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Unleashing the Potential of Technologies on the MDGs

06/12/2010

Holly Wong, IAVI's VP for public policy, on bringing advances in the lab to practice in the field

On September 8, 2000, then Indian Prime Minister Shri Atal Bihar Vajpayee took the stage at the United Nations General Assembly in New York - 26th in a line of 66 world leaders to take to the mic on the final day of a summit serious about starting the new millennium off right.

The leaders sought to utilize the UN not only to prevent world wars, but to address the other major threats to the planet and humanity. Vajpayee put it this way, "Giant strides in science and technology marking the conquest of new frontiers of knowledge have helped us grow more food, produce life saving drugs and send satellites into space. Yet, millions still go hungry, die of easily curable diseases and are deprived of the enlightenment and empowerment that education ensures."

With this paradox in mind, 189 UN member states at the summit signed on to reach a set of eight targets by 2015 to end extreme poverty and hunger, provide primary education to every child, promote gender equality, improve child and maternal health, combat HIV/AIDS and other infectious diseases, ensure environmental sustainability, and establish a global partnership for development. This September, world leaders once again will convene at the UN to review the progress made over the past decade toward these targets, known as the Millennium Development Goals or MDGs. If we are really to achieve the laudable progress called for in the MDGs, these leaders must make a substantial and sustained commitment to the development and deployment of new technologies to stop the world's top killers in their tracks and remove the burden they place on development.

There is no doubt that we have seen progress toward meeting the MDGs. A World Health Organization report released last month found that 30 percent fewer children under five died in 2008 than in 1990, and there were 16 percent fewer new HIV infections in 2008 than 2001, among other positive gains. However, the WHO report also highlighted areas where we're lagging - a slight decline in maternal mortality appears to be well below MDG targets; the number of stunted children in the African region is projected to increase from 45 million in 1990 to 60 million in 2010; and despite progress on HIV treatment and prevention, the virus continues to outpace our efforts to cope with it.

Imagine the progress that could be made toward these goals if we had a few more tools at our disposal. Take HIV/AIDS. If we had a vaccine that could prevent new HIV infections in most people, it would help us take a giant leap toward the MDG target of providing universal access to HIV prevention, care and treatment. Impact modeling analysis conducted by the organization I work for - the International AIDS Vaccine Initiative - and our partners demonstrates that an AIDS vaccine that is 70 percent effective and given to 90 percent of the population could reduce the number of new infections worldwide by as much as 94 percent a year. That would make coping with existing and new infections a more sustainable undertaking.

An effective AIDS vaccine could also erase the grim reality that unequal progress between countries toward MDG targets in the last decade is strikingly related to HIV burden - highlighted clearly in a PLoS Medicine study published in March. Researchers found over half of the inequalities between countries toward child mortality and tuberculosis MDG targets could be attributed to HIV and non-communicable diseases. The authors found that just a one percent decrease in HIV prevalence would reduce child mortality to the equivalent effect of a 40 percent rise in a country's Gross Domestic Product. What's more, HIV/AIDS is the leading killer of women of reproductive age, hindering progress toward maternal mortality targets. Gaps in primary education, malnutrition and gender inequity issues are all also exacerbated by the pandemic.

A nurse-counselor vaccinates a volunteer (volunteer only for picture) under the supervision of a physician in Pretoria, South Africa. Photo courtesy of IAVI.

As leaders consider how to invest strained budgets to achieve the MDGs, here's the great news: major advances in the lab and in the field give us more reason than ever to believe these life-saving and poverty-reducing technologies can be delivered. Last year, an experimental AIDS vaccine tested in Thailand proved to be effective, although modestly - proving for the first time that a vaccine could protect humans from HIV infection. In the lab, IAVI researchers have been part of exciting discoveries in the field of retrovaccinology, which could allow us to design a potentially powerful vaccine that produces antibodies that neutralize a broad spectrum of HIV variants. In addition, the promising malaria vaccine candidate RTS,S is beginning late-stage efficacy trials in Africa, and trials are planned or underway for several vaccine candidates for TB, as well as for other preventive technologies for HIV, such as microbicides and pre-exposure prophylaxis.

As exciting as these advances are, we must remind ourselves of what Prime Minister Vajpayee observed nearly a decade ago when the MDGs were adopted: scientific breakthroughs have the power to change the world, but only if there is political commitment to bring these advances from the lab through the trial stage and ultimately to each and every person who needs them. Perhaps UN Secretary General Ban Ki-moon said it best in his recent report on the MDGs, "The shortfalls in progress toward the Millennium Development Goals are not because they are unreachable or because time is too short, but rather because of unmet commitments, inadequate resources, lack of focus or accountability, and insufficient interest in sustainable development."

Ten years into the new millennium, it is time that the world's leaders strongly support creating and delivering the technological tools needed to fulfill the great goals they have committed to for the developing world.