Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.
Nathan Myhrvold's talk "Could This Laser Zap Malaria?" got me thinking about the relationship between inventors and implementers of health-related technology, particularly technology aimed at tackling important health issues in developing countries. According to the World Malaria Report (2012) of the World Health Organization, 219 million people globally were sick from malaria in 2010, and 660,000 died from it, with the majority of the deaths occurring in Africa, and children being disproportionally affected. Symptoms include headache, fever, chills, vomiting, seizures, convulsions and coma. It is a terrible way to die.
Malaria parasites are transmitted by mosquitoes, and there are three common approaches to malaria control: vaccinating humans against malaria infection, preventing mosquitoes from biting humans, or (to be frank) killing the little buggers. But no effective malaria vaccines have been discovered as of yet, and repellants and bednets are only effective if consistently and properly used. And they are not. This leaves the nuclear option: killing.
The idea of eradicating malaria by killing mosquitoes with innovative technology is seductive. Its simplicity harkens back to John Snow's insight that London's cholera epidemic could be stemmed by removing the handle of the Broad Street pump. Cholera in London was being spread by a tainted local water supply; cut off the supply, and you stem the cholera. Similarly, kill the mosquitoes, and you stop them infecting humans. Snuff out the vector. Better still, scientists seem underwhelmed by the ecological impact of wiping mosquitoes off the face of the earth. So this is literally a case of good riddance. Ending malaria is just a matter of designing technology that can get these little devils into our crosshairs and out of our existence.
When it comes to lasers that zap mosquitoes, implementers are likely to ask a lot of pragmatic and mundane questions. Where are you going to set these lasers up first? -- Stuart Rennie
But hang on a minute. For decades, public health professionals have warned against 'magic bullet' approaches to disease control. Developing a technological innovation (be it a drug, device or a machine) is generally not enough in itself to make a significant impact on a disease on a population level. This is painfully evident in developing countries, whose citizens often do not have access to medical inventions (like antibiotics or MRIs) that were developed decades ago and currently standard of care in more affluent settings. In order to effect real change, you need more than inventors: You need implementers. Who are implementers?
Implementers are those who take innovations, and try to turn them into the 'new normal' in the field, in communities, in health care systems. When it comes to lasers that zap mosquitoes, implementers are likely to ask a lot of pragmatic and mundane questions. Where are you going to set these lasers up first? Can they only be operated by experts? What happens when they break down? Will locals 'buy in' to the idea of lasers being set up in their communities? How will they take to this? And given that there are billions of mosquitoes to kill, are foreign and local governments committed to support laser technology mosquito eradication efforts over the long haul? Implementers are highly sensitive to the social, political and economic circumstances that both determine health and throw up challenges to any newfangled ways of improving health. Implementers also fear the effects of half-baked public health initiatives, particularly when the attention of funders and governments gets drawn to the Next New Thing.
Compared to invention, implementation is unsexy work. You are more likely to get a Nobel Prize for invention than for implementation. Editors of leading medical journals are generally more interested in new drugs than they are about how to deliver the drug effectively in rural Ghana. Of course, in the face of serious and persistent diseases like malaria, we do need inventors and their innovations. But to fulfill the promise of human ingenuity, and ensure inventions to improve global health are more than laser light shows at prestigious conferences, we desperately need the implementers too.
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