LAUSR

A little over 30 y ago, human immunodeficiency virus (HIV) was first identified as the cause of acquired immune deficiency syndrome (AIDS). Within a decade the nature of the infection, the pathogenesis and a series of combination therapies had been developed that transformed a deadly infection into a challenging but manageable condition. The challenge was then to ensure that everyone who needed these lifesaving therapies had access to them.With more than 20 million people still without access to antiretroviral drugs, that remains a real challenge, but the progress in science and innovation has been truly remarkable. The start of the HIV pandemic in the mid 1980s was all the more concerning because in the last few decades of the twentieth century infectious diseases around the world were in retreat. Smallpox had been eradicated, terrifying illnesses like polio were starting to be eliminated and common childhood infections of the past, like measles, were increasingly under control through vaccination programmes while antibiotics remained broadly effective and multiple resistance had yet to emerge. In the first decade of this century, in support of an energised World Health Organization (WHO) and with strong public support, agencies such as the Global Alliance for Vaccine Initiative (GAVI), Global Fund to Fight AIDS, TB and Malaria (Global Fund) and the Joint United Nations Programme on HIV and AIDS (UNAIDS) were established to finance and bring focus through public–private partnership models to support science and innovation and ensure equitable access to essential public health interventions within countries. By creating financial incentives, advance market commitments, guarantees and volume of sales to develop new vaccines, GAVI was able to transform the global research and development for vaccines and ensure those vaccines could reach those who needed them most. Similarly, the Global Fund, UNAIDS and other such partnerships pooled resources from public, private and philanthropic sectors to take on some of the great challenges of our time and by doing so achieved more than any one sector could achieve on its own. Many others such partnerships followed, accompanied by increasing public and political support for the power of science to transform lives and the commitment to ensure those benefits were available to the maximum number of people globally, independent of their ability to pay. The first draft of the human genome was published in 2001 and through the work of many international organisations, including the US National Institutes of Health, the Wellcome Trust and laboratories in China, France, Germany and Japan, was made publicly available to the world, marking a high point in international scientific collaboration and a clear commitment to sharing and open, safe access to critical scientific knowledge for the benefit of everyone. Almost 20 y on, there is almost no part of public health and medical research that is not touched by the knowledge gained from the Human Genome Project. It has led to advances in technology and data science beyond human health that have transformed almost all areas of biology and will continue to do so throughout this century. In 2003 the world was reminded of the power of infectious diseases and the impact of globalisation when an epidemic of a novel lung infection, severe acute respiratory syndrome (SARS), spread from southern China to Hong Kong and thereafter to many other countries, including those in Southeast Asia and Canada. SARS was caused by a previously unknown virus the SARS–coronavirus (SARS-CoV), a zoonotic virus that was eventually traced back through an intermediary of civet cats from bats in Yunnan province. Between November 2002 and July 2013 there were >8000 known cases and almost 800 deaths across 37 countries, with an estimated cost of approximately US$60 billion. Since 2004 there have been a series of major national, regional and global epidemics, including SARS, avian flu, Nipah, Ebola, Zika, yellow fever, non-polio enteroviruses and Middle East respiratory syndrome (MERS). Each demonstrates that we remain vulnerable to endemic and emerging infectious diseases. In lowand middle-income countries, where many infections are endemic, the double burden of infectious diseases and increasing burden of non-communicable diseases pose an CO M M EN TA RY