The Grandest Challenge: Taking Life-Saving Science from Lab to Village Hardback - 2011 - 1st Edition

Our inspiration for writing this book stems from a simple but powerful fact: If your home is in London, New York or Toronto, you can expect to live well into your late seventies or early eighties. If you live in Morogoro, Tanzania, on the other hand, you will live only about half as long.
 
In fact, roughly 90 percent1 of human beings live in poor regions of the world, and their lives are routinely cut short by infectious diseases such as malaria and tuberculosis and hiv/aids, diseases that in rich countries are preventable or controllable. The overwhelming majority of the world’s citizens are also increasingly more susceptible to non-infectious diseases, such as diabetes and heart disease, which in developing nations kill more readily because of poor diet, poor living conditions and limited access to health care.2 For many decades and perhaps even longer, most of us have accepted these inequities as inevitable, a function of the great divide between the lesser-developed world and prosperous nations. But does it really have to be this way? Is there any solid evidence to suggest that life expectancy in some places must necessarily be shorter than in others? And is a life in the developed world really more valuable than the life of someone living in a poorer region?
 
Absolutely not.
 
In fact, with the mapping of the human genome we are poised at the edge of a revolutionary wave of science, one that offers incredible opportunities to improve life sciences and medical possibilities—for all people on Earth. In this book, we will tour the groundbreaking new discoveries and technologies spawned by the Human Genome Project, innovations that will change many aspects of modern medicine, including the way drugs and vaccines are discovered and developed, and how diagnoses are made.
 
We will also pose a critical question: now that we have such extraordinary capabilities, what will we use this power to achieve? To create designer drugs for the rich, which will only widen the health gap between rich and poor? Or will we finally choose to tap the enormous potential of the new science to address the needs of 90 percent of the world?
 
We are two scientists—one born in an affluent Canadian city, the other in a poor Tanzanian one. A number of years ago, we joined forces to pursue an audacious goal: to use modern genomic science to give a child in sub-Saharan Africa—or any other disadvantaged area—the chance to live as long and healthy a life as a child in New York or Toronto. Contrary to what many people believe, this goal is not a grandiose, abstract ambition. Rather, it is a scientific and ethical mission that, even as we write these words, is being put into practice in labs and in villages around the globe.
 
It is true that until recently, the Human Genome Project, an epic scientific achievement that is turning information hidden in the double helix of DNA into a readable language, ignored the needs of the developing world. Most scientists thought that genomic research and applications were too sophisticated to be of use to people in poor countries. But imagine if we challenged that thinking. Imagine what would happen if the ability to read the code of life were applied specifically to problems of the poor. Suddenly, recently discovered cutting-edge powers to heal would be available to the very people who need them most. This kind of thinking could positively change the world we all live in, and save tens of millions of lives.
 
Here’s the good news: it’s now starting to happen. Exciting research is under way all around the world, and in this book we will be your guides through both the thrilling scientific and medical exploits of the past decade and the most promising of today’s innovations in life sciences, those that hold the greatest possibility for improving the health of the world’s poorest and most disenfranchised citizens. We will tell the story of how, in 2003, a half-a-billion-dollar investment from the Bill & Melinda Gates Foundation was deployed to help researchers use the new life-sciences revolution to fight ancient diseases such as malaria from new angles. In California, Australia and London, scientists are now tweaking the DNA of mosquitoes to stop them from spreading malaria. In Seattle, a malaria vaccine is being developed that knocks out genes the malaria parasite needs to survive in the human body.3 Some of the world’s greatest researchers are, at last, focusing on the problem of malaria in the developing world and using the newest scientific breakthroughs to address an age-old scourge. And this scientific awakening is not limited just to malaria but is growing to cover problems as diverse as dengue fever, tuberculosis, pneumonia and diarrhea, all of which are serious ailments in the developing world.
 
But acquiring the knowledge is only one half of the solution, and only one half of the story we tell. How do you transfer the knowledge found in labs around the world right to the hands of the poor in disadvantaged villages? Both of us have devoted much of our professional lives to answering that very question, and what we can tell you is that it’s a long road from lab to village, with many roadblocks to overcome. In this book, we will take you to labs in India and China that have become potent new players in biotechnology and in the discovery and manufacture of drugs. We will go to Bangalore, where one of India’s richest women started a biotechnology company that supplies affordable insulin to India’s growing population of diabetics.
 
We will go to Hyderabad, where a biotechnology company brought down the price of hepatitis B vaccine more than twentyfold through clever thinking and innovation. In these pages, you will also meet scientists, thinkers, doctors, heads of state, CEOs, ethicists and ordinary people who have taken up the call to action to close the gap between the developed and developing worlds.
 
Beyond encountering the people and places on the forefront of a revolution in life sciences, you will also learn about the profound ethical challenges we face on the road ahead. How do you persuade a rural, isolated community to test a new genetically modified mosquito? How do you get female sex workers to try out an anti-HIV gel that could save their lives? How do you obtain consent to trials in a way that respects the health, cultural beliefs and social structures of individual traditional communities around the world? How do you overcome decades of suspicion of multinational companies so that private organizations can contribute to finding a cure to a killer disease? How do you promote the building of labs and other facilities, not in the developed world but close to the people who need them most? How do you encourage companies to make lifesaving drugs and vaccines more affordable? And finally, how do you handle the political roadblocks that can stymie even the most creative and important of scientific endeavours?
 
We contend that if we can answer these questions and overcome these obstacles, we can not only save lives, we can begin to imagine a new world. True innovation means that the discovery of new cures and remedies will take place not only in Stanford and Oxford but in Bangalore, Shanghai and Cape Town. It means the cities of the poor world will begin to reap the health and economic benefits of science. The greatest gift for poor nations is the scientific power to heal themselves.

Praise for The Grandest Challenge
"The Grandest Challenge is not only enlightening, solution orientated and deeply personal but it also encourages the reader to challenge the existing norm and encourages us to ask ourselves pivotal questions."
—The Independent (UK)

ABDALLAH DAAR was born in Tanzania. He is a Professor of Public Health Sciences and of Surgery at the University of Toronto, and Director of Ethics and Commercialization at the McLaughlin-Rotman Centre for Global Health. He is the recipient of the UNESCO Avicenna Prize for Ethics of Science, and often advises governments and the UN, UNESCO, WHO and OECD on global health.
PETER SINGER is Director of the McLaughlin-Rotman Centre for Global Health and Professor of Medicine at the University of Toronto. He has advised the Bill and Melinda Gates Foundation, the UN Secretary-General's Office, the Government of Canada, and Pepsico Inc. He is also a sought-after commentator and public speaker.