As someone who is dedicated to improving the health of the world’s populations, Pasteur Network Executive Director Rebecca Grais may surprise people when she says she has a problem with the term “global health.”
Grais’s concerns are rooted in fairness and equity.
Speaking at the Yale School of Public Health Dean’s Lecture & Epidemiology of Microbial Diseases/Yale Institute for Global Health Seminar on Feb. 16, Grais said global health can be viewed as a collaboration between people in high-income countries and low- to middle-income countries in which most of the funding comes from outside of the country where the research is conducted.
“One of the consequences of this setup is that there's an extreme global mismatch,” said Grais, whose lecture was titled, “Muddling Through: Research for Public Health, Global Health, and Crisis.”
Any definition of global health is contentious and problematic, she said, and the global mismatch that often arises has consequences.
Grais said an example of the mismatch in global health is that only about 2%-5% of randomized controlled trials (RCTs), which are critical to the development of vaccines, drugs, and therapeutics, are conducted in Sub-Saharan Africa. This low investment in research and development perpetuates a reliance on a very small number of well-resourced funders, philanthropies, and industry.
“The wealthiest and best-equipped institutions, which are almost always located in the Global North, have a significant advantage,” Grais said.
As a result, people “in high-income countries that come with the power to make changes,” have “pretty much failed both in crises and outside of crises.” The reasons for these failures can include sparse data; limits in terms of presentation, formulation, and storage of the available vaccines; political considerations; lack of decision-making guidance; and poorly adapted methodological approaches among others.
She gave several examples, including a randomized, double-blind, placebo-controlled phase 3 trial to assess the efficacy and safety of a rotavirus vaccine against severe rotavirus gastroenteritis among infants in Niger that was hampered by sparse data.
Successful global health projects depend on good financial and human resources management, professional development, equitable partnerships, and ensuring that research is relevant to the communities in which it is being conducted, Grais said. The Pasteur Network, comprised of 33 members worldwide, does this by working to promote global health through shared Pasteurian values, which include humanitarianism, universalism, rigor and dedication, freedom of initiative, knowledge transfer, and free access to information.
Grais is known for her seminal work on vaccine trials. Her primary areas of interest are the prevention of infectious diseases and emerging infections in low- and middle-income countries. She has particularly focused on population-based studies of the effectiveness of public health interventions and efficacy trials of novel vaccines and therapeutic agents.
“Dr. Grais has decades of boots-on-the-ground experience working with partners from low- and middle-income countries,” said Albert Ko, Raj and Indra Nooyi Professor of Public Health and professor of epidemiology (microbial diseases) and of medicine (infectious diseases).
“It was critical for our students to hear this vision of global health, and how global health grounded in the framework of health and research equity is not only critical to achieve just and effective prevention and control but to empower communities and low- and middle-income countries, and correct long-standing problems, such as colonization, which is inherent in the field,” Ko added.
During her lecture, Grais emphasized the importance of semantics in global health. “Global health is multicultural and multilingual, and most of these projects fail for lack of common understanding of roles and responsibilities and priorities.”
She told the audience that learning from mistakes is important. “In terms of the projects that you conduct, sharing lessons about failures is an essential component.”