October 5, 2022

In this module you read an article about offering clinical judgment using data and predictive analytics.? Throughout the course, you have read and been exposed to a multitude of resources

In this module you read an article about offering clinical judgment using data and predictive analytics. Throughout the course, you have read and been exposed to a multitude of resources on global health and how artificial intelligence, machine learning, and predictive analytics can be used. Using these resources and your understanding of the subject, address the questions below in your post.

READ: The attached

What are the pros and cons in the use of artificial intelligence in global health interventions?
What questions or concerns do you have about the use of artificial intelligence in global health interventions?

Courtesy of Mark Tuschman.

Skolnik, Richard. Global Health 101, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/indianatech-ebooks/detail.action?docID=5894023. Created from indianatech-ebooks on 2022-10-05 02:42:17.

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CHAPTER 18 Science, Technology, and Global Health

LEARNING OBJECTIVES

By the end of this chapter, the reader will be able to do the following:

■ Articulate the needs for diagnostics, vaccines, and drugs to address high-burden diseases that affect the poor in low- and middle-income countries

■ Assess the extent to which existing products meet those needs

■ Note the potential of science and technology to develop new products to address high-burden diseases

■ State some of the key constraints to investments in such products

■ Indicate mechanisms to overcome these constraints and encourage the development and uptake of new diagnostics, vaccines, and drugs

■ Outline lessons for future efforts from selected cases of new product development

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J ▶ Vignettes

uan lived in the highlands of Peru. He had tuberculosis (TB) and was being treated at a local TB clinic. He had to take four

drugs for the first 2 months of his treatment and two drugs for 4 months after that. Juan felt better within weeks of starting his drugs but struggled to take the remaining pills because there were so many to take and he had to take them for so long.

Wezi lived in South Africa, where about 19 percent of the adults are HIV-positive. Despite intensifying efforts to reduce the spread of new HIV infections in South Africa, the number of these infections is still large. In fact, the latest estimates suggest there were about 270,000 new infections in 2017 and that about 7.2 million people in South Africa are now living with HIV/AIDS. Some people believe that stopping the transmission of HIV in countries like South Africa will depend on the discovery of a safe, effective, and affordable HIV vaccine.

Mei-Ling was 4 years old and lived in the west of China. Like so many children in her region, Mei-Ling was infected with hookworms. The community had a deworming program, and every 6 months Mei-Ling was given medicine to get rid of the worms. This medicine was generally safe and effective. However, it had to be given twice a year, and there was some indication that the hookworms were becoming resistant to it.

David was 7 years old and lived in the eastern part of Kenya. He had a high fever and chills, and his mother took him to the local health clinic. The nurse there examined David, decided he had malaria, and prescribed antimalarial medicine. This was the third time in a year that David had malaria. A safe, effective, and affordable malaria vaccine would have prevented him from getting

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malaria, being sick so often, missing so much school, and spending so much money on medical care.

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▶ Introduction Scientific and technological progress has contributed substantially to improvements in human health. Such progress has included, for example, new and more effective diagnostics for a range of diseases; vaccines for a number of potential killers; a variety of drugs, such as penicillin; and safer and more effective family planning devices.

In fact, some scientific and technological discoveries have been of exceptional importance to public health. The discovery of the smallpox vaccine led to the first important efforts at vaccination and ultimately to the eradication of smallpox. Jonas Salk’s discovery of the polio vaccine began to eliminate the scourge of polio from many societies, and his work was advanced further by Albert Sabin’s work on the oral polio vaccine. It is difficult to imagine living in a world without antibiotics but they emerged only just before World War II.

The enhancement of medical devices has also had an important impact on public health. The invention of the bifurcated needle was instrumental in enhancing the effectiveness of the smallpox eradication campaign. The intraocular lens for cataracts has provided a very low-cost tool for improving visual acuity.

The purpose of this chapter is to examine how science and technology could assist in speeding up the development and dissemination of new products that could address the largest burdens of disease in low- and middle-income countries. First, the chapter examines the characteristics that such products need to possess if they are to have the desired impact. Next, the chapter reviews the extent to which some existing diagnostics, vaccines, and drugs have those traits. The chapter then discusses the potential of science and technology to develop products in

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selected areas of importance and reviews constraints to product development. Several case studies illustrate the key concepts of the chapter.

As you read this chapter, it is very important that you keep several things in mind. First, you should remember that very substantial gains in health could be obtained from the effective implementation of existing technologies. There are a number of low-cost but highly effective interventions that are well known but not used widely enough:

■ Reducing maternal disability and deaths through better identification of complications, speedy transport to the hospital, and appropriate emergency obstetric care

■ Reducing neonatal deaths by training birth attendants in resuscitation, keeping the baby warm, and providing antibiotics for infection

■ Reducing young child deaths by expanding vaccination coverage with the six basic antigens and Hib, rotavirus, and pneumococcal vaccines

■ Reducing infant morbidity and mortality by promoting exclusive breastfeeding for 6 months

■ Reducing morbidity and mortality from TB by expanding case finding and cure rates

■ Better controlling hypertension to reduce the risk of stroke

In addition, we must remember that better hygiene practices, such as handwashing with soap, do not require the development of any new products but could substantially improve health.

As you read this chapter, it is also important to keep in mind that the development of new products will not be a quick fix. Rather, while supporting the continued search for scientific and technical progress, it is critical to continue to focus on the underlying sources of ill health in low- and middle-income countries. These

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include, among other things, poverty, the lack of education, the lack of political interest in the health of the poor, and the place of some minority groups and women in society. Enhancing basic infrastructure, water, and sanitation will also be critical in many settings to sustainable improvements in health.

Finally, you should note that this chapter focuses on a narrow range of the scientific and technological matters that concern global health. It looks largely at new product development, the constraints to it, and what might be done to speed up the process. It does not examine research or operational research. Nor does it focus on the dissemination of existing technologies.

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▶ The Need for New Products As we think about the characteristics of diagnostics, drugs, vaccines, and medical devices that could most effectively and efficiently address the critical health problems of low- and middle- income countries, we need to keep several points in mind. First, the most important target groups for these products are poor people. Their financial resources are limited, and the countries in which they live, particularly low-income countries, generally spend little per capita on health. Second, the quality of care in many countries is low and injection safety is often poor. Third, many low- and middle-income countries have health systems that are poorly organized and cannot effectively manage logistics. In addition, transport and storage of goods is weak, and the supply of electricity for keeping goods cool is often limited.

In this light, what are some of the ideal characteristics of diagnostics, drugs, vaccines, and medical delivery devices to help address the most critical burdens of disease in low- and middle- income countries? The most important of these characteristics are shown in TABLE 18-1.

TABLE 18-1 Some Ideal Characteristics of Diagnostics, Vaccines, Drugs, and Delivery Devices

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As you can see in the table, it is important that diagnostics be specific, sensitive, easy to use, and noninvasive. Ideally, diagnostic tests could be done quickly by relatively untrained workers and would rapidly produce easy-to-read results. They would also be easy to transport, heat stable, inexpensive, and not require refrigeration.

Much the same would be true for the ideal drugs. These drugs would be safe, effective, inexpensive, and have a long shelf life. They could also be used for many years without becoming susceptible to resistance. In addition, the number of pills that patients would have to take would be limited, and patients would not have to take them for very long.

Vaccines to meet the most important health needs in low- and middle-income countries would also be safe, effective, and inexpensive. They would be easy to transport and store, would be heat stable, and would not require refrigeration. The ideal vaccines would be an inexpensive combination of many antigens, and only one dose would confer lifelong immunity against a number of diseases. It would also be ideal if therapeutic vaccines, which are vaccines that can be used to treat diseases rather than prevent them, could be developed for some diseases.

The present state of key products does not meet the ideals noted here. Until recently, for example, a child receiving full coverage of the six basic antigens in many countries would require six contacts with the health system to get all of these vaccines.

Could vaccines be developed that combine required antigens in such a way that only a few contacts would be needed between the health system and patients to fully vaccinate a child? The pentavalent vaccine is a step in this direction.

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There is a cultural preference in many societies for injections, despite problems with injection safety. Could vaccines be delivered in noninvasive ways, such as sprays, air injectors, and skin patches, that would be safe, effective, heat stable, easy to transport, not very costly, and culturally acceptable?

There is a vaccine for tuberculosis and drugs that are effective against TB. However, the effectiveness of the TB vaccine against adult pulmonary TB is variable. In addition, the drugs that are used to treat TB require a large pill burden, and TB bacteria are increasingly becoming resistant to some of them. What is needed to develop new drugs for TB that could make treatment shorter and easier? Is it possible to develop a safe TB vaccine that could be effective against all forms of TB?

Artemisinin-based combination therapy is effective against malaria that is resistant to chloroquine, although resistance to artemisinin is already growing. However, the cost per treatment with this drug, even at globally negotiated prices, has been about 10 times the cost per treatment with chloroquine for children and 20 times the cost for adults. The search for a malaria vaccine has gone on for many years, and there has been some progress in developing and testing a vaccine. However, there is only one vaccine, RTS,S, that has shown any efficacy in reducing the burden of malaria in young children, when combined with other interventions, and it is now being carefully piloted in a number of countries. What would it take to develop additional low-cost and highly effective malaria drugs? What can encourage the development of a safe and even more effective malaria vaccine?

Drugs for HIV/AIDS can control the virus for most people but cannot cure them. In addition, many people develop resistance to those drugs, and some of the drugs have important side effects. Moreover, there is still no preventive or therapeutic vaccine for HIV/AIDS. How can the world encourage the development of safer

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and more effective HIV/AIDS drugs, an HIV/AIDS vaccine, and mechanisms, such as microbicides, by which women could protect themselves better from the risk of HIV?

The scientific and technological gaps indicated previously also apply to some of the neglected diseases. Despite the ubiquity of hookworm, there is no vaccine for this parasite, the drug used to treat it has to be administered regularly, and resistance to it is increasing. Can a safe, effective, easy-to-use, affordable vaccine be developed for hookworm and some of the other “wormy” diseases?

PHOTO 18-1 There has been a large gap between the burden of disease in low-income countries and the focus of medical research. However, more and more scientists and researchers from low-income countries are being trained. How might one spur scientific collaboration between higher- and lower-income countries to promote more research on the “unfinished agenda”

in nutrition, maternal and neonatal conditions, and communicable diseases?

Courtesy of Mark Tuschman.

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▶ The Potential of Science and Technology Scientific progress has led to a number of areas in which science could be harnessed to address some of the gaps noted in the previous section and to improve human health. Four such areas, as examples, are noted in this section.

Sequencing the genomes of important pathogens will help scientists better understand why they cause disease, how they develop resistance, and what drugs can best fight them, while reducing the onset of resistance. The genomes have been sequenced for more than 30,000 microbial species. The speed with which the SARS virus was sequenced is an indication of the speed with which this can be done, if sufficient priority is given to this work. The sequencing of the mosquito genome may allow scientists to engineer mosquitoes so that they cannot carry malaria and other diseases, such as lymphatic filariasis. Scientists have already sequenced the genome of 16 species of Anopheles mosquito, including the Anopheles stephensi mosquito, a key vector of malaria throughout the Indian subcontinent. This research has provided new insights into mosquito biology and mosquito–parasite interactions, which have important implications for the prevention of malaria transmission.

Improvements in information technology, chemistry, and robotics, as well as in genetic and molecular epidemiology, will also facilitate the development of new and better drugs. These tools will allow scientists to understand better the nature of disease. They will also enable scientists to more quickly try different chemical compounds to address those pathogens.

In addition, a number of technologies exist that can assist in the design and manufacture of new and improved vaccines. The use of recombinant DNA technology, for example, helped an Indian

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vaccine company reduce the cost of the hepatitis B vaccine from about $8 to 50 cents. DNA technology should also be very helpful to the development of drugs.

Genetic modification of plants is a controversial subject because, among other things, there are concerns over the environmental and health risks associated with it. Yet, it is possible to engineer plants that can carry higher levels of certain nutrients, such as vitamin A, while being very resistant to disease. In addition, plants can be modified genetically so that they can produce edible vaccines. However, while research on this front has provided proof of the concept, no such vaccine is very far along in development.

There is an increasing understanding of the promise of science and technology for improving global health. In one study, the views of 28 experts were sought about the biotechnologies that could help improve health in low- and middle-income countries in the following 5 to 10 years. In particular, these scientists were polled about how these potential biotechnologies could :

■ Improve health ■ Be affordable and appropriate in low- and middle-income

countries ■ Have an ability to address the most pressing health needs ■ Be developed in the next 5 to 10 years ■ Advance knowledge ■ Yield important indirect benefits

They were also asked how they would use science and technology to achieve these aims. As the highest priority, these scientists would use biotechnology to develop new diagnostics, vaccines, and drugs, in that order. They would use technology to improve the environment, including water and sanitation. The scientists also put a premium on the development of products that can help

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empower women to protect themselves against sexually transmitted diseases, including HIV, such as microbicides.

In fact, the Grand Challenges initiative aims to engage the world’s most innovative researchers in defining and addressing critical research and operational challenges in global health. The Bill & Melinda Gates Foundation launched the initiative in 2003, in conjunction with the Canadian Institute for Health Research, the Foundation for the U.S. National Institutes of Health, and the Wellcome Trust. This effort has now grown into a family of initiatives, supported largely by the Gates Foundation, Canada, and USAID. To date, these programs have awarded 2,390 grants in 90 countries. The list of members of the Grand Challenges initiative is shown in TABLE 18-2.

TABLE 18-2 The Grand Challenges Initiatives

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In this module you read an article about offering clinical judgment using data and predictive analytics.? Throughout the course, you have read and been exposed to a multitude of resources

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