The CEO Notes

North-South collaboration can strengthen health research

In today’s world, technology and scientific evidence play a key role in increasing life expectancy. Conducting research and translating it into technological innovation is vital to reducing the disease burden on populations worldwide.

The advent of vaccines to prevent childhood diseases and the provision of treatment with antiretroviral therapy to prevent or treat HIV are just two examples of innovations arising from scientific studies. With its good scientific infrastructure, including skilled scientists, countries in the global North are better able than those in the global South to generate knowledge, apply it and thereby reduce mortality in their populations.

Global health challenges

Using the WHO analysis framework, there are four major non-communicable diseases (NCDs) globally that share the same behavioural risk factors. These are cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, and all share risk factors relating to tobacco use, an unhealthy diet, physical inactivity and the harmful use of alcohol.

These four diseases contribute to 60% of deaths globally; and 80% of these deaths occur in developing countries. Of these deaths, 40 to 50% are premature. When we grasp the sheer magnitude of these figures, we begin to understand the major socioeconomic impact NCDs have on poorer countries.

Many of these deaths are preventable if we apply the knowledge and technology gained through scientific studies. Premature deaths can be prevented if we combat the risk factors by changing our behaviours, and early treatment of the diseases can extend life expectancy.

Health challenges in Africa

Africa is plagued by both communicable and non-communicable diseases. HIV/AIDS, tuberculosis, malaria and other tropical diseases continue to exert a disproportionate disease burden on its inhabitants.

Taking a look at HIV/AIDS, 67% of those living with the disease globally reside in sub-Saharan Africa. While the prevalence of HIV is continuing to grow in this region, new infections (incidence) are declining in 22 high-burden countries, and so is AIDS mortality, thanks to the application of scientific knowledge. The long-term projections show this trend is likely to continue.

This, however, is the opposite of what is happening in the area of NCDs, of which the WHO projects significant growth over the next two decades.

Of great concern is that both communicable and NCDs occur in the same population and sometimes in the same person. Considerable resources were dedicated to the prevention and treatment of HIV/AIDS, while NCDs were left to grow unchecked.

Another complication is that as more people with HIV/AIDS live longer due to the use of ARTs, they are likely to develop NCDs, posing challenges to health service provision in sub-Saharan Africa – a region with too few skilled scientists to conduct the necessary research .

This calls for more and better North-South collaboration to increase the capacity to manage this epidemiological transition in the South

Scientific knowledge production and use

For collaboration to occur there is a need for research capacity in the North and South, but currently research capacity is skewed towards the North. The Economist of 9 January 2010 published an article celebrating the 350th anniversary of the Royal Society of London and its contribution to the development of science. This is indeed a very productive society, with 74 of its 1 300 living members being Nobel Laureates.

Royal Society Fellows have been credited with the invention of processes used by modern science, such as experimentation and peer-review, and it has published articles since the 1660s. The French Academy of Science was established in 1666; and the American Academy of Science was formed in 1848. In contrast, the Third World Academy of Sciences (TWAS) was formed in 1983; and ASSAf, the Academy of Science for South Africa, in 1995.

But we should not forget that in Africa, as early as the 12th century, scholars were flocking to Timbuktu to study ancient manuscripts. ‘Islamic study during this period of human history, when the intellectual evolution had stalled in the rest of Europe, was growing, evolving, and breaking new ground in the fields of science, mathematics, astronomy, law, and philosophy within the Muslim world,’ wrote Chris Rainier, for National Geographic News in the 27 May 2003 edition.

It is sad that today Africa has lost many of its intellectual capital to developed countries due to a lack of research infrastructure, career growth paths and poor salaries at home.

Knowledge equals growth

Obtaining knowledge and applying it is vital to the growing of economies. Health is a significant sector of the economy – in some countries contributing to more than 8% of its gross domestic product.

Using the 2009 World Bank knowledge economy index (KEI), which is the average score derived from the four key indicators of knowledge economy (economic incentive and institutional regime; education and human resources; the innovation system; and ICT), Western Europe leads in the knowledge economy, followed by the G7 countries, which include Canada, France, Italy, Japan, UK and the USA.

Next in line is the East Asia and Pacific region, but with lower scores than industrialised countries, followed by the Middle East, North Africa and Latin America. Sub-Saharan Africa and South Asia have a long way to go to become knowledge economies.

Investment in research infrastructure

Investment in research and development is crucial for production of a critical mass of scientists. Based on the latest Organisation for Economic Cooperation and Development (OECD) indicator of Gross Expenditure on Research and Development (GERD), it is clear that there is a low level of investment in research and development in the South compared to the North. Sweden, Korea, Finland and Japan lead in spending on research and development.

International Comparisons [GERD]

It is therefore not surprising that the number of full-time researchers per 1 000 people in employment is lowest in countries of the South; for example, South Africa (1.4), has a low FTE rate compared to countries such as Sweden (10.5), Japan (10.4), Australia (8.4) and Spain (7.0).

Opportunities for global collaboration

Funding remains a major factor in making North-South collaboration possible. Although there are examples of Northern institutes calling for joint applications, the issue of equal partnership is still a major concern.

Investment in research infrastructure

For scientists from the South to be able to collaborate with scientists in the North on an equal footing, they need good infrastructure. Scientists in African countries, with the exception of South Africa, Nigeria and Egypt, face major barriers to conducting research, preventing them from becoming global players in knowledge production and dissemination.

These include poor economic development, low investment in research and development, poor salaries, few libraries – often containing older books and journals, and poor access to ICT with high-speed bandwidth. Other barriers are a shortage of skilled scientists to tutor, provide mentorship and review articles, and institutions that promote scientists without requiring them to have a scientific publishing record.

Some of the external factors (real or perceived) have to do with attitudes or practices of scientific journal editors and scientists in the North. English as the language of scientific communication results in higher rejection rates from Northern-based journals for research papers submitted by non-English speaking authors. One solution is for journals to create sub-editing departments dedicated to translation.

Another major obstacle to publishing scholarly articles from the South is the high fees some journals charge for publishing electronically or in hard copy. If a researcher wants an article to appear within 12 months he/she may have to pay an exorbitant fee. One publisher charges authors a fee of US$ 3 000 to post papers online with immediate unrestricted open access. For researchers in resource-constrained settings in a country where the majority of the population lives on two dollars per day, this simply means that the article won’t be published.

Delayed access to information hinders the speed of knowledge application. Northern publishers should adopt a free open-access policy to allow those living in resource-constrained settings to participate in global information exchange.

In my own experience, collaboration becomes easier when scientists articulate the principles of collaboration up-front, subscribe to concepts of cogeneration of knowledge, and the use of an integrated science approach.
The epidemiological transition offers an opportunity for us all to build capacity and tackle non-communicable diseases that are becoming a global health phenomenon common to all countries.

Extract from the keynote address delivered by Dr Olive Shisana, CEO of the Human Sciences Research Council and president of the World Social Science Forum on 24 October 2011 at the World Health Summit, Berlin.