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Addressing Global Health Needs
Varmus Invites 'Grand Challenge' Ideas, Stimulates New Thinking

Former NIH director Dr. Harold Varmus, who now leads Memorial Sloan-Kettering Cancer Center in New York, is also wearing another NIH-related hat these days: he is chairman of the scientific board of "Grand Challenges in Global Health," a $200 million initiative of the Bill and Melinda Gates Foundation — in partnership with NIH and the Foundation for the NIH (FNIH) — to stimulate creative thoughts about solving major global health problems that receive a disproportionately small share of research attention.

The project lays down a gauntlet before the world's science community: What are the greatest scientific and technological challenges in global health? The sponsors hope to collect a focused set of critical problems that, if solved, would lead to advances against diseases of the developing world. According to the Global Forum on Health Research, only 10 percent of today's medical research is devoted to diseases that cause 90 percent of the health burden in the world.

Varmus's call for "breakthrough questions" went out via email and advertisements in scientific journals in late April, with a deadline of June 15 for submissions to He and the board will designate as "Grand Challenges" 10 to 15 of the most promising avenues and post them next fall, followed by solicitations for research grant proposals to address the challenges. Grants of up to $20 million will be awarded; it is expected that multi-discipline consortia will have the best chance of winning awards, although individual submissions are also welcome.

The project's provocative approach is borrowed from an intellectual competition set in motion by British mathematician David Hilbert in 1900. He articulated a set of crucial, unsolved problems — dubbed "Grand Challenges" — in mathematics, which were quickly picked up by a field revitalized by the taunt. According to the Gates Foundation, "Hilbert's Grand Challenges continue to drive progress toward major breakthroughs in [mathematics] and have even led to unexpected returns outside the discipline...There is an opportunity to achieve for global health what Hilbert attained in mathematics...Solutions to grand challenges will enable major advances in research against diseases of the poor, and the development of products that will save millions of lives."

Examples of potential challenges include finding novel approaches to preventing and treating HIV, identifying an "Achilles heel" to block reactivation of latent TB, and finding a way to make mosquitoes incapable of transmitting such diseases as malaria, dengue and West Nile. Organizers explicitly discourage restatements of already-recognized problems, calls to apply what is already known, or requests for development of innovative strategies for health care delivery or infrastructure.

In addition to Varmus, the project's scientific board, international in nature, also includes NIH director Dr. Elias Zerhouni, NIAID director Dr. Anthony Fauci and former NCI director Dr. Richard Klausner.

The initiative was first announced last January at the World Economic Forum's annual meeting in Davos, Switzerland. Observed Zerhouni at that occasion, "This groundbreaking public-private an ideal complement to the NIH's efforts to improve global health. We will strive to create an unprecedented synergy, focused on engaging the best scientific minds of our time, maximizing the impact of our respective resources and thus spurring creativity and innovation in this field for the ultimate benefit of all humankind."

FNIH will administer the Grand Challenges initiative and NIH will provide scientific advice, expertise and support. Established by Congress in 1996, the non-profit FNIH builds collaborations with philanthropy, industry and academia to support NIH's mission. It recently raised $16 million from private funders to speed sequencing of the mouse genome.

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