It's time to face the real risks

Developing nations could profit from our aversion to risk, says Bridget Ogilvie.

The public is in a state of confusion concerning how best to protect its interests. People resent being told what to do by the state or by anyone in authority. Deference is no longer a national characteristic. We all insist that we be allowed to do our own thing and to develop our own values and moral standards. At the same time, we expect to live in a risk-free environment While as individuals we have developed this selfish view of life, we expect our fellow citizens who work in the public service to do their job in an increasingly regulated environment and thus to have a totally different world view - to suppress their rights and needs and to accept the responsibility to deliver services that solve the nation's problems with the minimum of risk.

Clearly, these life views are incompatible. Somehow we need to find a way to persuade people that life simply cannot be risk free and that progress and change inevitably involve risk.

One of the risks we fear most is the threat of disease. Advances in public health and science have ensured that in countries such as Britain we can mostly avoid the infectious diseases that struck down our ancestors. The major life-threatening ones are, for most of us, the degenerative kind.

But the pattern of disease is very different in developing countries. Though the number of people affected by diseases such as malaria is large, and despite the great need for new therapies, with the exception of HIV, both public and private investment in medical research tend to ignore them. This is because of "market failure" - the people who suffer most have no money to pay for cures. Enlightened self-interest, if no higher motive, should encourage us to do something about this.

People in rich countries are not immune to these diseases. Both increased international travel and climate change have altered the spread of disease, and between 1980 and 1992, 18 new infectious diseases were recorded, including HIV. Also, antibiotic resistance is increasing.

Private companies that invest in developing scientific ideas into marketable products need a return on their investment. The cost of developing a drug can run to millions, and this is increasing all the time. These costs are partly the result of more stringent safety assessments by government bodies - to ensure that drugs are free of side-effects, we must pay more for their development.

This is not the only barrier to access to medicines in developing countries. Corruption, lack of investment in health by governments and wars all contribute.

In recent years, incentives have been introduced to encourage the development of drugs for neglected diseases. These include increasing the patent life of a company's product in return for that company creating a product for a neglected disease, or offering tax returns on the sale of drugs to third parties such as the United Nations.

There have also been efforts to encourage private and public bodies to work together to deliver medicines to poor nations and to develop treatments for neglected diseases - the Medicines for Malaria Venture and the Global Alliance for TB Drug Development, for example.

I have no doubt that such ventures are risky, but it is in the public interest that government funds are made available to help them to succeed.

This is an extract from Bridget Ogilvie's Dainton lecture at the British Library, November 2000. Dame Ogilvie is chair of the Committee on the Public Understanding of Science, visiting professor at University College London and chair of the board of Medicines for Malaria Venture.