Spurred on by challenges

Professor Abdallah S Daar, ex-professor and head of the department of surgery at Sultan Qaboos University, is now on a global mission to transform lives in the developing world using advances made in global health. In a revelatory book, called The Grandest Challenge, co-authored with Peter Singer, another distinguished scientist, Prof Daar writes that every person’s life is of equal value, regardless of where he or she is born or lives in this world. The book argues that the revolution in biotechnology can save millions of lives but only if we find a way to bring knowledge and treatments out of state-of-the-art labs and into the world’s most remote villages.


The doctors lead us on an eye-opening, globe-spanning tour, showing us in vivid detail how developing countries can and are breaking the cycle of dependence, exchanging knowledge, and creating solutions that work for their own people as well as the rest of us.

Prof Daar started at a medical school in Uganda and then left for the University of London, moving on to Texas, then back to Oxford, the UAE and finally Oman, where he was professor and head of department of Surgery at Sultan Qaboos University. He is currently professor of public health sciences and of surgery at the University of Toronto and also holds several other posts internationally. He is senior scientist, Sandra Rotman Centre for Global Health; chief scientist of Grand Challenges Canada; and chair of the advisory board of the United Nations University International Institute for Global Health. He was the founding chair of the Global Alliance for Chronic Diseases.

Excerpts from an interview with Visvas Paul D Karra:

What was the inspiration behind writing the book The Grandest Challenge?
The world does not know how unequal it is and the disparities that exist, particularly in health. And there is a link between health and income - they reinforce each other. How is it possible to improve the situation using modern science and technology? My colleague Dr Peter Singer and I have worked very closely and over the past 10-12 years have developed a programme in Toronto which has been very successful both in terms of coming up with new ideas and support to get research funding. This is the first book I have written that is aimed at the public rather than professionals. It aims, among others, to inspire young people to be more aware of what they could do to change the world and make a difference both by advocacy and also finding their own entry points into wide area of global health.

What is the best way for an Omani individual to enter into this innovative field?
In Oman, we should have better global public health education. We have good medical schools but they are not yet connected to the larger world and none of them are focused on how to make a serious contribution to the health and welfare of the rest of the world, and especially the poor. But they can make a difference. There is a beautiful example of His Excellency Yusuf bin Alawi bin Abdullah, the minister responsible for foreign affairs, investing $1mn in a bio-tech company known as Shantha Biotechnics in Hyderabad, India. That biotech company developed a vaccine against Hepatitis B bringing down the cost by a huge margin – from $20-25 per shot to less than $1 initially and later to about 35 cents. That company is among the largest suppliers of this vaccine to UNICEF and millions of children are now getting the benefit out of it from the initial investment of 1mn. The company was valued at $600mn a few years ago. The Hepatitis B vaccine has been in existence since 1969 but wasn’t available to the developing countries until Shantha developed it and made it affordable. The challenge isn’t just about developing such vaccines but also to reach out to the needy. We need health insurance schemes for the poor that would be more affordable.

Talent, ingenuity and the ability to innovate do not know any borders. What is important is to identify them, and provide an environment for their productive expression. There is a proposal to build a science city here in Oman. This is a great opportunity to harness and unleash Oman’s creative potential, in addition to help build public awareness of the value of ethical science to society.

The book also talks about frugal low-cost, efficient health care delivery systems that we, and even the wealthy countries, can all learn from. Take for example the Aravind eye-care system in Madurai, India. They have a few clinics around and they do as many eye care surgeries in one year as the whole of Canada and their results are better than that of the National Health Service of the UK. Yet remarkably Aravind does all this at one hundredth of the cost of the UK while treating half of all their patients for free because they are poor; and at the end of the year they get a profit which they plough back into the system since it is a non-profit organisation. So in the book we highlight the importance of not only north-south flow of knowledge but also south-north and south-south learning.

What makes your book different from others on the same subject?
In our centre in Toronto we have developed a niche which is at the intersection between global health, life sciences (biotechnology) and entrepreneurship. The book is informed by this approach and also by what we call integrated innovation i.e innovation in science/technology but coupled with social and business innovation. Our book covers these issues in a narrative form, with many intriguing stories and events. To our knowledge this is the first book to do this. We also narrate stories of how we came to work with funding organisations like the Bill and Melinda Gates Foundation and the work we still do with them. We have also now evolved into being a research funding organisation, Grand Challenges Canada, which focuses on funding great researchers in low income countries who have great ideas.

You have brought out different ideas in your book, but what exactly is the road map? Who will benefit from the ideas you have discussed and how?
First of all, people like reading about exciting new developments. A few years ago a book similar to ours, Thomas Friedman’s bestseller’s The World is Flat talked about information and communication technology (ICT). Today India is just as good as the US – very connected. We argue that the world has also become flat in terms of innovation, creating wealth and making an impact on society through life sciences and global health innovation. But interestingly, ICT and life sciences are now converging. We also aim to get students interested in global health, identify their own entry points in this wide field, and make them compassionate agents of change who are aware of the rationale for mutual caring. The book might also help investors think beyond the obvious.

The book is also full of stories that take place in many countries and this might inspire people to travel more and more purposefully. A person could say, “I haven’t travelled to this particular place and I don’t know how a particular concept works so let me go there and see it myself”. They could visit, for example, a hugely successful company in Arusha, Tanzania, called “A to Z”. This company, which employs about 7000 people, mostly women, manufactures about 30 million insecticide impregnated bed nets. These bed nets have dramatically reduced the mortality rate of children from malaria. They might thus become better global citizens, in addition to being Omani citizens.

We don’t realise how much innovation exists in the developing world. In wealthy countries we cannot survive on less than a dollar a day, because even a cup of coffee costs more. But there are about a billion people who survive on a dollar less than a day and about 2.7 billion who survive on less than 2 dollars. To do so that you really need to be innovative, creative and ingenious. In The Grandest Challenge we discuss the ways and mechanisms of harnessing and unleashing these ideas to bridge knowledge, health and power gaps.

You have talked about taking labs to the villages and ‘flattening’ the world in its true sense. Can you give us a real life experience of success in this drive?
Let me start with a story of a failure. A professor called Moses Musaazi from Uganda developed an ingenious incinerator for burning medical waste that doesn’t require any fuel other than the medical waste itself. He has got a prototype. But unfortunately he has got no way of taking his idea forward. There is no efficient system for him to protect his innovation. He has no mentors to help him with commercialisation. There is no venture funding. So his technology is stagnant.

A success story is ‘A to Z’ that I spoke about earlier. A textile company in Tanzania that used to be a tiny factory producing t-shirts and hats. One day someone from the World Health Organisation (WHO) and a Tanzanian scientist called Hassan Mshinde visited them and another company and said they had some evidence that impregnating insecticide into bed nets would stop kids dying from malaria, and asked whether these companies are interested. The other company declined but ‘A to Z’ agreed and the rest is history.

The book describes the real ethical, regulatory and political challenges facing researchers and companies as they develop ideas, do research and develop and commercialise their products. Yet it is a profoundly optimistic book, full of examples of how these challenges are and can be overcome. A great example of this is the story we tell of HE Yusuf bin Alawi bin Abdullah and Shantha Biotechnics. There are many others we talk about in the book.

That kind of smart learning, collaboration and investing can happen in any direction. Look what’s happening in India, which is transforming itself from a ‘copycat’ nation in terms of innovation to a truly innovating nation. It initially started with ICT and now moved on to biotech and pharmaceuticals. So if it’s possible in India, it could be possible in Pakistan, Nigeria or Ghana. Most of the oil for US comes from Africa rather than the Middle East. Africa is a rising star. Countries there are beginning to invest seriously in science and technology and training of human resources. The opportunities of the future lie in Africa, Latin America, India and China.

As the ex-Professor and Head of Dept of Surgery at Sultan Qaboos University, can you give us your outlook on Oman’s health system?
Oman has actually got a relatively good health care system, although of course it can always get better. Oman is a long way away from investing in health to the same extent as, say, the UK or Canada in terms of percentage of GDP. Nevertheless, a few years ago Oman was ranked by the World Health Organisation as No.1 in the world in terms of how much health value you get on a dollar spent on health. Since then there has been huge improvements in the healthcare system at the tertiary end, mainly in the Muscat region. We now have not only high powered care like kidney and bone-marrow transplants, but also open heart surgery. We performed the first kidney transplant nearly 20 years ago. Oman holds two world records for performing the youngest kidney transplant in history. Furthermore, private sector healthcare is also growing. However, talking to young Omani doctors recently I was told that away from Muscat the situation is not so rosy. So there is work to be done there to improve things. Investing in health is investing in wealth. Some economically developed countries spend in excess of $5000 per capita per annum on health, constituting more than 10 per cent of GDP (the US spends 17-18 per cent, but a lot of that is wasted). But poor countries in sub-Saharan Africa spend as little as 15 to 20 dollars per capita.

What are the major discoveries in biotechnology?
Genomics in the long term would make our approach to medical care more personalised and preventive. It has also allowed us to look at the genetic make-up of viruses, bacteria and parasites so we can intelligently develop drugs and vaccines against them. It has also enabled us to understand mosquitoes that carry those parasites like malaria and develop ways to stop them from transmitting those diseases. A major breakthrough is that until now we haven’t had a malaria vaccine but there is now going to be one in 2016 and others will follow. I believe that in 10 to 15 years, malaria will not be such a big killer of children.

(The Grandest Challenge is available at W H Smith in Oman or can be downloaded to Kindle from www.amazon.com). It reached No.1 on the amazon.ca international non-fiction bestseller list and No.6 on the same category on amazon.com.) 

 

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