The Necessary Failure

We must champion the targets even though many of them will not be achieved. If it were not for those idealistic goals, there would be no moderate advances.

I haven’t heard from my friend for a long time, but I still remember the question I asked her one day:

—Do you really go into that lab every day and spend hours and hours staring at the screen and down that microscope knowing that you’re never going to find what you are looking for?

—Hey, never say never hombre! You never know that for sure. But I do know that our line of research is on the wrong path. The premise is flawed.

She was a scientist researching treatments for neglected diseases. The institute where she worked had received funding for the project. But halfway through, she realised that they were headed in the wrong direction. At that point, the team had to decide whether to continue with their research or to throw away the work they had done and relinquish their funding. They chose to continue with the aim of publishing papers detailing why they failed, which would take a few more years. One thing that should be taken into account is that my friend’s income was precarious (nothing unusual in the sector, but worth mentioning nonetheless).

Photo: Ana Ferreira
 

I thought that a person who dedicates a chunk of their life to pursuing something they know in advance they will never find, must be touched with a certain degree of obsession and madness. But some things are not viewed in the same way in the field of science as they are in everyday life. And, indeed, my friend explained it to me like this:

—Ok. It is true that we are very likely going to fail. But we represent the necessary failure.

Her explanation helped me to understand that—while scientific advances are built on evidence—the body of evidence necessarily includes more failures than successes. And, very often, we arrive at findings through, or even thanks to, an accumulation of errors. My friend seemed to take great pride in the fact that she and her team were playing their part in this ongoing story of essential failures.

Rather than being conformist, her attitude was that of a realistic and pragmatic person. I should add that she also had a touch of geeky black humour. Even so, to devote so many of your working days and hours, and even your dreams, to something you will never see come to fruition, you have to be motivated by something deeper.

I believe that this ““mystic” attitude” that guides scientists is much more powerful than the ego trip of publishing papers in high percentile journals or battles to become the first or last author of a paper: far less quantifiable, but more visible than some material evidence.

This ““mystic” attitude” that guides scientists is much more powerful than the ego trip of publishing papers in high percentile journals or battles to become the first or last author of a paper.

I am remembering my friend today, on the eve of the World Health Assembly, with the publication of the progress report on the Road Map for the Elimination of Neglected Tropical Diseases (NTDs) in 2030. The elimination of NTD pandemics is one of the targets of SDG 3.3 . We should not forget that 1 billion people worldwide suffer from these neglected diseases. Snakebites, rabies and dengue alone kill 200,000 people every year, to name just a few of the more than 20 NTDs currently listed by the World Health Organisation (WHO).

Photo: Ana Ferreira

How Is the Progress Countries Are Making on NTDs Measured?

The WHO Road Map measures progress using three types of goals or targets: global, cross-cutting and disease-specific indicators. These three groups of indicators are based on three fundamental pillars: accelerating programmatic action to reduce the burden of disease, disability, etc.; intensifying cross-cutting approaches and improving cross-sectoral coordination between health systems and their services; and changing current operating models to reinforce national ownership and country involvement, including more horizontal decision-making and fundraising.  The aim is that countries should also allocate their own national resources to combatting these diseases.

In reality, there has not been much progress, although these reports are always worded to convey an optimistic tone.

In reality, there has not been much progress, although these reports are always worded to convey an optimistic tone. The Road Map was approved in 2021 and indicators were measured up to the end of 2023. At the end of this three-year period, the most significant result was that 50 countries had eliminated at least one NTD—half the number required to meet the 2030 target of 100 countries.

Another target for 2030 is to achieve a 75% reduction in disability-adjusted life years (DALYs) related to neglected disease. However, the information in the report on this indicator is already outdated and incomplete and refers to a reduction of only 10% in the period between 2010 and 2024.

Photo: Ana Ferreira

The Problem

The problem is that the Road Map was drawn up before the COVID-19 pandemic and includes indicators and horizons deemed achievable at the time. Subsequently, the pandemic obliged the world’s most fragile health systems, and even the more robust ones, to expend enormous financial and human resources, an effort that weakened the plans of some NTD programmes and delayed them by years.

The problem is that the Road Map was drawn up before the COVID-19 pandemic and includes indicators and horizons deemed achievable at the time.

Efforts to combat NTDs have resumed in the wake of the crisis but, as far as I can ascertain, no changes have been made in the targets set in the pre-pandemic Road Map. Common sense would suggest that targets should be revised downwards. But reworking the Road Map would involve an investment that I am not sure the WHO wants to, or even should, make. And countries tend to prefer grand speeches and elevated goals even when they are not in a position to achieve them.

While some diseases, such as African trypanosomiasis (sleeping sickness), are very close to eradication, the situation with others, for instance its close cousin in the Americas Chagas disease, is very different and their elimination as a public health problem is still a very distant goal.

And this is where the true role of the 2030 Agenda and the SDG goals comes into play: the need for objectives and, why not, for the immutable goal of a shared dream.

While some diseases, such as African trypanosomiasis (sleeping sickness), are very close to eradication, the situation with others, for instance its close cousin in the Americas Chagas disease, is very different and their elimination as a public health problem is still a very distant goal.

In the case of Chagas disease, elimination would mean interrupting all forms of transmission, since it is difficult to completely eradicate the principal vectors of the Trypanosoma cruzi parasite (the Triatominae or kissing bugs). According to the latest WHO report, progress has been made to date on only one of the five indicators: interruption of domiciliary vectoral transmission. However, there is still no data indicating concrete progress on the expansion of treatment coverage or on the interruption of other transmission routes. In those areas, progress remains at 0%.

Photo: Ana Ferreira

Should We Abandon the 2030 Targets?

By way of contrast to the conspiracy theories vilifying the 2030 agenda, we must champion the targets even though we may be aware that many of them will not be achieved. And should that frustrate us or lead us into gloom and doom? I don’t think so. Rather, I believe that if it were not for those idealistic goals, there would be no moderate advances. My researcher friend chose not to feel frustrated.

We must champion the targets even though we may be aware that many of them will not be achieved. And should that frustrate us or lead us into gloom and doom? I don’t think so. Rather, I believe that if it were not for those idealistic goals, there would be no moderate advances.

I haven’t heard from her in many years, but I would like her to know that I remembered her today, as I do on days when the horizon in my work becomes blurry, when projects don’t work out, and when life doesn’t seem to offer a fair return for the effort invested.

And I remember her because there will always be time to give up, to do nothing, to protest, or to wait for someone else to come up with a better plan. Or, like her, I can persevere in the teeth of failure, in the knowledge that we are all parts of the failure that is necessary to keep the project moving forward.