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The Grandest Challenge:

Taking Life-Saving Science from Lab to Village by Abdallah Daar & Peter Singer

Abdallah Daar
Abdallah Daar

With the world’s population now approaching 8 billion, approximately 90% live in the poor periphery with half the life expectancy of the 10% who are privileged to live in the centre of the developed world. Abdallah Daar and Peter Singer are bringing to the peripheral countries the scientific power needed to heal themselves through translation of scientific knowledge.

Abdallah attended medical school in Kampala, Uganda until the notorious dictator Idi Amin ordered all Asians out of the country. Abdallah completed his degree at the University of London and subsequently studied surgery and internal medicine at Oxford, completing a PhD in Immunology. As a young surgeon, he performed a double kidney transplant from a tiny 34 week gestational age stillborn donor. This is still a world record and the recipient is alive nearly two decades later.

"The 10/90 gap refers to the statistical finding of the Global Forum for Health Research that only 10% of worldwide expenditure on health research and development is devoted to the problems that primarily affect the poorest 90% of the world’s population." (http://en.wikipedia.org/wiki/10/90_ gap). Reciprocally, 90% of research funding is devoted to problems of the most fortunate 10%. The efforts described in this book are shifting the proportion toward 16/84.

The death of his sister from inadequately treated malaria drove home to Abdallah the lived experience of the 10/90 gap. She was one of the million who die each year from malaria. In 1998, he left his position as Chief of Surgery in Oman for the new field of Global Public Health and Ethics. Though the genome revolution was on, the periphery was left out. "But the discovery of quinine and the malaria patients were all in Africa".

Peter Singer
Peter Singer

He met Peter Singer while on sabbatical at the University of Toronto Joint Centre for Bioethics. Peter had come to realize the injustice of the 10/90 gap as his meteoric career in bioethics was unfolding. He served as founding director of the Joint Center for Bioethics, where international students from Africa, India, Pakistan and South America came to study under an NIH - Fogarty Foundation grant aimed at promoting justice in international research ethics. Peter was trained in internal medicine at the University of Toronto and in public health and research methods at Yale. He studied ethics at the University of Chicago. He developed the unique model of the Joint Center for Bioethics with its network of ten university hospitals. This allowed him to introduce bioethics from inside the medical system. At a bioethics meeting in Cape Town, he visited a clinic in an African slum and saw first hand the intensity of the 10/90 problem. "The clinic was a small room with peeling paint and nothing in it."

Book: The Grandest Challenge
The Grandest Challenge:
Taking Life Saving Science
from Lab to Village

When Abdallah joined Peter at the Joint Centre they launched a campaign to bring the innovations of the genomics revolution to the developing world. Despite initial rejection of their idealistic quest by the scientific community, they published a study in Nature Genetics, ranking the top 10 priorities to improve the health of the developing world. Attracted to the grand challenges proposed by Abdallah and Peter, The Gates Foundation asked their advice on how best to address these problems. This excellent book documents their remarkable experience.


"There can be no peace, no security, nothing but ultimate disaster, when a few rich countries with a small minority of the world’s people alone have access to the brave, and frightening, new world of technology, science and high material living standard, while the large majority live in deprivation and want, cut off from opportunities of full economic development; but with the expectations and aspirations aroused far beyond the hope of realizing them."

Nobel prize winner and Canadian Prime Minister Lester Pearson

They had used the Delphi method - "a structured way of building consensus among a group of experts that avoids the interpersonal dynamics of meeting." In Davos, Switzerland, Harold Varmas, former director of the U.S. National Institutes of Health and former director of the Memorial Sloan -Kettering Cancer Centre, came up with the idea of overcoming critical barriers as a model for the grand challenges project. This new, unfamiliar and brilliantly simple way to think about a scientific project extended the range of the diseases that could be affected by eliminating a bottle neck. For example, by eliminating the need for refrigeration, needles, syringes, and repeated doses, the barriers to immunization against many diseases could be addressed directly. Scientists from the developing and developed world collaborated in defining the challenges. Abdallah & Peter guided the selection process, and Bill and Melinda Gates provided the inspiration, determination and the initial financial support to move the projects forward.

The compelling narrative style and in-depth accounts of problems and strategic solutions, told from the personal viewpoint of the authors who participated in every step, provide a gripping story that will engage and benefit scientists and lay readers alike. Curiously, the chapters are entitled "Chapter 1", "Chapter 2" etc, leaving the reader uncertain about what will happen next as the story unfolds. A fitting climax develops when the Canadian Grand Challenges Program is launched with funding from the Canadian Government as part of its foreign aid budget. The program is serving as an operating system to deploy coalitions of international public, private and not for profit organizations like the Gates Foundation, US NIH, the Welcome Trust, the World Health Organization and other sponsors. Peter serves as CEO, and Abdallah as Chief Science and Ethics officer of the Canadian Grand Challenges Program.

Current Project of Grand Challenges Canada include identification and funding of rising starts in Global Health, point of care diagnostics, global mental health and creating and strengthening health enterprises.


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