JEREMY FARRAR Jeremy Farrar is the assistant director- general of Health Promotion and Disease Prevention and Care at the
preserve of wealthy countries, almost all of which have become rich because of decades of national investment in science and technology. Instead, we must recognise science and technology as essential infrastructure investments – as fundamental to sustainable economic growth and opportunity as roads, telecommunications or energy. This means establishing principles, transparent and trusted systems that underpin and protect sustained, efficient government support for science, including research, careers, innovation, regulation, manufacturing and employment. Governments must determine priorities aligned with national and regional needs and strengths, and then focus inevitably limited resources in thoughtful, strategic ways. This will mean multiple choices: what and how to focus on; what areas of science to support; which sectors; which models of support – universities or dedicated institutes, multiple or a limited concentrated number; which career paths, incentives and training, in-country or internationally or both; whether to conduct peer reviews; what role for the government in direct funding decisions; and what kind of engagement with the private sector and philanthropy. So many models have been tried around the world, but none is perfect: each country needs to review and adapt them to its local context. A CALL FOR GLOBAL COOPERATION The effects of Covid-19 remind us that infectious diseases and pandemics are not the only global challenges we face. Climate change, demographic shifts, access to clean water, antimicrobial resistance, and the rise of non-communicable diseases and mental health – like the corona and influenza viruses – challenge every country and transcend borders. They will not be defeated by insular scientific nationalism or by blaming others. Doing so only leaves everyone more vulnerable. Rather, these challenges can be solved by enhancing international cooperation while building strong domestic science ecosystems. The international institutions established after the Second World War grew out of enlightened self-interest. They require reform, and they are reforming – but they are needed today more than ever. ▪
Investing in public engagement and understanding to inform the public about how science contributes to people’s lives would help counter the misinformation plague and underpin the necessary political support. When communities see science happening in their midst, by them and for them, and contributing to their prosperity and addressing challenges, they develop a stake in scientific advancement. ADDRESSING GLOBAL HEALTH CHALLENGES The Covid-19 pandemic demonstrated both the power of science and the dangers of scientific nationalism. Like every crisis, the pandemic amplified existing social divisions and inequalities. We saw how quickly scientific achievements could be undermined by unequal access and distribution. The same pattern risks repeating itself with other 21st-century health challenges. Science for health must extend beyond the development of medicinal products and biotechnological solutions to cover the broad spectrum of health determinants, including environmental, behavioural and social determinants. A One Health approach is essential, with interdisciplinary research and cross-sectoral collaboration among the fields of human, animal and environmental health. POLITICAL CHOICES AND FUTURE DIRECTIONS What are the political choices that must now be made? Countries face fundamental decisions about how to organise and sustain science ecosystems with domestic resources and ownership. Three overarching questions demand attention: 1. How can countries best structure and finance their science and research ecosystems for maximum health and economic impact? 2. How can countries organise their scientific advice to government in ways that ensure that the best available evidence informs policy? 3. How can countries protect their populations from misinformation and provide information on the benefits of investing in science for human health and development? The answers require moving beyond the traditional model of science as the
World Health Organization, having been chief scientist between 2023 and 2025. Before joining the WHO, he was director of Wellcome from 2013 to 2023. Between 1996 and 2013 he was director of the Clinical Research Unit Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam. He is a fellow of the Academy of Medical Sciences UK, the National Academies USA, the European Molecular Biology Organization and a fellow of The Royal Society. X-TWITTER @jeremyfarrar
FATIMA SERHAN Fatima Serhan is the executive officer in the Health Promotion, Disease Prevention and Care Division of the World Health
Organization. A biomedical scientist, she brings extensive experience in global health, research, strategy and policy. Previously, as executive officer to the WHO Chief Scientist, she advised senior management and led initiatives to strengthen scientific ecosys- tems. She has expertise in building scientific networks, vaccine-preventable disease sur- veillance and science–policy engagement to advance health equity worldwide.
THIDAR PYONE Thidar Pyone is a technical officer in the World Health Organi- zation’s Office of the Chief Scientist. A tri- lingual physician with
a PhD in public health, she has led initiatives across the United Kingdom Health Security Agency, the London School of Tropical Medi- cine and international agencies, combining field, country and headquarters perspectives across Asia and Africa. She specialises in evidence synthesis, grant development, cross- divisional coordination, and evaluation of public health interventions and policies. who.int
Health: A Political Choice – The Future of Health in a Fractured World 65
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