27 February 2021 | New Scientist | 43Rowan Hooper is podcast editor
at New Scientist and author
of How to Spend a Trillion Dollars
(Profile Books, 2021)bucket when it comes to what is required
to free humanity of all disease and extend
everyone’s lifespan. But what if we set our
trillion dollars to the same goal? When I
put this to Jeremy Farrar, head of Wellcome,
one of the world’s largest medical research
charities, with an endowment of around
£30 billion, he laughed. A trillion dollars is
nowhere near enough money, he said.
When you look into what needs to be done,
you get a better idea of the scale of the task.
Much of the research and spending on public
health work is siloed as a result of being
directed at specific diseases. Take the global
effort to eliminate malaria, which kills
about 400,000 people each year, most of them
children under 5, and mostly in sub-Saharan
Africa. Around $4.3 billion per year is spent
on malaria. But it is just one of dozens of
infectious diseases. And as well as targeting
those, we would also need to spend globally on
the other three main disease categories: heart
disease, neurological disease and cancer.
We would burn through our trillion dollars
and only make a fleeting impact on health and
lifespan. If you want to make immense gains in
public health on a global scale, and make them
equitable and sustainable, there is one thing
that needs to be implemented. It is difficult,
complex and expensive, which might be why
it isn’t something that is much talked about
or invested in by billionaires. It is universal
healthcare (UHC): free healthcare, for everyone.
In 2013, an international Lancet commission
put together an investment framework to
achieve what it called a “grand convergence”
in health by 2035. By this they meant reducing
deaths from infectious disease, as well as
child and maternal mortality, in low and
middle-income countries to the levels seen in
the best-performing middle-income countries.
This, the framework predicts, could prevent
more than 10 million deaths in 2035.
The commission found that UHC isn’t only
the most efficient, but also the only sustainable
way to achieve a convergence in global health.
Their framework was written before the
coronavirus pandemic, but the response of
countries like Singapore and South Korea,
in contrast to that of the US, shows that UHC
is a good protector for pandemics, too.
As Farrar says, a trillion dollars isn’t
enough to change the world’s healthcare
system, so here’s another idea. We allocate
some of our money to building a universal
healthcare system in one country, which
becomes a flagship, an advert to other
countries of the benefits of UHC investment.
Let’s choose Ethiopia. With a population
of more than 100 million, it has a large
economy, but only about three doctors per
100,000 people. The UK has almost three
doctors per 1000 people. Maternal and child
mortality in Ethiopia are relatively high,mainly because most births take place at
home, without the presence of a trained
modern midwife. Our investment would
make Ethiopia more like Ghana, where there
are around five midwives per 1000 births
and much lower maternal mortality rates.
Ghana operates a universal service through
its National Health Insurance Scheme.
So a sizeable chunk of our trillion goes
on a demonstration of^ UHC. Another
should go on vaccines. The development,
testing and equitable distribution of a vaccine
is a huge and costly undertaking – but one
that could save millions of lives.
We will fund the Coalition for Epidemic
Preparedness Innovations, a global partnership
working on vaccines for many so-called
emerging infectious diseases, including
covid-19. We can help boost vaccination rates
around the world, but we can also move the dial
at the basic research level. As well as covid-19,
effective vaccines against HIV, malaria and
tuberculosis would be transformational. In all,
320 or so emerging infectious diseases have
been identified since the 1940s. And if we can
create a universal flu vaccine, we would be
protected from what is still one of the greatest
health threats to our species: a flu pandemic.
Jessica Metcalf, an infectious diseases
biologist at Princeton University, has proposed
a programme of sampling people’s immune
systems that would allow scientists to pick up
signs of new pathogens as they emerge.
The coronavirus won’t be the last such threat.
But Metcalf says her Global Immunological
Observatory would help “rapidly detect,
define and defeat future pandemics”.
Again then, this is money that could hardly
be better spent – a sentiment that came up
time and again as I was researching the book.
The lesson I learned along the way was clear.
A trillion dollars might sound like an immense
amount, but the benefits of spending such
a sum on these projects would pay back
handsomely, and often quite quickly. ❚Universal health care
is by far the best way
to make immense gains
on a global scale
The coronavirus
pandemic has shown
that tackling emerging
infectious diseases
must be a priority