by Stuart MacLeod, MD, PhD, FRCPC, with speech by Peter A Singer, MD, MPH, FRCPC, FRSC 

In his landmark book, “The End of Poverty” (2005), Jeffrey Sachs, the director of the Earth Institute and Professor of Health Policy and Management at Columbia University, defined improved health as a cornerstone on which any effort to end the cycle of poverty in low income countries must be based.

The following provocative message from Dr Peter Singer of the McLaughlin- Rotman Centre for Global Health at the University Health Network, University of Toronto, points us toward an important role for Canada in this all important task. This speech on Canada’s strategic role in global health was delivered in October 2009, on the occasion of the Gairdner International Award. Dr Singer presents an inspirational view of what might be achieved by Canada in global health and related research. As a country, we represent less than 0.5% of the world’s population, but we are fortunate to possess a much higher percentage of the expertise and human resources that could be applied to address one of the world’s fundamental problems.

Those of us who work in academic centres cannot fail to notice the overwhelming interest of students and trainees of all ages in international issues, including those in the health sciences. Any student seeking a meaningful career is likely to recognize the significant challenges in health related fields such as nutrition, child survival, vaccine development, andprevention and management of communicable diseases. Most of these challenges are centred in low income countries that are also confronting related issues such as rapid population growth and transition to an older population. The latter trend forces them to confront diseases of aging while continuing to deal with the existing problems of communicable disease among infants, the young and the middle aged.

Universities have an important role to play in helping Canada and other high income countries work with low and middle income countries to achieve improved health outcomes and, as a consequence, improved economic development.

The idea of a “social contract” originated with Jean Jacques Rousseau more than 200 years ago, but its currency remains undiminished. Modern universities have a responsibility to use the resources placed at their disposal through government support, philanthropy, and other sources of competitive funding to contribute, as described by Dr Singer, to a diversity of efforts including research that will strengthen the world order, increase prosperity, and improve quality of life for people everywhere. Canadian universities have long been aware of their responsibilities in global health. It is more than 20 years since the leading health science universities in Canada banded together to create the Canadian University Consortium for Health In Development (CUCHID) and there remains a spirit of cooperation amongst those universities that is presently embodied in the Canadian Coalition for Global Health led by Dr Vic Neufeld, Professor Emeritus at McMaster University.

Those early efforts at inter-university collaboration have also contributed to the developments that are outlined by Dr Singer, including the Global Health Research Initiative, the Development Innovation Fund, and the Canada Gairdner Global Health award. There are many outstanding examples of engagement by Canadian health professionals and scientists in global settings, beginning with the heavily populated countries of China and India and extending to many parts of Africa, Latin America, and the Caribbean. Much has been done, but much remains to be addressed, particularly with respect to the response to our collective Canadian responsibility for training of highly qualified personnel. We need more individuals prepared to contribute to the research and evaluation needed if health outcomes are to be improved in low and middle income countries, many of them experiencing extraordinary pressures of population growth and the volatile conditions of climate change.

As the director of a children’s research institute, I must observe that the opportunities are particularly acute in relationship to child health. The developing world is characterized by the youth of its population. In many African countries, the median age hovers around 15, and the research agenda for improved health in such countries must focus on maternal and child health in particular.

Canada has substantial human resources that can be contributed to the efforts at improved global health. Most importantly, we have a generation of students, research trainees, and young health professionals who can be encouraged to see the career potential in health research for low and middle income countries. If even some of Dr Singer’s future vision is recognized, career opportunities will multiply and global health research efforts will be enhanced, both in Canada and internationally. Canada also has enormous educational and training capacity within its health science universities and could share this through initiatives to attract more international graduate students and post professional trainees. Once engagement in Canadian settings has been experienced, it is likely that a lifetime bond will be forged, leading to productive interactions when trainees return to their home institutions and countries.

In all of these efforts, individual Canadians and their institutions must be conscious of the need to develop true partnerships with international counter-parts. Partnerships must be based on a deep understanding of the health environment in low and middle income countries and must embody a fundamental respect for partner institutions and research colleagues coming to Canada or entering into collaborative agreements with Canadian scientists.

The speech: Canada’s strategic role in global health

In 1957 Lester Pearson won a Nobel Peace Prize for his role in resolving the Suez crisis. Pearson’s proposal, the creation of peace keeping forces, revolutionized international relations, revitalized the United Nations and cemented Canada’s reputation in global affairs. It was a time when Canada’s foreign policy mattered to Canadians and to the world.

In my view it is now time for Canada to again make that kind of distinctive contribution – to building a better, safer world. Just as Canada articulated a new way to address global conflict through peacekeeping, today we have the opportunity to address global health challenges through science. In the process, a coherent and compelling new Canadian global health “brand” would be created. The brand would feature a role for Canada – and Canadian scientists and health professionals – in helping to solve global health challenges. We can do so both directly and by fostering innovation in developing countries.

This would be a unique niche for our country, one in which we lead the way and inspire others to follow. The time is right for this kind of bold initiative. The need is great: we live in a world where almost 10 million children die before their fifth birthday, where more than a billion people go hungry every day. However, it must be kept in mind that this is an interconnected world, that international problems are our problems, as H1N1 has made abundantly clear.

Rationale

Why should Canada make these efforts to brand itself as a country whose scientists help solve global health challenges by fostering innovation?

First, Canada will help solve important problems plaguing five billion people in the developing world and, in the process, address one of the most critical issues of our times – the disparities in health and wellbeing between citizens of rich and poor countries. Why is it acceptable, for example, that a child born in Canada will live to 80 years of age, while a child born in many parts of sub- Saharan Africa will only live to age 40?

Second, Canada will develop solutions that will benefit us domestically, especially with respect to shared threats such as H1N1, climate change and chronic disease. Some of these solutions will apply to Canada’s Aboriginal communities, and addressing the challenges of our own Aboriginal population will reinforce our credibility as a country that helps developing communities abroad by also addressing needs at home.

Third, helping countries to solve problems using science helps them to develop and to raise their living standards. Stated another way, the best way to keep countries poor is to make sure that they do not develop their own talent or successfully turn their own domestic ideas into products and services. Canada can help countries escape that trap. Traditional models of international development are increasingly being called into question – Dambisa Moyo’s book “Dead Aid”* is the most recent example. It’s time for a new approach, focused on science and innovation. For example, Canada could create a centre in sub-Saharan Africa to connect scientists and entrepreneurs, similar to the model followed by the MaRS Discovery District in Toronto.

Fourth, developing a brand related to innovation, while it may begin with development, will also reinforce trade relations in innovative sectors, helping to market Canadian companies abroad. Making Canada a leader in global health will create opportunities to develop and sell Canadian innovation and products to the world. Developing and emerging economies also represent the fastest growing markets for Canadian life sciences technologies, knowledge and products, so there are significant opportunities for Canadian businesses.

Fifth, science fosters diplomacy. A friend who was an American Colonel involved in negotiations with the Soviets on issues of biosecurity, told me that often, when the diplomats reached an impasse, it was scientists, on both sides, who broke through. That’s because they spoke a common language. Perhaps the language of science is the only universal language.

The role for science

The question is whether science can help address these global challenges. Recent scientific advances suggest that it can and is doing so. An example is the development of a vaccine for malaria, a disease that kills one million children in Africa every year. A successful vaccine would have a profound effect on global health. Today, there are 3 malaria vaccine candidates in the pipeline. Another example is in the battle against HIV/AIDS. Very recent research results of the Thai Prime Boost Trial suggest for the first time that a vaccine for HIV might work.

In the field of nutrition, the Bill & Melinda Gates Foundation Grand Challenges in Global Health Initiative has funded research into staple crops like cassava, sorghum, rice and bananas that are loaded with micronutrients – iron, vitamin A and zinc – all critical to human health but so often missing from the diet of the poor. This research has now reached the point where field trials are being initiated. These advances show that science is delivering results and there are tremendous opportunities to make a difference in global health.

And yet here in Canada, where we spend about $580 million per year in our international development envelope on global health, only a tiny fraction of that expenditure – less than one or two percent – goes to discovery science.

Canadian capabilities

Does Canada really have what it takes to develop a distinctive new priority for its foreign policy – one based in science and driven by innovation? The evidence suggests that it does. Much of the infrastructure is already in place. We have the International Development Research Centre, not as widely known in Canada as it should be but respected around the world. Its tag line is “science for humanity”, and it was created in 1970 to help developing countries to employ science and technology to find “practical, long-term solutions to the social, economic and environmental problems they face.” We have the Global Health Research Initiative, a partnership among the Canadian Institutes of Health Research, Public Health Agency of Canada, Health Canada, IDRC and the Canadian International Development Agency, which promotes twinning between Canadian and developing world scientists.

We have Canadian scientists already making an enormous contribution to global health. Consider the efforts of Drs. Allan Ronald and Frank Plummer in Nairobi. Their work on HIV/AIDS, over a period of thirty years, has improved our understanding of how that virus spreads, created research opportunities for African researchers and improved – and in many cases started – sexually transmitted disease treatment and counselling in Nairobi clinics. Recently, Plummer has also done amazing work under a grant from the Grand Challenges in Global Health Initiative to improve understanding of HIV resistance among sex workers.

We have world class universities that could become more involved, not only through collaborative research, but also by harnessing the energy and enthusiasm of Canadian youth to address global problems. The commitment and creativity of today’s students in wanting to help solve global problems is impressive and inspiring. This is an extremely connected, globally aware generation that is looking for an outlet for their idealism. Branding Canadian foreign policy as helping developing countries through science and innovation will provide a needed stage on which their role may be developed.

Another important asset for Canada is our diaspora. There are few countries in the world that cannot look to Canada without seeing their own reflection. In fact, Canada is home to more than 15,000 scientific and health-related professionals from developing countries. Many of these still have family there, linkages that provide a unique opportunity to expand our scientific networks, while at the same time enabling our scientists and engineers to give back to the nations from which they have come.

Now as an important addition to this environment we have the Canada Gairdner Global Health Award, launched this year. The 2009 inaugural winner is Dr. Nubia Munoz, recognized for her epidemiological studies defining the essential role of the human papilloma virus in the etiology of cervical cancer. This work led to the development of successful vaccines. The Canada Gairdner Global Health awards will not only identify Canada with global health and innovation but also, by celebrating success in solving problems through science, inspire others from Canada and elsewhere to join the cause.

Very significantly, there is the new Development Innovation Fund. In the 2008 federal budget, the Government announced $50 million for the creation of the Development Innovation Fund which would “create breakthrough discoveries with the potential to significantly improve the lives of millions in the developing world.” So there’s no doubt that Canada has what it takes to help solve global health challenges and foster innovation in developing countries.

So what should we do?

The upcoming meetings of the G8 and G20 in Ontario next summer provide important opportunities to shape the agenda, to exercise leadership and set us on a new course. At a time when the G20 is emerging as the new institution for global governance, when power is shifting from the West to a more global community, Canada needs to redefine its role and re-establish its relevance. Canada should emphasize the role of science and innovation in improving health outcomes, showcase the Development Innovation Fund, and inspire and invite other nations to develop grand challenges initiatives. I

magine what could happen if every international development agency also funded science and innovation. Imagine different countries partnering on new, specific grand challenges, leveraging the success of the model. Think of what that could mean to global health, to the millions dying from preventable disease, to prospects for enhanced life expectancy in developing countries and to the creation of a safer and more equitable world.

For Canada, expanding beyond blue helmets to white lab coats brings significant benefits. To brand our foreign policy based on helping others through science will mark Canada as an “innovation power”, solving big problems, driving a Canadian culture of discovery, opening new markets, helping countries to develop, promoting diplomacy, and carving a niche for ourselves in the emerging G20. Canada is not a country of small dreams. Modest ambition. Limited vision. The proposal I have made builds on our strengths, honours our past and points us to a larger – and better – future.

Let’s seize this moment, this unique confluence of Canadian expertise and international need, to brand Canada as a leader in global health and innovation! It’s within our reach. And we have the ideal opportunity to take this new Canadian brand to market in June of 2010 when we host the G8 and co-host the G20.