Research Article: Grand Challenges in Global Health: The Ethical, Social and Cultural Program

Date Published: September 11, 2007

Publisher: Public Library of Science

Author(s): Peter A Singer, Andrew D Taylor, Abdallah S Daar, Ross E. G Upshur, Jerome A Singh, James V Lavery

Abstract: The Grand Challenges initiative has 44 projects worldwide aimed at addressing diseases of the poor. What are the ethical, social, and cultural issues that the initiative faces?

Partial Text: The Grand Challenges in Global Health (GCGH) initiative is a major effort to achieve scientific breakthroughs against diseases that kill millions of people each year in the world’s poorest countries. With 44 projects, more than US$450 million in funding, and scientists from 33 countries, it has the potential to greatly reduce the suffering and death that disproportionately affect the 2 billion poorest people on earth. The 14 Grand Challenges serve seven long-term goals in global health [1], which are shown in Box 1.

To our knowledge, the first large-scale science project to address ESC issues systematically was the Ethical, Legal and Social Implications (ELSI) program of the Human Genome Project. In 1988, James Watson determined that 3% of the project’s budget should be devoted to ELSI issues, raising this number to 5% in 1991 [9]. Although the ELSI program has stimulated efforts to inform the public about risks in genetic research and to deal with those concerns through research and education projects, a Science commentary on ELSI in 1996 revealed reservations about the program’s “blurry mandate” and distance from the applications of the actual science [9]. Watson himself suggested that he saw ELSI initially as a way merely to deflect criticism from those wary of the consequences of genetic research, saying “It kept us from being attacked” [9]. An independent review of the ELSI research programs in 2000 criticized the limited number of voices informing ELSI research and recommended drawing on “theoretical perspectives from outside the traditional community of ELSI researchers” from a “broader array” of disciplines and communities [10].

The goal of the advisory service is to facilitate the successful and appropriate achievement of milestones in the GCGH projects in the short- and mid-term. Below we discuss the advisory service consultation model and give examples of two advisory service consults.

The goal of the research program is to fill gaps in knowledge in order to facilitate the successful and appropriate adoption of the technologies resulting from the GCGH projects by communities in need in the long-term. The research program was designed to address cross-cutting issues in the GCGH projects. It has been shaped by a review of the project proposals, the results of the focus groups of GCGH investigators and program staff, and the survey of key informants in the developing world. Perhaps the most significant question addressed by the research program is: Assuming some of the projects are successful and the technologies are developed, how will they reach the communities that need them in the developing world? Below we discuss four aspects of the research program that offer insight into that question.

We believe that the ESC program is an innovative approach to dealing with key ethical issues in a large-scale science program that seeks to improve human well-being in the developing world. Our approach combines conceptual reflection, empirical research, and service activities. It incorporates input from research programs, funders, and the broader community of potential beneficiaries of research. The key features of this program, which may serve as a model for other large-scale science initiatives, are the close linkage of ESC activities to the science projects themselves, and the extensive inclusion of voices from the developing world.



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