Editorial | Possibilities for R&D

Generally, Professor Evan Dale Abel is right that there was nothing mankind could imagine “that you cannot achieve”. Indeed, the example he offered of the development of treatments for diabetes during his 38 years as a doctor was a powerful tale of those possibilities.

“ …When I was a student ... we had three medicines to treat diabetes – insulin which was made from cows and pigs and … two pills that we prescribed to patients …,” he told graduating students at The University of the West Indies (UWI), Mona, a fortnight ago. “Fast-forward three decades. Now we have a panoply of therapeutics. We have drugs now that will save lives, [and] we have artificial pancreases that, in fact, will completely control diabetes.”

The upshot of this is: several diseases that were death sentences when Professor Abel was a medical student at Mona now have cures, or can be better managed because of the advancement of technology.

Indeed, only last week, another of those diseases, which is prevalent in Jamaica, sickle cell anaemia, seems set to be less of a killer than it used to be. An expert panel recommended to the US Food and Drug Administration (FDA) that it approve a gene-splicing to cure sickle cell as safe for clinical use.

While Professor Abel’s aim was to excite young people to follow their dreams, what many of the Mona graduates – 80 per cent of whom, if historic data still hold true, will at some point emigrate to OECD countries – might have responded to about his examples is that none of those drugs were developed in Jamaica, or any other Caribbean country. And this is notwithstanding the substantial amounts of basic clinical research that takes place in this region that may well have contributed to the development of some of the mentioned cures and therapeutics.

POIGNANT

The issue of sickle cell is especially poignant, generating a panoply of emotions. The disease is a mutation of genes that causes blood cells to malform to a half-moon shape, similar to a sickle, making their traverse of blood vessels difficult.

During crises, sickle cell patients endure extreme pain and can face strokes and damaged organs. Most sufferers die before they reach 60, with the median ages of death being the early 40s.

The disease affects mostly people of African ancestry, which is the majority of the people in the Caribbean, including Jamaica. Indeed, one in 10 have a trait of the disease, or over 270,000 Jamaicans. Around one per cent of the population develops full-blown sickle cell. With small variations, these figures are largely similar across all language groups in the Caribbean.

What marked Jamaica as different among countries with a high prevalence of sickle cell anaemia is the amount of basic research of the disease and clinical expertise for its management developed at the Sickle Cell Unit at what is now the UWI’s Caribbean Institute for Health Research (CIHR). Professor Graham Sarjent was legendary in this field. Moreover, a sickle cell clinic at Mona helped to ameliorate the health outcomes of patients, who generally lived longer than their counterparts in the United States.

But the research of Mona’s Sickle Cell Unit has not led to breakthrough drugs like the one that is about to get the greenlight from the FDA. Exa-cel was developed by the Boston-based US company Vertex Pharmaceuticals, and its Swiss partner, CRISPR Therapeutics, which is known for its gene-splitting technologies.

FUNDAMENTAL PROBLEM

The fundamental problem is that this region and its academies are not deeply engaged in applied research, especially in science and technology, that might lead to the development of new products. It is an expensive enterprise, especially in a region that spends no more than one per cent of GDP on research and development (R&D).

Indeed, regional academic institutions, mostly (under)funded by governments, have a hard time meeting their basic expenses to keep their doors open. In other words, there isn’t an ecosystem within which R&D and innovation thrive.

These are difficult problems, with no easy solutions. Which does not mean that creative thinkers cannot find work-arounds, even if regional institutions do not reach the level of applied research of their counterparts in developed countries. As this newspaper recently suggested, one obvious way to start is through partnerships between regional academies.

For instance, The UWI, especially its Mona campus, where its new principal, Professor Densil Williams, is keen to have the university’s output positively impact Jamaica’s development, has done work that can be taken to new levels that can lead to breakthrough innovation.

It ought to be possible for The UWI, Mona to work with the University of Technology (UTech), which seems inclined to return to its core as a polytechnic university, to leverage their various skills. Indeed, UTech’s new president, Kevin Brown, comes from a background in R&D at Rolls-Royce, the jet engine maker. Similarly, its chancellor, Lloyd Carney, has a background in digital technology development, management and financing. Significantly, Mr Carney, a Jamaican, is a member of the board of Vertex, one of the partner pharmaceutical companies behind the sickle cell drug Exa-cel.

It should be possible, too, for The UWI, Mona and UTech to develop an R&D consortium with, say, Cuba’s Finlay Vaccine Institute, which developed the world’s first vaccine for meningitis, as well as two for COVID-19. And Cuba is not overflowing with capital.