There’s a clamor around the world to return to the pre-pandemic “normal.” In reality, though, a reset to the fall of 2019 is out of the question. Leaders at all levels, all around the globe, must apply the painful lessons learned these past three years. And that means fundamentally shifting the world’s approach to many aspects of health security.
One good place to start: Rethinking the paradigm for global scientific cooperation.
The scientific and political elite have long assumed that the Global North is the best place to develop solutions for challenges in Africa, South Asia, and Latin America. Top-down biases have generally blinded high-income countries to the enormous reserves of talent and ideas in low- and middle-income nations. Time and again, pioneers in the Global South have made crucial scientific discoveries, ranging from breakthrough research on Burkitt lymphoma to groundbreaking work on HIV treatment and prevention to the first sequencing of the Omicron variant, yet their contributions are often discounted.
The worlds of science and public health can no longer afford this arrogance. People in the Global North must stop ignoring, marginalizing, and patronizing the Global South.
In an era of global challenges, respectful, balanced global collaborations matter. It is essential that high-income nations accelerate building scientific infrastructure and capacity in low- and middle-income nations while also embracing the big thinking and bold innovation that exists within them.
Fortunately, there is movement in this direction. We have both spent considerable time working and supporting work in Africa, where we have seen multiple encouraging examples that we hope can emerge as models for engagement across the entire Global South. Among them:
- To change “aid to Africa” to “made in Africa,” David Moinina Sengeh, the minister and chief innovation officer for Sierra Leone’s Directorate of Science, Technology, and Innovation, launched Global Minimum Inc. in collaboration with the Massachusetts Institute of Technology. With diverse financial support from corporations such as IBM and philanthropies such as the Lemelson Foundation, this nongovernmental organization fuels entrepreneurship programs in Sierra Leone, Kenya, and South Africa.
- To turn African universities into R&D hubs, the Africa Union and Africa Centres for Disease Control and Prevention launched the Partnerships for African Vaccine Manufacturing, which aims to ensure that at least 60% of the routine immunizations needed in Africa are made on the continent by 2040.
- To support that initiative, institutions including the U.S. International Development Finance Corporation, the European Investment Bank, and the French Development Agency have invested in the Institut Pasteur de Dakar, a manufacturer in Senegal, to dramatically expand its capacity to make vaccines for Covid-19 and other devastating diseases, such as yellow fever.
Skeptics sometimes raise the specter of “brain drain,” arguing that there’s little point in training scientists and clinicians in the Global South if they’re just going to head elsewhere to pursue careers in wealthier nations. This is a tired trope. Yes, some trainees and established scientists will leave for good. Others will spend time abroad and then return home with exciting new ideas. And many will stay right where they are in Africa, South Asia, or Latin America, committed to building scientific capacity at home. Indeed, they may be more experienced than peers in wealthy countries in developing pragmatic solutions to address threats like climate change and infectious disease, though their contributions — which are often extremely valuable to their home countries — aren’t always appropriately valued by scientists in the Global North.
Whether researchers in the Global South stay at home or migrate abroad, the key point is that everyone benefits from unlocking their potential. These programs don’t promote brain drain. They promote a global “wisdom gain.”
There is perhaps no better recent example of successful capacity building in the Global South than the Botswana-Harvard AIDS Institute Partnership, the first lab to identify the Omicron variant and alert the world to its existence. Established in 1996, this NIH-funded lab has about 350 full-time employees, with local researchers taking the lead in researching and treating AIDS in Africa. When the Covid-19 pandemic struck, the lab pivoted to genomic surveillance within two weeks. As it turned out, the team’s excellence provided an early warning to prepare for the next stage in the pandemic.
Such scientific excellence is not isolated. Major developments in HIV prevention, treatment, and vaccine development have come from scientists who got their start in the U.S. National Institutes of Health’s AIDS International Training and Research Program (AITRP), which was established in Africa in 1988 and later merged with the Fogarty HIV Research Training Program. It trained 2,000 physicians and scientists at the forefront of public health in 100 low- and middle-countries. Research by AITRP trainees, for instance, uncovered how HIV and co-infections interface, leading to earlier screening and treatment for tuberculosis and cervical cancer.
As these examples demonstrate, institutions in the Global South are not starting from zero — not by a long shot. Targeted investments have improved infrastructure. Health crises such as Ebola and Zika have also spurred major leaps in R&D and clinical capacity. It was after the Ebola outbreak of 2014-16 that the Africa CDC took off, and multilateral partners such as the World Bank invested in the Regional Disease Surveillance Project covering 16 countries in Africa.
Now is the time to accelerate that work by bringing together the private, public, and academic sectors to invest more aggressively in training talent and scaling infrastructure across Africa, South Asia, and Latin America.
To be clear, nations in the Global South also need to step up their own investments, as Christian T. Happi, director of the African Centre of Excellence for Genomics of Infectious Diseases, and John N. Nkengasong, director of the Africa CDC, pointed out in a recent article in Nature. Twenty years ago, countries across Africa pledged to dedicate at least 15% of their annual budgets to the health sector, and high-income countries pledged to allocate 0.7% of their gross national incomes to international aid. Both pledges have fallen woefully short. Today, no nation in Africa spends more than 2% of its gross domestic product on health and very few high-income countries are close to their 0.7% targets. That needs to change.
The scientific and public health communities cannot rely solely on government spending to drive innovation, however. Jeremy Farrar, director of the Wellcome charitable foundation, eloquently highlighted the role of philanthropy in a recent interview, calling it a “catalytic disruptor” that takes risks the commercial sector and governments won’t take. Academia can be another such catalyst.
That’s why we believe private-public-academic partnerships are so essential. It will take all sectors, working together, to activate the full power and potential of scientific talent worldwide.
Covid-19 is just the latest threat to make clear that global health challenges require global solutions. The world must rise to the occasion.
Muhammad Ali Pate, a former health minister of Nigeria and former global director at the World Bank, is professor of the practice of public health leadership at the Harvard T.H. Chan School of Public Health. Michelle A. Williams is the school’s dean of faculty.