There is ambition and there is Silicon Valley ambition. For where else on a map could a pin be placed when asked to guess where billionaire philanthropists had declared their intention to cure, prevent or manage all human disease before the end of the century?
It was clear from the start that the announcement from Priscilla Chan and her husband, Mark Zuckerberg, nudged at the boundaries of belief. Writing in praise in the US journal, Science, David Baltimore, a Nobel laureate at California Institute of Technology concedes the goal “may raise eyebrows”. Even Cori Bargmann, the renowned neurobiologist who will lead the charge, is aware how it might be perceived. It is “ambitious”, she says, “but not completely ridiculous”.
It is tempting to dismiss the Chan Zuckerberg Initiative as hubris. But the best part of a century is a long time in medicine. Most babies born in 1900 did not live to see the age of 50. Medicine has not been the only reason for the dramatic rise in life expectancy since, but it was a crucial factor. “By 2100 we’ll be shocked by how much we’ve achieved, and we’ll be more shocked with initiatives like this,” says Jim Smith, chief of strategy at the UK’s Medical Research Council.
If not hubris, then what about one-upmanship? Bill Gates wants to eradicate malaria in a generation. Elon Musk wants a Mars colony in a decade. Yuri Milner has set his sights on sending a spacecraft to a star at one-fifth the speed of light. How better to leave your mark higher on the wall than to make every human disease obsolete within your child’s lifetime? Or at least find a way to manage awful conditions, so they no longer mar people’s lives?
But audacious goals are precisely what are needed. “We have to be bold about the scale of the challenge we face in improving human health,” says Steve Craddick, professor of chemical biology at University College London and director of innovation at the Wellcome Trust, the world’s largest biomedical research charity. “What is truly important about this kind of approach is that it creates the hope you need to go from exploratory science to making the world a better place.” He goes on: “Aspiration is essential. This idea that if we put our minds to it, almost anything is possible – that is what can sustain people through the peaks and troughs of decades of research.”
Chan and Zuckerberg will stump up at least $ 3bn (£2.3bn) for the effort over the next 10 years. That is not a vast sum for the task ahead. The new Francis Crick Institute in London, now filling with 1,400 scientists, could be built and run for 10 years on that. The Wellcome Trust itself will spend £5bn on biomedical research in the next five years alone. But part of Chan and Zuckerberg’s hope is to grow a movement to fund science: where they have led, they want other wealthy individuals to follow. An audacious, long-term goal backed by world-class scientists is the way to make that happen.
As Chan and Zuckerberg state, four types of diseases cause most of the deaths in the world: heart disease, cancer, neurological diseases and infectious diseases. The research kicked off by the initiative will focus on the basic science underlying them. The rationale is sound: it takes fundamental breakthroughs to make a real difference in medicine.
The first step is a $ 600m “Biohub” that will draw scientists and engineers from the Bay Area’s leading institutions: Stanford, the University of California, San Francisco and the University of California, Berkeley. The hub has two major projects lined up already. The Human Cell Atlas will map out the internal workings of every cell type in the body, a mammoth task that is bound to open up new avenues in medicine. The Infectious Disease Initiative aims to bring fresh thinking to drug design, diagnostic tests and vaccines. According to Tom Solomon, a neurologist and director of the Institute of Infection and Global Health at Liverpool University, such radical new approaches could be as important as the money itself.
And yet in Silicon Valley, it seems the only solutions are hi-tech solutions. This is one area where Chan and Zuckerberg may fall short in their aim to leave the world a better place for children. Only 10% of health research funds are spent in developing countries, where 90% of preventable deaths occur. The Chan Zuckerberg Initiative will apparently direct three-quarters of its efforts towards heart disease, cancer and neurological disease, the chronic conditions of the west. That may leave too little emphasis on infectious diseases.
A recent report from the World Health Organisation made clear that unless developing countries have the means to gather and study their own medical data, public health is unlikely to improve. It is the old adage about teaching a man to fish. Childbirth still kills hundreds of thousands of mothers and babies in low-income countries. To prevent those deaths does not require a scientific breakthrough. It takes know-how and facilities.
“It is not as sexy as saying you are going to develop a drug or a vaccine, but what is needed is research capacity development,” says Trudie Lang, director of the global health network at Oxford University. “Nurses, midwives and community health workers need to be trained and supported. It’s hard to get funding for it, because you can’t show how many lives you have saved, but it is absolutely vital,” she says. “It’s a slow win, but it’s what they should be doing.”
Cure all diseases? The Chan Zuckerberg plan is brilliantly bold | Ian Sample
