Interviewed by Marilynn Larkin

Dr. Nils Daulaire is President and CEO of the Global Health Council, the world’s largest membership alliance of public health professionals and organizations working in more than 100 low-income countries, and dedicated to raising the attention, resources, and knowledge needed to improve health worldwide. He is presenting a keynote address, entitled Making a Difference on a Global Scale, at the SBS 12th Annual Conference & Exhibition in Seattle (September 17-21), and is a featured speaker in an SBS special event for conference participants and the general public. The event, Global Health Forum: Impact of Globalization on Drugs and Diseases, will take place on Tuesday, September 19.

What is your main message for drug-discovery professionals regarding their role in global health?

ND: The bottom line is that a fundamental reconfiguration needs to take place. So much of what’s going on in biomedical research today is aimed at the high end—affluent populations in the later years of life. However, we must recognize that the vast majority of years of healthy life lost around the world are occurring among the young, and in developing countries. While there are therapeutic approaches to many of the diseases that are prevalent in the developing world, very often the delivery mechanisms are poorly attuned to the difficult conditions under which these people live. So here, too, the opportunities for really world-changing research is enormous. I accepted the invitation to speak at the SBS conference in order to engage and activate scientists who are involved on the cutting edges of biomolecular sciences to make a real difference in the world.

This means shifting priorities from, say, the next generation of statins to something more relevant to diseases of the developing world?

ND: That’s correct. In my talk, I’ll address issues affecting premature death and disability in the developing world, which are predominantly—but not exclusively—infectious diseases that affect younger people. Among children, these include a whole variety of pneumonias and diarrhea-causing diseases, as well as the diseases that people are most familiar with, namely HIV/AIDS and tuberculosis, and the growing dangers of vector-borne diseases such as malaria. Other areas that warrant attention and research include new technologies for voluntary management of fertility, and appropriate means of addressing the emergence of chronic disease as a growing factor of health in the developing world.

It’s clear that you are deeply committed to global health. How did you become involved in this area?

ND: When I went to Harvard Medical School, initially it was very much with the idea of taking a traditional academic approach to medicine. However, I had an opportunity in the last half of my fourth year in medical school to spend six months in Asia, and I went to Bangladesh and worked in a primary care rural outreach clinic. I had been struggling throughout medical school with the question of where and how I could really make a difference, which was the reason I had gone into medicine. And the Bangladesh experience, coupled with my interest in making a difference on a broad population scale, rather than on a micro-organelle scale, were really what moved me in the direction of public health first, with global health growing out of that. My feeling is that the opportunity to save 10 million lives a year is a remarkable one. It is one that the global health community faces today.

You’ve noted that making a difference involves applying existing technology and creating new technology. What are some examples?

ND: Right now, for instance, we have a great technology to remove measles from the face of the earth. Measles kills about a half million children or more each year. We have a vaccine that’s highly effective, that has been around for decades, that requires only a single application to provide 95% life-long immunity, and it’s inexpensive at 12 cents per dose. So from the technological standpoint, we have a pretty good product. Yet. a third of the world’s population are not immunized against measles. That’s the example where we need to be doing better with technology that we have.

At the same time, we need new technology. One of the reasons that we haven’t optimized measles coverage is that the measles vaccine is extremely labile. Therefore, a stable vaccine that would perhaps be able to be administered without injections would be a significant technological step forward that could lead to lots of lives saved.

Of course, we also need better tools for addressing HIV/AIDS, TB, and malaria, as well as better delivery for the tools that we’ve got.

What has been the greatest challenge in your global health career?

ND: The biggest challenge is being able to reflect on the ‘fullness of the glass,’ if you will. Because there’s so much needless suffering, it’s easy to become discouraged. Because the conditions of life and medical services in the places where these diseases are occurring are so challenging, it’s easy to feel that it’s hopeless. And this is where having been at this for three decades helps me, because I actually see the remarkable progress that has been made.

Ten years ago, nobody outside the immediate field was even aware of global health. Nobody had it on their radar screen, certainly not policy makers or the general public. And when you look at the recognition that global health issues have today, starting with AIDS and moving through a whole range of conditions, there’s been enormous progress in terms of getting the message out. As a result, the resources available have quadrupled over the last 10 years, and the brain power going into global health has probably increased by an order of magnitude, so I’d say we’re sitting at the edge of something monumental. My speaking to the Society of Biomolecular Sciences is, in fact, a marker of that change.