Some would argue poor living conditions and gender inequity affect health more than the biological causes of disease. Flickr/LivingWaterInternational

As Forum 2009 closed on Friday, we were left with some thoughts on the future direction of global health research. The conference in general was heavily weighted towards the need to drive health systems research and research on the social determinants of health.

Mention these issues to many lab scientists, however, and they would argue that these fields of study are far too “soft” a science for them to engage with.

This is what really damages research into the social factors affecting health. Traditional robust methods of interrogating an issue and gathering data such as randomised controlled trials have no traction when you are thinking about how a health system functions or when you are trying to evaluate a complex health intervention.

These don’t fit into neat scientific boxes in the way that parasite counts or viral loads do.

But transforming these fields will require rigorous evidence – how else will we know what changes to make to improve health systems across the developing world?

It’s good news then that the EU announced yesterday at the meeting that its next call for grants in January 2010 would focus heavily on research into the social determinants of health.

Some would argue that poor living conditions and gender inequity affect health even more than the biological causes of disease. There is only one way to find out, of course: more research, and more robust evaluation of that research.

Priya Shetty, www.scidev.net, priya4876@gmail.com

The realities of climate change. Photo credit: Flickr / UN Photo-Evan Schneider

Those in the know about the draft agenda for the Copenhagen climate change meeting next month have bad news: health does not seem to be high on the agenda.

This may well change as the meeting draws closer, but panellists at a session yesterday on climate change and health equity suggested that the poor links between health researchers and environment experts may explain part of this disconnect.

Look through the pages of the BMJ, The Lancet and Nature and you’ll find most papers on links between climate change and health written by researchers who study the social determinants of health.

Their input is vital for explaining how alterations in living conditions or air quality will affect health, but climate science is complex and the technologies developed to study it are continuously being updated. Environmental scientists, meanwhile, publish their own papers separately.

BMJ editor Fiona Godlee, who chaired yesterday’s session, wants to see an end to this “silo mode of operation”. Forging stronger links between the disciplines should ensure that climate agreements cannot ignore health impacts.

Kumanan Rasanathan, a WHO technical officer on ethics, equity, trade and human rights, summed it up well: “It’s time that the rhetoric around intersectoral collaboration be put into practice,” he said.

Priya Shetty, www.scidev.net, priya4876@gmail.com

Studying gender inequality won't fix health without the political will

Claudio Schuftan, an advocate for the right to health based in Vietnam, sounded a pessimistic note yesterday in a discussion on research into the social determinants of health.

As participants discussed the best ways to ensure that research into poor living conditions and gender inequality is treated as a rigorous science, Schuftan asked us whether we “were living in a dream world”. His point was that the scientific community talks of the need for more evidence – but what about the political will?

This is an obvious point but one worth making again amidst calls for more evidence-based policies. First, we have a lot of evidence already for what works and what doesn’t. Second, all the evidence in the world will not convince a policymaker who does not see the political will to alter health-care policies.

This was the point that Carlos Morel, director of the Center for Technological Development in Health at FIOCRUZ in Brazil, made when I spoke to him about translating innovation from Cuba to the rest of the world.

Morel said that there would be little point in Cuba transferring knowledge to countries that don’t have the capacity to use that information. Cuba’s political dictatorship – in essence, its unswerving political will – is what ensured that it first developed a robust health system on which to build more advanced scientific institutions, he said.

Africa needs to find a way now to imbue its own democracies with that strong political will for healthcare reform.

Priya Shetty, www.scidev.net, priya4876@gmail.com

Public-private partnerships in drug development were intended to marry the business savvy and deep pockets of big pharma with academic rigour. But this morning representatives from the biggest partnerships – including the International AIDS Vaccine Initiative (IAVI) and the Global TB Vaccine Foundation – gathered to convince us their presence hasn’t been for nought.

In 2004, PDPs were responsible for 75 per cent of R&D in neglected diseases. It’s hard to quantify, however, how much of the R&D boost over the past decade or so has been due to PDPs and how much to a rising profile of global health issues.

What struck me most was the desire of several of the PDPs to “move beyond product development”.  At the conference so far, there has been much talk of moving away from short-term goals of rolling out antiretrovirals to a more holistic long-term approach to ensuring health systems are equipped for big health programmes to parachute in.

But surely if any organisation could be forgiven for focusing solely on a product, it would be a product-development alliance? It’s commendable that, as IAVI’s Holly Wong said, some PDPs share clinical site capacities and help build capacity. But their primary goal must be to develop urgently drugs for TB and neglected diseases.

Most PDPs are relatively young . It’s still a little too early to question whether they have fulfilled their promise but in a few years they will need to be accountable. In the meantime, they must concentrate on getting products to market.

Priya Shetty, www.scidev.net, priya4876@gmail.com

Welcome to the blog for Forum 2009, taking place this week in sunny Havana!

The theme of the meeting, innovation, is the lifeblood of research. Without it, countries never truly develop a thriving science base and are relegated to the shadow of innovative neighbours.

It’s appropriate then that scientists from around the world have gathered in Cuba to discuss scientific and technological innovation.

Political circumstances have forced Cuban researchers to innovate and develop with homegrown talent. The question now is how these lessons can be translated to the rest of Latin America – and to Africa and Asia.

Transferring knowledge isn’t the only issue of course – developing countries need to create an innovation-friendly environment for researchers to thrive in.

I’ll be writing more about how to bridge these knowledge gaps, through better knowledge translation and South-South collaboration, for example.

Another issue that I’ll write about this week is innovation in health systems research. This is an enormously tricky topic in global health. We know that developing countries need better health systems but we know very little about the science of how to improve them.

Tim Evans, assistant director-general for for information, evidence and research at the WHO and TDR scientist Shenglan Tang are leading sessions this week on health systems research as a prelude to the first global symposium on health systems research that they are hosting next November in Switzerland.

Over dinner last night, Evans maintained that innovation is most urgently needed in health systems research. It’s certainly true that while funders and big pharma fall over themselves to pump money into research for drugs and vaccines, few line up to pour money into developing an evidence-base for improving health systems.

Do you agree? We’d like to hear your thoughts on the top priorities in innovation for developing countries. Comment below to share your ideas.

Priya Shetty, SciDev.Net, priya4876@gmail.com

The 11th TWAS general conference came to an end today with Jacob Palis, the president of the organisation, extending a greeting from another Jacob; Zuma, the president of South Africa.

Meeting Palis and his colleagues in Cape Town yesterday, Zuma promised that if TWAS was to organise another conference in his country he would attend in person. Oh well…

It has not just been hard work. Last night, TWAS members and staff were dancing on tables in a casino where the final party of the week took place. Unfortunately, your correspondent did not attend with her camera, otherwise this post may have had more interesting images to go with it.

The conference signalled a deepening collaboration between TWAS and South Africa, which is going to set up a regional chapter of the organisation.

It may also mark the end of an era. Mohammed Hassan, TWAS executive director, is expected to retire at some point. This could be his last general conference. But then again, it might not…

Even if Hassan retires, he is unlikely to sever his ties completely with the organisation, according to sources in TWAS. Like a certain Russian president-cum-prime minister, he is likely to stay involved for some time to come. Which, in this case, isn’t a bad thing!

Linda Nordling, SciDev.Net

University scientists in Cameroon have had their pay cheques increased by over 40% over two years. I was told this by the vice-chancellor of the University of Buea, Vincent Titanji, during lunch today.

Amid the gloom of the tales coming out of African universities about how they are facing uncertainty as a result of the financial crisis, this comes as a ray of sunshine.

Apparently, the government of Cameroon has decided to spend part of the money it “received” as a result of two major debt write-offs on health, engineering and teacher education. How very wise!

Titanji’s university is also getting a whole new faculty for health sciences with two specialised laboratories.

The payrise has stabilised the university sector, says Titanji. People are happy in their jobs now, and the institutions work harmoniously.

It is too early to evaluate the impact of the programme. But it is reminder that there are many possible sources for funding for S&T if a government is serious about supporting it.

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In other news, Mohammed Hassan, executive director of TWAS, has been away from the conference today. For a good reason, we are assured. He has supposedly been to see South Africa’s president Jacob Zuma who has been awarded TWAS presidential medal.

We hope he will take a photo

Linda Nordling, SciDev.Net

School Children in Cameroon. Photo credit: Flickr / emeryjl

This morning we heard from some of the more recent success stories in science and technology. Atta ur Rahman, the former science advisor to Pakistan’s prime minister, described how targeted policies had managed to increase the country’s citations in international journals by 1000% in the last four years.

He emphasised the importance of nurturing excellence, saying that too often, developing country universities lack the creative “soul” of science embodied by the “beautiful” minds that work in places like Oxford or MIT.

Excellence had been top of the list when drawing up Pakistan’s S&T policies, he said. Paying high salaries for mediocre scientists would not give the desired results. So efforts focused on identifying the brightest students used independent auditors to ensure they got the scholarships rather than the merely well-connected.

Quality has been a buzzword at this conference. This indicates a growing maturity in the debate. But not all developing country governments seem to have caught up on this. One South African delegate I spoke to after Rahman’s lecture told me his government would never place such emphasis on top of the line science and technology.

South Africa’s science minister Naledi Pandor would disagree. She is actively promoting excellence, she says. But some academics fear that a more left-leaning government in South Africa will regard elite universities and research as a bourgeois luxury. The country’s mid-term budgets next week may show which way the wind is blowing…

Linda Nordling, SciDev.Net

The University of Oxford - really excellent. Image credit: Flickr / Missy and the Universe

Last post of today I think…

This conference has been dominated by voices from a small number of countries. As they are the host, it is not strange that South Africa has taken a prominent role. But many talks have also come from India and Brazil.

In a way, it’s not surprising. There are more scientists in South Africa and India than in, say, Mali. But it is putting a slightly weird spin on things.

For example, we are not hearing enough from the poorest of the poor—except in the third person when delegates from the countries above talk about wanting to boost South-South cooperation.

And that they do, constantly, which is really encouraging. The financial crisis has opened up avenues for them to rally and try to plug the gaps left by the worse affected developed countries, who foot much of the bill for science and technology support for the poorest countries.

The governments of the ‘big three’ are also pushing strongly for collaboration with each other. The IBSA (India, Brazil, South Africa) partnership is still evolving, but speaking to South Africa’s science minister it seems like it is going well. Each party has put $1 million into a central pot for 2009/10.

Perhaps one of the outcomes of this conference should be some sort of gentlemen’s agreement between the better off developing countries and those who are really struggling for closer cooperation, perhaps plugging some of the gaps left open by Western donors cutting funding due to the financial crisis?

Linda Nordling, SciDev.Net

Just a note to point out an inconsistency I have encountered with regards to the last post. Speaking to one of Ezin’s officials after his talk, I was assured that the AU department for science, technology and human resources has quite enough money to carry out their duties, thank you very much!

Still, I queried two of my journalistic colleagues down here, and they confirmed that what I had heard Ezin say during his talk was what they too had heard.

(After Ezin’s talk I spoke to him about what projects were ‘less of a priority’ than the Pan African University and he mentioned teacher training as an example. Which points to there being a problem with funding…)

Linda Nordling, SciDev.Net

The African Union Commission department for science, technology and human resources has run out of money.

This is essentially what Jean-Pierre Ezin, commissioner in the department, told this afternoon’s symposium on the impact the financial crisis has had on research.

The commission depends on three sources of funding—Africa’s 53 states, philanthropists and rich countries’ aid agencies—and all of them have been hard hit by the crisis, he said.

As a result, the department has not been able to raise all the funding needed to fulfil its planned activities for 2009.

Ezin did not mention what projects will fall by the wayside. The priorities for funding is clearer. Apparently, the commission president has asked all departments to draw up a prioritised list of activities for 2010. For Ezin’s department, this will be the Pan African University. Another is the department’s research grants programme.

Out of the speakers, Ezin by far voiced the most concern about the crisis and its effects. Science ministers from South Africa, India and Brazil all said there would be no major cuts for science.

Naledi Pandor addressing the symposium

South Africa’s science minister Naledi Pandor said her ministry will ‘cut the frills’. That will mean less dinners and conferences in 5* hotels, but researchers themselves will not suffer, she said.

South Africa’s midterm budget is due next week, so we will see how much truth there is to this.

But we still have to hear from the poorest countries how the crisis is affecting them. They should be sensitive to the same pressures as the AU commission, so their picture is probably not as rosy as that of the middle-income countries. Where were they at the TWAS symposium??

Linda Nordling, SciDev.Net

Gevers, photo by ASSAf

This morning, Wieland Gevers from the Academy of Science of South Africa painted a picture of the “two worlds” he has worked in as a biomedical scientist.

Gevers is one of three TWAS members to receive a “TWAS medal” in 2009. This is an accolade given to a selected few members each year in recognition of the research they have done in their field.

In the 1960s, Gevers got a Rhodes scholarship to study for a PhD in Oxford. Although the science he did there feels ancient by today’s standards, he says it was a privilege to be able to spend time at the very forefront of research and, as he puts it, “absorb the principle of doing science”.

When he returned to South Africa in the 1970s, by contrast, he was faced with the task of doing something with very little. Along with his research chair went only one assistant and two small pieces of scientific equipment.

This is a common problem across the developing world today, and one of the main reasons many emigrated scientists do not want to return. If they do, many—like Gevers in the 1970s—face the task of building up the institutions necessary to enable good science at the same time as pursuing their research.

Gevers’ picture of South Africa in the 70s may be at odds with the image the country enjoys today as the brightest jewel in Africa’s scientific crown. But the excellence the country has achieved over the past 40 years should encourage scientists in countries that currently struggle with their scientific capacity to feel hopeful about their own future.

Linda Nordling, SciDev.Net

A fascinating lecture by a South African astronomer provided food for thought this afternoon.

David Block from the University of the Witwatersrand made an impassioned and convincing argument that Edwin Hubble, the legendary astronomer, stole many of his iconic ideas from less famous colleagues.

Block’s research is published in Shrouds of the Night, a book about dark matter he co-authored with Ken Freeman last year.

For example, he says that the Hubble “tuning fork”—a way of classifying galaxies that was supposedly published by Hubble in 1926—was in fact invented in 1929 by a Sir James Jeans. Hubble, Block says, only used the tuning fork in a 1936 paper, without giving Jeans any credit.

According to Block, Hubble also stole another galaxy classification system and the “Hubble” luminosity profile—a way of modelling the light intensity emitted by a galaxy—from a mysterious “Mr Reynolds” who penned an article on it years before Hubble mentions it in his work.

Block believes this to be a J H Reynolds, an amateur astronomer living at the same time. Incidentally, his telescope eventually found its way to Egypt where it for a long while was the most powerful telescope to study the southern skies.

Figures like Reynolds and Jeans are the unsung heroes of science, Block said. Without a doubt, it should be the Jeans tuning fork, the Reynolds luminosity profile and the Reynolds galaxy classification system.

Why Reynolds or Jeans never spoke up about the blatant plagiarism of their ideas is a mystery. Reynolds and Hubble corresponded, and Block has unearthed strong evidence that Hubble borrowed ideas from Reynolds in old letters.

This begs another important question: Scientific collaborations between Northern and Southern scientists are not always equal. How many unsung scientific heroes from the developing world had their ideas nabbed by people who had the power and networks to claim them as their own?

Linda Nordling, SciDev.Net

Much has changed in the fortunes of developing countries since last year’s TWAS meeting, the organisation’s president Jacob Palis said at the inaugural session before lunch today.

The financial crisis may have almost brought the world economy to a standstill—but it was the economic resilience of the developing country’s biggest economies that kept it going, he said.

Next year’s football World Cup in South Africa, a black man in the White House and Brazil winning the 2016 Olympics are all signs that the tide has turned for developing countries, he added.

Palis’ point was that one of the drivers of this change in developing countries’ fortunes is investments in science and technology.

But the progress has been uneven, and now it is up to the emerging economies—China, India, South Africa—to step up to the plate and share their successes with their neighbours, he concluded.

During the conference, South Africa and Brazil will meet for bilateral talks on how to boost science cooperation. There will be plenty of best practice examples for how to boost such links further.

But so far, the main voices in Durban have come from the powerful emerging economies, or from the developed world. Hopefully we will also be hearing from those who are a bit further from achieving a “knowledge revolution”.

The least developed countries will have access to help, but they also need to help themselves said South African science minister Naledi Pandor.

She voiced concern that four years after Africa adopted a common science plan, many countries either don’t have science ministries, or have not outlined a role for S&T in their national development plans.

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In “recession watch” news, the German ambassador to South Africa said developed countries will not cut funding for developing country science.

Tell that to the Swedish development agency SIDA which may cut its research cooperation budget by 20% in 2010!

Linda Nordling, SciDev.Net

TWAS – an overwhelmingly grey and male affair – is trying to get more female and young scientists involved in their activities. This was the main message from the general meeting of TWAS members this morning preceding the official opening ceremony of the conference.

The organisation is preparing a strategic plan, to come into force next year. Women, youth and having a more direct impact on policy are some of the important issues to be highlighted in the plan.

To the organisation’s credit, a record number of female scientists were elected to TWAS in 2009. But the women – eight this year – still only make up a small part of the 50 new members announced this year. Of all the members of TWAS, only 7-8 per cent are women.

The meeting also heard that there will be more activities involving young scientists at next year’s TWAS conference in Hyderabad, India.

All this sounds good. But some members complained that there was not enough emphasis on basic, and in particular experimental, science in the new TWAS strategy.

Linda Nordling, SciDev.Net