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Dr Jeremy Farrar of Wellcome Trust addresses global health in a changing world during Barmes lecture at NIH
July / August 2019 | Volume 18, Number 4
Global health has been a phenomenal success story, according to Dr. Jeremy Farrar, director of the Wellcome Trust.
Photo by Marleen Van den Neste
Wellcome Trust Director Dr. Jeremy Farrar presented the
David E. Barmes Global Health Lecture and addressed global
health in a changing world.
“Over the last few decades the transformation in people’s lives around the world has been nothing short of remarkable.” However, to continue to make progress and spur significant advances as seen with malaria and HIV, for example, Farrar believes 21st century scientists are going to have to look and think differently.
“We have to appreciate the world is changing,” Farrar said, which was his theme for the
David E. Barmes Global Health Lecture he recently
presented at the NIH [video]. The event is sponsored by Fogarty and NIH’s
National Institute of Dental and Craniofacial Research (NIDCR), where Barmes served, and honors his dedication to improving health in low-income countries.
Farrar, a clinical scientist and leader in infectious diseases, spent 18 years at the helm of a Wellcome-supported clinical and public health research unit in Vietnam, and was on the front lines of avian influenza and SARS outbreaks. Now, he is in his second term as Wellcome’s director, guiding the London-based independent global foundation that supports thousands of researchers and works closely with the NIH.
In introducing Farrar, NIH Director Dr. Francis S. Collins called his friend and colleague a wonderful contributor to Wellcome’s agenda and “to all of us that care deeply about global health.”
Both Collins and Farrar acknowledged the value of the relationship between their organizations, exemplified by the jointly funded
Human Heredity and Health in Africa (H3Africa) project that has stimulated genomics research at institutions in across the continent.
Malaria research advances are another success story, Farrar said, with “staggering” progress. About 700 million cases and more than 3 million deaths have been averted since the beginning of this century. He said that’s the result of science - the development and implementation of effective bed nets and artemisinin combination therapy.
Turning to HIV, Farrar paid tribute to NIH for helping transform it from a death sentence into a manageable condition but encouraged scientists to continue to push forward. “I believe ... in the absence of a vaccine, we will see transmissible, untreatable HIV.”
Photo by Marleen Van den Neste
NIH Director Dr. Francis S. Collins and Fogarty Director
Dr. Roger I. Glass joined hundreds of audience members to
hear Wellcome Trust Director Dr. Jeremy Farrar deliver the
David E. Barmes Global Health Lecture.
The new global health
Drawing on his personal and professional experiences, Farrar talked about changes taking place in the world and the challenges they pose for global health.
“I think people who are at earlier stages in their career perhaps than I am are going to see unbelievable changes in society in the next 20 to 30 years in ways that we cannot predict but will be very disruptive,” he said. “Whether that’s in the environment, in the way people come together, the way societies work, the way cities work, urbanization, migration, conflict around the world - that’s the new global health.”
Looking at Ebola, Farrar noted that when the virus was first discovered in 1976 in a rural area of what is now the Democratic Republic of Congo, a person with the virus might come across seven to nine other people during their infectious period. In the devastating 2014-2016 outbreak in West Africa, someone with Ebola could encounter 200 people. The virus and genetic backbone of the population hadn’t changed, the society in which it occurred had, he explained.
“Ebola in an urban setting is a completely different infection than in the rural setting of 1976. And that change is what is driving Ebola in the DRC at the moment,” said Farrar, who recently traveled there to see the situation for himself.
The rise in cancer and other noncommunicable diseases will require health systems to shift their economic model and training from dealing with acute infections to chronic diseases. And he said we need to figure out how advances such as cancer immunotherapy can be more affordable and accessible.
“This is not a political point, but climate change is happening and it’s manmade,” Farrar said. The health impact will be profound, and warning signs are there, he said, pointing to air pollution and new environments favorable to mosquitoes. “I think re-linking climate change and human health and animal health and agriculture and nutrition is an absolute nexus that we have to bring back together because the impacts of climate change are not just going to happen in 2050, they’re happening today.”
Science, innovation and society
Another global challenge Farrar noted is the growing inequality between the haves and have-nots, which he said has to be addressed in order for science and innovation to reach as many people as possible.
Achieving the maximum benefit of science and innovation requires a third component - society - and Wellcome aims to bring all three together, Farrar said.
Citizens are increasingly skeptical of scientific advances. Farrar cited the results of the
recent Wellcome survey of 140,000 people in 140 countries regarding their attitudes toward health and science. When asked about vaccines, only 33% of participants in France believed they are safe, while almost everyone surveyed in Rwanda and Bangladesh reported confidence in them.
If anti-vaccine sentiment is exported from the U.S. and western Europe to other countries, Farrar said, the impact on health will be enormous. He sees those findings, especially at a time of progress, as a harbinger of more questions and challenges from the public.
“As a scientific community, I think we have been complacent that people would accept scientific advances and they would just thank us for it,” he said. “And I think as a community, we’ve got to engage much better than we have done in the past in order to bring society with us.”
21st century scientists
To meet the public health demands of the future, Farrar said more clinical scientists - adept at treating patients as well as making new discoveries in the lab - are needed. Recognizing it’s an intense and costly career path, he intends to seek NIH input as he explores how to cultivate that workforce. Scientists also must recognize the value of data and genomics, he said. And they have to break out of siloes and incorporate social sciences such as anthropology and communications.
In an increasingly convergent world, it’s not local vs. global health, he observed. They are one and the same.
“The lessons you’ve learned here, good and bad, will benefit other countries, and other countries will benefit the system here,” he said. “In the end, the world will be a better place if we break down those barriers and we break down that sense of here or there. It’s about all of us."
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