Tag: Developing world

South Korea can boost the research potential of low-income countries

[ad_1]

South Korea has the resources and history to collaborate with low-income countries in a mutually beneficial way.Credit: imaginima/Getty

Science is often viewed, at least in its most idealized form, as a perfect form of public knowledge that is freely available to everyone. In principle, scientists in low-income countries (LICs) can consume and build on this knowledge to produce their own research. However, the processes of training scientists, acquiring and setting up equipment and materials, and organizing resources and personnel are not straightforward or found in textbooks. They involve tacit knowledge that is often embedded in specific organizational and institutional contexts, such as experimental routines and methods passed down through experiences, which present further barriers for many resource-limited nations.

Collaborative potential

International research collaborations can provide opportunities for LICs to overcome resource limitations, increase visibility and build sustainable scientific capacity. First, such cross-border partnerships can enable researchers in low-income regions to access resources and expertise that might not be locally available. Second, given that a substantial amount of the research produced by scientists in LICs is underappreciated — for example by being cited less on average — collaborations with more-research-intensive countries can help to boost the impact of their work. At the same time, collaborating with researchers in high-income countries (HICs) might, in principle, allow researchers in LICs to find more ways of understanding problems, by combining their local contextual knowledge about a subject with the general knowledge available in HICs.

2024 Research Leaders

Finally, and perhaps most importantly, international collaboration can help to pass on informal tacit knowledge about research practices to researchers in LICs. This can include information on organizing research workflows, securing funding, choosing impactful topics and training students, issues that are essential to developing local and sustainable scientific capacity.

However, despite the importance of international collaboration in building research capacity, LICs are still struggling to play a key part in international science. A preprint posted on 16 October¹ suggests that researchers in LICs are more likely than those in HICs to be included as middle authors rather than first or last authors in internationally collaborative papers. Such contributions are also more likely to be completely ignored so that those researchers receive no credit at all. For example, in clinical research, contributors from LICs are less likely to be granted authorship than are those in HICs. This is consistent with the trend of more LIC-based research projects being led by HIC institutions for ease of collecting local data. This pattern reflects deeper inequities: LIC scientists rarely lead research agendas or control project funding, limiting their ability to build independent capacity.

Honest broker

Steps are being taken to make collaboration more equitable, but the challenges might be difficult to overcome given the power and resource imbalances that exist between HICs and LICs. Often, these imbalances have deep historical roots, such as colonialism, or are being shaped by modern geopolitical trends, such as the rise of China.

With a strategic position that is not fully engaged in the US–China scientific rivalry, South Korea stands out as a country uniquely positioned to act as an ‘honest broker’ in research collaborations between HICs and LICs. Unlike many prominent powers that often dominate partnerships by controlling resources and decision-making structures, South Korea, free from colonial ties with LICs, has the potential to foster equitable, sustainable research partnerships (See ‘Index live: growing Korean research performance in an uncertain world’).

South Korea’s rapid scientific and technological development since the 1970s has endowed it with both the resources and experiences necessary to assist LICs. Furthermore, its close political relationships with the United States and European nations, along with strong geographical and historical ties to Asian science powerhouses such as China and Japan, give it a strategically advantageous position. With an increasing budget for international research collaborations, South Korea has a great opportunity to establish partnerships that are mutually beneficial, supporting LIC’s research-capacity building without imposing exploitative dynamics that echo colonial relationships, thus helping to advance scientific equity between HICs and LICs.

Previous cases have shown how successfully South Korea has already been acting in this respect in international science. One is the long-standing collaborations between South Korea and Brazil, which began in the 1990s in many fields, including nuclear energy, biotechnology, information technology and clean technologies. The resource disparities between the two nations were addressed by identifying mutually beneficial areas of collaboration — starting with nuclear energy and agricultural technology. More recently, this expanded to biomedical engineering — to tackle common health challenges such as brain diseases — and to astronomy, focusing on developing advanced optical systems for telescopes. The partnership esulted not only in numerous research publications, but also in South Korea’s inclusion as one of the first Asian participants in Brazil’s Science Without Borders programme, which facilitated the inclusion of hundreds of Brazilian students in science, technology, engineering and mathematics fields in South Korea.

Another example of South Korea’s aspiring role in promoting international science, particularly for LICs, was prominent during the height of the COVID-19 pandemic. The Korea Research Institute of Bioscience and Biotechnology and the National Research Foundation of Korea, both based in Daejeon, supported a three-year grant to build and establish an Asia–Pacific hub for Global Research Collaboration for Infectious Disease Preparedness (GloPID-R), focused on information sharing and proactive monitoring to prepare against infectious diseases. Given South Korea’s role as a hub country tasked with accommodating and addressing diverse and sometimes conflicting viewpoints from the Asia–Pacific countries, it is well positioned to lead the complex yet essential coordination of research collaborations in this area in a way that benefits the whole region.

These are just two examples, but they show how South Korea has been initiating and boldly taking opportunities to promote international collaboration, particularly with LICs. Despite this progress, it should remain vigilant against partnerships that resemble previous exploitative relationships and should strive to adopt non-discriminatory practices by including local authors who contribute to such research. Empowering these researchers can result in meaningful and productive collaborations that enhance autonomy for local scientists, boost motivation and improve research quality.

Index live: growing Korean research performance in an uncertain world

South Korea’s role in international research collaboration will be one of the core themes of a conference hosted by the Korea Advanced Institute of Science and Technology (KAIST) in Daejeon, South Korea, on 5 February 2025, and co-organized by Nature Index.

Titled ‘Index live: growing Korean research performance in an uncertain world’, the event will feature keynote presentations from world-renowned scholars in science policy, including Cassidy Sugimoto (Georgia Institute of Technology), John Walsh (Georgia Institute of Technology) and So Young Kim (KAIST), and panel discussions involving leading academics from South Korea and Japan.

More information and registration.

Nature Index’s news and supplement content is editorially independent of its publisher, Springer Nature. For more information about Nature Index, see the homepage.

[ad_2]

Source link

November 12, 2024
Is it time to give up trying to save coral reefs? My research says no

[ad_1]

I relocated from California to Placencia, on the coast of southern Belize, in 1995, when there were no paved roads, no vehicles and everybody walked around barefoot. Back then, I was working as a research assistant and scuba-diving instructor. That meant that I had access to Belize’s stunning coral reefs, but also that I began to witness — and document — an ever-more depressing decline in the reefs’ health.

In 1999, while managing Glover’s Reef Marine Reserve for the Belize Fisheries Department, I saw the effects of the 1998 global bleaching event caused by an El Niño followed by a strong La Niña — weather patterns resulting from variations in ocean temperatures in the Equatorial Pacific.

Coral reefs deserve evidence-based management not heroic interference

Then in 2001, the category-4 Hurricane Iris hit Placencia and the Laughing Bird Caye National Park 12 miles offshore, causing catastrophic damage. Laughing Bird Caye, part of the Belize Barrier Reef World Heritage Site, is crucial to local tourism. The devastation, for both the reef and the community, got me thinking about whether the corals could be re-established.

Coral-reef restoration or rewilding has since become the subject of often intense debate, with a growing number of scientists maintaining that it is a losing battle in a rapidly warming world. Specialists continue to argue over even such basic questions as ‘what is a coral?’ and ‘what is a reef?’, before you get to ‘how much coral cover restored counts as restoration?’ Some researchers question whether reef restoration can be done at scale, whereas others have made overzealous assertions about how easy it is, what it can achieve and how. Reef restoration has taken off — like yoga, I often joke — with ever-wilder ideas about how to ‘save the reefs’. Instead of ‘yoga with babies’, ‘yoga with goats’ or ‘yoga with snakes’, it’s ‘feed the corals’, ‘shade the corals’ or ‘mix in some probiotics’.

My and my team’s experiences, over almost two decades in Belize, show that coral-reef restoration projects can be an uphill battle. But — for now at least — done in the right way, the work can help the corals, their surrounding ecosystems and the communities that depend on them.

Great Barrier Reef’s temperature soars to 400-year high

It took four years to find funding to trial transplanting coral fragments from Belize’s outer reef to Laughing Bird Caye. But since 2010, a team of Belizeans and I have moved genetically distinct colonies of elkhorn coral (Acropora palmata), staghorn coral (A. cervicornis) and hybrids (A. prolifera) — amounting to more than 96,000 fragments — to Laughing Bird Caye and more than 20 other sites across 7 marine protected areas.

To better assess changes in coral cover, in 2014 we started using an imaging approach called diver-based photomosaics, a type of large-area imaging. Annual analyses of nine plots (each measuring 50–200 square metres) showed that coral cover increased from 4–6% in 2014 to more than 60% in 2021.

In 2019, we began using drones to assess larger areas, and, by 2021, showed that we had re-established live corals in more than 0.2 hectares of reef around Laughing Bird Caye alone. Although survival rates could turn out to be a lot worse this year, even after two major coral-bleaching events in 2023, nearly 80% of 1,200 transplanted A. palmata fragments at four Cayes in southern Belize had survived (these data are yet to be published).

‘Ecological grief’ grips scientists witnessing Great Barrier Reef’s decline

We are trying to keep portions of shallow reefs alive for as long as possible in a warming world, partially in the hope — which admittedly is thinning — that humanity begins to bend the warming curve so that corals can thrive again. But our experiences suggest that these efforts are likely to prove beneficial only if the water quality is good enough, and if living corals and macroalgae grazers are present. Macroalgal mats interfere with the settlement of coral larvae when they switch from their planktonic phase to the sessile one; sea urchins, crabs and other grazers keep levels of macroalgae down. No-take or highly protected marine zones are also crucial because they preserve species such as lobsters, which feed on the snails that feed on corals.

Restoration can have all sorts of benefits. It can provide a habitat for hundreds of species and protect shorelines from erosion and flooding. It can provide an economic boost, too — and not just by driving tourism. In 2013, a group of us founded an initiative called Fragments of Hope to continue our coral-restoration work. Since then, we have employed only people who live in Belize. More than 100 have trained with us so far. Last year, more than 70% of our operating costs (nearly US$250,000 per year) were spent in Belize. Each person who worked with us last year (for 20 hours a week) earned around $5,000. And this year, it will be around $10,000. This is in a country where the minimum wage is $2.50 per hour and the gross domestic product per capita was less than $7,000 in 2023.

Today, around 25 researchers from different disciplines use Fragments of Hope for their work. Environmental engineers are trying to quantify wave attenuation or work out how to improve waste-water treatment, and anthropology students are pursuing socio-economic studies.

I often feel like giving up. But as long as the corals don’t, nor will I. Whenever I see tiny remnants of coral fusing together — often in the space of a year — to create a living coating over what had looked like a huge dead coral skeleton, I am persuaded to keep trying. Fragments of Hope and other interdisciplinary learning hubs should not be abandoned yet.

Competing Interests

The author declares no competing interests.

[ad_2]

Source link

October 23, 2024
The global imbalance of neurological conditions

[ad_1]

High burden

The top ten neurological conditions by disability-adjusted life year (DALY) globally are shown for 2021. Stroke has more than double the DALYs of any other condition, at 160 million. In 2021, stroke was the third leading cause of death globally, after coronary heart disease and COVID-19.

Uneven impact

Rankings DALY rates* for neurological conditions are shown for high-income regions and sub-Saharan Africa. Conditions with a high impact in African regions have some of the highest DALYs for children under five globally. Autism spectrum disorder has higher DALY rates in high-income regions, but a lack of diagnostic tools in lower-income countries is a contributing factor.

Source: Steinmetz, J. D. et al. Lancet Neurol. 23, 344–381 (2021). Infographic by Bec Crew and Tanner Maxwell.

Time trend

The absolute number of global deaths attributed to neurological conditions has not changed much since 1990, but ageing and growing populations mean there are now more people living with these conditions. When age is standarized — all populations are given the same age structure, so the percentage of people under and over 40 years old is consistent, for example — death rates sharply decline.

Source: Steinmetz, J. D. et al. Lancet Neurol. 23, 344–381 (2021). Infographic by Bec Crew and Tanner Maxwell.

Workforce spread

Europe overwhelmingly leads in the number of neurologists and neurosurgeons per capita. The World Health Organization reports a significant difference between income groups, with low-income countries reporting a median of 0.1 specialists per 100,000 population, compared with a median of 7.1 per 100,000 population in high-income countries. These workplace population numbers are self-reported.

[ad_2]

Source link

October 2, 2024
Support the Pact for the Future

[ad_1]

The United Nations Summit of the Future took place shortly before the start of the General Assembly (pictured).Credit: Thomas Trutschel/Photothek/Getty

Last week’s United Nations General Assembly debate saw a lot of anger. Some was directed at the UN, some at powerful nations, for their seeming inability or unwillingness to do more to tackle the world’s crises. UN secretary-general António Guterres did not mince his words in his criticism of world leaders. “Conflicts are raging and multiplying, from the Middle East to Ukraine and Sudan, with no end in sight. The climate crisis is destroying lives, devastating communities and ravaging economies. New technologies, including artificial intelligence, are being developed in a moral and legal vacuum, without governance or guardrails,” he said.

The world is in what social scientist Pedro Conceição, the editor-in-chief of the UN’s annual Human Development Report, describes as a “new uncertainty complex” of inequality, planetary pressures and polarization. In 2019, the Human Development Index, a composite measure of well-being, dropped for the first time in its more than three-decade history, although it is now recovering. It is also extremely unlikely that any of the Sustainable Development Goals (SDGs) will be achieved by the UN’s self-declared 2030 deadline.

Yet, amid the anger and frustration, a different meeting, the UN Summit of the Future, brought a sliver of hope that a better future is possible: one in which science and cooperation are front and centre. Through a document called the Pact for the Future, Guterres says that he wants to “turbocharge” climate action and efforts to meet the SDGs. The 61-page text was signed off by world leaders on 22 September. It might be one of the few remaining opportunities that the world has to correct course.

Unearthing ‘hidden’ science would help tackle the world’s biggest problems

The pact is a list of 56 pledges across 5 themes, in which world leaders promise, among other things, to provide more finance for low-income countries; work harder towards peace and security; mobilize science; and listen more to young people. The document also advocates reform of the UN’s top level of governance, as well as changes to global financial institutions such as the International Monetary Fund and the World Bank. These organizations have not changed much since the end of the Second World War, when they were established in part to support countries devastated by the conflict.

The document already has its critics. Some are disappointed that there is no mechanism for monitoring whether the pledges are kept. Others see it as another example of governments getting unnecessarily involved in peoples’ lives. Some of these points are valid, although there are a number of concrete mechanisms for following up on the pledges, including ones on improving Internet governance while protecting its autonomy, and improving the world’s financial architecture. These are also reasons why it would be wrong to dismiss the pact. The benefits of such documents are as much about the process of writing them as they are their actual content, and need to be judged by what has changed from what came before.

Several things are worthy of note. First is the fact that there is a whole section of the report devoted to science. This is not always the case with system-wide reports from the UN’s highest office. For example, advancing science is not one of the SDGs. Some argue that it doesn’t need to be, because science implicitly underpins the process of achieving all 17 goals. This is true, but science’s invisibility at the highest level also means that it risks getting ignored. Guterres recognizes this. He has re-established a board of science advisers reporting to his office, which was originally established by his predecessor Ban Ki-moon, but wasn’t continued in Guterres’s first term. Also, as Nature reported last week, researchers, including those working at the UN, are pushing national governments to establish a much greater role for evidence in policymaking (see Nature 633, 493; 2024).

How to stop a looming ‘splinternet’

Second, the pact was produced through a radical process — for governments at least — that needs to be studied for its replication potential. Starting with its founding charter in 1945, the UN has grown to oversee hundreds of treaties and conventions, which set the rules for everything from managing road traffic to conserving endangered species. These agreements often have their own legally binding text, governing structure and complicated schedule of conferences. The existence of so many individual agreements makes it challenging to tackle cross-cutting issues. Most countries have no formal mechanism for different government departments to work together to achieve the SDGs.

What was novel about the creation of the Pact for the Future is that representatives from different countries and across individual SDGs had to cooperate to produce it. SDGs, such as zero poverty or education for all, need to be achieved individually, but they also intersect — reducing poverty has an effect on education, and improving education boosts poverty reduction. In creating the pact, Guterres’s team broke through these silos, something that researchers have long been advocating and that is in fact the 17th goal: working in partnership. Researchers should help UN member states to learn from this process.

Third, and appropriate for the document’s name, the pact is a call for nations to invest more in their young people and involve them in decisions now. It is the coming generations that will “live with the consequences of our actions and inaction”, as the document says.

Ultimately, the pact will live or die on the actions of its signatory countries. If they choose to collaborate, they can achieve goals much quicker. If they build walls between them, there is a limit to what can be achieved. Guterres and his team have shown what can be achieved by prioritizing evidence and using a partnership approach. It is now up to all of us who care about sustainability, peace and security to run with the baton that has been passed to us.

[ad_2]

Source link

October 1, 2024
Tackling the reality of noma

[ad_1]

Adamu, a 14-year-old noma survivor, is screened by physicians at the Noma Hospital in Sokoto, Nigeria. Adamu’s father has been pursuing reconstructive surgery since Adamu first fell ill.Credit: Claire Jeantet and Fabrice Caterini/Inediz

The deadly condition noma is awash with contradictions. It destroys tissue and bones in the most visible part of the body — the face — yet finding cases is difficult, because people who have been affected by the illness are often hidden away owing to stigma. It is typically perceived as a disease that affects people in only certain parts of Africa, yet it was found a century ago in Europe and North America and still affects people — typically children — around the world. Although the condition can be successfully treated with antibiotics, if caught early, anyone who is not treated at this stage is very likely to die.

Noma begins as an infection in the mouth, often seen as swollen gums that fill with pus. Treatment with readily available antibiotics can stop the disease in its tracks. In the absence of early intervention, however, the infection becomes gangrenous and much tougher to treat; large parts of the face, tongue and jaw are destroyed. “From there on, you can just do wound treatment and stabilize the patient, such as giving them infusions of nutrients,” says Anaïs Galli, a researcher at the Swiss Tropical and Public Health Institute in Basel, who has collaborated on a large study of noma.

Many people who do not receive antibiotics early do not survive; mortality can be as high as 90% in this group¹. “Most of them die in the gangrenous stage because you’re very prone to sepsis,” Galli says. Those who do survive might be robbed of their ability to speak.

The relative ease with which this can be avoided is a source of frustration to many. “We do not need fancy and costly treatment innovations to fight noma,” says Fidel Strub, who survived the disease. He has been working with another noma survivor, Mulikat Okanlawon, to raise awareness and help others who have experienced the disease, through an organization they co-founded called Elysium Noma Survivors Association in Stockholm. In May, the pair were named among the 100 most influential people in health in 2024 by Time magazine.

After decades of abject neglect by researchers, funders and governments, the tide might finally be turning for noma. In 2023, the World Health Organization (WHO) announced that the disease — which gets its name from the Greek word meaning to devour — would finally be included on its official list of neglected tropical diseases (NTDs). According to Stuart Ainsworth, an infectious-disease researcher at the University of Liverpool, UK, this recognition should help to usher in fresh initiatives to tackle noma.

Putting a disease on the official NTD list “provides global awareness and legitimacy in the eyes of funders and governments”, he explains — countries usually follow the WHO’s lead in deciding which diseases to prioritize. Shining an international spotlight on noma in this way, he adds, “translates into substantive increases in funding and subsequent innovation and research on new therapies and diagnostics”.

Persistent mysteries

The neglect of noma is shown in just how little is known about the condition. It is unclear, for instance, how many people are affected by it. The WHO reports that 140,000 new cases occur each year, but that figure is based on 1998 data. In 2003, a smaller estimate of 40,000 was put forth by scientists tracking incidence based on individuals in a cleft lip palate surgical centre¹. The real number probably falls somewhere in the middle, says Galli.

A portrait of Blessing, a 17-year-old noma survivor, taken at Noma Hospital in Sokoto, Nigeria. Stigma around facial scarring can make finding people with the disease difficult.Credit: Claire Jeantet and Fabrice Caterini/Inediz

Galli was part of an effort to gauge the current geographical reach of noma. Historical records indicate that noma was known in classical and medieval European civilizations. Dutch physicians in the sixteenth and seventeenth centuries noted that the rapidly spreading disease affected the faces of children and was an ulceration that differed from cancer. In the next couple of centuries, people realized that the condition was linked to factors such as poverty and malnutrition. With economic progress that allowed more parents to feed their children sufficiently, as well as the advent of antibiotics, such as penicillin, in the twentieth century, noma gradually disappeared from Western countries.

Many specialists thought that the disease was now limited to what they called the noma belt. This vast swathe of territory is predominantly in the Sahel region of Africa — a band that separates the Sahara Desert to the north and tropical savannas to the south, and that includes parts of Chad, Niger and Nigeria. But Galli and her colleagues found that the truth was more complicated². Although there is a concentration of noma cases in the Sahel, the disease is also found in many other places, including parts of Asia. In 2022, Galli and her colleagues reported an updated global distribution of noma that showed that people had been diagnosed with noma in at least 23 countries in the preceding decade.

“One of the most interesting things coming out of the literature today is the vast geographical spread of all the case reports,” says Elise Farley, an epidemiologist with international aid organization Médecins Sans Frontières (also known as Doctors Without Borders) in Cape Town, South Africa, who has studied noma extensively, including cases in Laos³. “Noma is frequently, incorrectly, framed as a disease that mainly affects children in Africa,” Farley says. In reality, she contends, it is found all around the globe.

Perhaps the most persistent mystery surrounding noma is its origins: scientists still haven’t identified the pathogen, or pathogens, that cause it. Ainsworth says that scientists have long suspected that the disease is caused by some of the same microorganisms that infect the gums in gingivitis. The corkscrew-shaped bacterium Borrelia vincentii has been implicated as a possible culprit, but so have other bacteria, and attempts to single out which one is to blame have been unsuccessful. “Every time it’s done you get a slightly different result,” Ainsworth says. “There’s no smoking gun.”

In the past few years, more scientists have begun exploring whether this murky outlook might be because noma is caused not by any one microorganism but rather by a disruption of the oral microbiome. Ainsworth is part of a team of researchers that has initiated a project to analyse samples from 20 children with acute noma in northern Nigeria. The team is applying an approach called metagenomics — a method that casts a wide net by bulk sequencing genetic material and seeing what turns up. The researchers hope that this will yield an unprecedented level of detail about which microbes are present in acute disease.

What is known is that risk factors for noma include severe malnutrition, along with weakened immunity as a result of other ailments such as HIV infection, cancer, tuberculosis or measles. Malnutrition can also weaken the body’s innate immune response, which is an essential first-line defence in mucosal barriers, such as those in the mouth. But not everywhere that experiences severe malnutrition has cases of noma. The paradox has led some scientists, including Ainsworth, to speculate that it is the absence of specific micronutrients in certain regions that might be a contributing factor. If this turns out to be true, then supplementation of those micronutrients might offer some protection.

A plan for the future

Even before the WHO’s inclusion of noma on its list of NTDs, there were signs that the research community was starting to look more closely at the condition. In the early 2000s, the number of papers published each year mentioning noma hovered in the single digits. In the past decade, however, the years in which more than a dozen noma papers were released have been more frequent. Although that’s still a small number, the increase represents a hugely significant change, says Philippe Guérin, an epidemiologist at the University of Oxford, UK, and director of the Infectious Diseases Data Observatory.

Luba cleans the wounds caused by noma on the face of her young daughter, Nasira; they live in a remote area more than 200 kilometres from the Noma Hospital in Sokoto, Nigeria.Credit: Claire Jeantet and Fabrice Caterini/Inediz

The WHO’s commitment to coordinating efforts to fight noma should only increase the attention paid to it. Although the exact amount has not yet been determined, the agency estimates it will spend US$600,000 on noma over the next two years. The money will be used to reinforce advocacy and help to carry out policy work to get noma included on the WHO’s road map for neglected diseases that charts activities through to 2030. “We see a growing interest around noma,” says Benoit Varenne, an oral-health specialist at the WHO’s department of Noncommunicable Diseases, Rehabilitation and Disability in Geneva, Switzerland.

“The inclusion of noma on WHO’s NTDs list has already been felt here,” says Abdala Atumane, who leads the oral-health department at the provincial health service of Zambezia in Mozambique. In January 2024, Atumane and his colleagues collaborated on a study with the Barcelona Institute for Global Health (ISGlobal) in Spain. All of this, he says, “has brought renewed interest in the disease to the country”. For example, Mozambique’s Ministry of Health already has plans to conduct more activities on noma. And, according to Atumane, the NTD designation has put the country’s noma efforts “on the radar” of the international community.

The results of the study have yet to be published. The preliminary findings, however, bring home the urgency of raising awareness about the disease at the local level. In a little more than three weeks of fieldwork, the team met 3 people with active cases of noma and 18 survivors. “Most of them were adults who had lived all their lives without knowing the name of the disease,” Atumane says. The results are also helping to map the need for preventive care, and highlighting gaps in care for survivors. “For existing cases, there is a great need for teams of plastic surgeons,” Atumane says.

Perhaps the most pressing challenge for scientists hoping to tackle noma, however, is finding people with the disease. Without a more active and organized search for individuals affected by the disease, and broader adoption of methods of diagnosing and categorizing cases, some researchers are concerned that the new found intensity in the fight against noma will be squandered.

The stigma that causes people to hide family members who have noma makes it harder to find cases. “You cannot deal with noma like with any other disease: the suffering and stigma are huge, and this factor needs to be taken in consideration,” Okanlawon explains. It’s also difficult to enumerate cases because the disease progresses so quickly. A person can reach the necrotizing gangrene phase in just two weeks. If they die from the infection, they might go uncounted.

Because of the challenges of finding individuals affected by noma, some scientists, including Farley, advocate for a more active approach. This might involve, for example, performing oral screenings as part of malnutrition surveys or vaccination programmes for other disease. Gallin agrees that piggybacking on existing health campaigns would be smart. These efforts “already access very remote populations, and often children in the age of noma-onset risk”, she says. “So they could screen orally, for first signs” to catch cases early enough so that antibiotics can avert the destruction of facial tissue and death.

When a person does present with symptoms, there can then be disagreement between researchers on whether the person’s oral infection can be called noma. The WHO has offered a five-stage system for categorizing cases: acute necrotizing ulcerative gingivitis, oedema, gangrene, scarring and sequela. But some medical experts have called for a simpler system. In 2022, a group of oral-health specialists argued that epidemiological studies should not count necrotizing gingivitis as a stage of noma⁴. That is because not all cases of necrotizing gingivitis progress to noma. To count them all as such, the authors of the paper wrote, “would make a mockery of the data about noma”.

Guérin thinks that getting researchers to agree on how to categorize and count cases of noma is essential for making progress. “If we don’t use a harmonized way to quantify it, it goes under the radar and nobody works on it,” he says.

The inclusion of noma in the WHO’s list of neglected tropical diseases could bring more consensus about how to classify stages of the disease, and bolster efforts to detect it early. According to Okanlawon, this might include awareness training for people in local communities so that they can take their children for intervention in the stages when the disease is still easy to treat. “If my grandparents knew,” she says, “they would have not allowed this to happen to me.”

[ad_2]

Source link

September 19, 2024
Why AI might be a game-changer for Africa

[ad_1]

To an outside observer, Olubayo Adekanmbi’s career in telecommunications epitomized success. At Airtel and MTN Group, two of the largest such firms in Africa, he applied artificial intelligence (AI) tools to help understand the consumer behaviour of 200 million mobile users in 20 countries, and designed ways of driving their consumption of products. He won awards for his work, but as his career progressed, he felt unfulfilled. “I began to think more about how these data could serve a greater purpose beyond commercial use,” says Adekanmbi, who lives in Lagos, Nigeria. “I felt it was time to make a difference.”

In 2016, Adekanmbi founded Data Science Nigeria, a non-profit group dedicated to bringing AI to sub-Saharan Africa. Since the group’s inception, Adekanmbi and his team have set up more than 100 AI learning clubs hosted by dedicated Data Science Nigeria tutors and volunteers at universities and community centres in 14 African countries, where people can come for weekly or bimonthly lessons in topics ranging from basic data-science literacy to expert-level machine-learning techniques. The group has launched programmes at universities and schools and, in 2020, published the first AI textbook for children in Africa.

Nature Index 2024 Artificial intelligence

In addition to education, Data Science Nigeria collaborates closely with academia, government, non-profit organizations and companies to create practical AI solutions to local challenges. “We try to demonstrate that, even with infrastructural gaps in Africa, we can still deliver the possibility of AI to everyone, everywhere,” Adekanmbi says. “We have the talents and the raw data sets to use AI to improve the quality of lives of people who need it most.”

Recent projects include a multilingual, voice-based chatbot that provides financial guidance to female business owners in Nigeria — for which Adekanmbi won a US$145,000 Global Grand Challenges grant from the Bill & Melinda Gates Foundation in 2023. During the COVID-19 lockdown, he spearheaded a project, funded by the Mastercard Foundation, to deliver a smartphone-based learning platform, underpinned by AI, for children without access to laptops or Internet connection. The technology reached millions of students and was listed by the United Nations cultural organization UNESCO as a top-100 AI project for meeting the UN’s Sustainable Development Goals.

Many other developers and researchers across Africa are using AI to design interventions and solutions that are tailored to local contexts and projects. But whether Africa can fully realize AI’s potential will depend on overcoming a number of hurdles, including a limited infrastructure for energy- and computing-intensive technologies and a relative dearth of computer-science expertise. Data scientists such as Adekanmbi are optimistic, though. They hope to see the continent become a global leader in AI tools that are not only technologically groundbreaking, but game-changers for communities and countries in the global south. “We’re trying to come up with solutions that are impactful and go straight to the societal needs we face,” says Rose Nakasi, a computer scientist at Makerere University in Kampala, Uganda.

Although relatively few people in Africa have training in computer science compared with countries in the global north, the continent is quickly catching up. This is thanks in part to groups such as Data Science Nigeria and Data Science Africa, a non-profit group based in Kenya, which has organized annual conferences and training events since 2015. The most recent conference — in Nyeri, Kenya — set a record with more than 300 attendees, says Ciira Maina, one of the organizers and director of the Centre for Data Science and Artificial Intelligence at Dedan Kimathi University of Technology, in Nyeri. Data Science Africa also provides research grants for AI projects that are geared towards social aims, and fellowships for computer scientists to visit partner institutions around the continent. Another group, Deep Learning Indaba, headquartered in South Africa, brings together the African AI community for an annual conference, and organizes mentorships, grants and awards.

The aim of all of these efforts is to nurture talent to design creative AI solutions “within the African context”, rather than borrowing solutions from outside the continent and “trying to apply them to Africa”, says Elaine Nsoesie, a data scientist and global-health researcher at Boston University in Massachusetts.

The focus on building local expertise is important for empowering African scientists and also for ensuring that solutions meet regional specific needs. Drug development is a clear example of why this is important, says Kelly Chibale, the Neville Isdell chair in African-centric drug discovery and development at the University of Cape Town, South Africa. Although Africa has the most genetically diverse population in the world, the vast majority of pharmaceuticals and vaccines are developed elsewhere and are rarely optimized for African people, Chibale says. Differences in metabolic rates can cause a drug that is designed to work for one population to be less effective, or even detrimental, in another. In short, “you’re overdosing or underdosing people”, Chibale says — a problem that can also contribute to the emergence of drug resistance.

Potential school drop-out cases can be identified by an AI model tracking behavioural data.Credit: Elen Marlen/Shutterstock

Chibale and his team use AI to speed up the discovery process and tailor drugs for African populations. One of their projects uses AI to identify genetic variants that are prevalent in the region, and which might affect the efficacy of malaria and tuberculosis (TB) drugs, owing to variations in metabolism. Their results can help to predict what the ideal dose of such pharmaceuticals should be relative to their patient population. In another project, supported by Schmidt Sciences — a philanthropic fund established by former Google chief executive Eric Schmidt and his wife, Wendy — Chibale and his colleagues use AI to predict potential interactions between drugs for treating conditions such as cancer and diabetes, and Mycobacterium tuberculosis, the bacterium that causes TB. Mycobacterium tuberculosis can change how the body takes up certain drugs, so Chibale and his team are also using AI to predict the best dosage for patients in such instances.

African computer scientists tailor their interventions by working closely with communities, Nsoesie says. A high dropout rate in schools, especially among girls, is a significant challenge in parts of Tanzania. Researchers from the Nelson Mandela African Institution of Science and Technology in Arusha, worked with teachers and parents to develop a machine-learning model that analyses information about students and predicts their likelihood of dropping out based on factors such as days missed and parental involvement in homework. Schools in the city are now using the tool as “an early warning system, so they can intervene”, Nsoesie says.

Africa’s ability to use AI can be hindered, however, by poor infrastructure. Reliable and affordable access to electricity and the Internet is not always guaranteed, says Miquel Duran-Frigola, co-founder and chief scientist at Ersilia, a non-profit organization based in Barcelona, Spain, that promotes open-source science as a way to tackle diseases in the global south. Rather than data being the limiting factor for pursuing AI solutions in Africa, Duran-Frigola says, it’s often a lack of computing power.

In the absence of such infrastructure, collaboration with the global north can provide a solution, Chibale says. Often, this has been Africa providing data and local expertise, while the global north offers funding and high-powered computing resources. More of these collaborations should be encouraged, Nsoesie says, but stresses that they need to be equitable so that knowledge is exchanged and built on.

Duran-Frigola and his team have a collaboration with Chibale and several other computer-science groups in Africa. A few universities are forming more formal partnerships, too. In 2023, for example, the Guild of European Research-Intensive Universities, a consortium of 22 European academic institutions, and the African Research Universities Alliance, a group of 16 leading African universities, established a programme called the Africa-Europe Clusters of Research Excellence to exchange PhD students between the two continents, including in the fields of AI and data science.

“These partnerships are strong because they’re equal,” says Joyce Nabende, who heads the Artificial Intelligence Lab at Makerere University, which is a member of the new exchange programme. “We’re co-supervising students and working together to develop models.”

Despite the challenges around infrastructure, AI provides the potential to be revolutionary for African research, says Gemma Turon, co-founder and chief operating officer of Ersilia. “The biggest opportunity is to use AI as a way to produce research that’s cheaper, faster and can cover gaps in data,” she says.

Nabende, Nakasi and their colleagues, for example, created an app called Ocular that uses a 3D-printed adapter that attaches a smartphone’s camera to the eyepiece of a microscope and uses a predictive AI model to determine whether cervical lesions are likely to be cancerous or not. This helps health-care workers, particularly in underserved regions, to quickly identify women who need a lengthier screening process. “We think this will be a very good first line of testing for nurses,” Nabende says. They are also using the same technology to detect malaria and tuberculosis in patient samples. The technology could be a “game changer” for both remote facilities where there are no pathologists, and for urban hospitals where patients far outnumber doctors, Nakasi says. The program will automatically file the findings electronically, saving doctors’ time and providing live data for officials in the event of an outbreak.

Pipeline of potential

In Nigeria, Adekanmbi and colleagues are pursuing practical applications, including a chatbot that will allow women to talk confidentially about contraception in their own language. This is important, Adekanmbi says, because women can be prohibited from seeking out information for cultural reasons.

According to Maina, programmers in Africa are leading efforts to create tools for working with ‘low-resourced languages’, or those that lack a robust digitized database. It’s important to pursue this, he says, because although many African people do speak English, it usually isn’t their mother tongue. Africa also has higher rates of illiteracy than other parts of the world, Adekanmbi adds, driving “a critical need for voice-first AI solutions”. For this reason, in 2023, Adekanmbi and his Data Science Nigeria colleagues launched a start-up to develop hyperlocal language data sets to train Africa-centric AI models, a project for which they won backing from the Gates Foundation.

African computer scientists are also getting involved in designing appropriate policies and guidance on AI usage — ones that they hope will put guardrails in place for safety and inclusivity while not stifling technology. This year, Adekanmbi began meeting with figures from government, industry and academia in Nigeria to develop a national strategy for AI. The aim, he says, is to create a bespoke strategy, “because we have our own unique challenges”.

AI might even be able to assist with policy making itself, says Uzma Alam, who leads science-policy engagement for the Science for Africa Foundation, a non-profit group that promotes science and manages grant programmes in Africa. It could help, for example, with evidence gathering, analysing current trends and writing first drafts of new policies — including those related to AI. Although human input would still be crucial, Alam says, there are “steps we could improve and make more efficient using basic AI”.

“Africa has a unique opportunity amid so many pressing health challenges to shape the future of AI and its capabilities in health care,” Nakasi says. But establishing inclusive policies that provide regulatory and ethical standards — while also supporting innovation — will be necessary for “ensuring a beneficial outcome”, she adds. “The AI revolution in Africa is no longer just a possibility — it is already under way.”

[ad_2]

Source link

September 18, 2024
Tackling antimicrobial resistance needs a tailored approach — four specialists weigh in

[ad_1]

This month, world leaders are gathering at the 79th session of the United Nations General Assembly in New York to discuss the problem of bacteria, fungi and protozoans increasingly evolving resistance to antimicrobial drugs. Historically, solutions have focused on high-income countries, even though 4.3 million of the estimated 5 million deaths associated with infections of drug-resistant bacteria occur in low- and middle-income countries. Ahead of the UN meeting, four specialists — from Bangladesh, Brazil, Nigeria and the Middle East — told Nature which changes will be most crucial where they live.

SENJUTI Saha: Bangladesh

Senjuti Saha sees the need for a global commitment to support data collection on resistance.Credit: Vivan Mehra

For more than a decade, I have seen the impact of antimicrobial resistance (AMR) on people, particularly newborns, at first hand. Bangladesh Shishu Hospital and Institute in Dhaka — one of the collaborating organizations of the Child Health Research Foundation, where I work — is the country’s largest children’s hospital. Here, six out of every ten babies with infections caused by multidrug-resistant Klebsiella pneumoniae bacteria die, often just a few days after being infected.

In Bangladesh, a major difficulty in the fight against AMR is the lack of data on which bacteria are infecting whom, on how the various strains respond (or not) to which antibiotics and on how decisions are made about which drugs to use.

Stop delaying action on antimicrobial resistance — it is achievable and affordable

Bangladesh’s health-care system is unusual in that most people receive treatment in community clinics, diagnostic centres and pharmacies rather than in hospitals. People tend to go to hospitals only when treatment obtained from these other places fails. But because most of the country’s AMR data come from hospitals, government officials, clinicians and microbiologists have a skewed understanding of the problem.

Thanks to biases in the available data, many people think, for instance, that resistance is ubiquitous. Physicians often give patients late-generation or last-resort antibiotics even though early-generation drugs could still work. This in itself might be worsening resistance.

Another issue that affects Bangladesh in particular is the lack of protocols and basic interventions in and around health care that, if implemented, would greatly improve the situation.

For the babies at Shishu hospital, the most effective approach to saving lives is preventing infections from taking hold in the first place. Strategies that could substantially reduce AMR include investing in parental nutrition during gestation (which, in turn, would improve babies’ birth weights and reduce their susceptibility to infection), ensuring that pregnant people receive antenatal and perinatal care and promoting delivery practices that minimize the risk of babies (and birthing parents) getting infections.

What’s needed in Bangladesh — and in low- and middle-income countries more broadly — is a global commitment to support research and data collection on AMR, and investment in the basic interventions that will reduce it.

ANA CRISTINA GALES: Brazil

Ana Cristina Gales thinks that even small changes can be transformative for Brazil.Photo courtesy of Ana Cristina Gales

Five years ago, a 15-year-old boy was brought into the hospital where I work in São Paulo, Brazil, after developing an infection. He had cut his ankle while retrieving a kite from a stream. The boy developed a severe, systemic infection caused by methicillin-resistant Staphylococcus aureus and died around five weeks after being admitted.

That boy stuck in my mind, because he was around the age of my two daughters at the time. As a consultant in infectious diseases, I have seen too many people affected by AMR. One of the most frustrating aspects is that this devastating problem could be greatly reduced with relatively simple measures¹.

Issues that affect hospitals in Brazil — and in many other countries — include staff members failing to keep surfaces and their hands clean, and failing to isolate people infected with bacteria that are resistant to antimicrobial drugs. Some people have to spend days waiting for beds on stretchers in hospital corridors, making it harder for health-care workers — who are often overworked — to implement basic measures to prevent and control infections. In fact, over the past two decades, investigators have described several cases in which identical antimicrobial-resistant bacteria (of the same clone) have been found in distinct hospitals² — the implication being that resistant bacteria are being transferred between institutions, perhaps through the movement of patients.

But as illustrated by the case I described, AMR does not occur only in hospital settings. And in Brazil, one of the biggest challenges is people’s failure to recognize AMR as a public-health problem. Most people who don’t work in hospitals lack the knowledge needed to understand what AMR is and how it could affect their health. The country is battling endemic diseases, such as malaria, leishmaniasis and Chagas disease. And over the past 10 years, Brazil has experienced numerous epidemics caused by mosquito-borne viruses, including Zika, chikungunya, yellow fever, dengue and, most recently, Oropouche fever. Such diseases tend to receive more attention than does AMR, which is harder for people to pin to a particular cause.

Antibiotic resistance is a growing threat — is climate change making it worse?

As long as AMR is not seen as a significant health threat at a societal level, it will continue to be overlooked by policymakers and politicians. More positively, however, Brazil has enormous potential to reduce AMR, because it has a universal, decentralized health-care system in place for bringing medical interventions to everyone. It also has national programmes that provide people with vaccines and medications to treat HIV and hepatitis for free. Moreover, as one of the world’s largest producers of animal protein, Brazil could help to lead the reduction of antimicrobial use in livestock rearing. In fact, over the past decade or so, Brazil has already made some key advances when it comes to tackling AMR.

Since a law was introduced in 2010, people have been able to buy antibiotics (for human use) only with a medical prescription. Over the past few years, the government has invested millions of US dollars in research on AMR — and in surveillance, both in state laboratories and in hospitals. Furthermore, Brazil has developed a national plan to reduce the problem using a multisectoral and transdisciplinary ‘One Health’ approach, which is currently under review.

Transforming this plan into a successful programme, similar to the country’s vaccination, HIV and hepatitis schemes, will require more political buy-in and a lot more investment in efforts to raise public awareness. It will also require the integration of priorities across human, animal and environmental health. But clinicians, scientists, government officials and others don’t need access to advanced technologies and new antimicrobials to make an enormous difference. A few, relatively simple changes could be transformative: more parents and other caregivers vaccinating children; more people avoiding the use of antimicrobials when they are unnecessary, such as those used to treat viral respiratory infections; and expanding the nation’s basic sanitation programme, so that every Brazilian city treats its sewage before releasing it into the environment.

IRUKA N. OKEK: Nigeria

Improved access to health care can help to reduce antimicrobial resistance, says Iruka Okeke.Credit: Science for Africa Foundation

Most Nigerian people have a severe bacterial infection or malaria at least once a year. So they have a real as well as a perceived need for antimicrobials. But people are often unable to obtain the ones they need, or they use antimicrobials without advice from health-care providers. (In 2019, only 41% of Nigeria’s population could access health care easily.) Often, physicians don’t have access to the diagnostic tools needed to inform their decisions about what antimicrobials people should take, or individuals can’t afford those specific drugs. So, although in many settings the use of antimicrobials is excessive or inappropriate, in Nigeria, improving people’s access to health care and medications must be part of any plan to address AMR.

An article in the Lancet Series on Antimicrobial Resistance published in May¹ proposes that authorities should aim to reduce the number of deaths caused by AMR by 10% and the inappropriate use of antibiotics in humans and other animals by 20% and 30%, respectively, by 2030. I am convinced that Nigeria could meet these targets using tools available today.

A patient receives dialysis in June at Al-Shifa hospital in Gaza City, which was damaged during the Israel–Hamas conflict.Credit: Dawoud Abu Alkas/Reuters

One-quarter of Nigeria’s population defecates outside, such as in fields, gutters and forests, instead of using a toilet, some or all of the time. And data from a 2024 report³ I was involved in show that most city residents rely on household water from wells or boreholes that is contaminated by faeces. This is the case in Ibadan, where I live. Agents of disease — including typhoid, diarrhoea and cholera — can spread easily, as can non-harmful (commensal) organisms harbouring resistance genes that can be transmitted to pathogenic bacteria. One such commensal microorganism is Escherichia coli, which is typically found in the intestine. Providing people with safe water and better sanitation could reduce the impact of both enteric infections (stomach or intestinal illnesses caused by microbes, such as viruses, bacteria and parasites) and AMR simultaneously, yielding an estimated return of US$5 or more for every $1 spent⁴.

Modest investment could also improve infection prevention and control practices at health-care facilities — such as promoting handwashing or the isolation of people infected with antimicrobial-resistant bacteria. In 2020, the Nigeria Centre for Disease Control and Prevention released updated guidelines on infection control and prevention. A modelling study⁵, published in May as part of the Lancet series, indicates that by following such guidelines judiciously, health-care providers could prevent antimicrobial-resistant infections in health-care settings, which currently account for about 300,000 deaths worldwide.

The fight against antimicrobial resistance

Nigeria has been rolling out pneumococcal vaccines since 2014 and rotavirus vaccines since 2022. But coverage, currently at 60% and 49%, respectively (according to data from the United Nations’ children’s charity UNICEF), needs to be extended. Malaria and typhoid-conjugate vaccines are yet to be deployed. Moreover, a global shortage of cholera vaccines has hampered their use in recent outbreaks. All of these vaccines could reduce levels of AMR — by lowering the chance of complications arising that involve bacterial infections, and of people administering antibiotics inappropriately. According to the modelling study in the Lancet series, vaccines could prevent around 180,000 deaths associated with AMR annually⁵.

In 2017, Nigeria launched an AMR surveillance system. Once this system covers a greater geographical area and more comprehensive data are collected — from people, animals and the environment — investigators will be able to quantify the impacts of each of these tools and support the prioritization of interventions for national deployment.

NOUR SHAMAS: Middle East

Humanitarian relief efforts should prioritize infection surveillance, says Nour Shamas.Credit: Aziz Reguig

I am constantly worrying about whether my mother, who has a recurrent infection of the urinary tract (which is resistant to most antibiotics), will be able to keep accessing the health-care services and antibiotics she needs. She lives in Beirut, Lebanon, and I am always reminding her to keep her passport and antibiotics to hand in case she has to flee in the face of a military attack.

The impacts of political and economic instability and conflict are often overlooked when people consider the factors contributing to AMR. But it’s much harder to implement and maintain the types of intervention often recommended to mitigate resistance, such as restrictions that limit over-the-counter dispensing of antimicrobials, in Lebanon and other eastern Mediterranean countries that are experiencing ongoing conflict. In fact, such an intervention could limit access to lifesaving antimicrobials for those who cannot otherwise obtain them.

The destruction of health-care facilities, schools and other infrastructure as well as people’s livelihoods, and the displacement of both local people and refugees, provide an ideal environment for AMR to increase. In those places facing conflict or receiving refugees, living spaces are becoming increasingly crowded. Many people have lost access to clean water and sanitation, health care, medications and vaccinations. Most have lost wages and many are no longer able to obtain adequate nutrition, and people are more likely to use antimicrobials inappropriately — if they can get hold of them.

Although investment must be made globally in interventions to mitigate resistance, I urge all funders and aid organizations to factor AMR into humanitarian relief efforts. More research must be done on the impact of AMR on communities living in conflict-affected areas, and on context-specific solutions. Extra resources must be devoted to improving supply chains and access to antimicrobials and diagnostic tools, and to improving their use in these regions. And AMR surveillance, infection control and health systems as a whole must be strengthened in conflict-affected areas.

[ad_2]

Source link

September 17, 2024
Stop delaying action on antimicrobial resistance — it is achievable and affordable

[ad_1]

The problem of antimicrobial resistance (AMR) — bacteria, fungi or protozoans evolving resistance to antimicrobial substances — is worsening. This month, heads of state are gathering in New York City at the 79th session of the United Nations General Assembly to discuss the issue, among other global challenges.

This is the second time that AMR has been featured at a high-level UN meeting. The first one, in 2016, highlighted the importance of the problem, which is associated with nearly five million deaths each year worldwide. Although there has been some progress in the past eight years, such as the development of national action plans by many countries, the pace of change has been slow. I am presenting at the upcoming meeting, and I hope to convince attendees that the next eight years could look very different.

Tackling antimicrobial resistance needs a tailored approach — four specialists weigh in

One of the main factors driving the global rise of AMR is the use of inappropriate or substandard antibiotics. Indeed, people in low- and middle-income countries, which often lack ‘second-line’ antibiotics — more effective, and often more expensive, than those that are the first choice for treatment — are much more likely to die of infections caused by resistant bacteria than are those in high-income nations. A modelling study published in The Lancet in May (which I was involved in) indicates, however, that even a fairly modest global investment — in the range of hundreds of millions of US dollars — to help prevent bacterial infections and improve access to relatively inexpensive antibiotics could avert millions of deaths (J. A. Lewnard et al. Lancet 403, 2439–2454; 2024).

Each year, about 7.7 million people die from bacterial infections. One-fifth of these are children under the age of five. According to our Lancet study, at least 750,000 of these deaths could be averted through prevention strategies such as providing safe water and good sanitation, ensuring that children receive recommended vaccines, isolating individuals infected with resistant bacteria and implementing protocols to increase the frequency of handwashing in hospitals. Our study also indicates that the largest reduction in deaths would come from improving people’s access to antibiotics that are not available in many countries where most of the world’s bacterial-infection-related deaths occur.

Antibiotic resistance is a growing threat — is climate change making it worse?

Malaria and most bacterial infections do not last as long as do tuberculosis or AIDS, from which people tend to die months or years after infection. A child with an infection who develops a fever in the morning can be dead the next day if they don’t receive the right antibiotics. But in low- and middle-income countries, those are unavailable in many public-sector clinics. Parents and other carers must frequently turn to their local pharmacies for help. Because it is harder in those pharmacies than in public-sector ones to set up systems that limit the entry of inappropriate, poor-quality or fake drugs, hundreds of millions of people are using them.

Bacterial infections have been unfairly neglected — probably because a diverse array of pathogens are responsible for them, so there is no clear group of stakeholders who can advocate for change, as is the case for AIDS, tuberculosis and malaria. Each year, the Global Fund to Fight AIDS, Tuberculosis and Malaria, based in Geneva, Switzerland, spends nearly US$5 billion to ensure that the drugs to treat these diseases are available in low-income countries. These three diseases collectively kill about 2.8 million people each year — less than half the number linked to bacterial infections other than tuberculosis.

The fight against antimicrobial resistance

International funders, such as the Global Fund, must step up. People with HIV have a high risk of developing bacterial, viral, fungal and protozoal infections. Providing people with access to effective diagnostics and antibiotics targeting bacterial infections more broadly would be a natural extension of the Global Fund’s existing mandate.

Furthermore, prevention strategies — especially the provision of vaccines, safe water and good sanitation — need to be supported by organizations such as Gavi, the Vaccine Alliance, as well as through bilateral donors, including the United States Agency for International Development in Washington DC. They also need to be prioritized in national budgets in low- and middle-income countries.

Experience from past UN declarations shows that specific commitments made by countries are more likely to translate into action than is language that is unclear about what is expected of which organizations. The Lancet Series on Antimicrobial Resistance, published in May, calls for a 10% reduction in human mortality from AMR, a 20% reduction in the inappropriate antibiotic use in people and a 30% reduction in the inappropriate antibiotic use in animals by 2030 (see go.nature.com/4d4xg) — all relative to levels in 2019. And support is growing for an independent panel set up by four intergovernmental organizations — the World Health Organization, the United Nations Environment Programme, the Food and Agriculture Organization and the World Organisation for Animal Health — to appraise the evidence around tackling AMR.

With investment from global funders, specific targets and accountability through an independent panel, there is a much higher chance of this year’s discussions at the General Assembly translating into global action to tackle AMR.

Competing Interests

The author declares no competing interests.

[ad_2]

Source link

September 17, 2024
how conquest and carnage have decimated landscapes worldwide

[ad_1]

The Burning Earth: A History Sunil Amrith W. W. Norton (2024)

In the 1620s, King Charles I of England commissioned a Dutch water engineer, Cornelius Vermuyden, to drain the flat fenlands of East Anglia, which he considered a desolate wasteland. Locals were outraged. These wetlands, writes historian Sunil Amrith in The Burning Earth, “sustained a richness of human and more-than-human life that was now in danger”. As a pamphleteer at the time declared, many thousands of cottagers lived by harvesting “reeds, fodder, thacks, turves, flaggs, hassocks, segg” and “many other fenn commodytyes”.

How the peanut trade prolonged slavery

Locals, dubbed the Fen Tigers, smashed the dams, dykes and sluice gates that had been installed to divert rivers. But England’s political elite were determined to see nature “bound into service”. The marshes were ultimately drained and the land repurposed for agriculture, with the benefits accruing to rich landowners. Now known as the bread-basket of Britain, this once biodiverse wetland is at perpetual risk of flooding.

This pattern of conquest and carnage — pitting rich against poor, colonialist against indigenous, control of nature against the flourishing of the wild — has, tragically, been repeated countless times throughout history and across the globe. Amrith narrates this sorry (and sometimes inspiring) saga with flair, in his epic exploration of human innovation and destruction.

The fenfolk of East Anglia, he notes, were not the first to lose their livelihoods and wild land to the rich — and not the last to fight back. People with power and privilege conquered the world with machinery and lethal weapons, but the poor and powerless persevere. Indigenous peoples of Brazil, Indonesia and India continue to fight corporations that encroach on their pristine rainforests, just as Fen Tigers fought for their marshlands. It is these overlooked environmental and political conflicts on which Amrith centres his narrative.

The fenlands of eastern England have been at constant risk of flooding since they were repurposed for agriculture.Credit: Chris Howes/Wild Places Photography/Alamy

Bloody commerce

For 600 years, many of these conflicts have revolved around the pursuit of luxuries. When Portuguese ships reached the North Atlantic island of Madeira in 1426, the colonists set fire to most of its forests, and later enslaved Indigenous Guanches from the nearby Canary Islands to clear the ground for sugar cultivation. In the 1470s, the Portuguese reached the coast of Ghana. In Elmina, they built a fortress that thrived as a centre first for trade in gold, ivory and peppers, and later for “the bloody Atlantic commerce in enslaved human beings”.

The climate crisis is solvable, but human rights must trump profits

At every stage, European colonists spread death and environmental destruction. In sixteenth-century Peru, Spaniards kidnapped Indigenous people and forced them to mine a mineral source of mercury called cinnabar — used to extract silver from ore. Toxic vapours from the cinnabar refineries poisoned water, mammals, fish and the shackled humans toiling at “the mine of death” at Huancavelica. As Amrith quotes one report of the time: “there used to be in this mountain”, it laments, “deer with antlers, and now not even grass is found”. Today, mercury still seeps from roads and houses made with contaminated bricks.

Rebellion and retaliation

But everywhere that people were enslaved, significant numbers rebelled. In Palmares, Brazil, a 10,000–20,000-strong quilombo, or community of once-enslaved fugitives, formed a self-governing society. Most residents, who survived on subsistence agriculture and trade, had roots in Angola and Congo, but some were Indigenous Brazilians, Jews and Muslims. Together, they held off attacks by Dutch and Portuguese militaries for almost a century, before the quilombo was conquered in 1694.

A fortress built in Elmina, Ghana, was used to hold enslaved people captive.Credit: Chuck Bigger/Alamy

Conflicts over land and nature continue today. For centuries, Indigenous peoples in rainforests grew food, including fruit and nut trees, for their own needs; as they moved to new areas, the forests rebounded. By the 1980s, however, a contagion of chainsaws and burning had led to the loss of an area of Amazonian and southeast Asian rainforest equivalent to half the size of India. In Brazil, labour leader and conservationist Chico Mendes led the fight to establish forest reserves inhabited and managed by locals. In 1990, the state of Acre created the first such zone: the 500,000-hectare Chico Mendes Extractive Reserve. But Mendes himself had been shot dead in front of his house in Xapuri in 1988, allegedly by gunmen hired by local landowning ranchers.

In a similar grievous tale in Nigeria, environmental activist Ken Saro-Wiwa founded the Movement for the Survival of the Ogoni People, rallying 300,000 in 1993 to protest against rampant oil pollution by the energy company Shell, which had left the landscape a “desolate expanse of blackened crust”. Saro-Wiwa and eight other Ogoni leaders were imprisoned and hanged by Nigeria’s military government in 1995.

Ongoing battle

Development isn’t entirely bad, as Amrith stresses. Rates of death from infectious diseases have fallen drastically around the world since the start of the twentieth century, thanks to sanitation, vaccines and antibiotics. The Green Revolution — a period of rapid development of high-yield, disease-resistant wheat and rice varieties — led to tremendous booms in crop production. Between 1961 and 2014, production of cereal crops increased by 280% worldwide.

But the Green Revolution had unintended impacts. Petrochemicals furnished the pesticides and fertilizers on which high-yield seeds depended. Diesel powered the groundwater pumps that irrigated the harvests, and pesticides permeated and poisoned the soil. In India, the revolution also perpetuated inequality between farmers who had access to transport, water and money, and “those with land too measly, too stony, too unyielding to accept new seeds”. Thousands of farmers in India die by suicide every year, faced with debt to pay for seeds and fertilizers, amid heatwaves and drought caused by climate change.

How white supremacy became a global health problem

If there’s cause for hope, it comes from those who continue to fight for environmental justice, often from the margins. In 2006, in West Timor, Indonesia, 150 women surrounded a marble mine on Mount Mutis, protesting against the destruction of eucalyptus forests and waterways on which they depended. A few years later, mining there ceased.

And since the late 1990s in Bogotá, Colombia, 44,000 square kilometres of road have been transformed for pedestrian use, and an electrified bus network has been introduced. Five hundred kilometres of protected bicycle lanes, championed by civil-society group the Green City, intersect with the bus network.

“More and more people are challenging the self-destructive folly that captured the imagination of the powerful and privileged for two hundred years,” Amrith writes. Almost 2,000 environmental activists — one-third of them from Indigenous communities — have been murdered around the world in the past decade. Yet powerful movements, especially of young people, continue to fight for Earth’s future.

For these brave and unwavering humans, we can be grateful.

[ad_2]

Source link

September 16, 2024
How to support Indigenous Peoples on biodiversity: be rigorous with data

[ad_1]

Profits from rooibos tea are being shared with South Africa’s Indigenous Khoi and San People, in recognition of their contribution to its development.Credit: Mike Hutchings/Reuters

For at least two decades, scientists, policymakers and journals, including Nature, have cited a statistic without determining its validity. The data point in question is that 80% of global biodiversity is under the stewardship of Indigenous Peoples. There is no doubt that Indigenous communities are core to the conservation of biodiversity, but to say that they are stewards of 80% of the world’s genetic, species and ecosystem diversity isn’t supported by evidence, as the authors of a Comment article last week stated (Á. Fernández-Llamazares et al. Nature 633, 32–35; 2024).

No basis for claim that 80% of biodiversity is found in Indigenous territories

A single, unsubstantiated number also does not reflect Indigenous values and world views, the authors add. There are better indicators and statistics on Indigenous communities and biodiversity, says Álvaro Fernández-Llamazares, a co-author of the Comment article and an ethnobiologist at the Autonomous University of Barcelona, Spain, in an accompanying Nature Podcast.

Biodiversity — defined as the variety of life on Earth, including its variation at the level of genes, species and ecosystems — is extremely hard to quantify. Even the simplest statements come with great uncertainty: there is no consensus, for example, on the number of species on the planet¹. There are at least 50 ways to value nature, according to researchers working with the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) in Bonn, Germany².

Podcast: The baseless stat that could be harming Indigenous conservation efforts

The authors of the Comment article, three of whom identify as Indigenous, reveal that the 80% statistic seems to have emerged in policy reports, from which it spread into the scientific literature. As of 1 August, the researchers found the 80% claim mentioned in 186 peer-reviewed journal articles. The earliest mention that they found was in a 2002 United Nations document that said that Indigenous Peoples “nurture 80% of the world’s biodiversity on ancestral lands and territories”, without a citation. The number is repeated in an influential 2008 World Bank report.

So why might this number appear in policy documents first? It stems from Indigenous Peoples’ centuries-old encounters with more-powerful interests, the resulting exploitation and mistreatment, their fight for rights, and the international community’s ongoing policy response.

Assessing the values of nature to promote a sustainable future

Worldwide, there are some 467 million Indigenous People across 90 countries. Today, they are among the poorest, most vulnerable and least protected people in their nations. Some international laws and modern research practices pertaining to biodiversity derive from the 1992 UN Convention on Biological Diversity. This agreement has its origins in a movement to create protected areas — ironically, areas often initially created by taking away Indigenous Peoples’ rights to land or expelling them. During the negotiation, representatives of low-income countries and Indigenous Peoples fought to ensure that the agreement included provisions for the equitable sharing of biodiversity’s benefits, such as profits from food or medicines.

By the early 2000s, organizations such as the World Bank were working with Indigenous Peoples’ representatives, and examining the impact and legacy of their own previous lending practices on Indigenous Peoples and creating ways to involve them in their decisions.

The research community also had work to do. When IPBES was established in 2012, it pledged, for the first time, to incorporate Indigenous and local knowledge in its global scientific assessments of biodiversity. Studies are now being co-produced between Indigenous and non-Indigenous authors. A next step needs to be more studies designed and led by Indigenous authors³.

Around the world, the struggle for Indigenous rights has a long way to go. Researchers have a crucial role in supporting communities, which includes being rigorous with data. As Fernández-Llamazarez says in the Nature Podcast, unproven data risk fuelling scepticism on the role of Indigenous communities in biodiversity stewardship.

[ad_2]

Source link

September 10, 2024