Posts Tagged ‘science diplomacy’
By: Steven Brooks, PhD
Science diplomacy is an important conduit through which nations can cooperate with each other to help address issues of common concern. Establishing international collaborations based on scientific research and resource sharing can be a valuable tool to promote advances in global health and to help foster research communities in developing nations. In 2001, Nelson Mandela proposed a model for building and advancing a network of institutions investing in Science, Engineering, and Technology (SET) across sub-Saharan Africa (SSA) to enhance economic diversification, promote job growth, and improve living conditions for peoples across the region. Since then, significant strides have been made by many international organizations, including the World Health Organization, World Bank, and United Nations, to invest in SET institutions and researchers across SSA. Much work is still needed, however, to address the significant global health disparities affecting SSA. According to the United Nations Development Programme, life expectancy in SSA is on average only 46 years. Among the largest contributory factors to this gap is HIV/AIDS, but non-communicable diseases and genetic conditions such as Sickle Cell Disease (SCD) contribute as well. SCD in particular offers a stark geographic contrast in disease outcome: in the United States, childhood mortality (up to age 18) from SCD is below 10%, while in SSA the early childhood mortality rate is 50-90% by age 5. This drastic difference in childhood mortality from SCD raises an important question- why is the difference in mortality rates so large, and what can be done to eliminate it?
SCD represents a significant public health success in the United States. From the early 1970s, average life expectancy of people with SCD has substantially increased from 14 years of age to over 40 years, and childhood mortality rates have continued to decline. These vast improvements in SCD mortality in the US are attributable to improvements in screening and early diagnosis, as well as surveillance for early childhood infections and prophylactic treatments. Availability of therapies like hydroxyurea and access to blood transfusions have also contributed to reducing childhood mortality, while several currently ongoing clinical trials in the US are testing the use of bone marrow transplantation as a curative procedure for patients with severe complications of SCD. While the best practices for diagnosing and treating SCD are well-established in developed nations, lack of global implementation has meant that these advances in treatment have had very limited effect on reducing mortality and improving quality of life in developing nations. More than 85% of all new SCD cases occur in SSA, with over 240,000 infants with SCD born in SSA annually (compared to less than 2,000 in the US). Many nations in SSA do not have the resources or personnel to implement protocols for screening and diagnosis, and many children are born outside of hospitals. As a result, most children born with SCD in SSA will go undiagnosed, and therefore untreated, leading to devastatingly high rates of early childhood mortality for children with SCD.
The disparity in health outcomes between children born with SCD in developed nations and developing nations in SSA should be addressed through science diplomacy. An opportunity exists for diplomatic cooperation between scientists and health officials from the US and their counterparts in SSA to build infrastructure and train researchers and healthcare professionals to diagnose, treat, and innovate new solutions for SCD. The crucial first steps towards improving outcomes in SCD – parental and newborn screening, early childhood nutrition standards, parental and community education, and anti-bacterial and anti-viral vaccinations and prophylaxis – are achievable through diplomatic efforts and collaboration with governmental health agencies across SSA. Proof of this concept has been demonstrated in Bamako, Mali, with the success of the CRLD (The Center for Sickle Cell Disease Research and Control), a SCD-specific treatment and research center that reflects an effort of the government of Mali, with funding and medical resources provided by the Foundation Pierre Fabre. The CRLD utilizes modern diagnostic techniques to screen for SCD. It also provides immunizations, hospitalizations, and access to preventive medicine, and provides education and outreach to patients and to the larger community. Historically, the infant mortality rate from SCD in Mali was estimated to be 50% by age 5. Since the opening of the CRLD in 2005, only 81 of the over 6,000 patients enrolled at CRLD have died, a mortality rate for this cohort that is comparable to rates in the US and UK. The CRLD also has modern laboratories that conduct research, with over 20 academic papers published from the CRLD so far. The ongoing success of the CRLD is proof that investment in, and collaboration with, governments and medical professionals in Africa can lead to equitable health outcomes in SCD. Similar investments by the US government and the National Institutes of Health (NIH), possibly through intramural research programs, and in cooperation with health-focused private foundations, could lead to similar success stories in communities across SSA.
The NIH supports and facilitates collaborations in global health research through the NIH Fogarty International Center (FIC), which currently sponsors projects in 20 countries across SSA. NIH has also invested intramural resources into collaborations in SSA to combat Malaria. The National Institute of Allergy and Infectious Diseases (NIAID) trains and sponsors investigators to independently conduct research in Mali (NIAID’s Mali ICER (International Centers of Excellence in Research)). Despite its significant history of investment in SSA, the NIH offers almost no international support for research related to SCD. The NIH FIC only currently funds one project related to SCD, preventing pediatric stroke in Nigerian Children. The Division of Intramural Research at the NIH is currently home to robust basic science and clinical-translational research on SCD. Intramural researchers can and should collaborate with clinicians and scientists from SSA who will lead the effort to combat SCD in their home nations. More broadly, the NIH could spearhead an initiative to bring together stakeholders from the US government, health ministries from nations in SSA, and private foundations that support efforts to reduce or eradicate global disease, to begin establishing a network of laboratory and clinical facilities for testing and treatment, as well as to train clinicians and researchers from SSA in diagnostic and research techniques specific to SCD, and to design and disseminate educational resources for increasing communal knowledge regarding SCD across SSA.
In addition to significantly improving SCD mortality and health outcomes in SSA, these efforts of science diplomacy will have substantial benefits in the US as well. The US is home to a sizeable, and growing population of people living with SCD. As life expectancy continues to increase, new challenges will arise for effectively treating serious complications associated with SCD, such as renal disease, stroke, cardiovascular disease, heart failure, cardiomyopathy, and pulmonary hypertension. By collaborating with researchers and healthcare leaders studying large populations of people with SCD in SSA, the NIH will foster innovation and generate new insights about SCD that are uniquely informed by the data and perspectives of African scientists and populations. The NIH and the US government can establish a mutually beneficial program of treatment, education, and research that will enable developing nations to treat their patients with the same methods available in the US. Investing in 21st century methods of diagnosis and treatment, as well as contributing funding, training, and infrastructure to clinicians and researchers in SSA, can strengthen diplomatic relationships between governmental leaders and scientists alike and lead to lasting collaborations that strengthens research and innovation into new treatments for SCD.
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By: Steven Witte, B.Sc.
Located less than 90 miles apart, Cuba and the United States share many of the same environmental and public health challenges. Invasive species such as lionfish, African catfish, and marabou are threatening native species. Oil drilling in the Gulf of Mexico poses a potential risk for an environmental disaster, and tourism is threatening coral reefs and other important ecosystems. And recently, the Zika virus and chikungunya have been spreading throughout the Caribbean. It is predicted the viruses may make their way to Cuba and eventually even parts of the United States. By working together, these two countries could develop better strategies to solve these problems. But cooperation between the US and Cuba has been extremely difficult for several decades because of strained relations between the two nations.
In the past, American and Cuban scientists have successfully collaborated together. In the mid-nineteenth century, the Smithsonian Institution in Washington, DC, established ties with two Cuban institutions in Havana: the Economic Society of Friends of the Country, and the Royal Academy of Medical, Physical, and Natural Sciences. Soon after, Jesse Lazear and Carlos Finlay, scientists from the USA and Cuba, respectively, collaboratively made crucial discoveries concerning the transmission of yellow fever, leading to effective preventive measures. During the Cold War, however, diplomatic relations between the United States and Cuba were severed. Further, embargoes were put in place preventing trade between the countries. As a result, Cuba could no longer receive funding or equipment from the United States, except in very specific circumstances. It also became difficult for American scientists to travel to Cuba for meetings, thus affecting scientific relationships.
Re-establishing scientific collaborations with Cuba would benefit both the US and Cuba in a number of ways. Vaccines or drugs are currently unavailable for Zika and Chikungunya viruses, and the best option is to closely monitor the spread of these diseases. Sharing data with Cuba, which already has observation programs in place, would help identify outbreaks and develop responses. The Cuban biotechnology industry has many products that could be used by Americans – for example, Cuba is an important producer of vaccines, exporting them to many other countries. More recently, a company in Cuba has developed a drug for treating severe diabetic foot ulcers, which can prevent the need for amputations. Other companies have products to prevent or treat many diseases that impact U.S agriculture and cattle, such as a vaccine for serious tick infestations. Cuba would benefit from scientific expertise in America, as well as funding and equipment that could be provided, as many of the research institutions in Cuba currently operate on small budgets. Allowing Cuban scientists to attend conferences in America would provide a healthy exchange of knowledge and expertise.
Over the past several decades, many attempts have been made to re-establish scientific relationships with Cuba. During President Jimmy Carter’s administration, the National Science Foundation (NSF) considered establishing links with Cuban research institutions and tried to finance joint research projects, but these goals were never realized. More recently, the Center for Science Diplomacy of the American Association for the Advancement of Science (AAAS) has made several visits to Cuba to promote scientific cooperation. In 2014, the AAAS and the Cuban Academy of Sciences signed a historic agreement in which both organizations agreed to work together on four scientific areas: infectious diseases, cancer, antimicrobial resistance, and neuroscience. Following this agreement, Cuban and American scientists met in Washington, DC, and discussed plans to create further agreements on collaborations for ocean science research and conservation. In 2015, President Barack Obama’s administration re-established diplomatic ties with Cuba. Although this is beneficial for fostering scientific relationships, many barriers still remain. The trade embargo is still in effect, for example, and it is still difficult for scientists to travel to Cuba. However, progress has been made. The United States has enacted policy to allow Cubans to get educational grants and scholarships. And scientific equipment can now be donated to Cuba, unless it has potential military applications.
Going forward, several ideas have been proposed to foster scientific relationships between Cuba and the United States. High-level governmental agreements could go a long way in enabling scientific collaboration. Non-governmental organizations (NGOs) that work internationally in partnership with governments to try and solve global problems could also catalyze shared scientific programs. For example, the Clinton Climate Initiative has partnered with the governments of several island nations and helped them reduce their dependence on fossil fuels by using renewable energy. Others have suggested that the United States shut down its Naval base in Guantánamo Bay, and re-purpose the facilities as a marine research institution and peace park.
Regardless of the form it takes, cooperation between scientists in Cuba and the United States could benefit both countries as they address emerging environmental, public health, and biomedical problems. In addition, cooperation through science could pave the way to peaceful cooperation in other arenas between both countries, as they re-establish connections following several decades of unfavorable relations.
By: Courtney Pinard, Ph.D.
In one of the most impressive feats of synthetic biology so far, researchers have harnessed the ability of bacteria to fight and destroy viruses, and have been able to precisely and cheaply edit genetic code using a genetic technology called clustered, regularly-interspaced short palindromic repeats (CRISPR) and CRISPR-associated endonuclease protein 9 (Cas9). CRISPR has been used to find and detect mutations related to some of the world’s most deadly diseases, such as HIV and malaria. Although CRISPR holds great promise for treating disease, it raises numerous bioethical concerns, which were sparked by the first report of deliberate editing of the DNA of human embryos by Chinese researchers. Previous blog posts have described scientific discussion surrounding the promise of CRISPR. At least three scientific research papers per day are published using this technique, and biotech companies have already begun to invest in CRISPR to modify disease-related genes. However, the use of CRISPR, or any genetic editing technology, to permanently alter the genome of human embryos is an issue of concern to a much broader range of stakeholders, including clinicians, policymakers, international governments, advocacy groups, and the public at large. As CRISPR moves us forward into the realm of the newly possible, the larger global, social and policy implications deserve thorough consideration and discussion. Policies on human genetic editing should encourage extensive international cooperation, and require clear communication between scientists and the rest of society.
There is no question that CRISPR has the potential to help cure disease, both indirectly and directly. CRISPR won the Science Breakthrough of the Year for 2015, in part, for the creation of a “gene drive” designed to reprogram mosquito genomes to eliminate malaria. Using CRISPR-Cas9 technology, investigators at the Universities of California (UC) have engineered transgenic Anopheles stephensi mosquitoes to carry an anti-malaria parasite effector gene. This genetic tool could help wipe out the malaria pathogen within a targeted mosquito population, by spreading the dominant malaria-resistant gene in 99.5% of progeny. The gene snipping precision of CRISPR can also treat certain genetic diseases directly, such as certain cancers, and sickle cell disease. CRISPR can even be used to cut HIV out of the human genome, and prevent subsequent HIV infection.
There are limitations of CRISPR, which include the possibility of off-target genetic alterations, and unintended consequences of on-target alterations. For example, the embryos used in the Chinese study described above, were non-viable, less than 50% were edited, and some embryos started to divide before the edits were complete. Within a single embryo, some cells were edited, while other cells were not. In addition, researchers found lack of specificity; the target gene was inserted into DNA at the wrong locus. Little is known about the physiology of cells and tissues that have undergone genome editing, and there is evidence that complete loss of a gene could lead to compensatory adaptation in cells over time.
Another issue of concern is that CRISPR could lead scientists down the road to eugenics. On May 14th 2015, Stanford’s Center for Law and the Biosciences and Stanford’s Phi Beta Kappa Chapter co-hosted a panel discussion on editing the human germline genome, entitled Human Germline Modification: Medicine, Science, Ethics, and Law. Panelist Marcy Darnovsky, from the Center for Genetics and Society, called human germline modification a society-altering technology because of “the potential for a genetics arms race within and between countries, and a future world in which affluent parents purchase the latest upgrades for their offspring.” Because of its potential for dual use, genetic editing was recently declared a weapon of mass destruction.
In response to ethical concerns, the co-inventor of CRISPR, Dr. Jennifer Doudna, called for a self-imposed temporary moratorium on the use of CRISPR on germline cells. Eighteen scientists, including two Nobel Prize winners, agreed on the moratorium. Policy recommendations were published in the journal Science. In addition to a moratorium, recommendations include continuing research on the strengths and weaknesses of CRISPR, educating young researchers about these, and holding international meetings with all interested stakeholders to discuss progress and reach agreements on dual use. Not all scientists support such recommendations. Physician and science policy expert Henry Miller disagrees on a moratorium, and argues that it is unfair to restrict the development of CRISPR in germline gene therapy because we would be denying families cures to monstrous genetic diseases.
So far, the ethical debate has been mostly among scientists and academics. In her article published last December in The Hill Congress Blog, Darnovsky asks: “Where are the thought leaders who focus, for example, on environmental protection, disability rights, reproductive rights and justice, racial justice, labor, or children’s welfare?” More of these voices will be heard as social and policy implications catch up with the science.
In early February, the National Academy of Sciences and National Academy of Medicine held an information-gathering meeting to determine how American public attitudes and decision making intersect with the potential for developing therapeutics using human genetic editing technologies. The Committee’s report on recommendations and public opinion is expected later this year. One future recommendation may be to require Food and Drug Administration (FDA) regulation of genetic editing technology as a part of medical device regulation. Up until recently, the FDA has been slow to approve gene therapy products. Given the fast pace of CRISPR technology development, guidelines on dual use, as determined by recommendations from the National Academies, should be published before the end of the year. So far, U.S. guidelines call for strong discouragement of any attempts at genome modification of reproductive cells for clinical application in humans, until the social, environmental, and ethical implications are broadly discussed among scientific and governmental organizations.
International guidelines on the alteration of human embryos are absolutely necessary to help regulate genetic editing worldwide. According to a News Feature in Nature, many countries, including Japan, India, and China, have no enforceable rules on germline modification. Four laboratories in China, for example, continue to use CRISPR in non-viable human embryonic modification. Societal concerns about designer babies are not new. In the early 2000s, a Council of Europe Treaty on Human Rights and Biomedicine declared human genetic modification off-limits. However, the U.K. now allows the testing of CRISPR on human embryos.
In a global sense, employing tacit science diplomacy to developments in synthetic biology may mitigate unethical use of CRISPR. Tacit science diplomacy is diplomacy that uses honesty, fairness, objectivity, reliability, skepticism, accountability, and openness as common norms of behavior to accomplish scientific goals that benefit all of humanity. The National Science Advisory Board for Biosecurity (NSABB) is a federal advisory committee that addresses issues related to biosecurity and dual use research at the request of the United States Government. Although NSABB only acts in the U.S., the committee has the capacity to use tacit science diplomacy by providing guidance on CRISPR dual use concerns to both American citizen and foreign national scientists working in the U.S.
Under tacit science diplomacy, scientific studies misusing CRISPR would be condemned in the literature, in government agencies, and in diplomatic venues. Tacit science diplomacy was used when the Indonesian government refused to give the World Health Organization (WHO) samples of the bird flu virus, which temporarily prevented vaccine development. After five years of international negotiations on this issue, a preparedness framework was established that encouraged member states to share vaccines and technologies. A similar preparedness framework could be developed for genetic editing technology.
Institutional oversight and bioethical training for the responsible use of genetic editing technology are necessary, but not sufficient on their own. Tacit science diplomacy can help scientists working in the U.S. and abroad develop shared norms. Promoting international health advocacy and science policy discussions on this topic among scientists, government agencies, industry, advocacy groups, and the public will be instrumental in preventing unintended consequences and dual use of genetic editing technology.
- By K. Shmueli
Despite some of the scientists I know behaving far from diplomatically, science diplomacy is an increasingly important endeavor which aims to improve international relations and solve pressing global problems encompassing health, security and the environment. A recent meeting exploring New Frontiers in Science Diplomacy introduced a useful conceptual framework highlighting the multiple dimensions of science diplomacy: Science in diplomacyinvolves informing foreign policy objectives with scientific advice. Diplomacy for science is the facilitation of international science, engineering and technology cooperation. Science fordiplomacy is the utilization of science collaboration to improve relations between countries.
Looking forward, science diplomacy may be most needed to tackle the challenges of global sustainability. Mechanisms such as the Intergovernmental Panel on Climate Change can help to inform global policymaking with scientific advice. It is not straightforward to measure the impact of such efforts in science diplomacy. One measure of success is the continuation of scientific relationships beyond the life of grant funding. Results in science and science diplomacy often take years to appear thus science and technology have become pillars of long-term strategic planning in the foreign policy arena.
Why is science diplomacy effective? Because scientists share a common language and values such as rationality and transparency, science can provide a non-ideological environment that helps to engage people across different cultures and build trust between nations even amidst political tensions. Using science and technology to address shared challenges can lead to mutual benefits. Scientific collaboration may also give access to influential and politically connected people in contexts where few channels for dialogue exist.
When does science diplomacy fail? Technology and knowledge transfer can be difficult between competitors, particularly where there are security concerns or with dual-use technologies. Asymmetries in scientific capabilities (e.g., between the USA and African nations) and lack of funding for international collaborative activities can also hinder diplomatically productive scientific partnerships.
For science diplomacy to work, scientific goals must be at the forefront and diplomatic goals should be clearly defined to avoid science being used for purely political ends. Some argue that, ironically, science diplomacy works best on an individual level when scientists focus on doing good science without an overt science diplomacy agenda.