Science Applied to the Greatest Needs

In June, I plan to travel for the first time to sub–Saharan Africa. I've never gone before because I felt so uncomfortable at the idea of being confronted with the inequalities between my lifestyle and the grinding poverty of billions in the developing world.

I'm setting the guilt aside partly as an exercise in personal development and partly to help expand The Scientist's coverage of science in the developing world, especially on the impact of new knowledge on improving the lot of the poorest of the poor. In the past few years, we have sent reporters to remote areas of Brazil, Thailand, and war-ravaged Croatia. For this issue, we sent staff writer Bob Grant to Haiti. My June visit will be to Uganda.

There has always been a core of outstanding and dedicated scientists working on tropical disease and implementing scientific advances in the field. However, relative to the scale of the problems, the investment has been pitiful and progress has been halting. It is fair to say that, at this point, science has failed the developing world.

Why? One reason is that the major science-producing states are simply not that interested in the problems of the developing world. Since most scientists are under Western society's thumb, it follows that science too has given the problems short shrift.

A lot of us like to think of ourselves as independent entities, at arm's length from the "establishment." Spend a couple of hours reading Richard Lewontin's Biology as Ideology, and that consoling notion will be sorely challenged. "People earn their living by science, and as a consequence the dominant social and economic forces in society determine to a large extent what science does and how it does it," writes Lewontin. Later in the book – and this is the really discomforting part – he writes: "Despite its claims to be above society, science, like the Church before it, is a supremely social institution, reflecting and reinforcing the dominant values and views of society at each historical epoch."

The ongoing lack of interest in the developing world is clearly reflected in state funding. There is a smattering of relatively small programs such as the National Institutes of Health's Tropical Medicine Research Centers and the Fogarty International Center. But overall, when compared to the percentage of people around the world who are affected by diseases such as malaria and trypanosomiasis, the amount of NIH funding is tiny. Those numbers are similar if not worse in corporate–sponsored life sciences research, which now comprises roughly half of all funding.

Luckily, the charitable/philanthropic sector is heavily involved. The Wellcome Trust has funded tropical medicine for decades, notably through overseas units, and the massive budget increase that it recently announced will likely see more for research on tropical diseases. The Bill & Melinda Gates Foundation is also doing creative things – especially the $100 million fast–track grant program to fight global health scourges.

There is, however, another reason why science–based programs have generally not achieved the levels of success that was expected of them in Africa and elsewhere. We are now beginning to find out why. As Grant reports in his article Implementing Change, rigorous, location–specific, scientific follow–up and evaluation has been lacking in programs aimed at healing the health woes of the developing world. People in the public health arena have begun clamoring for more and better "implementation science" as integral parts of such public health programs. Some projects that have incorporated impact evaluation and subsequent adaptation into their structures have seen success. Others, without minding the real effects of interventions, have failed.

There's a long slog ahead, but science is at last focused on unshackling the chains that bind the developing world.

rgallagher@the-scientist.com