Tuesday, April 15, 2008

NEJM Piece on Global Health Challenges

The latest issue of the New England Journal of Medicine has this interesting article by Tadataka Yamada, who is the President of the Global Health Program for the Bill and Melinda Gates Foundation. The essay is entitled "In Search of New Ideas for Global Health". Here is a sample:

The recent failure of another potential vaccine against human immunodeficiency virus (HIV) underscores the enormous challenges of tackling diseases whose heaviest burden falls on the developing world. A quarter of a century after the first report of AIDS, our knowledge about how an HIV vaccine might work is still distressingly limited. It seems clear that neither current dogma nor traditional thinking is likely to get us to the next step. Truly creative ideas will be required.

....New ideas should not have to battle so hard for oxygen. Unfortunately, they must often do so. Even if we recognize the need to embrace new thinking — because one never knows when a totally radical idea can help us tackle a problem from a completely different angle — it takes humility to let go of old concepts and familiar methods. We have seemed to lack such humility in the field of global health, where the projects related to diseases, such as HIV, malaria, and tuberculosis, that get the most funding tend to reflect consensus views, avoid controversy, and have a high probability of success, if "success" is defined as the production of a meaningful but limited increase in knowledge. As a result, we gamble that a relatively small number of ideas will solve the world's greatest global health challenges. That's not a bet we can afford to continue making for much longer.

....To help promote a more adventurous approach to research, the Bill and Melinda Gates Foundation, where I am president of the Global Health Program, is willing to take risks as well. We are launching a $100 million initiative called Grand Challenges Explorations, which will supplement our current grant making by funding hundreds of innovative early-stage projects over the course of 5 years, investing $100,000 in each one. We want bold ideas — even seemingly wacky ones — that need just a little help to get tested. Proposals will require creative thinking but no preliminary data. The applications are only two pages long, and we'll make a funding decision within about 3 months after the May 30 submission deadline. We'll run each idea past two groups of reviewers — one composed of internal scientists, and another of partners and advisers with a history of identifying creative solutions to difficult problems. We expect many of these projects to fail, but we stand ready to put substantial funding behind those that succeed.

Details about the Grand Challenges initiative are available here.