We’ve Solved Many Medical Mysteries. Where Are the Cures? | Saloni Dattani | TED

I've been writing about global health and medical innovation for years, and when I tell my friends and family how much progress there's been, the reaction is almost always the same. They had no idea most of it was happening. Take the most common cause of death today, heart disease. People today have roughly a quarter the chance of dying from heart disease as people did in the 1950s at the same age. A quarter. Back then, there were no statins, no cholesterol testing, no implanted pacemakers, no anti-smoking campaigns, no bans on trans fats, no bypass surgery, no CPR. But hardly anyone hears about the long-term impact of those breakthroughs. When progress happens gradually, it's rarely considered news. And I think it's a problem. I think it’s part of why people don’t know how important it’s all been -- public health, vaccines and all the rest -- in improving people’s lives.

But what I want to tell you about is the thing that doesn't make the news at all. Not the breakthroughs themselves, but everything that got in the way of them. I used to have this impression that breakthroughs were uncommon, sporadic, sometimes happening by pure chance, sometimes by sheer determination. The way I see it now, it's more like there's a continuous stream of medical innovation every year. In just the last two years, for example, we've had a new antiviral against HIV, which protects against infections with an efficacy of nearly 100 percent with just a single dose given every six months. There are new drugs that reduce cholesterol levels by 60 percent, beyond the effect of statins. There are new treatments that slow down the progression of certain cancers, certain lung cancers, brain cancer and multiple myeloma by half or more.

And in just the last five years, we've had new vaccines against four diseases for the very first time. COVID, of course, but also the first malaria vaccine, the first chikungunya vaccine and the first vaccine against RSV. The tools to develop new drugs and vaccines have improved enormously. Like genome sequencing, for example, which has touched almost every part of biology. Back when the Human Genome Project was completed in 2003, it cost $50 million to sequence one person’s genome, and it took half a year. Now it takes under four hours and it costs a few hundred dollars. There's also been a revolution in the technology of microscopes. Over the past 200 years, their resolution has increased over 10,000-fold. We can now see viruses down to their individual atoms and design new drugs to target them extremely precisely.

This is RSV, respiratory syncytial virus. It's in the middle right there. And we can now see its atomic structure on the right. Until the 1930s, no one had ever seen a virus. So if our technology has advanced so much, why are so many diseases still untreatable today? What I've learned is that technology isn't always the barrier. Sometimes it’s about the funding, the institutions and the incentives. We recently got a new malaria vaccine, as I mentioned, and when I first heard about it, I was amazed. I remember learning that malaria was a very complicated disease, scientifically. It's caused by a parasite, not a virus or bacterium. And that parasite changes shape multiple times during its life cycle, which makes it really hard to know what to target with a vaccine. So I wanted to write about it, this amazing breakthrough. But one of the first things I learned about this new malaria vaccine that was introduced just a few years ago, was that it was developed in the '90s.

Decades ago. The researchers who developed it, struggled to find funding to test it at every stage of the process. There was no commercial incentive. It's not profitable to develop new drugs and vaccines against diseases that affect people in poverty, in poorer countries, even if millions of children might benefit. Even if there’s a huge economic benefit as well. It took foreign aid and philanthropy to fund the research to test it. And it literally took decades to reach the children who needed it. When I learned about this, I felt like there was nothing to celebrate. It seemed more like a failure. How could we let that happen? How could it take so long to test a vaccine that had already been developed, while half a million children were dying from malaria every year? Why wasn't that the story? Those children aren't coming back. But what I wanted to know was how we could prevent that from happening again.

Like, what if we could change the economic incentives? Well, economists have come up with an idea to do just that. It’s called an “advanced market commitment.” It's where donors commit to buying a vaccine at a certain price per dose, but only if it's developed and proven safe and effective. That commitment gives companies the confidence to invest in it in the first place, and it can bring vaccines into existence that would otherwise never get made. And most importantly, it makes sure that they're manufactured at scale and sold at an affordable price, so they reach children who need them. That idea was used over a decade ago to help develop new vaccines against pneumococcal disease, which is a deadly bacterial infection of the lungs. Vaccines already existed, but they didn't include the strains that were common in Africa and South Asia. So in 2009, several countries and philanthropists came together to fund an advanced market commitment for new vaccines.

And it actually worked. Several companies developed them, and they reached children much faster than usual. It's estimated that those vaccines have saved over 700,000 children's lives since then. (Applause) This idea to fix market incentives is one way to speed up the process. But it's not the only thing we can do. Take childhood leukemia, for example. It used to be very difficult to test new treatments for the disease because leukemia is rare and individual hospitals struggled to find enough patients to run clinical trials. So researchers built networks across the US and later Europe and Canada to help recruit patients from all over those countries into larger clinical trials. That collaboration made it possible to test treatments and learn what works faster. And it's why leukemia is no longer the disease it used to be. Before the 1970s, only around 15 percent of children with leukemia would survive even five years from a diagnosis.

That's the bottom line on these graphs. Two types of leukemia. Now the top line -- that figure is 85 percent. Most children in richer countries today survive and are effectively cured of the disease. This graph is thousands of children who wouldn't have survived without that collaboration, without that progress. I want to give you another example. Back when I was at university, we had a substitute lecturer one day in my course on infectious diseases, and she told us that our original lecturer was away because he had gone to West Africa to do research to develop an Ebola vaccine. I remember sitting in that lecture theater at the back, and I was thinking to myself, can you just do that? Can you just pack up and go? It hadn't even occurred to me, and it made me realize that all of these breakthroughs came from people like him, people who changed their lives to make them happen, or people who thought differently, whether they were scientists, economists, operators or managers.

They created the incentives and institutions so that generations in the future, all of us, wouldn't have to face the same problems that they did. And what's amazing is that we have an Ebola vaccine now against the most common strain. It wasn't made by my lecturer, but by researchers like him. And it was hard to develop and test it for all the same reasons. There was little commercial incentive, and it was hard to run clinical trials because it was hard to predict where Ebola outbreaks would arise and vaccinate people in advance. So scientists came up with a different idea. They waited for individual cases of Ebola to appear and then quickly vaccinated all of the people around them [and] tested the vaccine that way. That idea, called ring vaccination, helped find a vaccine that we now know is very effective. Now these are just some of the ideas that people have had so far. But what I've learned from them is that breakthroughs don't just happen because we have the tools to make them.

They depend on how innovation happens in the real world. And there's something else that I've learned from them that I find much harder to stomach. Many of them might not have happened at all. So when I think back to that stream of innovation, all of those breakthroughs and all of that progress that we've seen, I do find it amazing. It's incredible. But it also really frustrates me. That's how much progress we've made despite it being so hard. The good news is people have come up with ideas to change that. Some of them really work, like the ones I've told you about today, and they just haven't been used enough. But we also need people to come up with new ideas and test them and scale them up too. I think it's more important than ever that we do it, because of cuts to science, global health and foreign aid, we have to find ways to make our resources go further. Progress isn't inevitable. It takes people who decide to persist despite that.

And I think here it takes people who recognize something quite simple. That diseases are not a fact of life. They're problems that we can solve. Thank you. (Applause)