diagnostic tool to identify malarial infection. New classes of insecticide need to be developed to deter mosquitoes without harming human health or local environments. And the cost of artemisinin must be reduced, either by breeding higher-yield varieties of the plant or making the drug synthetically. With that, over the next 5 years, we can remove malaria as a major public health problem across sub-Saharan Africa,8 saving an additional 500 000 lives annually, most of them children.9

The frightening growth of drug-resistant strains of the tuberculosis pathogen - some of which cannot be treated - make the case for combating the disease more urgent than ever.10 The current best hope is to improve detection of tuberculosis by using rapid genetic diagnostic tools that can identify the presence of disease and its resistance to antibiotics. But even if tuberculosis is accurately detected, current treatment regimens require direct observation and a long course of treatment. We need to focus on dramatically reducing the length of treatment regimens, the effectiveness of new combination therapies, and on integrating control of tuberculosis tightly into health systems.11

Finally, to win the war on AIDS, we must engage on multiple fronts. Having achieved tremendous impact with our campaign to treat millions with antiretroviral drugs, we should now sharpen our focus on preventing new HIV infections.12 Here, last year’s landmark trial by the Centre for the AIDS Programme of Research in South Africa, CAPRISA, provided a preview of the next crucial tool in this fight: a gel microbicide that women can use to protect themselves from HIV infection.13 By empowering women with this powerful tool, we can counter the pernicious gender imbalance that limits a woman’s ability to protect herself from the risk of transmission.14

We also need to strengthen behavioural campaigns that reduce risky sexual behaviour, and reduce mother-to-child transmission of HIV. Finally, we will need to look to the future. We must build on studies which showed that antiretrovirals taken as prophylaxis could reduce HIV acquisition amongst men who had sex with men by as much as 44%,15 as well as the positive HIV-vaccine results we saw in Thailand in 2009.16 This is an ambitious agenda. And while hopeful, it is also daunting.

But today, we stand on the cusp of the next generation of science, technology, pricing, and operational breakthroughs. If we can find the courage to do things differently, and quickly deliver these breakthroughs to the field, we can usher in a new decade of unprecedented global health gains.

Raj Shah
US Agency for International Development, Washington, DC 20523, USA
rshah@usaid.gov

I declare that I have no conflicts of interest.

References

  1. Shah R. David E. Barmes Global Health Lecture. Feb 15, 2011. http://www.usaid.gov/press/speeches/2011/sp110215.html (accessed March 10, 2011).
  2. GAVI Alliance. GAVI Alliance set to save four million lives by 2015. Dec 1, 2010. http://www.gavialliance.org/media_centre/press_releases/gavi_board_kigali.php (accessed March 10, 2011).
  3. USAID. USAID welcomes announcement of lower prices for life-saving vaccines. June 7, 2011. http://www.usaid.gov/press/releases/2011/ ps110607.html (accessed June 10, 2011).
  4. UNFPA. Ensuring that every pregnancy is wanted. Nov 15, 2009. http://www.unfpa.org/rh/planning.htm (accessed March 10, 2011).
  5. Countdown to 2015 Initiative. Causes of maternal and child deaths. Dec 1, 2010. http://www.countdown2015mnch.org/documents/2010report/CountdownReportPages11-21.pdf (accessed March 10, 2011).
  6. WHO. World malaria report 2010. 2010. http://www.who.int/malaria/world_malaria_report_2010/worldmalariareport2010.pdf (accessed March 10, 2011).
  7. President’s Malaria Initiative. PMI results. Jan 1, 2010. http://www.fightingmalaria.gov/about/results.html (accessed March 10, 2011).
  8. UN. Leaders at UN event pledge to scale up eff orts to end malaria deaths by 2015. Sept 22, 2010. http://www.un.org/apps/news/story.asp?NewsID=36068 (accessed March 10, 2011).
  9. President’s Malaria Initiative. Lantos-Hyde United States Government Malaria Strategy 2009–2014. April 25, 2010. http://www.fightingmalaria.gov/resources/reports/usg_strategy2009-2014.pdf (accessed March 10, 2011).
  10. WHO. Anti-tuberculosis drug resistance in the world: report 4. Feb 26, 2008. http://www.who.int/tb/publications/2008/drs_report4_26feb08.pdf (accessed March 10, 2011).
  11. Stop TB Partnership. The global plan to stop 2011–2015. Oct 13, 2010. http://www.stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011-2015.pdf (accessed March 10, 2011).
  12. The US President’s Emergency Plan for Aids Relief. Latest results. http://www.pepfar.gov/results/index.htm (accessed March 10, 2011).
  13. USAID. Statement from USAID Administrator Rajiv Shah in response to today’s historic progress in preventing HIV infection in women. July 19, 2010. http://www.usaid.gov/press/releases/2010/pr100719.html (accessed March 10, 2011).
  14. USAID. Microbicide stakeholders meeting. Nov 19, 2010. http://www.usaid.gov/our_work/global_health/aids/TechAreas/research/ microbfactsheet.html (accessed March 10, 2011).
  15. National Institute of Allergy and Infectious Diseases. Daily dose of HIV drug reduces risk of HIV infection. Nov 23, 2010. http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx (accessed March 10, 2011).
  16. National Institute of Allergy and Infectious Diseases. HIV vaccine regimen demonstrates modest preventive effect in Thailand clinical study. Sept 24, 2009. http://www.niaid.nih.gov/news/newsreleases/2009/pages/thaivaxstudy.aspx (accessed March 10, 2011).