"Science for Society: Risks and Opportunities"

[The following is the text of an address delivered on 19 February 2005 by South African physician and educator Mamphela Ramphele to the AAAS Annual Meeting in Washington, D.C.]

My intention in choosing the topic of this talk today is to be unashamedly provocative. But I also hope that I can persuade you to take up some constructive actionable recommendations that are now in the public domain. Action and not words is what is needed to make ours a better world for all.

We live in a world that has reached unprecedented consensus on the value of science for society. Today's knowledge-based global economy is powered by scientific discoveries and innovation at a dizzying pace. The well-documented mal-distribution of benefits of science for society reflects the growing inequities between the 'have's' and the 'have-nots' in our world today.

As the United Nations prepares to take stock of progress towards meeting the Millenium Development Goals (MDG's) at its September 2005 General Assembly, scientists also need to pause and take stock. How have scientists engaged with society to promote the value of science for society? Where have we fallen short and why? It would be interesting to find out just how many scientists know about the eight MDG's. It would also be enlightening to find out the extent to which scientists as citizens have focussed their minds on the appropriate roles they could play in helping to meet these minimalist goals. The reality is that of all the regions in the world, Sub-Saharan Africa stands out as the one that will not meet any of the MDG's. A major effort would have to be mounted by all between now and 2015 to help Africa meet the MDG's.

Africa's status as a laggard in development terms is not surprising. None of the eight MDG's can be met without the engine of S&T powering the process. Whether one takes the prospect of halving the number of people living in extreme poverty with associated hunger and malnutrition. Or turn the focus to universal primary education. Or tackle the shame of maternal mortality that claims a woman's life every minute we sit here tonight. Take HIV/AIDS, or other communicable diseases. I could go down the list. But ultimately the case is clear. Each one of these reasonable, minimalist goals cannot be met without employing the power of the knowledge we already have to make ours a better world for all.

Why then has there been such inadequate attention paid to the importance of enhancing science and technology capacity as an essential component of efforts to promote sustainable development? How does one explain this critical oversight in the light of established fact that science and technology is the engine that drives knowledge-based development? What accounts for this large know-do gap in tackling inclusive socio-economic development that addresses the demographic, public health, food security, environmental and other pressures that plague the world?

How could development theory have been so silent for so long on this missing link in the development process? To add insult to injury, the use of "rates of return" analyses led to wrong-headed development policies that promoted investment in primary education at the expense of secondary and tertiary education. The mistaken conclusion that the return on investment in education is higher for primary than for secondary and tertiary levels ignored important linkages. First, primary education needs inputs from secondary and tertiary education in the form of teachers and curriculae. Second, good education policy-making, implementation and monitoring are typically driven by professionals who are products of tertiary education. Finally, good governance and economic growth — essential foundations for sustainable investments in education — depend on capable well trained public officials. Without tertiary education such professionals cannot be developed. How economists could ignore the long-term impact of such wrong-headed policies is difficult to understand.

The 2000 report sponsored by Unesco and the World Bank: Peril and Promise: Higher Education in the Developing World, offers the best critique of this narrow economist view of the rate of return on education. It makes the case for higher education as a global public good that ensures not only greater socio-economic prosperity, but also higher quality governance by an informed citizenry able to hold their leaders to account to ensure good governance.

Conspiracy theorists might argue that this oversight in development theory should be seen as part and parcel of the desire by the industrialized world to prolong its hegemony over the poor part of the world. Or is it simply a question of double standards that stems from failure to understand that poor people have the same aspirations as well off people? Reference could also be made to the cold war era and its focus on 'divide and conquer' strategies. So too could some point to the post-cold war reality of the scramble for natural resources driving development agendas. It is a cruel irony that the most sought after natural resources reside in some of the world's poorest countries. The sting of the resource curse could not be more painful than when one looks at The Democratic Republic of the Congo, Nigeria, Angola, to name but a few.

Others might argue that the billions of US dollars poured into development aid over the last 60 years have spawned an industry that thrives on providing opportunities for professionals in the North to service "the needs" of the South. This industry could be said to have built-in incentives against promoting sustainable institutional capacity enhancement. It is estimated that at least $4bn is spent annually on technical assistance in Africa alone. Institutions and individuals involved in this form of technical assistance have much to lose from working themselves out of a job by ensuring the emergence of strong professionals and institutions in developing countries. It would not be surprising if those involved work to ensure their own indispensability. These arrangements have in some cases been built into "tied-aid" that makes donor money conditional on use of donor country citizens as consultants to projects being funded.

Over the last few years there have been laudable efforts to untie aid and co-ordinate donor efforts, but vested interests continue to lobby hard against change. Indeed the USA Congress measures the performance of USAID by amongst others, how many cents to the dollar given in aid comes back to the USA. The higher the proportion returned to the USA, the better the investment according to this logic. It is not hard to see where such an approach would lead in the medium to long-term.

We are however in the fortunate position that more and more powerful governments are coming to grips with the reality of the inter-dependent nature of the global economy. Globalization has succeeded in ways unforeseen by anti-globalization activists in demonstrating the inter-dependence of the global society. For better or for worse we can no longer plead ignorance or feign indifference to what happens in other parts of the world. The impact of shocks in one region reverberates in other parts almost instantaneously. Be it the tsunami, financial crises, SARS or other public health crises. We are in this world together.

In 2002, a meeting of world leaders on financing for development in Monterrey, Mexico, produced a consensus spelling out how this inter-dependence should translate into complementary responsibilities to meet the MDG's. Developing countries are to get their governance act together, invest in their people and promote sustainable socio-economic growth. The developed world is to improve the quality and quantity of aid, open their markets to trade with poor countries especially in those areas where the latter have comparative advantages such as agricultural goods, and provide deeper and faster debt relief. Development agencies especially multilateral ones such as the World Bank and International Monetary Fund, are to support poor countries to strengthen their capacity for national strategic planning, implementation of development programs and better governance.

The challenge of implementation remains. There has been much talk, but little action on many fronts. Africa's laudable efforts to put its own house in order through establishing the African Union and the New Partnership for Africa's Development have delivered patchy results. The capacity to turn commitments into sustained actions is often lacking at the individual, the institutional and the societal levels. The legacy of neglect and inequity persists.

As the world community takes stock of the implementation gaps where do scientists stand? You might argue that you as scientists are already doing your bit. By doing good science you are making your contribution. Sure. You might even add with justifiable indignation that you cannot be held responsible for problems arising from actions resulting from bad public policies or corrupt governments that neglect their public duty. You might even recall the numerous occasions you have tried to engage but was rebuffed or your advice ignored. Or you might even say that you are doing so much already under enormous pressure with little added resources that it would be irresponsible to take on more. All this sounds reasonable. But is it all you as an individual can do? Is it all the AAAS can do? Is it all we as a scientific community can do?

I would like to make the case for doing more and better. There are risks embedded in the continuing inequities in the accessibility of the benefits of science for society within and between nations. These risks are both of a material and philosophical nature. At the material level, the recent tsunami catastrophe is an example of the cost of asymmetries in access to information and disaster preparedness. That scientists in the USA detected the signs of the earthquake, but could not or did not communicate this information to the countries involved due to inadequate systems in the latter is a tragedy that ought to move us to ensure that information gaps are addressed.

At the philosophical level we run the risk of poor people being further alienated from science. This would undermine efforts to manage public health problems such as HIV/AIDS and SARS with potential devastating consequences for global health. The perception, sometimes re-inforced by scientists themselves, that science is a "western construct" also undermines the universality of scientific principles. The designation of science as "western" is ahistoric given the well documented multi-focal origins of both natural and life sciences. There are also risks in going about redressing these inequities in a manner that may do more harm than good. Collaborative approaches are needed to build and enhance local capacity. Doing things for poor countries leaves them perpetually dependent.

But we also need to look at the positive side. There are enormous opportunities in forging mutually beneficial partnerships to address the challenges of harnessing the power of science and technology to make our world a better place for all. There are numerous examples of great North/South and South/South partnerships to promote science and technology capacity across the globe.

Allow me to cite two vignettes from my own country. Both involve scientists who have seized the opportunity of using world-class scientific methods in resource-constrained environments to tackle public health challenges. Both have sought answers to complex problems by firmly locating themselves in their specific context, yet reaching out to the world to find support for their innovations from scientifically advanced countries. Both innovations are borne out of adversity.

Let's take the first case. Professor Deborah Glencross, is a molecular science haematologist at Witwatersrand University. She has developed a new approach to CD4 testing in HIV/AIDS management. This "Panleucogating" or PLG CD4 test is 70-80% cheaper than traditional methods. The test has received the FDA stamp of approval and is being rolled out in South Africa and elsewhere in Africa and worldwide. Cost savings resulting from this innovation run into billions: R66 (US$11) per test versus R1500 (US$250) for the traditional approach. Prof. Glencross makes a point of showing her students an upside down map of the world with Africa at the top as she says: "It is all about perspectives. The First World often patronizes Africa…..It's (the PLG test is) such a big thing. It came from the tip of Africa"

The second case involves Professor Lynette Denny, an O&G specialist at UCT. She has developed a reliable test for Cervical Cancer detection amongst poor women in Khayelitsha, Cape Town, where the prevalence rate is 40-100 per 100 000 women compared to 6 per 100 000 in the UK and other well resourced countries. Working from converted shipping containers on the premises of local Primary Health Care facilities with locally trained nurses and community health workers, Prof. Denny has developed a model of enhancing access and availability of high quality care. She applies ordinary household vinegar to the cervix to highlight pre-cancerous lesions. Using controlled trials she has demonstrated the efficacy of Direct Visual Inspection and testing for Human Papillomavirus by screening and treating 7200 women between 2000-2003. Her follow-up rates are amazing by any standard: 98% at one month, 86% at 6 months and 80% for the 12 months examinations.

She is saving women's lives and affording them the dignity often denied them. They are saved the trauma of the slow death that befalls victims of late stage cervical cancer and the unpleasant smell that marks them. She is also contributing to the identification, training and retention of health care professionals who are in short supply in Africa. She has been labelled as "a crusader — not a scientist" by some of the traditionalists in the Health Science Faculty. Crusader or not, her contribution is recognized as world-class and appreciated by many more. She is inundated with requests to roll out her model across South Africa and the rest of Africa. But she needs much more resources to be able to do more.

Where do we go from here? A firm foundation has been laid over the last few years to enable the scientific community to do more and better in promoting science for society. The Inter-Academy Council, established in 2000 to advice governments and multilateral agencies such as the UN, World Bank etc., has produced two important reports with clear recommendations. The first, Inventing a Better Future, spells out how S&T capacity can be built globally through promotion of partnerships between scientifically lagging, proficient and advanced countries. It focuses on the centrality of universities in promoting science and technology as well as the need for centres of excellence in all regions however poor.

The second report, Realizing the Promise and Potential of African Agriculture, homes in on using S&T to improve Africa's food security. It identifies why Africa was by-passed by the green revolution and why a different approach is needed from what worked in Asia and elsewhere. Africa's ecology, cultural specificities, especially the gender dynamics of food production, the complications of HIV/AIDS pandemic and its impact on women's ability to continue to carry the enormous burdens of production, reproduction and care, all have to be factored into appropriate responses.

Africa's food security is hampered by the under-utilization of known and relatively cheap technologies to enhance agricultural productivity. It is also undermined by inadequate national development strategies that impede private sector investment and economic growth. There has to be a way of tackling this problem by working with Africa's higher education institutions. The revitalized Makerere University in Uganda is already showing how this could be done. Thanks to the support of American philanthropic foundations, Makerere has re-invented itself as a premier university using national development challenges as a teaching and research platform. First-rate work is being done in the fields of HIV/AIDS and agricultural extension services to enhance productivity.

In addition to this work, the Joint Learning Initiative, sponsored by the Rockefeller Foundation, WHO and with World Bank collaboration, has focussed on the challenges of human resources for health in developing countries. They estimate that the global health workforce at 100 million people, with doctors, nurses and midwives making up only 24 million. Sub-Sahara has one tenth of the doctors and nurses for its population compared to Europe. Ethiopia has one fiftieth of the health professionals that Italy has. The reality of globalization is that the emergence of a single global labour market is likely to worsen the situation of poor countries like Ethiopia. The increasing mobility of skills and the fierce competition for talent is likely to see them losing more of the few graduates they produce.

What are the implications of a single global market for skills for poor and emerging market economies that may not be competitive? The cruel reality is that all countries would need to reposition themselves as desired destinations for skilled talented personnel. What poor countries cannot offer in hard currency, they would need to make up in conditions of service approaches that leverage the comparative advantages of lower costs of living, pleasant climates and more relaxed lifestyles in the South than in advanced economies of the North. Locational issues would take on greater importance in the recruitment, promotion and retention of nurses, teachers, doctors and other skilled personnel.

The Joint Learning Initiative takes us beyond lamenting "the brain drain" towards developing strategies for a global labour force that is sustainable. They estimate that of the current $10bn of ODA (13% of $57bn) annually spent on health, $4bn is devoted to human resources. If $400m of this could be dedicated to a well-targeted 'country by country' human development strategy, it could lead to a sustainable pool of well trained health professionals to meet both national and international needs. Recognition of the complimentary needs of the developed and developing world in this sphere could lead to a win-win-win situation. The aging northern economies need to help the poor but youthful southern economies to invest in the human development of their people for the benefit of the total global market. This would be complementarity taken to its logical conclusion to ensure sustainable development for all. It is not about charity, but about enlightened self-interest by all parties involved.

The Global Commission on international Migration, which I co-chair, welcomes this approach. It resonates with our own analysis that international migration is a reality that stems from the asymmetries of democracy, development and demography, "the three D's". People do, and will always move from their home bases in search of better opportunities. Through out history poor people have migrated from poor rural homes to urban areas as well as across their home country borders in search of better livelihoods and security. International migration should, and can be governed and managed better to ensure that the needs of most countries are met in a sustainable way whilst growing the total global economy.

A study done by the Conference Board, a New York based private sector think tank, published in 2003, suggests that the global economy is under-performing. It suggests that this underperformance results from not tapping into the full human potential that resides outside the advanced economies. It points out that the so-called booming 1990's had slower growth of the global economy at less than 3% compared to the 1960's average of 5.5%. Recent analysis estimates that emerging markets will have to double the size of their economies over the next ten years in order to significantly reduce poverty. We also know that productivity growth occurs when economies move from an agricultural focus to manufacturing and services.

The study urges that a greater focus be placed on the widening pool of ready workers in almost 200 countries who have the same aspirations as workers in advanced countries. Its conclusion is clear. "It has never been more important to take a global perspective on the new growth environment and ask not how to distribute growth or how to be sure no individual country advances too fast — but rather how everyone can advance faster together."

Let me conclude on a practical note. It would seem to me that there is a golden opportunity for scientists to rise to the occasion to make science for society the engine of prosperity across the globe. Let me suggest the following lines of action:

1. Familiarize yourselves with the reports of the Inter Academy Council I referred to earlier, namely: Re-inventing a Better Future and Realizing the Promise and Potential of African Agriculture. They contain practical actionable recommendations that could make a world of difference in the lives of the millions of young people across the globe whose talents need to be developed for the benefit of all of us. Make your commitment given your own professional position about how you and your institution can respond to the call for action.
   
   
2. Engage the report of the Joint Learning Initiative on human resources for health. As a citizen you can add your voice to ensure the redirection of ODA to focus more on sustainable human resource development to enlarge the pool of health professionals in both developed and developing countries.
   
   
3. As a scientist, you also have the opportunity of examining the way in which your institution currently engages globally. Are you prepared to be a catalyst for change towards more productive mutually beneficial partnerships with developing country institutions? The enrichment that could flow from collaborative approaches could set your career on a new path and make it much more rewarding.
   
   
4. Finally, the AAAS has an opportunity to be a champion of a greater focus on a global perspective on promoting a new environment in which everyone can advance faster to make this a better world for all.

Individuals can make a difference. As Margaret Mead reminds us, it is the only thing that has ever changed the course of history.

Thank you.

19 February 2005