Grand challenges in global health

Grand challenges in global health - POLICY FORUM P U B L I...

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398 O n 26 January 2003, at the World Economic Forum in Davos, Swit- zerland, Bill Gates announced a $200-million medical research initiative— the Grand Challenges in Global Health— based on a century-old model, the grand challenges formulated by the mathematician David Hilbert ( 1 ). Hilbert’s list of important unsolved problems in mathematics ( 1 ) has spurred major research innovations in the field. The Global Health ini- tiative was proposed by Gates Foundation (BMGF) on the assump- tion that, with greater encouragement and funding, contemporary science and technolo- gy could remove some of the obstacles to more rapid progress against diseases that dis- proportionately affect the developing world. The efforts to identify Grand Challenges in Global Health relied on financial and ad- ministrative resources of two collaborating foundations, the BMGF and the Foundation for the National Institutes of Health (NIH); on a selection panel (scientific board) of 20 sci- entists and public health experts from 13 countries, including several from the develop- ing world ( 2 ); and on the scientific communi- ty to supply ideas for challenges. In this Policy Forum, some of us involved in these events (H.V., R.K., and E.Z. as members of the Scientific Board’s Executive Committee and P.A.S., T.A., and A.S.D. as scholars who provided support to the selection process) de- scribe the deliberations that led up to this week’s announcement of an initial list of Grand Challenges in Global Health (see table, page 399). We also outline the next steps that will be taken to fund research that addresses those challenges and plans to formulate addi- tional grand challenges in subsequent years. What Is a Grand Challenge? On 1 May 2003, in a solicitation widely ad- vertised in the developed and developing world, a grand challenge was described as “a call for a specific scientific or technological innovation that would remove a critical barri- er to solving an important health problem in the developing world with a high likelihood of global impact and feasibility.” Throughout the process of developing the grand chal- lenges, the board struggled with how best to define them. A grand challenge is envisioned as distinct from a simple statement of one of the many “big problems” in global health, such as HIV/AIDS, malnutrition, the lack of access to medical care, or the lack of ade- quate resources. A grand challenge is meant to direct investigators to a specific scientific or technical breakthrough that would be ex- pected to overcome one or more bottlenecks in an imagined path toward a solution to one or preferably several significant health prob- lems. To satisfy this intent, a successful pro- posal would need to foresee a critical path of this type to get past a clearly defined road- block. This formulation worked most effec- tively for those medical problems that are well enough understood to allow a descrip- tion of what needs to be done, even if we do
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Grand challenges in global health - POLICY FORUM P U B L I...

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