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Transcript excerpt · English
I've been writing about global health and medical innovation for years,
and when I tell my friends and family how much progress there's been,
the reaction is almost always the same.
They had no idea most of it was happening.
Take the most common cause of death today, heart disease.
People today have roughly a quarter the chance of dying from heart disease
as people did in the 1950s at the same age.
A quarter.
Back then, there were no statins, no cholesterol testing,
no implanted pacemakers,
no anti-smoking campaigns, no bans on trans fats,
no bypass surgery, no CPR.
But hardly anyone hears
about the long-term impact of those breakthroughs.
When progress happens gradually,
it's rarely considered news.
And I think it's a problem.
I think it’s part of why people don’t know how important it’s all been --
public health, vaccines and all the rest --
in improving people’s lives.
But what I want to tell you about
is the thing that doesn't make the news at all.
Not the breakthroughs themselves,
but everything that got in the way of them.
I used to have this impression that breakthroughs were uncommon,
sporadic,
sometimes happening by pure chance,
sometimes by sheer determination.
The way I see it now,
it's more like there's a continuous stream of medical innovation every year.
In just the last two years, for example,
we've had a new antiviral against HIV,
which protects against infections with an efficacy of nearly 100 percent
with just a single dose given every six months.
There are new drugs that reduce cholesterol levels by 60 percent,
beyond the effect of statins.
There are new treatments that slow down the progression of certain cancers,
certain lung cancers, brain cancer and multiple myeloma by half or more.
And in just the last five years,
we've had new vaccines against four diseases for the very first time.
COVID, of course,
but also the first malaria vaccine,
the first chikungunya vaccine and the first vaccine against RSV.
The tools to develop new drugs and vaccines have improved enormously.
Like genome sequencing, for example,
which has touched almost every part of biology.
Back when the Human Genome Project was completed in 2003,
it cost $50 million to sequence one person’s genome,
and it took half a year.
Now it takes under four hours
and it costs a few hundred dollars.
There's also been a revolution in the technology of microscopes.
Over the past 200 years,
their resolution has increased over 10,000-fold.
We can now see viruses down to their individual atoms
and design new drugs to target them extremely precisely.
This is RSV, respiratory syncytial virus.
It's in the middle right there.
And we can now see its atomic structure on the right.
Until the 1930s,
no one had ever seen a virus.
So if our technology has advanced so much,
why are so many diseases still untreatable today?
What I've learned is that technology isn't always the barrier.
Sometimes it’s about the funding, the institutions and the incentives.
We recently got a new malaria vaccine, as I mentioned,
and when I first heard about it, I was amazed.
I remember learning
that malaria was a very complicated disease, scientifically.
It's caused by a parasite, not a virus or bacterium.
And that parasite changes shape multiple times during its life cycle,
which makes it really hard to know what to target with a vaccine.
So I wanted to write about it, this amazing breakthrough.
But one of the first things I learned about this new malaria vaccine
that was introduced just a few years ago,
was that it was developed in the '90s.
Decades ago.
The researchers who developed it, struggled to find funding to test it
at every stage of the process.
There was no commercial incentive.
It's not profitable to develop new drugs
and vaccines against diseases
that affect people in poverty, in poorer countries,
even if millions of children might benefit.
Even if there’s a huge economic benefit as well.
It took foreign aid and philanthropy to fund the research to test it.
And it literally took decades to reach the children who needed it.
When I learned about this,
I felt like there was nothing to celebrate.
It seemed more like a failure.
How could we let that happen?
How could it take so long to test a vaccine
that had already been developed,
while half a million children were dying from malaria every year?
Why wasn't that the story?
Those children aren't coming back.
But what I wanted to know was how we could prevent that from happening again.
Like, what if we could change the economic incentives?
Well, economists have come up with an idea to do just that.
It’s called an “advanced market commitment.”
It's where donors commit to buying a vaccine at a certain price per dose,
but only if it's developed and proven safe and effective.
That commitment gives companies the confidence to invest in it
in the first place,
and it can bring vaccines into existence
that would otherwise never get made.
And most importantly,
it makes sure that they're manufactured at scale
and sold at an affordable price,
so they reach children who need them.
That idea was used over a decade ago
to help develop new vaccines against pneumococcal disease,
which is a deadly bacterial infection of the lungs.
Vaccines already existed,
but they didn't include the strains that were common in Africa and South Asia.
So in 2009, several countries and philanthropists came together
to fund an advanced market commitment for new vaccines.
And it actually worked.
Several companies developed them,
and they reached children much faster than usual.