A decade of health advances: the victories and defeats in the war on disease

Breakthroughs have transformed and saved lives, writes Robert Matthews, with more to come

epa08087774 Afghan health workers administer polio vaccination to children in Kandahar, Afghanistan, 23 December 2019. Since the beginning of this year (2019), the number of polio cases in Afghanistan has risen to 26,9 incidents in Uruzgan, 5 incidents in Helmand,  5 incidents in Kandahar, two in Paktika, one in Kunar, one incidents in Nangarhar, Badghis, Baghlan and in Farah provinces.  EPA/MUHAMMAD SADIQ
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During a decade often short of positive news, one field of human endeavour has made genuine if often overlooked progress: the world war on disease.

While researchers often wince at that bellicose metaphor, they have achieved success on several fronts – with the prospect of more to come.

Some of the best news comes from the war on cancer.

First declared almost half a century ago by US President Richard Nixon, victory has long seemed a distant prospect.

But over the past decade, the global death rate from cancer has begun to level off.

Part of the reason is better treatment and the emergence of medicine such as monoclonal antibodies, which home in on target cells like missiles.

Once punitively expensive, these are now becoming much cheaper and available to far more patients.

There is particular excitement about the use of such monoclonals in so-called immunotherapy, where the body’s own defences are stimulated to attack cancer cells.

In 2014, the US Food and Drug Administration approved the use of Keytruda, a monoclonal that prevents cancer cells hiding from the immune system.

It is now being used to treat lung, skin and stomach cancers, among others – in some cases, even after they have spread around the body.

The promise of cancer immunology was reflected last year by the awarding of the Nobel Prize in Medicine to two leading researchers in the field.

The biggest driver of the declining cancer rate has only just revealed itself – and has little to do with wonder drugs.

This month, the World Health Organisation reported a fall in the global use of tobacco. As the prime cause of lung cancer, which along with breast cancer is the most common form of the disease, declining tobacco use is a major public health milestone.

FILE PHOTO: A man uses a vape device in this illustration picture, September 19, 2019. REUTERS/Adnan Abidi/Illustration/File Photo
Switching from cigarettes to vaping has helped contribute to a more positive health outlook. Adnan Abidi / Reuters

The fall is being helped along by the rising popularity of vaping, whereby e-cigarettes deliver the nicotine "hit" without the carcinogenic smoke. At the start of the decade, there were only about 5 million vapers globally. That figure has now increased almost tenfold.

But recent reports of respiratory problems and even deaths among vapers in the US have sparked a global debate over the balance of health benefits which looks set to continue well into the 2020s.

If the current decline in tobacco use continues, it will also help the fight against cardiovascular disease, still the biggest global cause of premature death. As with cancer, better treatment has helped push the CVD mortality rate down over the past decade in many countries – at least for now.

But there is growing concern that obesity rates could reverse the trend. The UAE has been a world leader in showing how public health measures can counter this threat. Since 2010, a combination of tougher regulation, higher taxes and health campaigns has produced impressive declines in adult smoking, obesity and high cholesterol.

Even so, CVD rates remain unacceptably high — which is likely to lead to wider use of a new weapon against it: the polypill.

Made from a mix of cheap medicine already used against the disease, the polypill was mooted more than 20 years ago and will likely be used more widely during the 2020s.

The biggest study of its effectiveness, published in September, revealed dramatic reductions in the risk of CVD, heart attacks and strokes over and above what's already possible through lifestyle advice.

There has also been welcome progress in the war against infectious diseases — once the principal cause of death globally.

We may at last be approaching the end of the 40-year Aids epidemic, which killed more than 35 million people and continues to blight the lives of even more. While a cure remains elusive, by the mid-2010s doctors had access to medicines that hold the virus in check for decades.

Another crucial advance came in 2012, when the FDA approved Truvada, a combination of drugs that helps block infection by the Aids virus – essential for ending the epidemic.

Health workers wearing protective suits tend to an Ebola victim kept in an isolation cube in Beni, Congo, on July 13, 2019. (AP Photo/Jerome Delay)
Health workers wearing protective suits tend to an Ebola victim kept in an isolation cube in Beni, Congo, in July 2019. Jerome Delay / AP

Other viral adversaries have yielded to more traditional weaponry. This year came the approval of the first vaccine against Ebola, the terrifying virus that killed thousands in central Africa in recent years.

Meanwhile, vaccination looks set to eradicate one disease completely: polio. Once a global threat to health, the virus now only has a presence in Afghanistan and Pakistan.

Last year, there were merely 33 cases – down from 350,000 in the late 1980s.

But while this virus may be about to follow smallpox – eradicated in 1980 – into oblivion, other infectious agents are making a comeback. Cavalier use of antibiotics has led to many bacteria evolving resistance to standard treatments.

The UAE has been among the toughest in cracking down on careless use of antibiotics, thus buying researchers time to find new ones. If they fail, we face returning to times when minor injuries often proved fatal.

Technology will play a crucial role in meeting this challenge. Over the next decade, AI will be used in the quest for new antibiotics, and much else besides them. One of the biggest disappointments of the last decade has

been the failure to find treatments for Alzheimer’s disease, which is becoming ever more common as longevity increases. Many researchers suspect a radical rethink is now needed. AI may find it lurking in the vast amounts of patient data now available.

We can also expect AI to make inroads into routine tasks such as screening, freeing up physicians to focus on the complex cases.

Nevertheless, perhaps the most exciting role for AI and “big data” lies in so-called personalised medicine.

Even today, most drugs do not work with most people, with genetic quirks making them either ineffective or even harmful. Tailoring medicine to each patient is one of the main goals of 21st-century medical science.

We’ll also doubtless see headlines about advances in gene editing, 3D organ printing, injectable “nanorobots” and the like. Yet these aren’t what saves lives on a global scale.

For the coming decade and beyond, forget the wizardry – the biggest gains will come from making more of what we already have.

Robert Matthews is visiting professor of science at Aston University, Birmingham, UK