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Sunday, October 30, 2016

The Latest Weapon in The Fight Against Disease Might Surprise You

Written by: Sue Desmond-Hellmann
CEO at Bill and Melinda Gates Foundation

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When most of us think about combating or curing diseases, the first thing that tends to come to mind is improving the effectiveness of drugs - either as vaccines to limit the spread, or medication to treat the infection. 

Medical and scientific advances remain incredibly important and always will. But today, another resource that you wouldn’t immediately associate with healthcare is also helping to turn the tide on a number of conditions – data.

Gathering evidence and analyzing information have always been essential to progress in health. When I was part of a team developing treatments for breast cancer, we conducted years of clinical trials. Each stage included pouring over our findings in order to perfect the drug. 

This was the start of the precision medicine revolution and our approach focused on an individual’s unique biological make-up. One of the most exciting prospects for the global health community now, is how we can use non-medical data to complement medical research and transform the lives of entire populations.

Think about how the presidential campaigns are using census data and other household surveys to identify and canvass potential voters; or how marketers are able to pinpoint people most likely to respond to their mailings and advertisements. We can exploit similar resources to look beyond a patient’s physical characteristics to better understand their physical environment - and how that may affect their health.

There’s a great example of this happening right now that I got to hear about this month in Cincinnati, Ohio. Here’s what’s happening. By combining existing data from a variety of sources, a team from the Children’s Hospital has linked poor housing conditions in a particular neighborhood to high levels of chronic asthma among children. That in itself may not sound too surprising – poverty and poor health often go together. But in fact, it’s incredibly profound because it changes our whole approach to treatment and prevention.

In this case, medical therapies, such as a steroid inhaler or airway opener muscle relaxant, like albuterol, are only providing short-term fixes. To ensure children are not constantly returning to hospital, the long-term solution lies in making sure their homes are free from mold, water damage, cockroaches and other pests - all of which exacerbate asthma. In Cincinnati, that means doctors and lawyers are teaming up to address serious housing code violations.

What the Cincinnati research demonstrates is that systematically tackling asthma requires examining both a patient’s biological and geographical circumstances. This allows for a more focused approach, which is the foundation of a concept known as precision public health. 

Precision public health brings the right interventions to the right populations, at the right times. And I believe it has the potential to revolutionize healthcare. The benefits are obvious: care is greatly enhanced, clinical outcomes are improved, and scarce resources can be targeted to those most likely to benefit – thereby cutting costs.

There is also the potential of using non-medical data in other areas of public health. The same technology your car sat-nav uses to help you steer clear of traffic jams, can be used to compile data sets that map outbreaks of infectious diseases. More precise disease surveillance, means we can respond with greater precision.

What’s happened with Zika – a virus spread by mosquitoes that can cause certain birth defects – is a case in point. Detailed information about the location of incidences, including charting the changing course of the outbreak, means resources are concentrated where they are most effective. That in turn means that unnecessary damage, which can be caused by blunt application of emergency measures where they aren’t needed, is avoided.

In Haiti, weak surveillance left significant questions about the extent and location of the Zika outbreak unanswered. Advice to women - including both Haitians and travelers – about the risk to pregnancy is inadequate, and costly travel restrictions have applied to the entire country for a prolonged period. 

In contrast, when Zika was initially identified in the U.S., it was pinpointed to one county in Florida - and only a 1.5-square-mile area of a single neighborhood was declared a high-risk area. This allowed for both the limitation of economic damage from travel restrictions and the concentration of effective mosquito control measures.

This capacity to map and track the Zika outbreak is especially useful for efforts to combat the disease that involve mosquitoes infected with a bacteria called Wolbachia, which can significantly reduce the capacity of insects to transmit viruses to humans, being released into affected communities. 

The science part comes from the Eliminate Dengue program, a non-profit international research collaboration based in Australia. It has pioneered ways to inoculate the mosquito species primarily responsible for transmitting Zika - and an array of other debilitating and often deadly diseases - with the Wolbachia bacteria. The data part is being able to narrow down precisely where to release these mosquitoes in the hardest-hit communities, in a thoughtful and targeted way that minimizes the exposure to people and the environment.

Over time, bringing together science and data in this way could dramatically reduce new cases of Zika and other viruses, especially among young children.
Eliminate Dengue has been conducting field trials for several years. We’re so excited by its potential at the foundation that – together with the U.S. and UK governments and the London-based charitable foundation, Wellcome Trust– we have decided to support efforts to step-up the program in Colombia and Brazil.

I am a clinical scientist. My experience in laboratories tells me that scientific and medical breakthroughs don’t just save lives, they also help people lead healthier, more productive lives. My conviction tells me that data are now an essential part of bringing that endeavor to life.

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