1. Saïd Business School 1-3 September 2004

2. Grand Challenges Working Group Professor Abdallah Daar 2 September 2004

3. Members of Working Group Bell Colagiuri Elkington McGinnis MacWilliams Sarraf-Zadegan Sorensen Yach Daar

4. Bill and Melinda Gates Foundation $200M Grand Challenges in Global Health www.grandchallengesgh.org

5. What is a Grand Challenge? Def’n: “A specific scientific or technological innovation that would remove a critical barrier to solving an important health problem in the developing world with a high likelihood of global impact and feasibility.” Not just a restatement of the many “big problems” facing global health today (ex. HIV/AIDS, malnutrition, lack of accessibility, etc.) Directive tool for investigators working towards overcoming one or more bottlenecks in an foreseeable path toward a solution to significant health problems.

7. Goals and Grand Challenges GOAL 1: To improve childhood vaccines: GC 1: Create effective single-dose vaccines that can be used soon after birth; GC 2: Prepare vaccines that do not require refrigeration; GC 3: Develop needle-free delivery systems for vaccines. GOAL 2: To create new vaccines: GC 4: Devise reliable tests in model systems to evaluate live attenuated vaccines; GC 5: Solve how to design antigens for effective, protective immunity; GC 6: Learn which immunological responses provide protective immunity. GOAL 3: To control insects that transmit agents of disease: GC 7: Develop a genetic strategy to deplete or incapacitate a disease- transmitting insect population; GC 8: Develop a chemical strategy to deplete or incapacitate a disease- transmitting insect population.

8. GOAL 4: To improve nutrition to promote health: GC 9: Create a full range of optimal bioavailable nutrients in a single staple plant species. GOAL 5: To improve drug treatment of infectious diseases: GC 10: Discover drugs and delivery systems that minimize the likelihood of drug resistant microorganisms. GOAL 6: To cure latent and chronic infections: GC 11: Create therapies that can cure latent infections; GC 12: Create immunological methods that can cure chronic infections. GOAL 7: To measure disease and health status accurately and economically in poor countries: GC 13: Develop technologies that permit quantitative assessment of population health status; GC 14: Develop technologies that allow assessment of individuals for multiple conditions or pathogens at point-of-care.

9. Three GCs of interest to chronic disease GC13: Develop technologies that permit quantitative assessment of population health status GC14: Develop technologies that allow assessment of individuals for multiple conditions or pathogens at point of care GC 9 Create a full range of optimal bio-available nutrients in a single staple plant

10. For NCD, the work has not yet been done The actual grand challenges will be sought through a formal international process These examples are a starting point for debate, to Develop a fundable set of Grand Challenges Excite the research community and donors

11. Different from infectious diseases 1.A more comprehensive approach is needed to tackle chronic diseases –Private behaviours –Environmental influences –Genetic factors 2.A broad-based, multi-sectoral research approach –Agriculture, education, transport, energy, urban development as well as health 3.Time between exposure & outcomes measured in decades; interventions only show impact after long time; long-term perspective is required

12. Goal 1 To measure disease, health status and health risks accurately and economically in developing countries.

13. GC1: Technologies to permit quantitative assessment longitudinally of deaths, diseases, risks related to chronic diseases. GC2: Cohort studies in diverse cultural and social settings that identify causal relationships between diets and physical activity, and chronic disease outcomes (see draft developed by Popkin et al attached). GC3: Develop technologies that allow assessment of individuals for multiple risks and diseases at point- of –care. This would contribute to the development of evidence based, economically affordable ways of screening patients who present to health services- critical if secondary prevention is to expand.

14. Goal 2 To develop comprehensive chronic disease prevention and health promotion research programs.

15. GC4: Identify key components of a comprehensive program, drawing on elements contained in the WHO Framework Convention on Tobacco Control and the Global Strategy on diet, physical activity and health, and test their effectiveness in large scale community based settings in different countries.

16. Goal 3 To evaluate the economic impact of chronic disease risks and diseases from a national and transnational perspective.

17. Goal 4 To understand early determinants of unhealthy consumption patterns in children.

18. GC6: Evaluation of the role of early taste acquisition and exposure to marketing on children’s consumption of foods and tobacco.

19. Goal 5 To promote health and make “healthy choices easy choices” for populations.

20. Goal 6 To demonstrate the effectiveness of specific interventions to address obesity and related risks in different settings.

21. Goal 7 To enhance health service effectiveness in addressing chronic disease risks and outcomes.

22. What needs to be done Raise funds Establish a Scientific Board Work through definitional issues Call for ideas Synthesize into a Grand Challenges list Ask for letters of intent Shortlist Ask for full grant applications from short list Review mechanism Grant oversight and management etc

23. Saïd Business School 1-3 September 2004