tag:theconversation.com,2011:/us/topics/medical-innovation-21811/articlesMedical innovation – The Conversation2022-10-02T12:38:28Ztag:theconversation.com,2011:article/1916852022-10-02T12:38:28Z2022-10-02T12:38:28Z100 years of innovation and inventions: South African vice chancellor reflects on what’s next<figure><img src="https://images.theconversation.com/files/487558/original/file-20220930-12-4t7wjk.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vice Chancellor Professor Zeblon Vilakazi and others in the IBM Lab at the opening of Wits university's Tshimologong Digital Innovation Precinct.</span> <span class="attribution"><span class="source">Lauren Mulligan/Wits University</span></span></figcaption></figure><p>We live in a world characterised by <a href="https://www.oxfam.org/en/5-shocking-facts-about-extreme-global-inequality-and-how-even-it">inequality</a>, <a href="https://www.worldbank.org/en/topic/poverty/overview">poverty</a>, economic volatility, globalisation, <a href="https://theconversation.com/africa/topics/climate-change-27">climate change</a> and ambiguity. In my own country, South Africa, residents have to navigate socioeconomic and <a href="https://ewn.co.za/2022/09/30/phalatse-ousted-morero-elected-mayor-as-anc-regains-control-of-joburg">political instability</a>, <a href="https://www.aljazeera.com/news/2022/9/12/south-africa-power-cuts-may-not-end-in-a-year-eskom-says">power</a> and water cuts, <a href="https://www.dw.com/en/pandemic-sees-south-africa-homelessness-numbers-soar/av-62399333">homelessness</a>, unethical governance and mediocre or no service delivery. </p>
<p>It is a far cry from what the country could be if we brought its best talent and resources to bear for the benefit of humanity. </p>
<p>Innovation will be key to any positive changes – and research-intensive universities have a central role to play in that innovation. As the <a href="http://www.wits.ac.za">University of the Witwatersrand</a> (or Wits, as it’s commonly known) turns 100, my colleagues and I have been thinking a great deal about the inventions and breakthroughs that have emerged from the university in the past 100 years – and what <a href="http://www.wits.ac.za/future">is coming next</a>.</p>
<p>Great innovations have emerged from the work done by Wits researchers that have shifted the dial in sectors ranging from health to computing to quantum and nuclear physics. These rich seams of knowledge continue to inform policy and daily decisions and are the foundation of cutting edge research the institution continues to produce.</p>
<h2>100 years of changes</h2>
<p>On 1 September 1939, Adolf Hitler <a href="https://time.com/5659728/poland-1939/">invaded Poland</a>. World War 2 was underway. Barely three months later, the <a href="https://www.theheritageportal.co.za/article/radar-wits-south-africas-development-radar-within-three-months-world-war-ii">first radar set</a> was tested on Wits University’s campus. Britain and its allies were looking for a way to detect enemy aircraft and ships. A group of scientists – among them Sir Basil Schonland, Director of the Bernard Price Institute of Geophysical Research and another Wits engineer, Professor Guerino Bozzoli – came together to harness the power of radio waves.</p>
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<img alt="" src="https://images.theconversation.com/files/487557/original/file-20220930-13-k22ich.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/487557/original/file-20220930-13-k22ich.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=838&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487557/original/file-20220930-13-k22ich.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=838&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487557/original/file-20220930-13-k22ich.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=838&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487557/original/file-20220930-13-k22ich.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1054&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487557/original/file-20220930-13-k22ich.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1054&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487557/original/file-20220930-13-k22ich.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1054&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An aerial view of the university’s Milner Park campus, 1930.</span>
<span class="attribution"><span class="source">Wits University</span></span>
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<p>Almost a century on, the science of sensors has taken several quantum leaps. <a href="https://www.wits.ac.za/news/latest-news/research-news/2019/2019-11/structured-light-promises-path-to-faster-more-secure-communications.html">Professor Andrew Forbes and his team</a> at Wits are encrypting, transmitting, and decoding data quickly and securely through light beams. He has just secured R54 million for the <a href="https://www.wits.ac.za/witsq/">Wits Quantum Initiative</a> which explores theoretical and experimental quantum science and engineering, secure communications, enhanced quantum-inspired imaging, novel nano and quantum-based sensors and devices. </p>
<p>The university has also come a long way on its computing journey. In 1960 it was the first university in South Africa to <a href="https://www.wits.ac.za/curiosity/stories/when-computers-came-to-wits.html#">own an IBM mainframe computer</a>. Today, in partnership with IBM, we’re the <a href="https://www.wits.ac.za/news/latest-news/research-news/2019/2019-06/wits-enters-the-quantum-computing-universe-with-ibm-q.html">first African university to access a quantum computer</a>. </p>
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<p>As the <a href="https://www.wits.ac.za/future/stories/wits-leads-quantum-computing-national-working-group-.html">Chair of the National Quantum Computing Working Group</a> in South Africa, this is an area where I see immense potential for Africa. Classical computing has served society incredibly well. It gave us the Internet and cashless commerce. It sent humans to the moon, put robots on Mars and smartphones in our pockets. </p>
<p>But many of the world’s biggest mysteries and potentially greatest opportunities remain beyond the grasp of classical computers. To continue the pace of progress, we need to augment the classical approach with a completely new paradigm, one that follows its own set of rules - <a href="https://www.ibm.com/topics/quantum-computing">quantum computing</a>. </p>
<p>This radically new way of performing computer calculations is exponentially faster than any classical computer. It can run new algorithms to solve previously “unsolvable” problems in optimisation, chemistry and machine learning, and its applications are <a href="https://ca.nexteinstein.org/our-work/quantum-leap-africa/">far-reaching</a> – from <a href="https://theconversation.com/quantum-entanglement-what-it-is-and-why-physicists-want-to-harness-it-171608">physics</a> to healthcare.</p>
<p>Innovative healthcare is sorely needed across the African continent. Here, too, Wits has been able to play a vital role in the research, teaching and learning, clinical, social and advocacy spheres. It was the first university to lead <a href="https://www.wits.ac.za/news/latest-news/research-news/2020/2020-06/the-first-covid-19-vaccine-trial-in-south-africa-begins.html">COVID-19</a> vaccination trials in South Africa. </p>
<p>Our researchers also developed <a href="https://www.wits.ac.za/news/latest-news/research-news/2017/2017-09/improving-the-accuracy-of-tb-testing.html">technology to improve the accurate testing for tuberculosis</a>. And the <a href="https://www.pelebox.com/">Pelebox</a>, an invention to cut down the time that patients spend waiting for medication in hospitals. </p>
<p>Elsewhere in the institution, researchers have <a href="https://www.wits.ac.za/news/latest-news/research-news/2017/2017-09/can-you-read-my-mind.html">connected the brain to the internet</a>, <a href="https://www.wits.ac.za/news/latest-news/research-news/2019/2019-11/engineering-pivotal-moves.html">used brainwaves to control a robotic prosthetic hand</a> and developed an affordable <a href="https://wits-enterprise.co.za/innovation-support/innovations/3d-printed-bionic-hand">3D printed bionic hand</a>. </p>
<h2>Difficult questions</h2>
<p>Research intensive universities in South Africa need to ask the difficult questions about their role in a changing society. </p>
<p>How do we serve as a catalyst for social change? How do we best use our intellectual dynamism and work with the public and private sectors to effect positive change? How do we create new, relevant knowledge and translate it into innovation? How do we best develop critical thinkers, innovators, creators and the high-level skills required to advance our economy, and the future world of work? </p>
<p>How do we quantify our social impact and ensure that it is contextually attuned? How do we influence policy change?</p>
<p>These questions are at the heart of the university’s strategy today. And they’re no doubt being considered across the higher education sector as universities work to harness their collective talent and the resources at their disposal to craft a new future and transform society for the benefit of all humanity.</p><img src="https://counter.theconversation.com/content/191685/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zeblon Vilakazi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Various innovations after the past century have improved the world for many - but there’s still much more for universities to do.Zeblon Vilakazi, Vice-Chancellor and Principal, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1825752022-06-28T16:03:30Z2022-06-28T16:03:30ZCanada needs to invest more money into science innovation to help prevent the next global crisis<figure><img src="https://images.theconversation.com/files/470375/original/file-20220622-26-15d611.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5074%2C2851&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If Canada wants to establish itself as a leading country in innovation, it has to invest in scientist-entrepreneurs and their projects.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Canada has <a href="https://www.conferenceboard.ca/focus-areas/innovation-technology/innovation-report-card">lagged behind its peer nations in innovation</a> for decades. Currently, Canada is ranked 11th out of the 16 similarly developed countries assessed. While our “C” grade is a moderate improvement over our previous “D” grade, innovation still remains a barrier to high-quality job creation and economic prosperity in Canada.</p>
<p>It’s not that Canadians aren’t creative and inventive — Canadian science was able to rapidly deliver the medical technology needed to provide the first FDA-approved COVID-19 treatment and enabled the most effective COVID-19 vaccines. The problem is that Canada <a href="https://www.youtube.com/watch?v=BLG4e57cIMw">doesn’t convert enough inventions into patents, products and science-based ventures</a>. </p>
<p>While Canada’s COVID-19 breakthroughs are a feat worthy of celebration, other innovative breakthroughs still remain underdeveloped, languishing away in research labs. In innovation circles, this purgatory of untapped science innovation is commonly <a href="https://doi.org/10.1016/j.drudis.2013.01.012">referred to as the “valley of death.”</a> </p>
<h2>University scientists are key innovators</h2>
<p>Innovation in lipid nanoparticle drug delivery — a key component of the mRNA COVID-19 vaccines — was led by <a href="https://www.cbc.ca/radio/quirks/jun-12-missions-to-venus-learning-instant-replay-wrens-spectacular-duet-and-more-1.6061094/meet-the-canadian-scientist-who-paved-the-way-for-groundbreaking-mrna-covid-vaccines-1.6061099">Canadian scientist and entrepreneur Pieter Cullis</a>, a professor who reduced his tenured appointment to half-time decades ago to take on a leadership role in his co-founded ventures and innovation initiatives. </p>
<p>Thanks to Cullis, <a href="https://doi.org/10.1038/s41578-021-00379-9">the potential of lipid nanoparticles was unlocked and commercialized over several years</a> with partners and founders from both Moderna and Pfizer-BioNTech. </p>
<p>One of his ventures, <a href="https://acuitastx.com/company/">Acuitas</a>, manufactures the lipid nanoparticle technology used in the Pfizer BioNTech vaccine. Without these earlier commercialization efforts, the novel COVID-19 vaccine would not have been developed. Similarly, the first FDA-produced treatment for COVID-19 <a href="https://www.theglobeandmail.com/business/rob-magazine/article-the-innovator-carl-hansen-abcellera-biologics/">was developed in the lab of then University of British Columbia professor</a> and <a href="https://www.abcellera.com/technology">AbCellera</a> CEO Carl Hansen. </p>
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<img alt="Close up shot of a woman in a hijab holding a vaccine vial" src="https://images.theconversation.com/files/470372/original/file-20220622-3417-d955d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470372/original/file-20220622-3417-d955d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470372/original/file-20220622-3417-d955d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470372/original/file-20220622-3417-d955d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470372/original/file-20220622-3417-d955d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470372/original/file-20220622-3417-d955d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470372/original/file-20220622-3417-d955d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A volunteer holds a vial of the Pfizer-BioNTech COVID-19 vaccine.</span>
<span class="attribution"><span class="source">(AP Photo/Maya Alleruzzo)</span></span>
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<p>Hansen is a key example of a <a href="https://doi.org/10.1038/s41565-022-01103-6">university scholar who demonstrated entrepreneurial capabilities</a> while still in the research lab, as well as later within the new science-based venture. Without Hansen and his lab researchers’ entrepreneurship, much social and economic benefit would have been lost.</p>
<p>Given that we heavily rely on entrepreneurial scientists to initiate breakthrough invention, and that <a href="https://www.sfu.ca/research/scholarly-impacts/support-scientist-entrepreneurs-crucial-rapid-crisis-response">science-based spinoffs have been a crucial component of global responses to crises</a>, it is surprising <a href="https://techtransfercentral.com/marketplace/innovosource/mind-the-gap-report/">how little is done to support the development</a> of entrepreneurial capabilities in scientists or their science-based ventures. </p>
<h2>The role of university spinoffs</h2>
<p>During the global COVID-19 pandemic, the <a href="https://doi.org/10.1038/s41565-022-01103-6">rapid development and commercialization of highly efficacious vaccines and treatments</a> was unprecedented, and university spinoff ventures played a critical role in their success. </p>
<p>Companies founded by professors or spun out of university research labs include <a href="https://www.gene.com/about-us">Genentech</a>, <a href="https://en.wikipedia.org/wiki/Genzyme">Genzyme</a>, <a href="https://www.biontech.com/int/en/home/about/who-we-are/history.html">BioNTech</a> and <a href="https://en.wikipedia.org/wiki/Google#Early_years">Google</a>. These companies impact their regions and countries by providing high-skilled and high-paying jobs. They export products and services globally. Even when small, such ventures also serve as a bridge between university research labs and established industry.</p>
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<img alt="A building that has a logo on the front that says 'MDA'" src="https://images.theconversation.com/files/470374/original/file-20220622-17-n6zzcc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/470374/original/file-20220622-17-n6zzcc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470374/original/file-20220622-17-n6zzcc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470374/original/file-20220622-17-n6zzcc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470374/original/file-20220622-17-n6zzcc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470374/original/file-20220622-17-n6zzcc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470374/original/file-20220622-17-n6zzcc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">MacDonald-Dettwiler is one of many university spinoff companies in Canada that provide high-quality and high-paying jobs and contribute to the regional and national economy.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Richard Lam</span></span>
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</figure>
<p>In Canada, university spinoff companies include <a href="https://mda.space/en/fifty-years">MacDonald-Dettwiler</a>, <a href="https://www.stemcell.com/about-us">STEMCELL Technologies</a>, <a href="https://carbonengineering.com/our-story/">Carbon Engineering</a> and the previously mentioned AbCellera and Acuitas. These companies also provide high-quality and high-paying jobs, help solve pressing global scientific challenges — like the pandemic — and contribute to the regional and national economy.</p>
<p>The <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html">most novel, highly efficacious and rapidly developed vaccines</a> — both incorporating mRNA and delivered by lipid nanoparticles — were driven by BioNTech, Moderna and Acuitis, working in partnership with the large pharmaceutical firm <a href="https://www.pfizer.ca/">Pfizer</a>. </p>
<p>Critically, <a href="https://www.theglobeandmail.com/canada/article-mrna-technology-vaccines/">no mRNA product had ever been developed and approved</a> anywhere in the world <a href="https://publichealth.jhu.edu/2021/the-long-history-of-mrna-vaccines">before the COVID-19 vaccine was developed</a>. This kind of breakthrough invention <a href="https://doi.org/10.1038/nmat4625">rarely originates in large incumbent firms, but rather in science-based university spinoff ventures</a>. </p>
<h2>Innovation gaps</h2>
<p>The current Canadian innovation ecosystem does a good job supporting innovations that can reach market success in three to five years, like software. But it is not conducive for slower-developing innovations like vaccine development or biomedical treatments. Canada needs to support the slower, more complex ones because having a development pipeline enables us to <a href="https://www.mckinsey.com/business-functions/strategy-and-corporate-finance/our-insights/innovation-in-a-crisis-why-it-is-more-critical-than-ever">rapidly respond to global crises and emerging needs</a>. </p>
<p>Currently, the biggest gap in science innovation support <a href="https://techtransfercentral.com/marketplace/innovosource/mind-the-gap-report/">occurs when the researcher is still in the lab</a> developing their invention. Scientist researchers are being asked to swim upstream for too long, instead of being given the support they need. Thus too many potentially impactful ventures are never founded, and too many breakthrough inventions remain within university walls rather than out in the world. </p>
<p>Founding and growing an impactful science-based company takes persistence, determination, skill — and some luck — and more scientists will embark on the innovation journey if they have a better chance of a positive outcome. </p>
<h2>A new innovation strategy</h2>
<p>The key to better supporting science innovation is funding and <a href="https://www.sciencedirect.com/science/article/pii/S0166497218307302">shaping it at its earliest stages</a>, while innovative ventures are still housed within universities — and even before the ventures are founded. </p>
<p>Known as a <a href="https://researchmoneyinc.com/articles/canadas-university-science-innovation-ecosystem-needs-a-build-for-scale-strategy/">build-for-scale strategy</a>, this approach would involve more flexible funding, <a href="https://www.mitacs.ca/en/invention-to-innovation">skills training</a>, stipends for post-doctoral fellows, intellectual property protection, incubation and acceleration services, enhanced access to prototyping, scale-up, and living lab facilities and government investment.</p>
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<img alt="A man in a suit standing behind a podium" src="https://images.theconversation.com/files/470373/original/file-20220622-17-6u37es.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470373/original/file-20220622-17-6u37es.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470373/original/file-20220622-17-6u37es.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470373/original/file-20220622-17-6u37es.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470373/original/file-20220622-17-6u37es.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470373/original/file-20220622-17-6u37es.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470373/original/file-20220622-17-6u37es.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Minister of Innovation, Science and Industry, Francois-Philippe Champagne, participates in a press conference. The Canadian government announced in April that it will create a funding agency focused on innovation in science and technology.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
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</figure>
<p>If we <a href="https://beedie.sfu.ca/ideas/2022/05/from-spinal-cord-research-to-circular-plastics-mitacs-i2i-skills-training-finale-celebrates-scientist-innovators/">train scientists to have an entrepreneurial mindset while still in the research lab</a>, their innovation decisions will give subsequent spinoff ventures a far better chance of success. These nascent science-based ventures can then be scaled by existing university accelerators, by a <a href="https://www.iincanada.ca/">continuum of science entrepreneurship programming</a> and by <a href="https://creativedestructionlab.com/">investor-focused mentoring and venture building programs</a>.</p>
<p>If Canada <a href="https://ised-isde.canada.ca/site/innovation-better-canada/en">truly wants establish itself as a leading country in innovation</a>, it will have to purposefully support scientist-entrepreneurs as they seek to translate their research into impactful innovation.</p>
<p>Canada’s <a href="https://doi.org/10.1038/d41586-022-01190-4">newly announced innovation agency</a> could play an important role in enabling universities and scientist-entrepreneurs to be more successful in bridging the “valley of death” with breakthrough science innovation. </p>
<p>Investing in <a href="https://researchmoneyinc.com/articles/canadas-university-science-innovation-ecosystem-needs-a-build-for-scale-strategy/">build-for-scale</a> supports will strengthen the Canadian economy by creating good jobs and knowledge-intensive export companies, and benefit our health, the environment and society as a whole. Such “<a href="https://link.springer.com/article/10.1007/s10961-018-09714-9">high quality</a>” university spinoff ventures will also be key to responding to — or helping prevent — future global crises.</p><img src="https://counter.theconversation.com/content/182575/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elicia Maine does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The key to supporting science innovation is funding and shaping it at its earliest stages, while innovative ventures are still housed within universities — and even before the ventures are founded.Elicia Maine, Van Dusen Professor of Innovation and Entrepreneurship , Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1814172022-04-26T12:14:00Z2022-04-26T12:14:00ZHow Robert Langer, a pioneer in delivering mRNA into the body, failed repeatedly but kept going: ‘They said I should give up, but I don’t like to give up’<figure><img src="https://images.theconversation.com/files/458348/original/file-20220415-26-upvb6i.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5640%2C3740&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Robert Langer</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/robert-langer-of-mits-langer-labs-is-photographed-on-april-news-photo/472982424?adppopup=true">Pat Greenhouse/The Boston Globe via Getty Images</a></span></figcaption></figure><p><em>The mRNA vaccines developed against COVID-19 owe a lot to the work of Robert Langer, a pioneer in the delivery of mRNA. <a href="https://scholar.google.com/citations?user=5HX--AYAAAAJ&hl=en">Langer</a>, who is the Massachusetts Institute of Technology David H. Koch Institute Professor and director of the Langer Lab, helped lay the foundation for the underlying delivery mechanism that has led to the development of the first commercial mRNA vaccines, which can be used for a variety of infectious diseases and conditions. Langer is a co-founder of Moderna, the biotech company that developed an mRNA vaccine against COVID-19. He also has authored more than 1,500 scientific papers and is the most-cited engineer in history.</em></p>
<p><em>Langer published the first paper to show that it was possible to deliver nucleic acids like RNA and DNA to the body via tiny particles. He spoke in March 2022 at the <a href="https://www.imaginesolutionsconference.com/">2022 Imagine Solutions Conference</a> in Naples, FL. about his journey from a chemical engineering doctorate to helping develop technology for various lifesaving treatments.</em></p>
<p><em>Below are some highlights from the discussion. Answers have been edited for brevity and clarity.</em></p>
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<figcaption><span class="caption">Robert Langer speaks at the Imagine Solutions Conference 2022.</span></figcaption>
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<h2>How did you end up where you are in your field?</h2>
<p><strong>Robert Langer:</strong> My story is not straightforward by any means. I got my doctorate in chemical engineering from MIT in 1974. One of the things I thought about doing was education, because when I was a graduate student at MIT I helped start a school in Cambridge, The Group School. And I got very involved in developing new chemistry and math curricula. </p>
<p>And I wrote to all these colleges and none of them wrote me back, so I started to think, well, what other way could I use my science and engineering education to help people? And I thought about medicine. I wrote to a lot of hospitals and medical schools. They didn’t write back to me either.</p>
<p>And then one day one of the people at my MIT lab said, “Bob, you know, there’s a surgeon named <a href="https://www.pnas.org/doi/full/10.1073/pnas.0806582105">Judah Folkman</a> in Boston and sometimes he hires unusual people.”</p>
<h2>From 1974 to 1977 you worked as a postdoctoral fellow at the Children’s Hospital Boston and at Harvard Medical School under Folkman. How did your work with Folkman influence your career?</h2>
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<a href="https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A balding man with glasses wearing a lab coat over a white shirt and tie sits at a lab bench surrounded by test tubes and lab equipment." src="https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458352/original/file-20220415-24-6xc04s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Dr. Judah Folkman (1933-2008) explored the role of blood vessels in disease and faced heavy skepticism.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/dr-judah-folkman-explored-the-role-of-blood-vessels-in-news-photo/474014739?adppopup=true">Bill Greene/The Boston Globe via Getty Images</a></span>
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<p>Dr. Folkman’s idea of how tumors grew was actually quite controversial. His theory was that tumors secreted a chemical signal, which he called TAF, tumor angiogenesis factor. And that would cause blood vessels to grow to the tumor. The tumor then could spread through those blood vessels. That’s a process called metastasis, which often kills people.</p>
<p>His theory was that if you could stop blood vessels maybe that would be a new way to stop cancer. To solve this problem we had to deliver large molecules to the body through tiny particles. Nobody before us had done that, and we were told it was impossible.</p>
<p>I spent about two years working in the laboratory, and I found over 200 different ways to get this to not work. Eventually I was able to make little microspheres, or nanospheres. We published our findings in the <a href="https://www.nature.com/articles/263797a0">journal Nature</a>. This was the first time nucleic acids had ever been delivered through tiny particles for any period of time.</p>
<h2>What was the process for obtaining the patent?</h2>
<p>Folkman and I filed for a patent, but the patent examiner rejected it five years in a row. And all the people at the hospital told me I was wasting a lot of money for the hospital. They said I should give up, but I don’t like to give up.</p>
<p>When we first started doing this, everybody told me it was impossible and that it could never work. So I did what’s called a science citation search, looking back at our 1976 Nature paper. One of the papers I found was really helpful. I had no idea it was even written but I found that five of the top material scientists in the world said that Folkman and I had shown some surprising results that clearly demonstrate that this idea could work.</p>
<p>We showed that to the examiner and he said, well, that’s interesting. He said, I’ll allow the patent if you can get written affidavits from these five people that they really wrote it. So I wrote them and they wrote back and sent the affidavits. We got this really broad patent, and with that patent I got involved in starting companies. </p>
<h2>What did this process teach you?</h2>
<p>I learned that if you’re not your own champion, nobody else will be. So I got involved in patenting things, and my students were very interested in seeing their work make a difference. That’s what led to a number of different companies, some of which we started and others which we guided, developing many products used today. My story is sort of one person’s example of how you can try to use science to help relieve suffering and prolong life.</p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/181417/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Langer co-founded Moderna. For a list of entities with which R.L. is, or has been recently involved, compensated or uncompensated, see:
<a href="https://www.dropbox.com/s/yc3xqb5s8s94v7x/Rev%20Langer%20COI.pdf?dl=0">https://www.dropbox.com/s/yc3xqb5s8s94v7x/Rev%20Langer%20COI.pdf?dl=0</a>
</span></em></p>Moderna co-founder Robert Langer developed the process that made COVID-19 vaccines possible. He spoke about his journey helping develop the science for various lifesaving treatments.Robert Langer, Institute Professor, Massachusetts Institute of Technology (MIT)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1708612021-11-08T14:41:18Z2021-11-08T14:41:18ZNose sprays, needle-free patches, durable immunity: towards the next generation of COVID vaccines<figure><img src="https://images.theconversation.com/files/430692/original/file-20211108-58905-1ws7bs8.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C7044%2C4675&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20200720001480978146?path=/aap_dev4/device/imagearc/2020/07-20/0b/85/7c/aapimage-7bj0eplpfmg8rs2j1uk4_layout.jpg">John Cairns, University of Oxford via AP</a></span></figcaption></figure><p>The past 20 months has seen an explosion of vaccine development, with COVID vaccine testing and rollout happening at an unprecedented pace in the face of a global pandemic. There have been absolute triumphs – the fact we have multiple safe, effective vaccines is remarkable – but there have also been challenges. </p>
<p>We’ve seen storage and delivery issues, vaccine hesitancy, breakthrough infections and the beginnings of waning immunity.</p>
<p>Vaccine innovators around the world have these challenges in their sights. They are already working on the next generation of COVID vaccines.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-vaccines-for-5-to-11-year-olds-are-inching-closer-heres-what-we-know-so-far-169732">COVID vaccines for 5 to 11 year olds are inching closer. Here's what we know so far</a>
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</em>
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<h2>Tweaking current vaccines</h2>
<p>After hundreds of millions of doses, we have a good handle on how current vaccines are performing and where they can be improved. As more data is gathered, a modified dose, time between doses, and/or using different vaccines together in mix-and-match strategies may become the preferred approach.</p>
<p>We could also improve vaccines that aren’t performing at their best. </p>
<p>Inactivated vaccines have been used in many parts of the world but their early protection has waned, <a href="https://www.nature.com/articles/d41586-021-02796-w">particularly in older people</a>, with the World Health Organisation now <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE_recommendation-Sinovac-CoronaVac-2021.1">recommending a third dose</a>. </p>
<p>One way to improve this could be to add an adjuvant – something that fires up the immune system. One such vaccine, called Valneva, has early results that suggest including an adjuvant <a href="https://valneva.com/press-release/valneva-reports-positive-phase-3-results-for-inactivated-adjuvanted-covid-19-vaccine-candidate-vla2001/">improves immunity</a>.</p>
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<a href="https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="vial of vaccine in gloved hand" src="https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">New vaccines and new modes of delivery are on the way.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1623682687393-9676a1ddec3c?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1yZWxhdGVkfDF8fHxlbnwwfHx8fA%3D%3D&auto=format&fit=crop&w=600&q=60">Unsplash/mika baumeister</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Making vaccination easier</h2>
<p>As we have seen, vaccinating large numbers of people is not easy. Innovations to make this easier will be welcome.</p>
<p>Needle-free approaches would be ideal. One approach, known as a nanopatch vaccine, coats the vaccine onto tiny spikes on a small patch. </p>
<p>The patch is applied to the skin and the spikes deliver the vaccine to a dense barrier of immune cells sitting just under the top layers of our skin. A nanopatch COVID vaccine developed by Vaxxas and researchers in Queensland has been shown to trigger <a href="https://www.science.org/doi/10.1126/sciadv.abj8065">strong immune responses in animal models</a>, with trials underway in humans.</p>
<p>Another approach, known as an intranasal vaccine, sprays a vaccine up the nose. This would be easier to deliver and it could also build immunity in the right location in our body. </p>
<p>The coronavirus infects us through the lining of the nose, mouth, throat and lungs – a type of sticky tissue that lines body cavities and some organs called <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/mucosa">mucosa</a>. </p>
<p>Currently, COVID vaccines are delivered into our arm muscle and build antibody levels in our blood and tissue, with <a href="https://onlinelibrary.wiley.com/doi/10.1002/cti2.1354">some antibody spilling out into the mucosa</a>. Delivering the vaccine <a href="https://www.science.org/doi/10.1126/scitranslmed.abh0755">directly to the mucosa</a> might be a better approach for preventing COVID infection. This is being trialled with a number of vaccines, including the <a href="https://clinicaltrials.gov/ct2/show/NCT04816019?term=intranasal+vaccine&cond=covid-19&cntry=GB&draw=2&rank=2">AstraZeneca vaccine</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1456552878743638019"}"></div></p>
<p>If yearly COVID boosters are recommended for some or even all of the population, it would be easier to deliver them together with the yearly flu vaccine. These “multipathogen” vaccines are being tested with current flu vaccine or <a href="https://ir.novavax.com/2021-09-08-Novavax-Initiates-Phase-1-2-Clinical-Trial-of-Combination-Vaccine-for-COVID-19-and-Seasonal-Influenza">even new types of flu vaccine</a>.</p>
<h2>More durable immunity</h2>
<p>With two doses of the current vaccines, <a href="https://www.nature.com/articles/s41591-021-01548-7">immunity is seen to decline</a> and poor responses are seen in certain groups such as the severely immune-compromised and older people. COVID vaccines that can induce more durable immunity, more consistently across vulnerable populations would be a major innovation. </p>
<p>This could require completely new vaccines. Protein subunit vaccines – which use purified protein from the surface of the virus as a target – are still working their way through approvals around the world. </p>
<p>One example is the <a href="https://www.tga.gov.au/tga-grants-additional-provisional-determination-covid-19-vaccine">Novavax vaccine</a>, but there are a <a href="https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines">large number of other protein subunit vaccines also development</a> that often use new adjuvants – again, the vaccine ingredient that fires up your immune system. These new adjuvants could support more durable immunity but this remains to be tested.</p>
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<a href="https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman gets injection" src="https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=297&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=297&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=297&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=373&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=373&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=373&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Vaccine protection is more likely to wane in immunocompromised and older people.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/woman-doctor-preparing-vaccine-older-600w-1928974274.jpg">Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/australians-will-soon-receive-covid-booster-vaccines-why-do-we-need-them-and-how-effective-are-they-170368">Australians will soon receive COVID booster vaccines. Why do we need them, and how effective are they?</a>
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<h2>Protection against future variants</h2>
<p>We can also update the current vaccines by changing their target. All current COVID vaccines use a target from the original strain of the coronavirus to train the immune system. </p>
<p><a href="https://www.nature.com/articles/s41591-021-01548-7">This is okay for vaccinating</a> against the Delta strain, as this new virus still looks pretty similar to the original virus to your immune system. But new viruses could emerge that the immune system struggles to recognise. </p>
<p>We could simply use a new target from a new virus. Some vaccines have been updated to target the <a href="https://www.sciencedirect.com/science/article/pii/S0092867421002269?via%3Dihub">Beta strain</a>, which is relatively hard for our immune system to recognise. <a href="https://www.nature.com/articles/d41586-021-02854-3">Trials are being run</a> with these Beta-targeted vaccines as a dry run, to make sure that we can update vaccines if we need to. </p>
<p>A more ambitious approach would be to focus the immune response on a target/s common to all coronaviruses. This “pan-coronavirus” vaccine would hopefully provide protection from all or most coronaviruses. Again, <a href="https://www.biorxiv.org/content/10.1101/2021.03.24.436523v1">early data from animal models</a> are promising.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1454665419785129985"}"></div></p>
<h2>Working out if vaccines are working</h2>
<p>An important innovation for COVID vaccines would be an immune correlate.</p>
<p>An immune correlate is something that can be measured in an immune response to indicate if someone will be protected against infection or not. For <a href="https://immunisationhandbook.health.gov.au/recommendations/serological-testing-for-immunity-to-rubella-is-only-recommended-before-or-after">rubella</a> and <a href="https://immunisationhandbook.health.gov.au/recommendations/non-responders-to-hepatitis-b-vaccine-are-recommended-to-receive-further-doses-and">hepatitis B virus</a>, we measure the amount of antibody targeting these viruses in our blood. If antibody is absent or too low, a booster dose of the vaccine is recommended. </p>
<p>An immune correlate for COVID could similarly allow us to identify people that need a booster.</p>
<p>Some researchers, including <a href="https://www.nature.com/articles/s41591-021-01377-8">Australian teams</a>, are sorting through data from around the world to see if there is something we can measure in our immune response to use as a correlate for COVID.</p>
<p>Research around the world is driving us towards the next generation of COVID vaccines. Innovations for COVID vaccines will lead to better vaccines for other infections too – those that currently afflict humanity and those that are yet to emerge.</p><img src="https://counter.theconversation.com/content/170861/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Quinn receives funding from the Rebecca L. Cooper Foundation, CASS Foundation and the Medical Research Future Fund.</span></em></p>The development of COVID vaccines has already been explosive. There are more innovations on the way.Kylie Quinn, Vice-Chancellor's Research Fellow, School of Health and Biomedical Sciences, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1622102021-07-01T12:15:38Z2021-07-01T12:15:38ZA medical moonshot would help fix inequality in American health care<figure><img src="https://images.theconversation.com/files/407540/original/file-20210621-35174-1v686lc.jpg?ixlib=rb-1.1.0&rect=37%2C9%2C6145%2C4060&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical breakthroughs like the COVID-19 vaccines need to be matched with programs that tackle health inequality.
</span> <span class="attribution"><a class="source" href="http://www.gettyimages.com/detail/1230691455">John Cherry/Stringer via Getty</a></span></figcaption></figure><p>COVID-19 has put the American health care system’s deeply entrenched inequities into high relief. The social, economic and political structures that predated the pandemic’s public health crisis and resulting recession have meant that Black and Latino people are more likely than white people <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html">to be exposed to, hospitalized for and die from COVID-19</a>. But Black and Latino people also <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6942e2.htm">died at higher rates than whites from non-COVID-19 causes in 2020</a>, underscoring the harm of delays in medical care generally. </p>
<p>Simply put, inequity kills.</p>
<p>As a <a href="https://scholar.google.com/citations?user=E3XmWfEAAAAJ&hl=en">health economist</a>, an expert in <a href="https://scholar.google.com/citations?hl=en&user=_SxNaQYAAAAJ">social determinants of health</a> and a <a href="https://www.aging.columbia.edu/about/people/Rowe">professor of health policy</a>, we have seen the evidence that new medical interventions can serve as a great leveler and help change the trajectory of health disparities in the United States. A concerted national effort to develop cures or enhanced treatments for conditions that disproportionately affect communities of color – such as high blood pressure, diabetes and obesity – would benefit all patients, while narrowing racial and ethnic disparities. </p>
<h2>How innovation can transform health outcomes</h2>
<p>Medical breakthroughs, as well as new ways of delivering existing treatments, can help advance health equity. How? Improved testing, diagnosis and treatment can help identify those who need care and can get them better care. But innovations don’t do that on their own. </p>
<p>Hypertension provides a good example. Breakthroughs in treatment over the past few decades – including antihypertensive medications, cholesterol-lowering drugs and heart surgery – helped decrease overall <a href="https://dx.doi.org/10.1056/NEJMsa053935">deaths in the U.S. from heart disease by 47% over two decades</a>. But mortality among Black Americans <a href="https://www.cdc.gov/mmwr/volumes/67/ss/ss6705a1.htm">is improving at a slower rate</a> than for their white counterparts, even though Black Americans are more likely to develop serious hypertension and have worse health outcomes – in part because <a href="https://doi.org/10.1016/j.jacc.2004.04.043">they are less likely to receive</a> key diagnostic tests and treatments.</p>
<p>The story has been somewhat different with HIV. Since the first wave of complex drug treatments in the 1990s, significant innovations – from combination treatments to single-tablet regimens to pre-exposure preventive treatment – life expectancy has increased and infection rates are down. People on <a href="https://doi.org/10.1080/09540121.2018.1442554">single-tablet regimens</a>, for instance, have been better able to maintain treatment regimens, <a href="https://doi.org/10.1371/journal.pone.0031591">leading to improved viral suppression and fewer hospitalizations</a>.</p>
<p>These simplified regimens help close disparities in HIV infection and treatment among people of color, who due to historic inequities found it <a href="https://dx.doi.org/10.1073/pnas.162086599">more difficult to adhere to the earlier, more complex HIV treatment regimens</a>. Improving outcomes for this population was a key component of <a href="https://www.hiv.gov/federal-response/hiv-national-strategic-plan/hiv-plan-2021-2025">the national strategy</a> to end the HIV epidemic.</p>
<h2>Linking innovation to equity</h2>
<p>New COVID-19 vaccines promise similar benefits. Single-dose administration, for example, eliminates the scheduling, transportation and child care needed for a second dose, making it ideal for <a href="https://theconversation.com/the-cold-supply-chain-cant-reach-everywhere-thats-a-big-problem-for-equitable-covid-19-vaccination-152057">hard-to-reach populations</a>. Community leaders in Washington, D.C., for example, used single-dose jabs at a <a href="https://www.wusa9.com/article/news/health/coronavirus/vaccine/dc-leaders-mobile-covid-vaccination-clinic-black-and-brown-communities/65-0da58697-3ae7-4ff8-adfb-3763962d62fd">mobile vaccination clinics</a> stationed in African American churches.</p>
<p>Similar innovations could help <a href="https://doi.org/10.1016/j.socscimed.2011.02.047">improve management of asthma or diabetes</a>, which both afflict nonwhite people <a href="https://www.lung.org/research/trends-in-lung-disease/asthma-trends-brief/current-demographics">at higher rates</a> than white Americans. Or make screenings for cancer and other chronic conditions more accessible, promoting earlier detection in another arena where significant health disparities exist.</p>
<p>Innovation is also key to addressing the health care needs of older adults, including older adults of color. The pandemic’s disproportionate impact on those <a href="https://www.kff.org/racial-equity-and-health-policy/issue-brief/covid-19-risks-impacts-health-care-workers-race-ethnicity/">living and working in long-term care facilities</a> has exposed the need to assist all health care workers, not just doctors and nurses. Beyond these measures, technological advances – from telemedicine to remote monitoring to therapeutic robots – have the potential to promote healthy, successful aging and improve disparities.</p>
<h2>Innovation is just part of the solution</h2>
<p>The <a href="https://dx.doi.org/10.1126/science.abj8547">White House and the National Institutes of Health</a> have proposed a new public-private initiative to improve health. It would be modeled on the successful <a href="https://www.darpa.mil/">DARPA effort by the Department of Defense</a>, which led to such technologies as the internet and GPS. To achieve equal access to health care, this initiative needs to work on not just developing new technologies, but also ensuring equal access. </p>
<p>It may not seem like much to simplify the steps in a treatment regimen or reduce the necessary number of visits to a doctor – but these can make a difference in people’s lives.</p>
<p>We also need more inclusive research designs. Including <a href="https://dx.doi.org/10.1158/2159-8290.CD-ND2020-015">patients of color in clinical trials</a> to test new drugs is vital to learn how well new interventions work across the entire population.</p>
<p>Communication strategies <a href="https://www.kqed.org/news/11861810/no-the-tuskegee-study-is-not-the-top-reason-some-black-americans-question-the-covid-19-vaccine">tailored to and respectful of marginalized communities</a> would reach them with messages that resonate with their concerns.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p>
<p>Medical advances are often costly as well. The promise of innovation can be realized only if new technologies are appropriately reimbursed by Medicare and Medicaid – the U.S.’s key public payers. So any health moonshot must also eliminate financial and other barriers to accessing new innovations.</p>
<p>Many factors contribute to health disparities. A systemic, multifaceted and trustworthy approach to closing them should not overlook the potential of new medical innovations in the fight to end health disparities for patients of color. Lives and livelihoods depend on it.</p><img src="https://counter.theconversation.com/content/162210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Goldman is a member of a National Academy of Medicine panel on Improving the Representation of Women and Underrepresented Minorities in Clinical Trials and Research. He has received research support, speaker fees, travel assistance, or consulting income from the following sources: ACADIA Pharmaceuticals, Amgen, The Aspen Institute, Biogen, Blue Cross Blue Shield of Arizona, Bristol Myers Squibb, Cedars-Sinai Health System, Celgene, Edwards Lifesciences, Gates Ventures, Genentech, Gilead Sciences, GRAIL, Johnson & Johnson, Kaiser Family Foundation, National Institutes of Health, Novartis, Pfizer, Precision Health Economics, Roche, and Walgreens Boots Alliance. </span></em></p><p class="fine-print"><em><span>Reginald Tucker-Seeley is a member of the Roundtable on the Promotion of Health Equity at the National Academies, a member of the board of trustees of the American Board of Internal Medicine Foundation, and a member of the board of directors of the National Patient Advocate Foundation. He has received funding from the National Cancer Institute, the California Health Care Foundation, AcademyHealth, and the Robert Wood Johnson Foundation, . </span></em></p><p class="fine-print"><em><span>John Rowe does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Medical innovations paired with innovative programs to get them to Black, Indigenous and Hispanic Americans can help close the health inequality gap.Dana Goldman, Leonard D. Schaeffer Chair and Distinguished Professor of Public Policy, Pharmacy, and Economics, University of Southern CaliforniaJohn Rowe, Professor of Health Policy, Columbia UniversityReginald Tucker-Seeley, Assistant Professor of Gerontology and Edward L. Schneider Chair in Gerontology, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1441812020-09-08T12:16:34Z2020-09-08T12:16:34ZHow the Civil War drove medical innovation – and the pandemic could, too<figure><img src="https://images.theconversation.com/files/354135/original/file-20200821-18-1jj8kww.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bernard Tobey, a double amputee, and his son, wearing Union sailor uniforms, standing beside a small wagon displaying Secretary of War Edwin Stanton's dispatch on the fall of Fort Fisher.</span> <span class="attribution"><a class="source" href="https://www.loc.gov/pictures/item/2017659614/"> Fetter's New Photograph Gallery/Library of Congress</a></span></figcaption></figure><p>The current COVID-19 pandemic, the largest public health crisis in a century, threatens the health of people across the globe. The U.S. has had the most diagnosed cases – <a href="https://www.worldometers.info/coronavirus/">surpassing 6 million</a> – and <a href="https://www.worldometers.info/coronavirus/">more than 180,000 deaths</a>. </p>
<p>But six months into the pandemic, the U.S. still faces <a href="https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/faqs-shortages-surgical-masks-and-gowns-during-covid-19-pandemic">shortages</a> of personal protective equipment for both front-line medical workers and the general public. There is also great need for widely available <a href="https://theconversation.com/will-the-new-15-minute-covid-19-test-solve-us-testing-problems-145285">inexpensive, rapid tests</a>; the infrastructure to administer them; and most importantly, safe, effective vaccines. </p>
<p>Moving forward, medical innovation can play a substantial role in controlling and preventing infection – and treating those who have contracted the virus. But what’s the best way to catalyze and accelerate public health developments? Research and history show that the federal government can play a major role in spurring private-sector innovation.</p>
<h2>Lessons from the Civil War</h2>
<p>Governments play far-reaching roles in health care. The U.S. Food and Drug Administration approves new treatments. Public and private insurance administrators determine what treatments to cover. The Medicare program sets prices that have <a href="https://www.journals.uchicago.edu/doi/pdfplus/10.1086/689772">effects across the heath care system</a>. By determining if and when competitors can enter the market, the U.S. patent system shapes pharmaceutical prices, which impacts companies’ financial returns. The National Institutes of Health and the National Science Foundation allocate funding for both basic and applied medical research.</p>
<p>Taken together, the government has substantial influence on medical innovation. That’s because private industry requires well-defined quality standards and clear financial incentives to speed forward – performance depends critically on the government agencies that often make the rules and set the payments.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=280&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=280&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=280&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=352&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=352&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354137/original/file-20200821-16-tujihc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=352&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Portraits of Civil War veteran amputees, Left to right: G.L. Burnette, Richard D. Dunphy and Henry A. Seaverns.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/pictures/resource/bellcm.15657">Library of Congress</a></span>
</figcaption>
</figure>
<p>In my <a href="https://scholar.google.com/citations?user=wFv_COwAAAAJ&hl=en">research as an economist</a>, I investigate the effects of government insurance programs on patient care, pricing and innovation across the health system. My colleague Parker Rogers and I recently <a href="https://econweb.ucsd.edu/%7Ej1clemens/pdfs/ProstheticsPaperLatest">analyzed</a> innovations in the design and manufacture of artificial limbs during the U.S. Civil War. The example resonates because wars, like pandemics, create dramatic, unanticipated needs for medical innovations. </p>
<p>With advances in weaponry, destructive Minié bullets and a lack of surgical experience among doctors, many Civil War soldiers with leg or arm wounds required amputation. Roughly <a href="https://www.rehab.research.va.gov/jour/07/44/4/Gailey.html">70,000 veterans</a> who survived the bloody, four-year conflict lost limbs.</p>
<p>As disabled veterans returned home, the government launched the “Great Civil War Benefaction” to provide prostheses. Officials <a href="http://www.siupress.com/books/978-0-8093-3131-4">examined and certified</a> inventors’ prototypes, and wounded veterans then chose from approved products, which the government then acquired at preset prices: US$75 per leg and $50 per arm. </p>
<p>The program’s cost-conscious approach shaped inventors’ efforts, leading them to emphasize simplicity in design and low-cost production. While prosthetic arms and legs remained quite primitive by modern standards, inventors emphasized improvements in comfort and modest gains in functionality. In total, 87 patents for prostheses were granted from 1863 through 1867, compared with 15 new patents between 1858 and 1862.</p>
<p>Production responded dramatically to the unprecedented needs. Just prior to the war, in 1860, <a href="https://econweb.ucsd.edu/%7Ej1clemens/pdfs/ExpandingHealthSystemCapacity.pdf">five manufacturers</a> sold an estimated 350 prostheses in the U.S. By 1865, production had increased tenfold. That year, the Union Army <a href="http://www.siupress.com/books/978-0-8093-3131-4">furnished</a> some 2,020 artificial legs and 1,441 artificial arms to its soldiers. By 1870, there were <a href="https://econweb.ucsd.edu/%7Ej1clemens/pdfs/ExpandingHealthSystemCapacity.pdf">24 manufacturers</a> in the industry. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354738/original/file-20200825-23-kyneen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A researcher holding vials of COVID-19 vaccine that will be used in clinical trials.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/healthcare-professional-in-protective-gloves-royalty-free-image/1254511513">Tang Ming Tung/GettyImages</a></span>
</figcaption>
</figure>
<h2>The economics of medical innovation</h2>
<p>Most research into the economics of medical innovation has focused on pharmaceuticals. This research has showcased the power of incentives. </p>
<p>For example, with the introduction of guidelines, mandates or other government policies that increased projected profits, <a href="https://economics.mit.edu/files/7894">vaccine development</a> accelerated. Clinical trial activity increased during the years immediately following these changes. </p>
<p>Additional evidence has shown that the introduction of <a href="https://doi.org/10.1016/j.jpubeco.2012.10.003">Medicare’s drug benefit</a> (passed in 2003 and enacted in 2005) sped pharmaceutical research for diseases that impact the elderly. Diseases that offer robust or expanding drug <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1756-2171.12113">markets</a> <a href="https://economics.mit.edu/files/4464">receive particular attention</a>. Economists have also found that drug development responds to incentives created by the <a href="https://pubs.aeaweb.org/doi/pdfplus/10.1257/aer.20131176">patent system</a>. Finally, when insurers begin to exclude drugs for a particular disease, <a href="https://cpb-us-e1.wpmucdn.com/sites.dartmouth.edu/dist/c/1998/files/2020/07/Agha-Kim-Li-Insurance-Design-Innovation-_-July-2020.pdf">R&D for that disease tends to slow</a>. </p>
<h2>Failures during the COVID-19 pandemic</h2>
<p>During the COVID-19 pandemic the U.S. government has, unfortunately, not provided the sort of certainty required for medical innovation to flourish as well as it could. By creating uncertainty, the federal government discouraged both states and private companies from acting on their own initiative, which has delayed our national response. </p>
<p>Early on, for example, the federal government equivocated over contractual commitments to companies that came forward to <a href="https://www.nytimes.com/2020/03/26/us/politics/coronavirus-ventilators-trump.html">produce ventilators</a>. State officials who prudently expanded stocks of <a href="https://www.vanityfair.com/news/2020/05/how-the-federal-government-took-control-of-the-ppe-pipeline">personal protective equipment</a> were unsure whether supplies would be commandeered by the federal government. </p>
<p>Federal actions also impacted testing. The FDA thwarted efforts to implement <a href="https://medium.com/@rzadek/unprepared-government-failure-at-the-cdc-fda-e157d2ca25c">new testing infrastructure</a> supported by <a href="https://www.businessinsider.com/bill-gates-backed-coronavirus-testing-program-stopped-by-fda-2020-5">the Gates Foundation</a>. The error was compounded by the <a href="https://www.sciencemag.org/news/2020/02/united-states-badly-bungled-coronavirus-testing-things-may-soon-improve">botched early rollout</a> of testing kits and rejection of tests manufactured in other countries. The result: Months into the pandemic, tests can still be difficult to obtain, and <a href="https://www.nytimes.com/2020/08/04/us/virus-testing-delays.html">results are often backlogged</a> to the point of uselessness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/355171/original/file-20200827-16-j71bs4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Catrina Rugar, 34, a traveling nurse from Florida, responded first to hospitals in New York City, then to Texas’ Rio Grande Valley, where she was treating COVID-19 patients. Rather than coordinate purchases of PPE to help drive innovation in the field, the federal government created uncertainty among states and other purchasers.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/july-20-2020-catrina-rugar-a-traveling-nurse-from-florida-news-photo/1227737165">Carolyn Cole/Getty Images</a></span>
</figcaption>
</figure>
<h2>A recipe for progress</h2>
<p>So what is the best way forward for spurring private industry to fight the pandemic? To me it’s clear that the government has a straightforward role to play in setting the stage. </p>
<p>As a narrow example, governments can increase demand for masks by issuing clear guidance and informing the public. The resulting demand creates strong financial incentives for companies to innovate and expand production.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>Further, the federal government can propel the development and distribution of <a href="https://www.nytimes.com/2020/07/03/opinion/coronavirus-tests.html">tests</a> and vaccines through “<a href="https://www.nytimes.com/2020/05/04/opinion/coronavirus-vaccine.html">advance purchase commitments</a>” that guarantee a market for newly approved products. The U.S. government has <a href="https://www.nytimes.com/2020/07/22/upshot/vaccine-coronavirus-government-purchase.html">taken a major step</a> in this direction by committing to purchase large quantities of COVID-19 vaccines upon approval.</p>
<p>While the science of medical innovation is difficult, policy is relatively simple: Set clear standards, establish clear incentives and let the scientists and entrepreneurs do their work. Vaccine development, rapid testing and widely available protective gear all have important roles to play in saving lives and getting the economy back on its feet.</p><img src="https://counter.theconversation.com/content/144181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeffrey Clemens does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lessons from history make clear that the federal government can spur medical innovation in a crisis, including this pandemic. Providing certainty and clarity is critical.Jeffrey Clemens, Associate Professor of Economics, University of California, San DiegoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/987532018-06-27T22:16:38Z2018-06-27T22:16:38ZThe creeping problem of drug shortages<figure><img src="https://images.theconversation.com/files/224606/original/file-20180625-152137-1npif4w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows that the number of drug shortages in Canada are increasing, even though patients may not be aware of it. </span> <span class="attribution"><span class="source">(Shutterstock))</span></span></figcaption></figure><p>Dozens of drugs are suddenly unavailable every year. In Canada, we read about <a href="https://www.cbc.ca/news/health/canada-drug-shortage-report-1.4597574">shortages of Epipens, opioids and antibiotics</a> and before that, <a href="http://www.businessinsider.com/drug-shortages-in-hospitals-could-lead-to-a-health-emergency-2018-5">it was saline</a>. In India, it is <a href="http://www.thehindu.com/sci-tech/health/india-runs-out-of-lifesaving-hiv-drug-for-children/article17413822.ece">anti-HIV drugs for children</a>. The problem is global, but most Canadians notice only when their pharmacists cannot fill their prescriptions. </p>
<p>Hyped reporting of individual shortages obscures the fact that they are all connected — as symptoms of a bigger, unprecedented and poorly understood problem. </p>
<p>Health Canada has acknowledged the problem, but it has never measured the shortages through time or attempted to analyze the types of products affected — injection or oral, generic or innovator.</p>
<p>Drug shortages provoke great anxiety. For pharmacists and health-care providers, they demand time-consuming and often frustrating searches for alternatives. For patients, they result in the stress and harm of delayed treatments and surgeries. For governments, they increase health-care spending to acquire the scarce products or their replacements from other sources or innovator substitutes. </p>
<p>Some studies have shown that <a href="http://www.canadadrugshortage.com/consequences/">drug shortages can lead to illness and even premature death</a>.</p>
<h2>How big is the problem?</h2>
<p>To measure the problem in Canada, I, together with Dr. Brian White-Guay of the Université de Montréal and two students, <a href="https://www.cdhowe.org/public-policy-research/assessing-canada%E2%80%99s-drug-shortage-problem">examined publicly available data to assess the size of drug shortages in Canada between 2010 and 2017</a>. Our sources were the websites recommended by the federal government since 2012 (notification of drug shortages became mandatory only in 2016). </p>
<p>We discovered that the reporting was often incomplete, inconsistent and inaccurate. However, this was the only publicly available information on the problem and it was sufficient to provide a baseline minimum.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/224605/original/file-20180625-152140-h7wpor.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224605/original/file-20180625-152140-h7wpor.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224605/original/file-20180625-152140-h7wpor.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224605/original/file-20180625-152140-h7wpor.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224605/original/file-20180625-152140-h7wpor.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224605/original/file-20180625-152140-h7wpor.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224605/original/file-20180625-152140-h7wpor.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A customer picks up a prescription at a pharmacy in Port Coquitlam, B.C., in April 2017.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Approximately 1,000 shortages have occurred annually in Canada, affecting 1,250 different products during a recent three-year period. Indeed, the number of shortages appears to be increasing, although the apparent rise might be explained by growing pressure to adhere to the policy of mandatory notification — a policy that is not enforced. </p>
<p>The majority (77 per cent) of shortages involve generic drugs, although a significant proportion (23 per cent) also affect innovator drugs. </p>
<p>Without blaming any particular branch of industry, <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html">these figures correspond to the relative prescription volume of generic and innovator drugs in Canada</a>. </p>
<p>In addition, we calculate that roughly 10 per cent of all products actively available have been affected by the shortages. </p>
<p>Since <a href="http://www.cmaj.ca/content/early/2016/06/13/cmaj.160134">Canada does not maintain an Essential Medicines List</a>, it is difficult to know how many of the affected drugs are medically necessary.</p>
<h2>Raising awareness</h2>
<p>Yet many people who have been affected are unaware of the shortages. If the family doctor substitutes a new drug for an old reliable product, patients might wrongly believe that “newer and more expensive” could mean “better.” </p>
<p>If they are lucky enough to have a drug plan, the added cost is absorbed by the insurer or later the employer when the premiums rise. If they are seniors or on welfare or in the hospital, the drugs are covered through other channels, and it is the taxpayer who will pay the additional cost. If they fall ill because they cannot locate or afford the substitute drugs, they will end up in hospital, and again, it is the taxpayer who pays.</p>
<p>The precise causes of drug shortages in Canada and all other affected countries are unknown. Little has been done to analyze root causes or explore the consequences of Canada’s limited capacity to supply its own needs for medicines with locally manufactured active ingredients and finished products. </p>
<p>The first step in trying to uncover the cause is to measure and characterize the shortages. Our research shows that those in Canada differ from those measured in the <a href="https://theconversation.com/drug-shortages-pose-a-public-health-crisis-in-the-us-98295">United States</a> and elsewhere. </p>
<p>A stable supply of a diversity of medicines will keep health-care costs down, avoid the expense and stress of sudden emergencies and maintain access to medications for the entire population. </p>
<p>Canadians should urge the government to undertake regular analysis of the drug shortage problem. Measurement will generate insight into the extent of the problem and its possible causes, and it will provide a baseline for assessing the effectiveness of policies created to manage and prevent it. </p>
<p>Only when the causes are identified can solutions be found.</p>
<p><em>Jacalyn Duffin gratefully acknowledges Dr. Brian White-Guay as co-author.</em></p><img src="https://counter.theconversation.com/content/98753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacalyn M Duffin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Canadian government must undertake regular analysis of the drug shortage problem, if we are ever to develop sustainable solutions.Jacalyn M Duffin, Professor Emerita in the Hannah Chair, History of Medicine, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/796772017-06-20T20:33:57Z2017-06-20T20:33:57ZHow 50 medical experts separated Kenyan conjoined twins in 23-hour surgery<figure><img src="https://images.theconversation.com/files/174881/original/file-20170621-30165-1qvzij2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Former conjoined twins, Blessing and Favour, after a successful surgery at Kenyatta National Hospital. </span> <span class="attribution"><span class="source">Kenyatta National Hospital</span></span></figcaption></figure><p><em>The successful <a href="http://www.nation.co.ke/news/conjoined-twins-are-separated/1056-3439186-9150ik/index.html">separation</a> of two year old conjoined twins at Kenyatta National Hospital marked a medical milestone in Kenya. Other than South Africa, <a href="https://www.ncbi.nlm.nih.gov/pubmed/16122113">very few successful</a> separations have been performed in <a href="http://www.bioline.org.br/pdf?rh09041"> sub-Saharan Africa</a>. In Kenya a multi-disciplinary team of medical experts operated on the twins for 23 uninterrupted hours. The Conversation Africa’s health and medicine editor Joy Wanja Muraya spoke to Dr Joseph Wanjeri about the surgery and post recovery of the twins who are home.</em></p>
<p><strong>Can you explain conjoined twins, and its prevalence?</strong></p>
<p><a href="http://www.mayoclinic.org/diseases-conditions/conjoined-twins/home/ovc-20198079">Conjoined twins</a> are two babies born physically connected to each other. The extent and site of their union varies from sharing a band of skin and underlying tissues to more complex varieties <a href="http://www.umm.edu/programs/conjoined-twins/facts-about-the-twins">sharing</a> vital organs.</p>
<p>Research shows that cases of conjoined twins are found in one of every <a href="https://www.innovativepublication.com/admin/uploaded_files/IJOGR_3(2)_181-184.pdf">50,000</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16122113">live births</a> globally. Kenya does not have a central repository for such cases.</p>
<p>Conjoined twins are the result of the embryo cells that have not completely <a href="https://sonoworld.com/fetus/page.aspx?i=2017">separated</a>. Embryo cells develop when the egg (ovum) is fertilised by sperm. They multiply and differentiate to form different body organs and tissues. An alternative <a href="http://example.com/">theory</a> is that two separate embryos fuse together in the early development of the twins. </p>
<p>The exact cause of conjoined twins is unknown but it’s thought that genetic factors interacting with environmental ones may contribute. Another possibility is the medicines taken by the mother <a href="http://emedicine.medscape.com/article/934680-overview#a8">during pregnancy</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174427/original/file-20170619-12397-cf9a2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174427/original/file-20170619-12397-cf9a2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174427/original/file-20170619-12397-cf9a2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174427/original/file-20170619-12397-cf9a2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174427/original/file-20170619-12397-cf9a2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174427/original/file-20170619-12397-cf9a2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174427/original/file-20170619-12397-cf9a2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The twins when they were first admitted at Kenyatta National Hospital on 5th September 2014. Photo: Author Provided.</span>
</figcaption>
</figure>
<p>Conjoined twins are classified based on the place they are joined. The most common types of conjoined twins are:</p>
<ul>
<li><p><a href="https://academic.oup.com/brain/article-abstract/129/5/1084/327141/The-craniopagus-malformation-classification-and?redirectedFrom=PDF">craniopagus</a> – fusion of the head</p></li>
<li><p><a href="http://emedicine.medscape.com/article/934680-overview">thoracopagus</a> – fusion of chest</p></li>
<li><p><a href="https://pediatriceducation.org/2012/04/30/what-are-the-different-types-of-conjoined-twins/">Omphalopagus Parapagus</a> – lateral fusion </p></li>
<li><p>Ischiopagus and <a href="http://www.mayoclinic.org/diseases-conditions/conjoined-twins/symptoms-causes/dxc-20198093">Sacropagus</a> – fusion at the lower back or sacrum</p></li>
</ul>
<p>Seperating conjoined twins can be difficult and can result in death. Complex cases can be inoperable and others may call for emergency surgery soon after birth if the life of the twins is threatened. </p>
<p>Separating twins that are conjoined at the lower back (sacropagus) has fewer complications and deaths. The Kenyan twins were conjoined in this way.</p>
<p>Expertise, careful preparation and team work is the perfect recipe for a successful outcome of the surgery.</p>
<p><strong>How is diagnosis done?</strong></p>
<p><a href="http://www.mayoclinic.org/diseases-conditions/conjoined-twins/diagnosis-treatment/diagnosis/dxc-20198110">Diagnosis</a> can be done before birth using an ultrasound scan or through physical examination at birth. Advanced tests like the Computerised Tomography (CT) scans and Magnetic Resonance Imaging (MRI) give greater details. </p>
<p>In the case of the Kenyan twins, a set of female conjoined twins was referred to the Kenyatta National Hospital in Nairobi in September 2014 from an upcountry health facility soon after their delivery. </p>
<p>The twins shared a spinal cord, rectum, anus, some muscles, subcutaneous tissues and skin. Paediatric, neuro and plastic surgeons agreed that separation was feasible but it should wait until the twins were bigger to withstand the complex surgery. </p>
<p>Paediatricians, nurses and nutritionists took care of the twins until they were one year old when the planning for the separation began. The plastic surgery team recommended tissue expansion, a procedure to help with closure of the huge soft tissue defects anticipated after separation. But the mother refused to give her consent, and the procedure had to be stopped. She clearly adored the twins but was overwhelmed by the decisions that needed to be taken. The matter was referred to court and the judge ruled that separation was in the best interests of the children. Their mother gave consent and the preparations for surgery were resumed.</p>
<p>A University of Nairobi plastic surgery resident created a 3D model of the twin’s pelvis to map the surgery.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174424/original/file-20170619-12416-1hags0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174424/original/file-20170619-12416-1hags0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174424/original/file-20170619-12416-1hags0s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174424/original/file-20170619-12416-1hags0s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174424/original/file-20170619-12416-1hags0s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174424/original/file-20170619-12416-1hags0s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174424/original/file-20170619-12416-1hags0s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A three-dimensional (3D) impression of the twins conjoinment. Kenyatta National Hospital.</span>
</figcaption>
</figure>
<p><strong>Can you explain the details of the planning and actual surgery.</strong></p>
<p>A multi-disciplinary medical team made up of 50 experts drawn from various medical fields did a dry run a week before the actual operation. </p>
<p>When the time came for the operation in November 2016 two sets of the anaesthetic teams took about three hours to anaesthetise and stabilise the twins.</p>
<p>The paediatric surgeons began the separation of the various soft tissues on one side up to the spine. The neurosurgeons took over and split the spine, opened the shared <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=32512">dura</a>,which is the tough outermost membrane enveloping the brain and spinal cord. They later separated the nerves before repairing the dura.</p>
<p>The paediatric surgeons completed their separation of the soft tissue and successfully placed the pair on separate beds for the first time. But one was left without an anus and rectum. This condition would be repaired in the recovery phase.</p>
<p>The closure of the huge soft tissue defects and wounds was done on each of the girls by plastic surgeons. Local flaps and skin grafts covered the wounds after which an opening from the large intestine – a colostomy – was done.</p>
<p>They were transferred to the intensive care unit for specialised monitoring for two weeks before transfer to the paediatric surgical ward.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174442/original/file-20170619-12416-1xs71t5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174442/original/file-20170619-12416-1xs71t5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174442/original/file-20170619-12416-1xs71t5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174442/original/file-20170619-12416-1xs71t5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174442/original/file-20170619-12416-1xs71t5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174442/original/file-20170619-12416-1xs71t5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174442/original/file-20170619-12416-1xs71t5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Blessing and Favour face each other for the first time since birth. Photo: Kenyatta National Hospital.</span>
</figcaption>
</figure>
<p>The wounds took about three months to heal. One of the twins developed impaired movement of one of her ankle joints. But after occupational therapy she was able to walk with only a slight limp.</p>
<p>The twin’s growth and development will be monitored in the coming months and further reconstructive surgeries scheduled at the appropriate time.</p>
<p>Blessing and Favour were <a href="http://www.nation.co.ke/news/separated-twins-finally-leave-hospital/1056-3972796-t3ju92/index.html">discharged</a> from hospital on June 15, 2017.</p>
<p><strong>What does this success mean for sub-Saharan Africa and what lessons can be learnt?</strong></p>
<p>First, it shows that medical experts in sub-Saharan Africa are qualified and capable of performing complex surgeries in spite of the poor resources at their disposal. </p>
<p>But it also shows that a referral centre with a multidisciplinary team is best suited for this kind of complex surgery.</p>
<p>And as far as the children are concerned, it shows that intense nursing care, nutritional support, advanced wound care techniques and close monitoring by paediatric specialists has been critical to their remarkable recovery.</p><img src="https://counter.theconversation.com/content/79677/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Kimani Wanjeri does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Successfully separating conjoined twins is a complex operation that depends on how they are joined as well as the experience and skill of the surgical team.Joseph Kimani Wanjeri, Lecturer - Dept. of Surgery, Speciality: Plastic & Reconstructive Surgery , University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/689882016-11-23T21:03:02Z2016-11-23T21:03:02ZAfrica’s health won’t improve without reliable data and collaboration<figure><img src="https://images.theconversation.com/files/146367/original/image-20161117-18123-mud2pw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children play alongside stagnant water and rubbish in Lagos, Nigeria.</span> <span class="attribution"><span class="source">George Esiri/Reuters</span></span></figcaption></figure><p>The Universal Declaration of Human Rights <a href="http://www.un.org/en/universal-declaration-human-rights/">asserts</a> that “all people are born equal in dignity and rights”. Sadly, this statement doesn’t reflect billions of people’s daily lives. Health is one of the areas in which many – if not most – people have no real rights.</p>
<p><a href="http://www.who.int/social_determinants/en/">Social determinants of health</a>, as defined by the World Health Organisation, are “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life”. These systems and forces include economic policies and systems, development agendas, social norms and policies, and political systems.</p>
<p>It’s clear, then, that social determinants can negatively affect health. The poor are denied basic needs that would keep them healthy: access to good quality food, shelter, clean water, sanitation and proper clothing. They have limited access to medical care, education and finance. </p>
<p>All of these drive health inequity – systematic disparities in health between social groups who have different levels of underlying social advantage or disadvantage. </p>
<p>Africa’s young scientists know that health inequity poses a major obstacle to improving population health and well-being. That’s why representatives from some of the continent’s Young Academies of Science met in Johannesburg in early November 2016 to discuss the issue. The young academies represented at the meeting were from Nigeria, Uganda, Ethiopia, South Africa, Kenya, Senegal and Zimbabwe.</p>
<p>We discussed a number of problems that cause health inequity in Africa. Then we collectively drew up some solutions. The <a href="http://www.sayas.org.za/">full statement</a> has been made available online, but here we’d like to focus on two issues: data limitations and an inability to scale up health innovations.</p>
<p>If these can be systematically addressed, we believe that the continent will take great strides towards keeping its populations healthy.</p>
<h2>Data limitations</h2>
<p>Africa has <a href="https://theconversation.com/poor-data-affects-africas-ability-to-make-the-right-policy-decisions-64064">a data problem</a>. This is true in many sectors. When it comes <a href="https://theconversation.com/without-good-data-africa-will-find-it-hard-to-fight-non-infectious-diseases-31543">to health</a> there’s both a lack of basic population data about disease and an absence of information about what impact, if any, interventions involving social determinants of health – housing, nutrition and the like – are having.</p>
<p>Simply put, researchers often don’t know who is sick or what people are being exposed to that, if addressed, could prevent disease and improve health. They cannot say if poor sanitation is the biggest culprit, or if substandard housing in a particular region is to blame. They don’t have the data that explains which populations are most vulnerable. </p>
<p>These data are required to inform development of innovative interventions that apply a “Health in All Policies” approach to address social determinants of health and improve health equity.</p>
<p>To address this, health data need to be integrated with social determinant data about areas like food, housing, and physical activity or mobility. Even where population data are available, they are not always reliable. There’s often an issue of compatability: different sectors collect different kinds of information using varying methodologies. </p>
<p>Different sectors also use different indicators to collect information on the same social determinant of health. This makes data integration challenging.</p>
<p>Without clear, focused, reliable data it’s difficult to understand what a society’s problems are and what specific solutions – which may lie outside the health sector – might be suitable for that unique context.</p>
<h2>Scaling up innovations</h2>
<p>Some remarkable work is being done to tackle Africa’s health problems. This ranges from <a href="https://theconversation.com/how-drones-can-improve-healthcare-delivery-in-developing-countries-49917">technological innovations</a> to harnessing <a href="http://www.universityworldnews.com/article.php?story=2013030712115748">indigenous knowledge</a> for change. Both approaches are vital. But it’s hard for these to be scaled up either in terms of numbers or reach. </p>
<p>This boils down to a lack of funding or a lack of access to funding. Too many potentially excellent projects remain stuck at the pilot phase, which has limited value for ordinary people.</p>
<h2>Young scientists’ recommendations</h2>
<p>We emerged from our meeting with a number of recommendations. Governments, researchers, universities and research institutions and science academies will need to work together to implement these.</p>
<p>Governments need to develop health equity surveillance systems to overcome the current lack of data. It’s also crucial that governments integrate and monitor health and social determinants of health indicators in one central system. This would provide a better understanding of health inequity in a given context. </p>
<p>For this to happen, governments must work with public and private sector stakeholders and nongovernmental organisations – not just in health, but beyond it so that social determinants of health can be better measured and captured.</p>
<p>The data that already exists at sub-national, national, regional and continental level mustn’t just be brushed aside. It should be archived and digitised so that it isn’t lost.</p>
<p>Researchers have a role to play here. They have to harmonise and be innovative in the methodologies they use for data collection. If researchers can work together across the breadth of sectors and disciplines that influence health, important information won’t slip through the cracks.</p>
<p>When it comes to scaling up innovation, governments need to step up to the plate. It’s crucial that they support successful health innovations, whether these are rooted in indigenous knowledge or are new technologies. And since – as we’ve already shown – health issues aren’t the exclusive preserve of the health sector, governments should look to different sectors and innovative partnerships to generate support and funding. </p>
<p>A single thread runs through these recommendations: the notion of shared learning across Africa. As young researchers from a range of disciplines and countries, we have learned first hand through our own work and our academies that collaboration is crucial.</p>
<p>That’s why another of our recommendations is that research institutions in Africa should produce and share documents that outline their best practices and their mistakes. Others can then learn from the good and avoid the bad. In this way, experts on the continent can learn from each other – and find common approaches to improving millions of people’s daily lives and health.</p><img src="https://counter.theconversation.com/content/68988/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tolullah Oni receives funding from the South African National Research Foundation. </span></em></p><p class="fine-print"><em><span>Fadzai Mukora Mutseyekwa works on a USAID funded project.
</span></em></p><p class="fine-print"><em><span>Mariamawit Yonathan Yeshak works for Addis Ababa University. She receives funding from International Science Program, Uppsala University, Sweden. She is affiliated with Ethiopian Young Academy of Sciences.
</span></em></p>Africa battles with a dearth of data and seems unable to scale up health innovations. If these can be systematically addressed, the continent can take great strides towards better health for all.Tolullah Oni, Senior Lecturer at the School of Public Health and Family Medicine, University of Cape TownFadzai Mukora Mutseyekwa, Research fellow in Public Health, Africa UniversityMariamawit Yonathan Yeshak, Assistant Professor of Pharmacognosy, Addis Ababa UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/549482016-03-11T03:18:37Z2016-03-11T03:18:37ZNature’s hidden wealth is conservation’s missed opportunity<figure><img src="https://images.theconversation.com/files/114756/original/image-20160310-26242-18nzvv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Spider silk is just one of the ways nature has inspired innovation.</span> <span class="attribution"><span class="source">Silk image from www.shutterstock.com</span></span></figcaption></figure><p>Australia has one of the <a href="http://www.abc.net.au/news/2015-08-19/fact-check-does-australia-have-one-of-the-highest-extinction/6691026">worst extinction records in the modern world</a>. Since European settlement, <a href="https://theconversation.com/to-save-australias-mammals-we-need-a-change-of-heart-27423">a third of the country’s native mammals have disappeared</a>. How can we stem the losses? </p>
<p>A recent article in Nature highlighted that most <a href="http://www.environment.gov.au/biodiversity/conservation/strategy">federal and state biodiversity conservation policy</a> fails to recognise biodiversity as <a href="http://www.nature.com/news/interdisciplinarity-bring-biologists-into-biomimetics-1.19188">a major source of industrial products</a>.</p>
<p>Much as explorers chart new territories, chemists, materials scientists, engineers and biologists are exploring biodiversity for medicine, agricultural and industrial products. This sits well with <a href="http://www.news.com.au/finance/economy/australian-economy/malcolm-turnbull-unveils-innovation-package-to-lure-migrants-and-boost-australias-science-and-technology/news-story/4ec71fb43db5d4416fc32ef97c4ee61e">Australia’s current focus on innovation</a>, driven by Prime Minister Malcolm Turnbull. </p>
<p>But the potential of biodiversity has been overlooked. </p>
<h2>Inspiring nature</h2>
<p>Animals and plants constitute a very small part of our native biodiversity (roughly 5%). The vast majority - fungi, bacteria and the enormous diversity of other microscopic organisms, including invertebrates - is a massive, largely unexplored economic resource. </p>
<p>The best known examples of commercial uses for biodiversity are the <a href="http://www.imb.uq.edu.au/drugs-from-bugs-new-agreement-to-harness-the-biodiversity-of-microbes">thousands of drugs secreted by bacteria and fungi</a>. But others are examples of what is known as “bio-inspiration” and “<a href="http://rsta.royalsocietypublishing.org/content/367/1893/1443.short">bio-mimicry</a>”, where wild species provide the blueprints for products. </p>
<p>While these products are of immense commercial value, the source species are rarely harvested in the conventional sense. Rather, a few specimens provide ample material for analysis. </p>
<p>So for microbes, invertebrates or plants, there is little concern that these industries are threats. For vertebrates, such as sharks, samples are either non-destructive or severely limited. </p>
<p>Some of the <a href="https://publications.nigms.nih.gov/insidelifescience/medical-materials.html">products such as spider silk and gecko feet are well known</a>. But these are the tip of an iceberg.</p>
<p>Other innovations include <a href="http://www.mdpi.com/2072-666X/6/6/718/htm">fire detection inspired by charcoal beetles</a>, <a href="http://www.nyp.org/deathstalkerscorpion">clinical compounds from scorpions</a> and <a href="http://iopscience.iop.org/article/10.1088/1748-3190/10/6/066012">leaping robots from locusts</a>. In fact, bio-mimicry is huge in robotics, including the astonishing new field of <a href="http://www.nature.com/news/meet-the-soft-cuddly-robots-of-the-future-1.19285">“soft robots” modelled on tentacles, caterpillars and worms</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/114758/original/image-20160310-26279-1rbeqk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Robotics have taken inspiration from nature too.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Stickybot.jpg">Biomimetics and Dexterous Manipulation Laboratory</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Products such as drugs can be sourced from <a href="http://www.mdpi.com/1660-3397/11/11/4594">single-celled animals and plants</a> and from <a href="http://www.drugdiscoverytoday.com/view/3247/marine-microbes-creating-green-waves-in-industry/">microbes of all kinds</a>, <a href="http://www.sciencedirect.com/science/article/pii/S1359644610002515">even those that are currently uncultivable</a>. <a href="http://iopscience.iop.org/article/10.1088/1748-3190/11/1/011001/pdf">Super-water-repellent materials</a>, are sourced from the outer surfaces of organisms as different as insects and higher plants.</p>
<p>Then there is bio-mineralization: soft-bodied animals make very hard substances, such as the radula of marine snails, a tongue tough enough to drill rock. To make materials that strong, industry currently requires high temperatures and pressures, not to mention polluting chemicals.</p>
<p>The snails make their radula and shell from natural materials and at normal temperatures and pressures. How do they do it? Many labs around the world are struggling to find out.</p>
<h2>Why are these stories so important?</h2>
<p>How can exploring biodiversity help conserve it? </p>
<p>First, much as charismatic animals such as tigers and whales are used as icons for conservation, so can species that we use for developing products - but with the added grunt that they are central to the economy. These are very sexy stories; fascinating tales of the transformation of natural phenomena into industrial products.</p>
<p><a href="http://www.environment.gov.au/biodiversity/conservation/strategy">Australia’s Biodiversity Conservation Strategy</a> states that we must “engage all Australians” to save biodiversity. But leaving out biodiversity and industrial products is a massive lost opportunity for engagement. </p>
<p>Second, as biodiversity products come from any kind of organism from any kind of ecosystem, these growing industries require the conservation of that resource. This would greatly expand the <a href="http://openjournals.library.usyd.edu.au/index.php/TEL/article/view/8076">current conservation focus on a few charismatic species</a>. </p>
<p>Third, much of biodiversity exploration research is overseas. Some Australian scientists and engineers are involved, for example, in utilising the arrangements of plant fibres to inspire <a href="http://dx.doi.org/10.1088/1748-3190/10/6/066008">lightweight strengthening of aircraft engines</a>. However, it is hard to find the promotion of this exciting research in any policy nation-wide; political, economic or scientific. </p>
<p>Given Prime Minister Turnbull’s focus on innovation, and given that <a href="https://www.wilderness.org.au/articles/australias-biodiversity-summary">Australian biodiversity is both vast and unique</a>, overlooking biomimicry and its related industries is another lost opportunity for both conservation and the national economy. </p>
<p>Scientists and engineers inside many industries are forging ahead with exploration for biodiversity products in many, non-destructive and highly imaginative ways all over the world. </p>
<p>It’s time our governments and conservationists wised up.</p><img src="https://counter.theconversation.com/content/54948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Beattie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Drugs, new materials and even more creative uses: biodiversity is full of potential.Andrew Beattie, Emeritus Professor, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/494042015-10-20T17:03:29Z2015-10-20T17:03:29ZWhy the Saatchi bill has been flawed from the outset<figure><img src="https://images.theconversation.com/files/99039/original/image-20151020-32231-qqjful.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">At the heart of the bill on innovative treatments lies a logical problem.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/herry/4353093489/in/photolist-7CEK32-7CEJNz-7CJyTq-7CJyxm-jKCaPu-a91K5P-jxHT8d-5ZPkZJ-9mFkBP-5ZP9qC-cEbuX-8w9VoP-oqp2QZ-7iMMfb-a95gvY-a94zXG-6bpgzJ-8UYRhA-8UVM1c-9oc6e2-9oc6bx-9of819-9of7XJ-9of7Wj-9of7Tm-9of7Pw-9of7Km-9oc5PK-9oc5LP-9of7CY-9oc5Jt-9of7A9-9oc5DR-9of7vQ-9of7tY-9of7s7-9oc5xg-9of7p5-9of7n9-9of7jC-9of7gS-9oc5kn-9of7dE-9of7cL-bAa93C-hZ7Fmg-5B4kL4-a95g67-5B4nN6-5B4ogg">Herry Lawford</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The Access to Medical Treatments (Innovation) <a href="http://services.parliament.uk/bills/2015-16/accesstomedicaltreatmentsinnovation.html">bill</a> aims to protect doctors from “fear of legal action” when trying out new or unusual treatments. It was <a href="http://www.telegraph.co.uk/news/health/saatchi-bill/11173161/Experimental-drugs-for-patients-could-be-available-from-March-after-Government-backs-Saatchi-Bill.html">first proposed by Lord Saatchi</a>, who argued that radical treatments were being denied to desperately ill patients because doctors feared being sued. But the so-called “Saatchi bill” is a Trojan Horse that will put patients at risk and could impede the very innovation it seeks to promote. </p>
<p>“Society has become more litigious,” says the <a href="http://medicalinnovationbill.co.uk/about-the-medical-innovation-bill/">Saatchi website</a>. “An unintended consequence of existing law is to act as a deterrent to medical innovation.” Chris Heaton-Harris MP, who has taken on the second version of the bill in this parliamentary session, <a href="http://www.publications.parliament.uk/pa/cm201516/cmhansrd/cm151016/debtext/151016-0001.htm">has repeated this argument</a>. But the bill (both its old and new incarnation) has been flawed from the outset, as its objective is based on a problem that doesn’t exist: that doctors are not innovating for fear of being found negligent if a treatment goes wrong. But is there any evidence to support this? </p>
<p>The overwhelming (although not unanimous) <a href="http://bit.ly/1AX1bCX">response to a Department of Health consultation</a> on the original bill was that innovation was not being deterred by a fear of litigation. Despite supporting the second bill even George Freeman MP, under-secretary of state for life sciences, <a href="http://www.publications.parliament.uk/pa/cm201516/cmhansrd/cm151016/debtext/151016-0001.htm">admitted that</a> “organisational, cultural and financial barriers are higher concerns”. </p>
<p>The <a href="http://www.themdu.com/">Medical Defence Union</a> – which knows a thing or two about clinical negligence – has said there is <a href="http://www.themdu.com/%7E/media/Files/MDU/Publications/Consultation%20responses/MDU%20response%20to%20consultation%20on%20Medical%20Innovation%20Bill.pdf">no evidence that doctors are avoiding innovation</a> because of a fear of litigation (<a href="http://scienceblog.cancerresearchuk.org/2014/03/11/public-consultation-on-the-medical-innovation-bill/">as has Cancer Research UK</a>). On the contrary, its members contact it for advice on how best to go about innovating. More than <a href="http://www.stopthesaatchibill.co.uk/over-100-of-the-uks-leading-cancer-specialists-oppose-the-saatchi-bill/">100 leading oncologists</a> wrote to The Times to say it was not a deterrent. Heaton-Harris himself chose to introduce his bill by acknowledging that:</p>
<blockquote>
<p>Not a day goes by without those practising medicine in our national health service innovating. Talk to any doctor, and especially any surgeon … and they will show how they have been innovative and, in being innovative, how they have helped those they are trying to treat. The levels of innovation are, without doubt, inspiring. </p>
</blockquote>
<p>The <a href="https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf">history of innovation in the NHS</a> includes antibiotics, vaccines, modern nursing, IVF, CT scanners as well as discoveries about the blood and DNA. Innovation is clearly not under threat from the fear of litigation. And analysis of the current legal framework reinforces the view that if there are any clinicians who are afraid to innovate because of a fear of litigation, this stems from a fundamental misunderstanding of the law.</p>
<h2>The Bolam and Bolitho tests</h2>
<p>The current legal framework for establishing whether treatment – innovative or conventional – has been negligent is formed of two parts. The first from the 1957 <a href="http://www.e-lawresources.co.uk/Bolam-v--Friern-Hospital-Management-Committee.php">Bolam case</a>, where it was held that “a medical professional is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art”.</p>
<p>Another safeguard was added by <a href="http://www.e-lawresources.co.uk/Bolitho-v-City--and--Hackney-Health-Authority.php">the Bolitho case</a>, where a requirement was added that a course of action, even if supported by a responsible body of medical professionals, must also be capable of “withstanding logical analysis”. In practice, this provides a pragmatic balance between ensuring patients can have redress if treated negligently, and providing a supportive legal environment for innovation. </p>
<p>The existing Bolam and Bolitho tests support responsible innovation, and herein lies the danger of the bill. </p>
<p>The current wording of the bill that “a departure from the existing range of accepted medical treatments for a condition is not negligent if supported by a responsible body of medical opinion” seems to mirror the Bolam test. But any reassurance is specious – elsewhere it says that it isn’t negligent for a doctor to depart from the existing range of accepted medical treatments “if the decision to do so is taken responsibly,” including asking at least one “appropriately qualified” doctor whether the treatment in question would be supported by a responsible body of medical opinion. </p>
<p>As Heidi Alexander MP pointed out in the parliamentary debate, this relies heavily on the other doctor’s subjective interpretation, rather than (as Bolam would provide) it actually being supported by a body of medical opinion. There is nothing in the wording of the bill to suggest that the other doctor’s opinion necessarily has to be listened to. The threshold for whether a decision would be supported by the medical community is therefore considerably lowered, introducing a risk that patients who are harmed by irresponsible care masquerading as innovation will have reduced routes for redress. </p>
<h2>Logical problem</h2>
<p>Unfortunately, this is not the only way in which the current law is potentially affected. Although the bill seems to make some effort – however flawed – to accommodate the Bolam test, no equivalent effort has been made to incorporate the Bolitho test – that a treatment must also withstand logical analysis. This is tantamount to saying that any doctor innovating with no logical basis for their actions is exempt from a negligence claim, no matter the harm caused by the decision – as long as a lower threshold for the Bolam test has been met. </p>
<p>At the heart of the bill is a fundamental logical problem. The drafters say doctors are “not negligent” provided a specific process is followed in advance, but it still suggests <a href="http://mli.sagepub.com/content/early/2015/09/15/0968533215605667.abstract?rss=1">that negligence law could apply</a> after the treatment, which makes a distinction between the decision to try a new treatment and the actual performance of the treatment itself. Surely any clinician put off by a risk of being found negligent for deciding to try something new – a complicated new surgical technique, for example – will still be put off if the bill leaves them liable for any mistake made in applying that unfamiliar treatment or technique. If the bill recognises the importance of patients being safeguarded after treatment, then it seems fundamentally inconsistent not to apply this principle to a treatment decision itself.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/99034/original/image-20151020-32231-17eq742.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/99034/original/image-20151020-32231-17eq742.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/99034/original/image-20151020-32231-17eq742.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/99034/original/image-20151020-32231-17eq742.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/99034/original/image-20151020-32231-17eq742.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/99034/original/image-20151020-32231-17eq742.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/99034/original/image-20151020-32231-17eq742.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pointing to the bill won’t protect against negligence claims.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-294400490/stock-photo-law-court-paper.html?src=HDe0BNJ93WZjm3Hn67UagQ-2-11">Court by Shutterstock</a></span>
</figcaption>
</figure>
<p>Instead of clarifying the law of clinical negligence in order to promote innovation, there is a danger that legislation of this nature will foster confusion and <a href="http://www.serjeantsinn.com/ImageLibrary/Medical%20Innovation%20Bill.pdf">generate more litigation</a>, which – ironically – could impede the innovation it seeks to unleash.</p>
<h2>Database already possible</h2>
<p>What of the merits of a database? The bill proposes that a database of innovative medical treatments be created that can be shared with others. Heaton-Harris maintains this will guard against the quackery that some fear will be a consequence of its passage. But even if there was consensus about this being a good thing, this is still no reason to pass the bill. The secretary of state for health already has the power to establish such a database under the Health and Social Care Act 2012. To be effective it would have to be compulsory to submit to; far from cutting the Gordian Knot of red tape, it would more likely tighten it. </p>
<p>The Academy of Medical Royal Colleges, which <a href="http://www.aomrc.org.uk/doc_download/9845-access-to-medical-treatments-innovation-bill.html">also rejected the bill</a>, was also particularly baffled by the spurious distinction between innovation (the purpose of the bill), and research (specifically excluded in the bill). “Innovation without research isn’t innovation, it’s more often just advertising,” it said. </p>
<p>To his credit, Heaton-Harris undertook to consult, listen, and take advice. He should now listen to the doctors who say they aren’t put off innovation because of a fear of litigation. And to the Greater Medical Council, whose guidance already clearly tells doctors that they can use innovative treatments in the same way that they use conventional treatments, underpinned by with good clinical decision-making and patient consent. Most importantly, he should listen to the <a href="http://www.theguardian.com/commentisfree/2015/oct/14/medical-innovation-bill-saves-lives-endanger">Patients Association</a> who have condemned the bill as an “ill-judged, dangerous and unnecessary attempt at legislation in this area.”</p><img src="https://counter.theconversation.com/content/49404/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Wessely is president of the Royal College of Psychiatrists</span></em></p><p class="fine-print"><em><span>Gregory Smith works for the Royal College of Psychiatrists, which opposes the Access to Medical Treatments (Innovation) Bill</span></em></p>A parliamentary bill aims to assuage fears that innovative treatment will lead to doctors being sued – but the problem doesn’t exist.Simon Wessely, Professor of Psychological Medicine, King's College LondonGregory Smith, Policy Analyst, Royal College of Psychiatrists Licensed as Creative Commons – attribution, no derivatives.