Today, April 7, marks World Health Day, which is celebrated worldwide with various slogans to highlight pressing health issues. This day serves to make us aware of our health and that of our loved ones. Yet, the priority for health interventions by various professionals vary—a doctor may be more patient focused while a public health professional would be more likely to be community focused. Similarly, a policymaker would want to use credible evidence from the clinical and public health sector to develop health programmes. Evidence-based health interventions, therefore, are a common necessity for health professionals. This can only come about through well-planned research activities.

Public health research

The importance of research on human beings should not need convincing. Conferences and meetings held in different sectors of public health across the globe use the ‘R’ word freely and frequently. This practice has become noticeable in recent times in Nepal too. However, multiple questions concerning the basic diseases prevalent in the country do not yet have answers. It is very clear that public health research should become a strong focus for the government in the coming days in order to answer those very questions.

The importance of research becomes relevant when we stop to think about the diseases plaguing humankind across the globe. The emergence of many non-communicable diseases (such as cancers, diabetes and heart disease) as well as communicable diseases of various types has become a clear and present danger for communities. The risk to health posed by influenza viruses (e.g. H1N1, H7N9, H5Na), diseases spread by vectors such as mosquitoes (malaria, dengue) or viral infections such as Hepatitis B or C are some of the ‘new’ concerns for the world health community. This holds true for Nepal too, since a developing nation cannot afford to be separated from global issues, as it is the weakest link in the global health chain.

The treatment of diseases is always important but the identification of causative agent(s) and the ways to prevent those agents from causing and spreading diseases should come first. Surveillance can allow public health professionals to keep track of important diseases that are likely to affect a community on a large scale before they become a bigger risk. Surveillance depends on reliable diagnostics by way of laboratory-based methods. Whether it is using standard microbiology-based methods to detect bacteria, virus or parasites (in communicable disease) or using molecular methods of detection (e.g. DNA or RNA) of cancerous cells (in non-communicable diseases), applied scientists these days are becoming increasingly more valuable in the area of disease surveillance.

Applied sciences

Where does applied science fit into all this and how can we make use of human resource with expertise in applied sciences to support health research in the country? It is now time for clinicians, public health experts and policymakers to start discussing this topic. Historically, microbiology and immunology have featured prominently in public health. Whether it was Alexander Fleming discovering penicillin or Edward Jenner discovering the power of vaccination against small pox, science has always been involved in life-saving discoveries. The knowledge of applied sciences is paramount for such discoveries. Science asks questions and it is necessary to answer them by carrying out necessary investigations. This is what ‘research’ is all about.

“Know thy enemy,” said Sun Tzu, an ancient Chinese army general and tactician. Though linked to human warfare, this pronouncement is applicable to health as well. The ‘enemy’ in this case is the pathogen (any virus, bacteria or parasite in the case of communicable disease and high-risk genes and proteins in the case of non-communicable disease). In order to understand this enemy, it is important to understand its behavioural patterns, strengths and weaknesses through research. This type of research, for example, can enable scientists to identify whether the pathogen is changing, thereby making vaccines and medications against it less useful. Similarly, knowing the genetic makeup of individuals in a given community can allow scientists to find out whether a specific type of cancer (e.g. breast or cervical) is likely to affect those individuals. Genetic analysis can tell us whether antibiotic resistance is present in some bacteria, thus providing medical professionals with evidence to refrain from using those antibiotics in the immediate future.

The concept of applied research in public health in Nepal also needs to be prioritised by the government and donor communities. Diseases that can easily be prevented by early screening or regular monitoring should be prioritised and investigations initiated to understand them better. Diseases like cervical cancer, hepatitis, diabetes, for example, need more research, the results of which will enable interventions and thereby, save lives. Similarly, routine monitoring and research into emerging diseases, such as influenza, need to be carried out to intercept infections before epidemics or pandemics begin. For example, cholera, which is caused by Vibrio cholera, needs more research to identify how best to implement vaccine programmes across the country. There are many more areas where applied science research is required in the public health sector in Nepal.

Coordination matters

Nepali clinicians, scientists and government line agencies need to continue to talk to each other about the country’s research priorities. The Nepal Health Research Council and the Epidemiology and Disease Control Division under the Ministry of Health and Population will need to play key roles in identifying those priorities. Donor agencies and the World Health Organisation should then support governmental and non-governmental actors to carry out research. Ideally, the role of the Nepal Public Health Laboratories would be to then facilitate diagnostics and surveillance by playing a leading role and bringing together other capable organisations for support. Academic institutions, especially the medical sector and non-governmental and private research institutions, also need to start focussing on result-oriented applied science research so that policymakers have access to much needed evidence for developing health policies.

Nepal needs to show the world that it is not only famous for the Buddha, Mount Everest and its natural attractions but is also a country of expert clinicians, scientists and academicians—who are in the country itself—are capable of carrying out important applied science research in public health. Nepal needs to contribute evidence from within the country for its own benefit, and for the world to see and appreciate.

Dixit is Director of Research at the Center for Molecular Dynamics Nepal