Why are you and the eleven other authors calling for a new approach?
Rudolf Guthoff: At the moment, the focus is on prevention. We are not critical of that, because large-scale vaccination and prevention programmes have achieved a great deal: tuberculosis, malaria and river blindness are on the decline, which are all major successes. However, there are diseases that cannot be prevented. That is why we are calling for a balance between prevention and curative treatments.
Does that mean the “Global Clinical Care” approach should be reinstated?
Guthoff: Yes, that is the term used for this integrative approach. We would like to revive it, partly because health policy tends to imply that prevention is cheaper than curative treatment for every disease. But this is not the case. There are 1.5 million children in the world who have already gone blind. A third of them can be cured, and we believe that these children also need to be helped. And this is possible with relatively inexpensive means.
Your ideas have been developed using the example of childhood blindness in Africa. The paper also discusses model calculations and the future productivity of children. Does the investment need to pay off?
Guthoff: It is sensible for a state to provide treatments for childhood blindness. It is easier and less expensive to send a child to school and ensure that they can support themselves later in life than to provide for them for the rest of their lives. We also know that blind children die prematurely and they are often neglected. We are not just treating blindness, but also extending lives.
Can we not just help out of altruism?
Guthoff: We will not eliminate childhood blindness in Africa by having charitable intentions, nor will we eliminate other diseases such as coronary heart disease. We need to set up structures on the ground that help people to help themselves. We need to show colleagues our techniques and help integrate them into a scientifically oriented healthcare system. This cannot be achieved without considering the financing. Pharmaceutical companies only provide equipment if it is economically viable. Unfortunately, that is the reality.
What structures are needed specifically?
Guthoff: Institutionalised partnerships between universities or clinics are key. In ophthalmology, for example, there are partnerships between Rostock and Kinshasa, Tübingen and Malawi, and Homburg and Mengo in Uganda. These have been established by cultivating personal contacts. This means that structures are being created that can be integrated into the local healthcare system.
It is important to note that we are not benefactors, we are partners and identify scientific problems together. There has to be give and take. But you need to want these kinds of partnerships and this is an additional requirement. At the political level, as part of development cooperation, steps should be taken to ensure that these structures are maintained in the medium and long term.
Why do you think the “Global Clinical Care” approach is so important?
Guthoff: We believe that with curative medicine we can also achieve something visible in terms of foreign policy. These partnerships are important for a country’s development and should also be important for our foreign policy as they enhance our country's reputation. It is significant that when children return home with their sight restored that is known to be a German initiative.
The Interview was conducted by Christine Werner