We need to invest in health maintenance over treatment of disease, argues scientist
Friesen Prize winner Sir Mark Walport is internationally acclaimed for his innovative work in health research
*Originally published on April 8, 2022.
In 2020, physician and scientist Sir Mark Walport won the annual Henry G. Friesen International Prize in Health Research. He was scheduled to deliver the annual lecture then, but COVID put a stop to that.
While his lecture was delayed, the innovator says he discovered new insights arising from the pandemic.
"Science has become part of everyday public discourse in the most extraordinary ways," he said. "The idea that people are sort of looking at the reproduction number of the virus and working [out] whether it's going up or down — and understanding exponential growth."
The internationally-acclaimed researcher is known globally for his innovative work in health research, and was the U.K.'s Chief Scientific Adviser from 2013 to 2017 and Chief Executive of U.K. Research and Innovation from 2017 to 2020.
In 2021, he was finally able to deliver the annual Henry G. Friesen lecture in Health Research at Massey College, University of Toronto. It is called Medical Research and Innovation: Post-Pandemic Priorities.
Sir Walport spoke to IDEAS host Nahlah Ayed. Here is an excerpt from their conversation.
NA: Do you think the world was prepared for COVID?
MW: No, I mean, the world wasn't prepared for COVID, and at some level each pandemic will be of a new virus, something that it may be a variant of the virus we've seen before, or it might be a completely novel virus.
And in that sense, we'll never be prepared in the details because we won't know what the virus is, or indeed any other infectious agent until it actually starts infections. What we do need to do — and we are in a position actually in the coronavirus pandemic — is that we can discover things about infectious disease at a pace that was inconceivable even five or 10 years ago.
Perhaps what might have been surprising is that there have been winners and losers broadly dividing the rich from the poor. And that has had a racial and geographic aspect to it. Did you expect that?
Well, I think that shouldn't have come as a surprise because disease does attack people in very unequal fashions. And so it doesn't matter whether it's chronic noninfectious disease, cardiovascular disease or diabetes or infectious diseases. We know that the poor, the malnourished, the elderly people who are weak for any cause are much more susceptible.
But I think it was a surprise to many people the extent to which this new coronavirus did have such unequal impacts.
If there's one lesson that comes out of this for every country around the world, that is that we haven't invested enough in public health in actually preventing things from happening.
But if we knew that there would be this disparity, where did the gap occur, do you think?
Different viruses, of course, do behave in different ways.
So the 1918 flu pandemic, which was the last great pandemic to hit human populations, which killed more people than died in the First World War. Interestingly, that virus was more lethal for younger people; whereas of course, it turns out that the new coronavirus is much more lethal for the elderly. And so there are always some differences that you can't completely prepare for.
But we essentially know that people's health — and it doesn't matter whether it's poorer populations in U.K. or minority populations around the world — they are more susceptible to chronic diseases, and there are all sorts of factors for that. It's partly that they are less healthy, potentially have more diabetes, more hypertension, more obesity.
It may be that they seek health care a bit later. They have less access to health care. They have the sorts of jobs that mean that they can't shelter themselves from infectious diseases more easily. They're never exactly the same for two different diseases, but it tells us that we need to be ever-vigilant and we probably need to spend more money on the maintenance of health rather than the treatment of disease.
You say when you refer to this pandemic that there are no grounds for triumphalism. What are you thinking about when you say that we shouldn't feel triumphant?
I think that science has contributed a lot and there's been a temptation to say, 'Well, we've discovered all these drugs, we've discovered all these vaccines. And, you know, somehow we've got on top of it.' There was a feeling in the 1950s that with the discovery of antibiotics, that infectious diseases weren't going to be a problem anymore, and that turned out to be about as wrong as it's possible to imagine.
So I think we mustn't somehow feel that science came to the rescue and we don't need to worry about future pandemics. We do.
When it comes to health care policy and research, you talk about the imbalance between focus on disease and focus on health. It seems intuitive to say that if we spend resources making sure people stay healthy rather than primarily intervening when they get sick, that in the long term we'll be better off. Why don't we act accordingly?
Well, I think it comes back to the sort of primary drivers of policy in governments around the world. And so the levers that are needed to maintain health are actually almost all levers that sit outside departments of health, which are mis-named. They should be departments of disease.
Healthy aging starts pre-birth. Actually, it starts in maternal education and maternal health, and then it starts in education from the earliest point. So what happens to you when you're 2, 3, 5, 10, 15 is going to affect how you age 50, 60 years later. It depends on housing. It depends on transport policy. It depends on clean air. And so being a healthy human, it's all the other aspects of our life: how we live, who we live with.
But if you are a housing department, then your primary concern is 'let's get as many houses built as we possibly can.' And there's probably too little attention paid, as it were, to public health decisions when it comes to education, to transport, to work policies. And that's the challenge. It's arguably the responsibility of government. The premier responsibility is the health, the well-being, the resilience and security of the population — and for governments to focus on that, they're in a potential position to make lots of good policies. But all of this comes at a price.
What is, do you think in your mind, the most significant challenge to scientific discovery today?
The need for it is enormous. I said in my talk that necessity is the mother of invention, but we need invention in order to tackle so many problems. So I think a lot of the challenge is capacity, to actually persuading people, in education, in school, about the power of research and discovery, persuading policy makers that it really matters, that they can make better decisions if they have the best evidence.
So I think the opportunity is really limited by this sort of capacity in the amount of funds available to do it. But boy, do we need it if we're going to tackle some of the huge challenges that we face.
Does it feel as though those challenges are bigger and different than those that came that face scientists before?
Yes, because the population of the planet is so much greater. It's the famous sort of hockey stick curve that people have talked about. But if you look at human population, almost everything is growing exponentially and the challenges with it.
One of the paradoxes of it is the young people on the planet who will face the most serious problems in the next 50, 70, 90 years. But they have in general, less of a political voice than the older.
And particularly in Europe and North America. In Japan, we've got increasingly elderly populations, and it's the danger that the old vote against the interests of the young.
Friesen Prize Lecture | Medical Research and Innovation: Post-Pandemic Priorities
*Q&A was edited for clairty and length. This episode was produced by Naheed Mustafa.