THE INTERFACE OF SCIENCE AND POLICY: THE CRUCIAL ROLES OF FOOD AND HEALTH IN ECONOMIC DEVELOPMENT

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• THE INTERFACE OF SCIENCE AND POLICY THE CRUCIAL
  ROLES OF FOOD AND HEALTH IN ECONOMIC DEVELOPMENT
• Gilbert S. Omenn
• University of Michigan
• APS Centennial Special Plenary
• On Agriculture, Food Security, and Public Health
• Global IssuesGlobal Solutions
• 28 July, 2008, Minneapolis
• American Phytopathological Association (APS)

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Disclosures

• Board of Directors
• Amgen, Inc (medical biotechnology)
• Rohm Haas Co (materials and chemicals)
• Occulogix (medical devices for eye
  diseases)
• Scientific Advisory Boards
• Divergence Inc (nematode genomics)
• Population Services Intl (social
  marketing)
• Innocentive Innovation Inc (internet
  problem-solving)
• Compendia Biosciences Inc (bioinformatics)
• 3M Co (toxicology and epidemiology)
• Motorola Inc (electric and magnetic fields)

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Outline of Talk

• Societal Context for Science
• Grand Challenges in Health, Nutrition, Water, and
  Economic Development
• UN Millenium Development Goals
• Gates Fdn Challenges in Global Health
• Importance of sociopolitical dimensions
• Need for indigenous scientific capabilities
• Need for public understanding/support of
  scientific approaches to these challenges

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International Science and Policy Often Dominate
the AAAS Presidential Addresses

• 2008, David Baltimore International Cooperation
  in Science and Technology
• 2007, John Holdren ST for Sustainable
  Well-Being (Science 319424-434, 2008)
• 2006, Gil Omenn Grand Challenges and
  Opportunities in Science, Technology, and Public
  Policy (Science 314 1696-1704, 2006)
• 2002, Peter Raven Science, Sustainability, and
  the Human Prospect. Science 297954-958, 2002.

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Contributors to Global Mortality, 2000 (WHO,
Holdren)

• Cause
  M yrs life lost
• Malnutrition (child, maternal) 200
• Excess nutrition/low activity 150
• Unsafe sex
  80
• Tobacco
  50
• Unsafe water
  50
• War and revolution
  40
• Indoor smoke (solid fuels)
  35
• Alcohol
  30

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Societal Context for Science

• Literacy, science, and math education for all
• Scientific researchindigenous and collaborative
• Practical applications of sciencepriority-based
• Evidence-based decision-making
• All depend upon the broader society---with
  functioning educational systems, robust economy,
  social justice, and effective governance and
  administration. And with respect for the
  scientific methods of observation,
  experimentation, and challenge of conventional
  views.

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U.N. MILLENIUM DEVELOPMENT GOALS

• These goals for peace, security, development,
  human rights and fundamental freedoms (1990 to
  2015) are people-centered, time-bound, and
  measurable 191 signatories.
• 1. Eradicate extreme poverty (lt1/day 1 billion
  people)
• and hunger--in 50 of the affected
  population
• Achieve universal primary education for boys and
  girls
• Promote gender equality and empower women
• Reduce child mortality rate before age 5 by 67
• Improve maternal health--reduce mortality ratio
  by 75
• Combat HIV/AIDS, malaria and other
  diseases---begin to
• reverse incidence and spread
• Ensure environmental sustainabiity--50 reduction
  in numbers without safe drinking water
• 8. Develop a global partnership for development

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Subtleties of MDG-1 Poverty and Hunger

• UN Secretary-General Complex concerns which must
  be overcome by addressing the interconnected
  challenges of agriculture healthcare nutrition
  adverse and unfair market conditions weak
  infrastructure and environmental degradation.
• Five indicators are used to measure progress on
  MDG-1
• 1.The proportion of people living in poverty
  (ltUS1/day)
• 2.The poverty gap (how poor are the poor)
• 3.The share of national income or consumption
  enjoyed by those in the lowest quintile of income
  distribution (a measure of inequality)
• 4.The proportion of people undernourished (a
  measure of food availability in a country)
• 5.The prevalence of underweight preschool
  children (a measure of child malnutrition)
• U. Gentilini P. Webb, Tufts Univ Food
  Policy/Applied Nutrition Program, paper 31, 2005

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Mid-Course Assessment Toward Millenium
Development Goals (MDGs)

• Excellent progress in most of south and east Asia
• Many Middle East, Latin American, northern and
  sub-Sahara African nations failing.
• Large sub-populations with persistent extreme
  poverty in middle-income nations like Brazil,
  China, Mexico

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Tracking Progress in Maternal, Newborn Child
Survival (MDGs 4,5)

• Despite rapid progress in providing vaccinations,
  vitamin A supplementation coverage and
  insecticide-treated mosquito nets to prevent
  major killers such as measles and malaria, few of
  the 68 developing countries that account for 97
  per cent of maternal and child deaths worldwide
  are making adequate progress to provide critical
  health care needed to save the lives of women,
  infants and children (MDGs 4,5).
• Exceptions China, Haiti, Turkmenistan, several
  countries in sub-Saharan Africa in all, 16 are
  on track for MDG 4.
• http//www.countdown2015mnch.org (4/16/08).

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Reasons for Slippage (Countdown to 2015)

• Family planning The unmet need for
  contraceptives is high. Only one-third of women
  in the 68 priority countries are using a modern
  contraceptive method a proven means of boosting
  maternal and infant survival. PSI and Buffett
  Foundation expanding global efforts.
• Skilled care at birth Only half of women and
  newborns benefit from a skilled birth attendant
  even fewer receive care in the critical days and
  weeks after childbirth.
• Clinical care for sick children Only one-third
  of children with pneumonia the biggest single
  killer of children receive treatment.
• Nutrition Under-nutrition is the underlying
  cause of 3.5 million child deaths annually, and
  20 per cent of maternal deaths.

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Food Security

• Dire needs, especially in sub-Saharan Africa15
  million people in the Horn of Africa alone
  dependent on emergency supplies
• Political chaos, worst in Zimbabwe
• Political recovery, most dramatic in Uganda,
  Rwanda
• Food aid in short term food production, less
  wasteful distribution in longer term
• Added value of local agriculture employment
• Crops at risk, like flu pandemic riskUg99 wheat
  rust (neglected since discovery in 1999)
• Cooperation, governance needed African Peer
  Review Mechanism, AU/NEPAD TICAD

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Broader Donor Programs--TICAD

• Tokyo International Conference on African
  Development (TICAD IV, Summit 5/28-30, 2008, 15th
  anniversary
• Convened 51 African countries, 74 regional and
  international organizations, private sector,
  civil society organizations, 34 partner
  countries.
• Proposed by Japan and initiated in1991 at UN
  General Assembly which promulgated the UN new
  agenda for the development of Africa in the
  1990s.

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Gates Foundation Grand Challenges in Global Health

• Launched in 2003 to harness the power of science
  and technology to dramatically improve health in
  the worlds poorest countries.
• Its roots lie in the Great Neglected Diseases of
  Mankind Program of The Rockefeller Foundation
  from 30 years earlier.
• The initiative seeks scientific breakthroughs for
  preventing, treating, and curing diseases that
  annually kill millions of people, especially
  children, in developing countries.

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Global Health GC Program Features

• The Gates Foundation looked for a specific
  scientific or technological innovation that would
  remove a critical barrier to solving an important
  health problem in the developing world with a
  high likelihood of global impact and
  feasibility.
• Based on 1500 suggestions from more than 1000
  scientists from around the world, 14 Grand
  Challenges were identified (next slide). Awards
  for 43 projects, involving collaborators in 33
  countries, were made in 2005. Total funding 500
  million from the Foundation, in collaboration
  with the Foundation for the National Institutes
  of Health, the Wellcome Trust, and the Canadian
  Institutes of Health Research. The Challenge
  generated tremendous interest and high
  expectations.
• A global participatory process note Innocentive
  problem-solving analogy (www.innocentive.com).

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GRAND CHALLENGES IN GLOBAL INFECTIOUS DISEASES 7
Goals, 14 Challenges, 43 Grants

• Improve childhood vaccines (3)
• Create new vaccines (3)
• Control insects that transmit agents of disease
  (2)
• Improve nutrition to promote health (1)
• Improve drug treatment of infectious diseases (1)
• Cure latent and chronic infection (2)
• Measure health status accurately and economically
  (2)

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Nutrition Projects in Grand Challenge 9

• Pioneers term Seeds of Hope
• Cassava, banana, sorghum, sweet potato
• Florence Wambugus African Biofortified Sorghum
  multiple enhancements
• --balanced amino acids (Lys, Trp, Thr, Met)
• --suppressed phytans, kafirin/more digestible
• --gene constructs to produce vitamin A (from
  rice) Lysine, Fe, and Zn (from maize strains)
• --training in U.S. companies of African
  scientists
• --close the yield gap with less fertilizer,
  maybe less water

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Policy Challenges and Lessons from Africa
Biofortified Sorghum Project

• Many candidates for nutritional and physical
  enhancementsmust be feasible and must be desired
  by the community
• Fear about first test and first use in
  Africa--show us it works first in the U.S., at
  the cost of delayed introduction and potentially
  irrelevant soil/weather conditions parallel with
  drugs
• Must satisfy many stakeholders---farmers,
  consumers, traders, regulators, activists,
  researchers, companies
• Dr. Wambugu Only products will drive
  acceptance of new technologies.

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Water and Health

• As described by Ray Martyn and Shiney Varghese,
  the quantity, quality, safety, and affordability
  of potable water are all at risk.
• Water-related diseases dominant mortality and
  morbidity statistics.
• Ag and public health needs are in conflict
  agricultural entitlement devastating.
• Local water purification kits effective (PSI).
• Big tech/desalinization long-delayed.

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ST for Smarter Water Policies

• Work with nations around the world to develop low
  cost ways to make polluted water potable
• Develop crop strains more resistant to drought 
• Design improved irrigation methods including
  reduced losses during water transport
• Improve technologies for low-water-use appliances
  
• Use water more efficiently in industry, with
  maximal recycling
• Improve weather and climate modeling to better
  understand how climate change and new weather
  patterns will affect rainfall and flood
  potentials in the US and around the world
• Implement stronger policies to evaluate water
  impacts as part of economic development planning

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Grand Challenges in Environmental Sciences

• Biogeochemical Cycles
• Biodiversity and Ecosystem Functioning
• Climate Variability
• Hydrologic Forecasting
• Infectious Disease and the Environment
• Institutions and Resource Use
• Land-Use Dynamics
• Reinventing the Use of Materials
• National Research Council, 2001

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Chemistry and Chemical Engineering for
Sustainability

• Green chemistry, replacing solvents, improving
  catalysts
• Life cycle analysis tools and models
• Toxicologic characterization of all chemical
  inputs and outputs
• Renewable chemical feedstocks from various
  biomass
• Renewable fuel sources
• More efficient chemical processing
• Separation, sequestration, and utilization of
  carbon dioxidediscussed by Dr. Field
• Science literacy at all levels

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Joining Science and Policy-Making

• Education, health, and governance
• Capacity-building in executive, legislative,
  judicial, public administration, and electoral
  institutions, with protection of human rights
• Proactive prevention of conflict and
  post-conflict reconstruction
• A results-oriented ST approach
• Setting priorities high maternal and under-five
  mortality rates, prevalence and spread of
  HIV/AIDS, TB, and malaria
• Need health system infrastructure/workforce
  continuity
• More nutritious crops with local production

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On The Responsibilities and Long-Term Interest of
Rich Nations

• Kai Lee Search for a life good enough to
  warrant our comforts. In Compass and Gyroscope
  Integrating Science and Politics for the
  Environment, Island Press,1993.
• Ismail Serageldin Humanity cannot survive
  partly rich and mostly poor. Science 29654,
  2002.
• Comment by Peter Raven The scientific attitude
  can bring people together on a rational basis.
• First, we must bring scientists together on hotly
  debated topics, as IPCC has. GEOs pending.
• A special opportunity for APS around global
  threats to the food supply.

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Donor/Partner Policies and Attitudes

• MDG 8 calls for partnerships, rather than
  donor-recipient relationshipkey distinction
• Rich nations have been very slow to step up to
  0.7 percent of GDP commitments from UN General
  Assembly in 1970 for O.D.A. Official Development
  Assistance
• Economic stresses always seem to trump foreign
  assistance or environmental pledges
• People needs, especially medicines for HIV/AIDS
  patients, trump prevention, nutrition, and
  environmental imperatives.

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New Instruments for Financing Global Health
Initiatives

• Intl Finance Facility for Immunization bonds
• Advance Market Commitments for vaccines
• Debt2Health Debt conversion for The Global Fund
  to fight AIDS, TB, Malaria
• Airline Solidarity Contribution, led by France
  since 2004 (surcharge on travelers)
• Global Artemisinin-Based Combination Therapy
  (ACT) subsidyto avert certain malaria resistance
  to monotherapy
• (Product)RED Bono/Shriver trademark,
  LLCcause-related marketing

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Data for the Next Decades IHME

• Gates Foundation created an Institute for Health
  Metrics and Evaluation (IHME) at the University
  of Washington (Chris Murray, PI).
• New Global Burden of Diseases, Injuries, and Risk
  Factors Study launched in 2007 (successor to 1990
  GBD study). DALY estimates due in 2010.
• First product under-5 mortality rates and
  projections ww.healthmetricsandevaluation.org.
• CJL Murray, J Frenk. The Lancet 3711191-1199, 5
  April, 2008.

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SUMMATION

• Improved health for the entire population,
  especially those in deep poverty and/or
  disenfranchised subpopulations, is an imperative
  in every country.
• Improved nutrition and health are essential to
  learn, to contribute to economic growth and
  sustainability, and to make decisions that
  control population numbers.
• The UN Millenium Development Goals for 2015 are
  science-based and technically feasible. They were
  launched with broad political agreement and
  financial commitments in 2001.

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• At this midpoint to 2015, the overall integrated
  strategy faces a chasm between lofty goals and
  social and policy deficiencies--reflecting poor
  governance, corruption, paralyzing poverty, armed
  conflicts, growing inequalities even within
  prosperous countries, and inadequate global
  investment, both financially and intellectually.
  
• There are remarkable successes in many places.
  The Gates Foundation Grand Challenges in Global
  Health and the multiple other initiatives
  described by the remarkable speakers in this
  Plenary give us optimism. The overall challenge
  is scalewe must find the will, the trust, the
  data, the resources, and the collaborative policy
  instruments to achieve innovation and measurable
  progress throughout the world.