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How do we prepare for the health challenges of the future?

24 Nov 2016

When it comes to disease-control our interconnectedness is a strength and a weakness, Professor Jeremy Farrar, director of the Wellcome Trust, explains how understanding disease is the first step to beating it

A little over 30 years ago, HIV was identified as the cause of AIDS. Within a decade, research into the nature of the infection and a series of combination therapies had transformed a deadly infection into a manageable condition. With over 20 million people still lacking access to antiretroviral drugs, ensuring that everyone who needs them can get these life-saving therapies remains a very real challenge, but the scientific and translational progress was remarkable.  

The start of the HIV pandemic in the mid-1980s was all the more shocking because infectious diseases around the world were in retreat. Smallpox had been eradicated, frightening illnesses like polio were being eliminated and common childhood infections such as measles were increasingly under control through vaccination programmes. Life expectancy was rising globally and we had to address the associated rise in non-communicable conditions like heart disease, diabetes, mental health and dementia.

Today, we recognise that while those conditions are a growing burden on our lives, we cannot afford to be complacent about infections. The inexorable rise in drug resistance threatens much of the progress made over the last few decades, while a series of epidemics – including SARS, bird flu, Ebola, Zika, yellow fever and non-polio enteroviruses – show that we remain vulnerable to endemic and emerging infectious diseases. In low- and middle-income countries, the double burden of infectious disease and non-communicable disease poses an enormous challenge to vulnerable healthcare systems.

But we are not passive observers of history. We can change the world, and we will if we act now.

We’ve done it before: between 2000 and 2015, there was a 60 per cent reduction in the number of people dying of malaria, according to the WHO. Millions of lives saved and hundreds of millions of people protected from infection, largely through the use of insecticide-treated bednets and artemisinin-based drug therapies, both of which were introduced after research (much of it Wellcome-funded) showed what a difference they could make. Unfortunately, malaria parasites are developing resistance to artemisinin and insecticides, so we need to keep innovating if we are to make the most of our success.

That is the nature of infections – pathogens are constantly evolving, finding ways to evade our immune systems and our drugs. But we are changing too, and Ebola showed us that a virus doesn’t have to mutate to present a new challenge. The world’s increasing population, urbanisation, freer and faster movement of people – these factors make it easier for a virus that might have been restricted to a village in 1986 to spread around the world in 2016. We’re so interconnected now that an outbreak in one part of the world is immediately a concern everywhere.

But these same factors are our advantages, too. Researchers can pool resources, collaborate across borders, share data and ideas instantly. Policymakers can base decisions on evidence from anywhere in the world; innovations in India can be applied in the Americas. And just as science crosses geographical boundaries, we can break down artificial boundaries between research disciplines. To improve health, we need the social sciences to understand the cultures in which we are operating as well as the biology to understand disease and the innovation to develop solutions.

Wellcome improves health by advancing ideas. We support thousands of researchers and other creative people in science and beyond. And as a large international funder, we can do more than fund people with great ideas. We also use our experience, expertise and authority to influence the contexts in which ideas progress, to make sure they can generate the most possible benefit. Because what we do today is laying the groundwork for better health tomorrow and in another 30 years’ time.

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