In 2023, the world was rocked by a series of major events, including the ongoing war in Ukraine, the renewed conflict between Israel and Palestine, and the rise of generative AI. In the midst of all this turmoil, global public health issues took a backseat, with funding for infectious diseases even declining in recent years.

However, beyond the headlines, diseases such as malaria and tuberculosis continue to have a devastating impact on developing countries. Climate change is also exacerbating the risk of transmission of diseases such as cholera and Dengue fever, and is bringing new challenges such as heat waves and air pollution.

How can we raise awareness of public health issues among the international community? How can cutting-edge technologies like mRNA and AI help developing countries better address health problems? And what role can China play in these efforts?

To answer these questions, NBD reporters interviewed Dr. Zheng Zhijie, the chief representative of the Beijing office of the Bill & Melinda Gates Foundation.

The Gates Foundation has long been a major funder of global health and development initiatives. Dr. Zheng is also a veteran in the public health field, having served as dean of the School of Public Health at Shanghai Jiao Tong University, chair of the Global Health Department at Peking University's School of Public Health, and vice dean of the Global Health Development Institute. He also holds leadership positions in professional organizations such as the Chinese Medical Association's Public Health Physicians Association and the China Global Health Network.

Photo/Bill & Melinda Gates Foundation

Preventing the next pandemic: Four key tasks

NBD: The COVID-19 pandemic has brought global public health into the spotlight. Looking back, what progress do you think this pandemic has made in public health, and what lessons has it left?

Zheng Jie: We have learned a lot from the response to COVID-19, but we are still a long way from being prepared for the next pandemic.

The latest report by the Global Preparedness Monitoring Board (GPMB), titled "A Fragile State of Preparedness," shows that we have made some progress in terms of global information platforms, community engagement, international regulatory guidance, independent surveillance capabilities, and regional laboratory capabilities. However, the situation is not optimistic in terms of countering misinformation, providing public goods, and developing a global preparedness strategy plan.

Although we do not know when the next pandemic will come or how severe the impact will be, the world urgently needs to summarize the lessons learned and prepare fully before COVID-19 becomes a "forgotten memory."

Specifically, we believe that there are four areas of work:

1. Strengthen the monitoring and accountability of pandemic prevention, preparedness, and response, ensuring its objectivity and transparency.

2. Strengthen the construction of financing systems, improve their fairness and sustainability.

3. Strengthen regional research and development capabilities, including early detection and monitoring, data collection and analysis, and the basic manufacturing capabilities of related health products.

4. Finally, it is also important to pay attention to cross-sector cooperation and coordination, especially the complementary knowledge and capabilities between the public and private sectors.

NBD: With the decline of COVID-19 and the superposition of geopolitical conflicts, the attention of the international community and the public to public health has declined. What health issues do you think are urgent and deserve more attention?

Zheng Jie: There is no doubt that the international community needs to continue to pay attention to public health issues. The 28th United Nations Climate Change Conference (COP28), which just passed, launched its first Health Day, reminding the public of the more serious challenges that climate change poses to global health. COP28's host country also jointly announced the "Climate and Health Declaration" with the World Health Organization, marking a global commitment to actively addressing the health impacts associated with climate change, including protecting communities and vulnerable groups, and making health systems ready to respond to health impacts such as heat waves, air pollution, and infectious diseases.

Several health areas that the Gates Foundation focuses on are closely related to climate change, especially infectious diseases that seriously affect developing countries. These diseases urgently need more attention, such as malaria, an important global health issue. On the first day of COP28, the World Health Organization released the "World Malaria Report 2023," which pointed out that there were about 2.49 billion malaria cases worldwide in 2022, an increase of 50 million from 2021. The goal of reducing malaria incidence and mortality is still facing great challenges. The direct or indirect impact of climate change on malaria is also not to be ignored, such as the survival and reproduction of vector mosquitoes, and extreme weather events caused by climate change.

It is against the backdrop of the superposition of multiple challenges that we need to increase investment in research and development for global health. A harsh reality is that the global investment in infectious diseases that seriously affect the lives and health of people in low-income countries is very limited, and has recently shown a downward trend. Data shows that while funding for overall health research is increasing, only about 2% is used for diseases that threaten the lives and health of the world's poorest people.

In fact, investment in infectious diseases has even shown a downward trend in recent years. For example, funding for tuberculosis research is only 20% of the target set by the 2023 United Nations high-level meeting, and funding for malaria research innovation has fallen to its lowest level in fifteen years. Therefore, we urgently need countries around the world to increase resource investment and strengthen cooperation through international cooperation mechanisms to promote the large-scale promotion and fair distribution of research and development results, so that the most vulnerable people can benefit.

China's innovation and production capabilities can make significant contributions to global health

NBD: You mentioned malaria and tuberculosis, which are both infectious diseases that already have treatments. Why do we still need to invest a lot of effort in research and development?

Zheng Jie: The World Health Organization's "Global Health Estimates Report 2019" analyzed the trends in mortality and incidence rates caused by diseases and injuries over the past 20 years. The report shows that infectious diseases still have a serious impact on low-income countries. Of the 10 leading causes of death in low-income countries, 6 are still infectious diseases, including malaria and tuberculosis, which rank sixth and eighth respectively.

Although these two diseases have corresponding drugs, the common problem of drug resistance poses a serious challenge to the treatment of diseases and the continued reduction of mortality. We urgently need to develop better and more effective innovative drugs as soon as possible in order to stay ahead of these pathogens. China has the potential in these areas: the Global Health Drug Development Center (GHDDI) in Beijing is making progress in the development of drugs for tuberculosis and malaria.

In addition, these two diseases also need more effective vaccines. BCG is the only vaccine currently in use for tuberculosis, first used in humans in 1921, and has been in use for over a hundred years. It can protect infants from serious systemic tuberculosis, but is very limited in its protection against pulmonary tuberculosis, which accounts for 90% of the burden of tuberculosis. The malaria vaccines that were just launched in 2021 and 2023 are also only effective in children, and we still need vaccines with a wider protection range and higher protection efficacy.

NBD: Currently, only two countries have wild strains of polio (commonly known as "poliomyelitis"), and the number of new cases worldwide is very low. The global public health community is yet to eradicate polio as a major goal. Why is this?

Zheng Jie: Polio is one of the few diseases that we have the opportunity to eradicate from the face of the earth. Thanks to the incredible achievements of global cooperation over the past three decades, the world has seen a 99.9% decline in polio cases, avoiding 20 million disabilities. After countless efforts, the global wild polio virus is now endemic in only two countries, Afghanistan and Pakistan.

However, viruses have no borders. Wherever it is, as long as one case remains, the whole world is in danger and must collectively pay a heavy price for it. Currently, 4.5 billion children worldwide still need to be vaccinated against polio, which consumes a lot of valuable medical resources from each country.

We also need to seize the window of opportunity to eradicate polio completely before the polio virus has another chance to spread on a large scale. The transmission of polio is seasonal, from late November to early May is the off-season of transmission, and the next few months are very important. At the same time, the world needs long-term support for the emergency response mechanism and continued investment in increasing vaccination rates. The next few years are the critical moment for the world to increase investment and eradicate polio.

China has the potential to play an important role in the global eradication of polio. China has repeatedly emphasized the importance of medical cooperation with Afghanistan, and in October of this year announced a donation of 30 million doses of domestically produced oral polio vaccine to Pakistan. These measures will help the world to quickly achieve the goal of ending the transmission of wild polio virus. China can also contribute to strengthening scientific monitoring, timely detection, and response to outbreaks around the world.

NBD: In addition to the eradication of polio, what other contributions can China make to global health and development issues?

Zheng Jie: Due to the continuous accumulation of a series of challenges such as climate change, the impact of the pandemic, geopolitical conflicts, and economic recession, the health improvement, poverty reduction process, and food supply of the most vulnerable countries and people in the world are facing unprecedented severe shocks. The world's demand for public goods in the field of global health and development has never been so urgent, and China has the potential to make significant contributions to bridging this gap.

In the field of health, a number of health products developed and produced in China have been provided as global public goods to middle- and low-income countries, including vaccines to prevent fatal diseases such as Japanese encephalitis, polio, and cervical cancer, vaccine cold chain equipment suitable for regions with weak infrastructure, artemisinin-based combination therapy for the treatment of malaria, and long-acting contraceptive depot preparations to meet the needs of women in middle- and low-income countries for contraception, and so on.

mRNA and AI: How cutting-edge technologies can benefit middle- and low-income countries

NBD: The successful promotion of mRNA COVID-19 vaccines has made this highly promising biomedical technology widely known. How can mRNA technology advance the global health cause?

Zheng Jie: The unfair distribution of COVID-19 response tools has made it clear that it is urgent and necessary to strengthen research and production capabilities in middle- and low-income countries such as Africa. We should continue to increase investment in improving research and development capabilities in middle- and low-income countries.

Expanding the ability of Africa to develop and produce affordable mRNA vaccines is of great importance for improving vaccine availability across the continent, and it is also an urgent task.

In 2023, the Gates Foundation provided $40 million in funding to expand the use of low-cost mRNA research and production platforms. Part of this funding ($10 million) was specifically used to support two local African institutions to develop and manufacture low-cost, high-quality vaccines based on this platform. Compared to traditional technologies, the modular design of this platform simplifies the vaccine development and production process, reduces production costs by more than 50%, and significantly reduces the need for senior trained experts, which is helpful for Africa, where research and development and production capabilities are still relatively limited.

NBD: AI has become the most talked-about topic in 2023, and Mr. Gates is very optimistic about the potential of this technology. In your opinion, how will AI technology help global health and development issues?

Zheng Jie: AI can make significant progress in achieving global health equity. AI technology also has great potential to improve maternal health and even global health. For example, AI portable ultrasound technology can help nurses and midwives in middle- and low-income countries monitor high-risk pregnancies to ensure that risks can be diagnosed and resolved early.

However, it is worth noting that whenever a major technological change occurs, the world's poorest people are often left behind or are the last to benefit. If the needs of the poor are not considered, the development, deployment, and use of AI tools may even deepen the existing inequality gap in the field of global health and development. Therefore, it is essential to drive the development of AI with the goal of promoting equity from the outset, and to reduce inequality by fully leveraging the potential of AI.

In line with the principle of ensuring that AI technology can benefit everyone in the long run, the Gates Foundation recently announced that it will invest $30 million to establish a new AI platform in Africa to provide African scientists and innovators with the necessary technical and operational support. To further support scientists in developing cutting-edge innovations in middle- and low-income countries, the Gates Foundation and its partners have also announced a call for health and development solutions for middle- and low-income countries based on large language models from AI.