Author: Scott Brouilette, 10x Genomics
A jam-packed Wednesday at ASHG 2017 ended with the much-anticipated discussion with Bill Gates and Francis Collins (Dir. of the NIH), the focus being on "where we stand in terms of global health, and about what we hope to achieve moving forward". Gates admitted that he didn’t really pay attention to biology at school and his chemistry grade was the worst ever, but he has always been fascinated by the software coding that evolution has produced.
Gates started to talk about the early successes of the Gates Foundation by highlighting that just 10 years ago around 12 million children were dying per year before the age of 5, but that number has now been halved primarily via utilization of existing solutions - i.e. vaccines. But, there are still many mysteries - over half of deaths under the age of 5 occur in the first month, and half again in the first 2 days. But the pathogens and mechanisms behind this remain unclear. What is clear is that pre-term birth remains highly associated with various health issues, with one interesting avenue of research looking at changes to the microbiome in the mother as a causative factor. The microbiome is also dysregulated, showing a reductio in diversity, in malnourished children. Malaria also plays a role; mothers exposed to malaria during pregnancy showed increased risk of pre-term birth, and in the lab CRISPR/Cas9 is currently being used to modify mosquitos to stop them carrying and transmitting malaria (if you haven’t seen Gates’ TED talk on malaria it is a fascinating watch).
Gates then came back to the broader aims stating that "in order to achieve our goals we need improvements to vaccination strategies". In the case of TB and HIV we don’t have vaccines, but they will be needed to reduce the current burden. He implored the genetics community to continue to innovate and drive developments that will eradicate these diseases.
Francis Collins then joined the discussion, starting by telling Gates (and the audience) that "this discussion is being captured live on FaceBook so don’t flub too badly!"
Collins: How are we doing on the HIV vaccine?
Gates: Glass half full. The US governments spend over \$6B per year on drugs for HIV treatment, so from an economic perspective this is a problem. But we’re not actually reducing the infection rate - it is remaining stable and won’t decrease without a vaccine.
Collins: What do you see as the greatest biological threat right now?
Gates: The movement/migration of people - pandemic spread - flu for example. Contracting flu during pregnancy again associated with reduced birthweight.
Collins then raised the issue that while we need innovation to drive improvements in global health, the issue is that the current curricula often "turns people off biology" as it evidently did with Collins himself, pushing him down a chemistry route before "returning to the good stuff" a little later. Gates' response was that the benefits of technology (such as the wide availability of lessons online, personalized learning, etc.) do not seem to have made their way into the educational system yet. There is clearly room for creativity in teaching biology and making it engaging.
Collins: What are you most exciting about?
Gates: The rise of micro biome study. In a short space of time we have learned that the microbiome is linked in so many ways to human health and disease. If just 10% of the current projects come to fruition we will see tremendous improvements in global health.
Collins: Concerned about?
Gates: A lack of a global perspective that may prevent large scale, international collaboration and data-sharing.
From the audience: With advances in genomic tech over last 10-20 years and the rise of data science, what is the next major bottleneck?
Collins: Large-scale data storage and analysts HAS to be cloud-based - we need to re-tool in order to make this successful, and we need to promote this however we can. Managing the research community is like herding cats, but guess what? I have a very big supply of cat food – it’s called the NIH budget!
On that note I suggest you get back to your grant-writing!
Read more abut this great session on GenomeWeb