By Dr Rachel Chikwamba
When society is not in the throes of a health emergency, it can be difficult to show the economic returns of public investment in science. There are ever-present demands on the public purse – health, education and other services – hence the decline in the amounts directed at research.
Covid-19 showed us how one needs to always have a strong toolkit of technologies to have a chance of responding effectively to a crisis.
Decades of work
mRNA technology delivered the first two vaccines (from Pfizer and Moderna) for protection against Covid-19. It’s worth realising that these two vaccines were launched off a decades-long platform of research that had not demonstrated much practical utility until the Covid-19 pandemic.
Closer to home, the capabilities built over many years in public research institutions – such as the CSIR, the SKA initiative, as well as universities and private-sector players – allowed us to build much-needed breathing equipment to address the ventilator crisis for critically-ill Covid-19 patients.
We know that another pandemic will come – it’s a question of when. Much as disease surveillance can assist with this question, “when” remains a huge unknown.
We can also anticipate more crises related to the changing climate. With so many unknowns, we best prepare for what challenges may come by developing the knowledge we do have, and the tools we can readily mobilise.
That means investing in science, technology and innovation.
But how can we build these capabilities and encourage more investment in science?
The capabilities we require range from disease surveillance, genomics, candidate vaccine molecule identification, production of prototypes and the attendant techno-economic, preclinical and clinical development, all the way to large-scale production.
Sustained support
We have seen a strengthening of the capacity for large-scale production in Aspen, and in the RNA hub. In Biovac, we see global collaboration, and we have also seen a surge in the number of innovators and SMMEs delivering valuable innovations at pace.
Support for these capabilities must be sustained, and must not become a once-off spike.
Investments have also been made in the areas of genomics and disease surveillance. Such investments must be planned and become part of the annual budgets of the responsible government departments.
South Africa and many parts of the continent have managed to strengthen their research and development capabilities over recent decades, and our increasing scientific outputs and publications are testament to this.
From research to manufacture
A missing link is the ability to translate these knowledge assets into tangible products. To this end, we have seen the government invest in translational research at institutions such as the CSIR, where open-access infrastructure and technologies for vaccine antigens, ranging from bacteria and plants and yeast, to mammalian cells, are being built – as well as skills around this.
Such investments should be shored up by further investments from the public and international sectors to avoid having many fragmented initiatives without achieving strategic capabilities.
By far the greatest step forward would be to see the private sector investing in such programmes. There is funding available, but private enterprise would be more keen to invest if we could define the necessary initiatives, with clear performance criteria.
Better research, better health outcomes
There is anecdotal evidence showing strong links between investments in research and technology development and better access to innovative health products. The developed world and countries such as India could historically leverage technology investments to make vaccines for their populations, which left those in the low- and middle-income countries scrambling for vaccines supplies.
Better healthcare outcomes are of course also dependent on the overall healthcare systems in which the research and development takes place. Health economists have also shown a link between the investments in, particularly, medical research and development, and better economic outcomes.
Social-science investment
Still, there is evidence of poor access to healthcare, even in developed countries that invest heavily in research and development. A case in point is limited access by some parts of the United States’ population to life-saving insulin for diabetes treatment.
Hence, I encourage also investing in social-sciences research and public health to better understand how to improve the efficiency of healthcare delivery for better health outcomes.
During the Covid-19 pandemic, the severest impact on the poor, in my view, was associated with the inability to carry out normal economic activities.
Here, the learning is that when the next pandemic hits, instead of hard lockdowns, we might consider rather making available masks and sanitisers, and promoting social distancing, even as we let the communities go about their normal economic activities.
This is not to say that the lockdowns of 2020 were not necessary at the time. Hindsight is 20:20, and at that stage we did not know what we were dealing with. We are wiser now, and it is key that we apply our learning from the recent past to be better equipped in future.
Ultimately, the best way of reducing pandemic impact on the poor remains vaccination, protecting people from severe illness, and helping them remain economically productive.
Dr Rachel Chikwamba, CSIR Group Executive: Advanced Chemistry and Life Sciences.
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