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| Interview with Herwig KOLLARITSCH |
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A right to
health? Health and the Millennium Development Goals.
(Translation, original interview is in German.)
• Goal 1: Eradicate extreme poverty and
hunger
• Goal 2: Achieve universal primary
education
• Goal 3: Promote gender equality and
empower women
• Goal 4: Reduce child mortality
• Goal 5: Improve maternal health
• Goal 6: Combat HIV/AIDS, malaria and
other diseases
• Goal 7: Ensure environmental sustainability
• Goal 8: Develop a Global Partnership
for Development
Out of 8 Millennium Development Goals, three are dedicated to health
issues, goal 6 specifically addresses Malaria. In your experience, have the
MDGs had an impact on the spread of Malaria? What changes could you observe
over the last 8 years, and which of those would you attribute to the MDGs?
Dr. Kollaritsch: We are discussing
a topic set in a long-time scale.
Changes can rather be noticed and
measured in a smaller scale, especially through projects. Global changes and
improvements of a health problem on a massive scale (malaria, HIV/aids,
tuberculosis …) not only require health specific interventions but also a
change in society – and such changes must be planned long-term.
E.g. HIV/Aids is an “information
problem”: societies, which are strongly infected by HIV/Aids, should be helped
and pushed to fight the problem from within.
This requires long-term strategies
which involve a whole generation and more. No concrete changes on a bigger scale
are therefore apparent after 8 years.
Health problems being on the agenda
of developing countries is very positive, indeed. This fact can at least be
seen as a start. Health problems in developing countries are a “bottomless pit”
which we just started to fill up.
Some big
international foundations are already engaged in health topics, for example the
Bill & Melinda Gates Foundation: http://de.wikipedia.org/wiki/Bill_&_Melinda_Gates_Foundation
From this perspective the MDGs are
a trigger for initiatives and others join in.
Goal 6 addresses HIV/Aids and malaria directly. Will
the future bring a breakthrough or an improvement in HIV or malaria research
and respectively on which area will this happen sooner if at all?
Dr.
Kollaritsch: I don’t see any immediate breakthrough on malaria research. What
is missing is a systematic and critical examination of the treatment in
affected areas - keyword “vector control”.
I
participated in a project in
It’s a
similar situation with HIV/Aids. The HIV/Aids treatments are already very
advanced. Life expectancies of HIV-positive
persons are nearly the same as of non-infected persons. But such treatments
cost a fortune and are hardly affordable in developing countries.
Malaria treatment
in comparison is considerably cheaper.
The
possibilities for HIV-patients in poorer countries in gaining access to such high-standard
treatments are very limited. Malaria doesn’t have any other host than the human
being and the combat against malaria is slightly easier and cheaper.
Example
Such is not as easy done with
HIV/Aids: an infected person will always stay infected and can not be cured
completely.
Other diseases are addressed generally in goal 6.
According to your opinion, on which disease should the research focus be
stronger?
Dr.
Kollaritsch: I would definitely name Tuberculosis. Especially the highly
resistant tuberculosis –treatment options are slowly running out.
And in
addition the tuberculosis problem is interlinked with the HIV/Aids problem.
A few words
on epidemics in general: We have to assume, that in short intervals (months and
years) new viruses come along. Lots are locally bound, but others have a high
pandemic potential (e.g. bird flu).
That’s why
a very important pillar of healthcare systems is the consequent and effective
monitoring of infections.
To do so,
developing countries need to get instruments transferred.
It is much easier
to combat a disease before it spreads out than to be unprepared and therefore confronted
with pandemics.
WHO already
made huge progress – by now a well developed worldwide monitoring is existent.
Nevertheless there is still enormous need for action.
I would like to discuss with you the role of science in development and
the combat against poverty and tropical diseases such as Malaria. Health issues
are often seen as humanitarian issues only, and investment in health research
is often a privilege of ‘Northern Societies’. What arguments would you bring
forth to support or discourage investment in science in so called developing
countries?
Dr. Kollaritsch: This is not an
exact question - research is a very broad. Local and sustainable research is a
positive and very good cause. Whereas I am strongly against the transfer of
high-technology-medicine into developing countries without taking proper
measures beforehand. For example it would be of no use to set up a hospital with
the standards of the
There are enough examples of such projects
which after a few years were no longer able to provide efficient service.
Of course, it is easier to present
and merchandise such projects in the media. However the actual benefit should
always be questioned.
Investment in local infrastructure
is often the considerably wiser choice.
Goal 1 wants to eradicate extreme poverty and hunger.
Goal 2 wants to achieve universal primary education (/ promote education)
Can you see a direct connection/relation between those
first two goals and the health specific goals?
Dr. Kollaritsch: A direct
correlation between hunger and education exists: the better someone is
educated, the easier it is to find a job and get enough to eat. Health problems
are often a question of information and education: for example, water should often
be boiled before drinking. Of course it would be better if water sources were
provided, from which people are able to drink directly without any danger. But
anyhow the relation between poverty and education is striking.
From your point of view, should the emphasis of
research be shifted more towards health issues or are these already
sufficiently covered?
Dr.
Kollaritsch: We should be thankful that there are initiatives at all. As
mentioned before, there is a “bottomless pit”.
If it’s
going on in this intensity and the means for use are optimised, then eventually
an improvement for the affected populations will occur.
Why did you decide to focus on malaria and infectious
diseases?
Dr.
Kollaritsch: Infectious diseases are a very exciting field to work on. Not only
because of their characteristics. Lots come direct from nature, they are
subject to complicated cycles and complicated biosystems. Some viruses are very
resourceful in utilising ecological niches. And all these connections are
extremely interesting to explore.
In your personal experience, what have been the most
compelling moments in your career as scientist?
Dr.
Kollaritsch: Before my active career, in the field and thematically: together
with the invention of antibiotics the fact that Watson and Crick decoded the
structure of the DNS molecule. These were definitely significant milestones in
the 20th century.
Since the
time I’m personally active as a researcher: the fact that vaccines against
infectious diseases were discovered. They not only allow individual
prophylaxis, but furthermore the control of diseases. For instance it was
possible to eradicate the pox entirely.
A reason
for my personal development to a vaccine specialist is that in this area it is
still possible to make a difference.
What should be done or changed, so that more means are
provided for research related to development (policies?) and respectively what
must be done or changed to mobilise civil society and the public sphere?
Dr. Kollaritsch: Action programs to
mobilise public opinion are important. The image and prestige of such measures
which support development must be emphasised. Private investors need to get
something in return. A crucial increase of social prestige also means
advertisement for the investing companies.
In this field need for action persists:
Firms need to recognise that competitive advantage can be reached through
investment in development cooperation. The gap between institutional and
private aid or sponsorship is (still) too big.
Is there any question which we didn’t discuss but you think
is really important?
Dr.
Kollaritsch: Indeed: the history of prestige of the pharmaceutical industry.
The public
image of the pharmaceutical industry is a bad one and that’s something I’m
personally unhappy about. The pharmaceutical industry should not be demonised a
priori and in principle.
Because the
prestige of this industry nowadays is much worse than 30 years ago and the
branch itself sees no way out, they no longer invest in less profitable drugs
since it is useless anyway. The already existing damage to the image of the
pharmaceutical industry is concerned as too big already.
Furthermore
because of the modern shareholder systems drugs need to be profitable. That’s
why governmental institutions should set their focus stronger on projects which
won’t be profitable immediately.
The area of
tropical medicine is extremely neglected by the pharmaceutical industry. The
expected budgetary benefits are often too minor.
Public
authorities and above all the media are called upon to provide incentive and
motivation to make such projects increasingly more attractive for
the pharmaceutical industry. Interview: Matthias Weissgram.
--> Back (Topic of the Month July 2008: A right to health? Health and the Millennium Development Goals.)
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