The Grand Challenges in Global Health
The Grand Challenges in Global Health (GCGH) is a research initiative launched by the Bill & Melinda Gates Foundation that, if embraced by creative thinkers around the world, might bring about real progress in the health of the developing world. The word "thinkers" is an important distinction because the program encourages leaders of every discipline to contribute, whether it be engineers, biologists, pharmacists, scientists, etc. The program is founded on the assumption that with increased support and funding, contemporary science and technology can contribute to the fight against diseases affecting the developing world. With the  generous offering of grants for projects, proposals are welcomed as they fit one of a set of 14 challenges, categorized in groups among seven stated goals. With the targeting of specific challenges, the initiative focuses on a variety of health problems inherent in today's developing world. While the 14 challenges are direct, the scope of the project is comprehensive as it welcomes strategies of prevention, diagnosis, detection, examination, etc. The disciplines involved may include immunology, microbiology, genetics, molecular and cellular biology, entomology, agricultural sciences, clinical sciences, epidemiology, population and behavioral sciences, ecology and evolutionary biology, etc. History. In January  2003, Bill Gates first announced the Grand Challenges in Global Health at the World Economic Forum in Davos, Switzerland. In partnership with the National Institutes of Health (NIH), the Bill & Melinda Gates Foundation (BMFG) granted $200 million to the Foundation for the National Institutes of Health (FNIH). The goal behind the initiative was to fund research to advance the fight against disease that disproportionately affects people in the world's poorest countries. At this time the scientific board's responsibilities were outlined: to identify scientific or technological innovations that have a global impact or show potential for feasibility. In  May 2003, the scientific board requested ideas through widespread advertising and marketing strategies. These announcements welcomed innovative ideas, and more than 1,000 suggestions from scientists and institutions in 75 countries were submitted by July. The scientific board met to further discuss these proposals, which were presented orally with a statement of the problem, descriptions of obstacles to progress, the challenge itself, and a discussion of potential benefits and priority areas for study and application. The following questions raised during the meetings reflect the difficulty in defining these Grand Challenges: Does the proposal describe a difficult and discrete roadblock to progress ? What is the likelihood that creative solutions are required and that grant proposals worthy of funding will be received to address it? Is there already substantial scientific activity aimed at solving the problem, which would make the intent of a grand challenge redundant? What are possible impacts on various diseases if the challenge is successfully met? Will envisioned advances be suitable for implementation in poorer parts of the world? In October 2003, the scientific board announced the 14 Grand Challenges. In August 2004, the evaluation of letters from around the world led to over 400 full proposals. Experts assessed proposals  and the Executive Committee of the scientific board and staff members from FNIH and BMGF reviewed the projects to move into the negotiations for grants. In May 2005, The Bill & Melinda Gates Foundation gave an additional $250 million to fund research for the initiative, bringing the foundation's commitment to $450 million. In June 2005, the initiative announced grants for 43 new projects, attracting international partners. Today, the work towards revolutionary advances in global health continues. 44 separate research projects are currently being managed, and solving even one of the 14 challenges could potentially improve the lives of  millions. The Grand Challenges. Goal 1: Improve Vaccines Goal 2: Create New Vaccines Goal 3: Control Insect Vectors Goal 4: Improve Nutrition Goal 5: Limit Drug Resistance Goal 6: Cure Infection Goal 7: Measure Health Status Today: The GCGH is launching a new Grand Challenge in Family Health. Currently, two new grant opportunities exist under this challenge: Explorations. Grand Challenges Explorations promotes invention in global health research. The Bill & Melinda Gates Foundation has committed $100 million to support scientists across the world in increasing the span of ideas to fight our most daunting health challenges. Launched in 2008, Grand  Challenge Explorations grants have already been awarded to 495 researchers from 42 countries. Currently, nearly 500 researchers from over 40 countries are using Grand Challenges Explorations grants to experiment with groundbreaking ideas. While some are pursuing radioactivity to kill infected cells, others are trying to develop a waterless toilet that is cost efficient as well as environmentally productive. The Explorations grant initiative requires two short page applications but no preliminary data. Applications are submitted online. Initial grants of $100,000 are awarded two times a year. Successful projects have the opportunity to receive a follow-on grant of up to  $1 million and could eventually evolve into Grand Challenges project. ESC Program. The key challenge associated with such large-scale research projects called for by the initiative is the addressing of ethical, social, and cultural (ESC) issues related to the Grand Challenges. Dr. Peter Singer and Dr. James Lavery and a team of colleagues are employing projects to address these barriers, but for the GCGH initiative to be successful, compliance and collaboration with this concept is absolutely critical. Project Goal. The Ethical, Social, and Cultural Program of the Grand Challenges in Global Health, launched in 2005, is targeted to  address the ethical, social, and cultural issues that may arise as a result of the initiative- either in the development of the research itself, or in the implementation of knowledge and technology by the communities in need. The GCGH ESC program is the first significant science project concentrated entirely on ESC issues linked to the developing world. ESC issues can have a series of consequences that involve new technologies and approaches: rejection of safety precautions or genetically modified foods, for example, because of culture sensitivity or perceived health, environmental, or economic risks. The ESC program assumes that science and technology  are essential to global health development, but the appropriate development of this technology requires attention to the accompanying ethical, social and cultural issues. The program aims to link ESC activities with the research projects and to include voices from the developing world within these projects. Its two main goals are (1) to provide an advisory service for GCGH projects and (2) to create a research program to facilitate appropriate adoption of them in the long-term. The Bill & Melinda Gates Foundation is in compliance with this idea and granted money in November 2005 for the program to be carried out . The program is described and discussed at length in a series of four articles published in PLoS Medicine. ESC Issues. In defining ESC issues, the program's creators underwent a process of document analysis, group discussions with investigators and program staff, and interviews with experts from the developing world. The findings include thirteen issues that include: community engagement, public engagement, cultural acceptability, gender, post-trail obligations/benefit sharing, collaboration, the involvement of civil society organizations, affordability, accessibility, regulatory issues, collection, management, and storage of tissue samples, corruption and poor governance, and unintended consequences. Program milestones. Advisory service. The ESC advisory  service was created to address ESC issues identified at the start of GCGH research projects, as well as challenges encountered as projects progress. The aim is to work in a close, unified way with the investigators on ESC issues appearing in their projects and thus guide the achievement of their milestones. An advisory service co-leader and a lead bioethicist are assigned to each GCGH project. During the initial phase of communication, the co-leader and lead bioethicist define the issues and develop a strategy for addressing the challenge's issues based on their specific expertise. A process of consultation  with the GCGH program officers has also been implemented to help identify issues within the challenges and its individual projects. The program officers often join the advisory service conference calls and offer expertise and insights that help anticipate ESC concerns. Research program. The goal of the research program is to provide knowledge in order to facilitate the successful adoption of technology by GCGH's targeted communities. With working papers, working groups, global case studies, and demonstration projects on public engagement, research enhances the ESC expertise with respect to specific goals of the Grand Challenges. Criticism. As is the case with  most health initiatives, the GCGH have been subject to a fair degree of criticism. A very widely circulated critique was published in 2005 in "The Lancet". In the column, Anne-Emanuelle Birn, Sc.D., an associate professor of Public Health Sciences at the University of Toronto, described the initiate's role as "weak" for focusing too narrowly on the power of science and neglecting the importance of economic, social, and political factors. She cites the 20th century cultural obsession with technological advancement as one that cannot ignore the need to redistribute economic and social resources within impoverished communities. She  suggests that rather than trying to finance, develop and distribute new and existing vaccines, a more sustainable effort might focus on public support for a universal, accessible public health system. She references Goal #4, which involves improved nutrition, as a specific challenge that is shortsighted and "overlooks key distributional questions". She explains that because malnutrition and famine are not the result of technical obstacles, but rather, political and economic ones, technology is not the answer. These issues are not about supply or the lack of nutritional value available in foods, but rather, poor income distribution and market shifts leading to  populations unable to afford food.