Ebola Outbreak Highlights Struggle for Science in Africa
and Inequalities in Global Health Research
by Tamer Fouad, MD
As authorities scramble to contain the spread of Ebola, it helps to take a step back and examine why the science has not kept pace. Despite some promising advances in immunotherapy, there remains a great deal we haven’t learned about the virus. In part, the lack of research in “non-profitable” infectious diseases occurring in underprivileged countries has left threats like Ebola largely unaddressed. In addition, inequalities within the system of international scientific collaboration have hindered African researchers from leading the way against diseases ravaging their continent.
Similar concerns were echoed by the director of the National Institutes of Health, Francis Collins, who acknowledged in a recent interview that the quest for an Ebola vaccine in the United States had been slowed by a combination of lack of interest from the pharmaceutical industry and domestic budget cuts to basic research. With the arrival of the first Ebola patient on U.S. soil, however, the urgency to find a cure has hit home.
Nonetheless, individual states cannot be expected to replace what needs to be a coordinated effort. Speakers at a security meeting last month acknowledged that investing in Africa’s ailing healthcare infrastructure, while necessary, was unsustainable. What is needed are African solutions aimed at paving the way for science-based economies. In the words of Dr. Nkem Khumbah, “Africa needs science, not aid.”
Enter global health science. The past two decades have seen a rapid rise of academic programs in the United States under the label of “global health science” — global health aimed at balancing the dual objectives of encouraging scientific collaboration opportunities with resource-poor countries and protecting against global health threats that disregard national borders. Its principles espoused notions of equal scientific partnership aimed at capacity building and leadership development in countries with limited resources.
For international researchers, collaboration was seen as a welcome opportunity to further their careers by publishing in high-impact journals that are almost exclusively found in Europe and the United States. A combination of domestic and international grants would allow African researchers to focus on diseases that are considered Africa-specific, such as tropical infections.
However, and despite promising indications that science in the continent is gaining momentum, the majority of local laboratories still fail to meet the basic requirements set out by the World Health Organization. Africans account for a mere 1.1 percent of the world’s scientific researchers, and, more alarmingly, there are fewer than 5 million students of higher education in sub-Saharan Africa, a region with a population of more than 1 billion.
As the current Ebola crisis has highlighted, the funding, mentoring and research on Ebola are still performed in centers located in Europe or North America, which, as we have seen, is not always viable. There are few if any academic programs that are dedicated to the research of Ebola in Africa. So why hasn’t the global health science initiative delivered on its promises?
In her book Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science, anthropologist Johanna Tayloe Crane traces the structural inequalities inherent in the system of global health science that have hindered progress on another virus: HIV. Science, as currently deemed legitimate by leading journals, has become increasingly “molecularized” and technologically mediated. In the context of today’s global science, clinical expertise and other “qualitative” knowledge that has been acquired through years of exposure to a particular disease are considered less valuable. In the absence of specialized laboratories, many international collaborators often find themselves relegated to the role of “sample providers” and in some cases lose authorship.
Contrary to popular belief, philosophers argue that science is not socially neutral. The American philosopher Thomas Kuhn emphasized that scientific truth is defined largely by consensus within the dominant scientific community and undergoes periodic “paradigm shifts.” As such, scientific truth is not determined by the linear accumulation of “objective” criteria alone and is heavily influenced by consensus within society. Nowhere is this influence more evident than in the arena of international scientific collaborations.
Under the header “Molecular Politics of HIV,” Crane highlights how the research of HIV has, until recently, focused on a particular genetic subtype that is predominant in North America, Europe and Australia and has subsequently been used to establish all we know about antiretroviral therapy and drug resistance.
As a result, despite the noblest intentions of their counterparts in the United States, collaborators in underprivileged countries usually find themselves consigned to positions of dependency. Many complain that they are not involved in the planning of collaborative projects, their voices not heard and the structural challenges they face at home not acknowledged. For African scientists, this has often led to frustration and has had a detrimental impact on the amount of effort they are willing to invest.
The importance of allowing African academics to pursue equal career ambitions and become leaders at the international level cannot be understated from a health security perspective. Only then will these academics champion their own homegrown innovative solutions and create self-sustaining and robust health science infrastructures.
As Ruth Katz of the Aspen Institute writes on the current Ebola crisis:
For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster…. To get ahead of the curve, we need a renewed commitment to research and action, and enough resources to put more public health boots on the ground, both at home and abroad.
The global health initiative can deliver. However, its policy makers and leaders need to be conscious of the inherent inequalities within the highly competitive academic environment. Active steps need to be taken in order to ensure that the current collaborative system is more inclusive of the career aims and ambitions of those whose lives are directly affected.
Tamer Fouad, M.D., Ph.D. is a medical oncologist and Faculty Fellow at the National Cancer Institute, Cairo where he is responsible for the treatment and care of patients with cancer. He is also a clinical investigator involved in international collaborations in breast cancer research. His work is published in peer-reviewed medical journals including Cancer, Annals of Oncology and Hematologica.
Dr. Fouad is also a commentator on current affairs with special interest in philosophy, critical theory and the Middle East. His writing appears in The Guardian, Voice Of America and openDemocracy.
Follow Tamer Fouad, MD on Twitter: www.twitter.com/FouadMD
Categories: Leadership in Medicine