The path from basic scientific discovery to effective therapy is rarely rapid or simple, especially in the developing world. Making this transition easier is a sizeable and pressing problem. What is the best way to tackle such a complex issue?
One important step is to identify the factors that help and hinder the uptake of health-related biotechnology in developing countries. Although knowledge about these factors in developing regions is lacking1, the spread of technologies and ideas across cultures has been studied extensively for several decades. The complex issues involved in the development of new technologies cover areas as diverse as science-capacity building2, culture3, economic analysis4, foreign investment and imports5, public–private product-development partnerships6, intellectual property7 and political policy8. These issues, however, have mostly been explored in the context of the developed world and in isolation from one another, which means that the bigger picture remains unclear.
The diversity of factors involved in the developing world is illustrated by several recent events. Treatments for HIV infection are urgently needed in Africa, yet clinical trials of the anti-HIV drug tenofovir were halted in Cambodia, Cameroon and Nigeria because of claims that efforts to inform and involve local communities were inadequate9. And, in the face of famine, the Zambian government rejected food donated by the United States because it was genetically modified10. On a longer timescale, there was a large delay between the development of a vaccine against hepatitis B in the developed world and its widespread availability in the developing world.
At present, there is great interest in exploring such issues because of the unprecedented increase in financial resources for improving the health of individuals in the world's poorest countries. For example, since 2005, biomedical research projects focusing on the developing world have received US$450 million from the Grand Challenges in Global Health initiative of the Bill & Melinda Gates Foundation. With the increase in resources comes added responsibility to ensure that optimal improvements are made.
We set out to identify the factors, or forces, that affect the uptake of health-related biotechnology in the developing world. To do so, we interviewed 70 key experts from various sectors — academia, industry, civil society (voluntary and civic organizations) and government — in developing countries (see Supplementary Information for full details and breakdown).
These interviews allowed us to identify eight key areas that affect the development and adoption of health-related biotechnology in resource-poor regions. These areas can be categorized into four main forces: scientific, social (including ethical and cultural), financial and political. As a result, we were able to generate a model that can be used to assess the likelihood of success of health-related biotechnologies (see graphic).
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