When we created the original Grand Challenges in Global Health almost 15 years ago, it could be summed up this way: “cutting-edge science for global health.” One of the key principles of the scientific method is to refine your hypothesis based on your data, and we’ve refined Grand Challenges continuously over the years.
For example, the data showed us that we needed to encourage a broader range of ideas from a broader range of investigators. So we created Grand Challenges Explorations (GCE), which awards smaller grants to promising early-stage ideas based on a simple two-page application. Investigators use these grants to see if their idea is viable and, if so, they apply for a second round of funding to develop it more fully. This way, there’s a low barrier to entry, which means we can take a risk on many more out-of-the-box approaches.
Another lesson we’ve learned over the years is that scientific challenges aren’t the only ones blocking progress in global health, and innovations don’t always happen in a test tube; they can relate to things like infrastructure and social and cultural norms. In fact, to make change in developing countries, we needed innovation in all these areas. And making progress on deeply embedded systems requires expert knowledge of the local context.
Today we announce 51 Grand Challenges Explorations awards from 16 countries reflecting all these lessons.
The first challenge, Wearables and Technology for Maternal, Neonatal and Child Health Behavior Change, borrowed the latest insights from consumer technology to help families keep their newborns healthy. If people in high-income countries now wear devices to track their sleep and steps every day, then people in low-income countries should be able to track lifesaving practices like breastfeeding. One of my favorite grants in this challenge is to Ratul Narain of BEMPU Technologies in India, who’s working on Kangagrow, a sling mothers can use for kangaroo care - that is, making sure that newborns get as much skin-to-skin contact as possible (which has been proven to make babies healthier). A lot of mothers in India - and everywhere else, including developed and developing countries - have trouble with kangaroo care because of the lack of any real-time feedback. Even if they’re doing it right, there’s nothing that indicates clearly how much it’s helping the baby: you can’t literally see an immune system getting stronger, for example. Narain’s sling fills that feedback gap. It displays a flower that changes color depending on the amount of skin-to-skin contact, giving mothers a visual cue that what they’re doing is making a difference.
We came up with our second challenge, New Approaches for Improving Timeliness of Routine Immunizations in Low-Resource Settings, because it’s easy for families in remote or spread-out villages to miss information about opportunities to vaccinate their children. And even if they have the right information, travel in these areas can be unpredictable, and vaccinators don’t always arrive when they’re expected. In the end, kids can miss vaccinations for months in a row. Robert Steinglass of JSI Research & Training Institute will teach community members in India to use a double-sided dhol, a traditional drum used for communication over long distances, to let families know that vaccination teams have arrived. Since cultures all over the world use sound to summon the community - even in the United States we know exactly what’s happening when we hear an ice-cream truck jingle - this project could help vaccinate hard-to-reach kids all over the world. Meanwhile, Daniel Carucci of The Immunity Charm Foundation is working on a bracelet, sort of like the wearable technology I mentioned above, to encourage families in South Asia to keep up with their children’s vaccinations. Carucci is working in an area where children already wear bracelets (black beads on a bracelet are widely believed to protect them from evil spirits), so Carucci’s project will feel less intrusive to parents. With each vaccination at the right time, another colored bead will be added to the bracelet.
In collaboration with the United States Agency for International Development (USAID) we issued our third challenge, Health Systems Strengthening: Ensuring Effective Health Supply Chains, to address the fact that it’s very difficult to transport health supplies in countries where roads are crumbling or non-existent and data systems don’t always work. Zawadi Mageni of the Ifakara Health Institute in Tanzania will train local shopkeepers, who have already developed effective transportation methods to maintain their own stock, to deliver essential medical supplies as well. In Ethiopia, almost 50 percent of maternal deaths are caused by hemorrhage, most of them in rural areas where blood delivery is challenging. Fassika Fikre Hailemeskel of Maisha Technologies PLC is working on a drone that can simply fly over difficult terrain to deliver blood to health facilities in record time.
Compared to some of the projects we fund, these projects may seem “simple.” They’re certainly easier to explain. But the fact is, none of the brilliant scientists we work with on “complicated” projects like gene editing and vaccine conjugation would have conceived of any of these projects, much less implemented them. It takes a nuanced understanding of how people lead their daily lives in specific places, why systems don’t work, and who is solving related challenges in smart ways.
Some of our Grand Challenges work is devoted to developing new vaccines in novel ways. The results of GCE round 19 will guarantee that those vaccines actually get to the people who need them.