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We’ve Solved Many Medical Mysteries. Where Are the Cures? | Saloni Dattani | TED
We’ve Solved Many Medical Mysteries. Where Are the Cures? | Saloni Dattani | TED
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Untertitel (212)
0:04
I've been writing about global health and medical innovation for years,
0:09
and when I tell my friends and family how much progress there's been,
0:13
the reaction is almost always the same.
0:16
They had no idea most of it was happening.
0:19
Take the most common cause of death today, heart disease.
0:23
People today have roughly a quarter the chance of dying from heart disease
0:27
as people did in the 1950s at the same age.
0:31
A quarter.
0:32
Back then, there were no statins, no cholesterol testing,
0:37
no implanted pacemakers,
0:39
no anti-smoking campaigns, no bans on trans fats,
0:43
no bypass surgery, no CPR.
0:47
But hardly anyone hears
0:48
about the long-term impact of those breakthroughs.
0:52
When progress happens gradually,
0:54
it's rarely considered news.
0:57
And I think it's a problem.
0:58
I think it’s part of why people don’t know how important it’s all been --
1:02
public health, vaccines and all the rest --
1:05
in improving people’s lives.
1:08
But what I want to tell you about
1:09
is the thing that doesn't make the news at all.
1:12
Not the breakthroughs themselves,
1:14
but everything that got in the way of them.
1:18
I used to have this impression that breakthroughs were uncommon,
1:21
sporadic,
1:22
sometimes happening by pure chance,
1:25
sometimes by sheer determination.
1:29
The way I see it now,
1:31
it's more like there's a continuous stream of medical innovation every year.
1:37
In just the last two years, for example,
1:40
we've had a new antiviral against HIV,
1:44
which protects against infections with an efficacy of nearly 100 percent
1:50
with just a single dose given every six months.
1:54
There are new drugs that reduce cholesterol levels by 60 percent,
1:57
beyond the effect of statins.
2:00
There are new treatments that slow down the progression of certain cancers,
2:04
certain lung cancers, brain cancer and multiple myeloma by half or more.
2:11
And in just the last five years,
2:13
we've had new vaccines against four diseases for the very first time.
2:18
COVID, of course,
2:19
but also the first malaria vaccine,
2:21
the first chikungunya vaccine and the first vaccine against RSV.
2:28
The tools to develop new drugs and vaccines have improved enormously.
2:32
Like genome sequencing, for example,
2:34
which has touched almost every part of biology.
2:38
Back when the Human Genome Project was completed in 2003,
2:42
it cost $50 million to sequence one person’s genome,
2:47
and it took half a year.
2:48
Now it takes under four hours
2:52
and it costs a few hundred dollars.
2:54
There's also been a revolution in the technology of microscopes.
2:58
Over the past 200 years,
3:01
their resolution has increased over 10,000-fold.
3:06
We can now see viruses down to their individual atoms
3:10
and design new drugs to target them extremely precisely.
3:14
This is RSV, respiratory syncytial virus.
3:18
It's in the middle right there.
3:19
And we can now see its atomic structure on the right.
3:23
Until the 1930s,
3:24
no one had ever seen a virus.
3:28
So if our technology has advanced so much,
3:33
why are so many diseases still untreatable today?
3:38
What I've learned is that technology isn't always the barrier.
3:43
Sometimes it’s about the funding, the institutions and the incentives.
3:48
We recently got a new malaria vaccine, as I mentioned,
3:51
and when I first heard about it, I was amazed.
3:54
I remember learning
3:56
that malaria was a very complicated disease, scientifically.
3:59
It's caused by a parasite, not a virus or bacterium.
4:02
And that parasite changes shape multiple times during its life cycle,
4:07
which makes it really hard to know what to target with a vaccine.
4:11
So I wanted to write about it, this amazing breakthrough.
4:15
But one of the first things I learned about this new malaria vaccine
4:18
that was introduced just a few years ago,
4:21
was that it was developed in the '90s.
4:24
Decades ago.
4:26
The researchers who developed it, struggled to find funding to test it
4:30
at every stage of the process.
4:33
There was no commercial incentive.
4:35
It's not profitable to develop new drugs
4:38
and vaccines against diseases
4:40
that affect people in poverty, in poorer countries,
4:43
even if millions of children might benefit.
4:46
Even if there’s a huge economic benefit as well.
4:50
It took foreign aid and philanthropy to fund the research to test it.
4:54
And it literally took decades to reach the children who needed it.
4:58
When I learned about this,
5:01
I felt like there was nothing to celebrate.
5:03
It seemed more like a failure.
5:06
How could we let that happen?
5:08
How could it take so long to test a vaccine
5:10
that had already been developed,
5:12
while half a million children were dying from malaria every year?
5:16
Why wasn't that the story?
5:20
Those children aren't coming back.
5:24
But what I wanted to know was how we could prevent that from happening again.
5:30
Like, what if we could change the economic incentives?
5:35
Well, economists have come up with an idea to do just that.
5:39
It’s called an “advanced market commitment.”
5:42
It's where donors commit to buying a vaccine at a certain price per dose,
5:46
but only if it's developed and proven safe and effective.
5:50
That commitment gives companies the confidence to invest in it
5:54
in the first place,
5:56
and it can bring vaccines into existence
5:58
that would otherwise never get made.
6:00
And most importantly,
6:01
it makes sure that they're manufactured at scale
6:04
and sold at an affordable price,
6:06
so they reach children who need them.
6:10
That idea was used over a decade ago
6:12
to help develop new vaccines against pneumococcal disease,
6:15
which is a deadly bacterial infection of the lungs.
6:19
Vaccines already existed,
6:21
but they didn't include the strains that were common in Africa and South Asia.
6:26
So in 2009, several countries and philanthropists came together
6:30
to fund an advanced market commitment for new vaccines.
6:34
And it actually worked.
6:35
Several companies developed them,
6:37
and they reached children much faster than usual.
6:40
It's estimated that those vaccines have saved over 700,000
6:44
children's lives since then.
6:45
(Applause)
6:51
This idea to fix market incentives is one way to speed up the process.
6:57
But it's not the only thing we can do.
6:59
Take childhood leukemia, for example.
7:02
It used to be very difficult to test new treatments for the disease
7:05
because leukemia is rare
7:07
and individual hospitals struggled to find enough patients
7:10
to run clinical trials.
7:13
So researchers built networks
7:16
across the US and later Europe and Canada
7:19
to help recruit patients from all over those countries
7:21
into larger clinical trials.
7:24
That collaboration made it possible
7:26
to test treatments and learn what works faster.
7:30
And it's why leukemia is no longer the disease it used to be.
7:34
Before the 1970s,
7:36
only around 15 percent of children with leukemia would survive
7:40
even five years from a diagnosis.
7:43
That's the bottom line on these graphs.
7:45
Two types of leukemia.
7:47
Now the top line --
7:49
that figure is 85 percent.
7:53
Most children in richer countries today survive
7:55
and are effectively cured of the disease.
7:58
This graph is thousands of children
8:01
who wouldn't have survived without that collaboration,
8:04
without that progress.
8:06
I want to give you another example.
8:09
Back when I was at university,
8:11
we had a substitute lecturer one day in my course on infectious diseases,
8:15
and she told us that our original lecturer was away
8:19
because he had gone to West Africa
8:21
to do research to develop an Ebola vaccine.
8:24
I remember sitting in that lecture theater at the back,
8:28
and I was thinking to myself,
8:30
can you just do that?
8:32
Can you just pack up and go?
8:35
It hadn't even occurred to me,
8:38
and it made me realize that all of these breakthroughs
8:41
came from people like him,
8:43
people who changed their lives to make them happen,
8:46
or people who thought differently,
8:48
whether they were scientists, economists,
8:50
operators or managers.
8:53
They created the incentives and institutions
8:56
so that generations in the future, all of us,
8:59
wouldn't have to face the same problems that they did.
9:02
And what's amazing is that we have an Ebola vaccine now
9:05
against the most common strain.
9:08
It wasn't made by my lecturer, but by researchers like him.
9:11
And it was hard to develop and test it for all the same reasons.
9:14
There was little commercial incentive,
9:16
and it was hard to run clinical trials
9:18
because it was hard to predict where Ebola outbreaks would arise
9:21
and vaccinate people in advance.
9:24
So scientists came up with a different idea.
9:27
They waited for individual cases of Ebola to appear
9:31
and then quickly vaccinated all of the people around them
9:33
[and] tested the vaccine that way.
9:35
That idea, called ring vaccination,
9:38
helped find a vaccine that we now know is very effective.
9:42
Now these are just some of the ideas that people have had so far.
9:48
But what I've learned from them is that breakthroughs don't just happen
9:51
because we have the tools to make them.
9:54
They depend on how innovation happens in the real world.
9:58
And there's something else that I've learned from them
10:01
that I find much harder to stomach.
10:04
Many of them might not have happened at all.
10:07
So when I think back to that stream of innovation,
10:11
all of those breakthroughs and all of that progress that we've seen,
10:15
I do find it amazing.
10:16
It's incredible.
10:18
But it also really frustrates me.
10:21
That's how much progress we've made despite it being so hard.
10:26
The good news is people have come up with ideas to change that.
10:29
Some of them really work, like the ones I've told you about today,
10:33
and they just haven't been used enough.
10:36
But we also need people to come up with new ideas
10:38
and test them and scale them up too.
10:41
I think it's more important than ever that we do it,
10:43
because of cuts to science, global health and foreign aid,
10:47
we have to find ways to make our resources go further.
10:51
Progress isn't inevitable.
10:53
It takes people who decide to persist despite that.
10:57
And I think here it takes people
10:59
who recognize something quite simple.
11:02
That diseases are not a fact of life.
11:06
They're problems that we can solve.
11:08
Thank you.
11:09
(Applause)
