The World Needs A Nobel Prize In Public Health

The Nobel Prize is one of the most prestigious awards in the world. In his will, Alfred Nobel, a 19th-century Swedish chemist, engineer, inventor and industrialist, directed that his fortune be used to create five prizes to recognize those who confer the “greatest benefit on mankind” in physics, chemistry, physiology or medicine, literature, and peace. Nobel died on December 10, 1896. Five years later, in 1901, the the first “Nobel Prizes” were awareded by a newly established Nobel Foundation.

In addition to global recognition, those honored with a Nobel Prize receive a gold medal, a personal diploma, and a roughly one-million-dollar cash prize. If two or more individuals share the prize, the money is equally divided. By tradition, recipients are announced in early October and the awards are conferred on “Nobel Day,” December 10, in Stockholm, Sweden. The Nobel Peace Prize is awarded on the same day in Oslo, Norway.

The sixth and final Nobel Prize in this year’s cycle, for achievements in Economic Sciences, was announced earlier this morning in Stockholm. It was established in 1968 with a gift from Sweden’s central bank in memory of Alfred Nobel. Like the original five prizes, it is administered by the Nobel Foundation.

Fifty-six years after the creation of a sixth Nobel Prize, the world needs a seventh to recognize individuals and organizations who have benefitted humanity through public health.

Public Health’s Impact

The world owes an immense debt to public health. In many ways, it made modern society possible. Thanks to its work, diseases that have ravaged humanity for millennia, particularly in densely populated urban communities, were finally controlled. In the 20^th century, adult life expectancy in the U.S. increased by 30 years, 25 of which can be attributed to public health. Vaccines played a key role in this progress, but no vaccine inventor has received a Nobel Prize, nor has any individual who led a vaccination program that saved many millions of lives. Case in point: nearly a century before Albert Nobel died in 1896, Edward Jenner demonstrated that inoculation with cowpox, a relatively mild virus, confers immunity against smallpox. 171 years would elapse before William Foege, then a young CDC doctor, devised the vaccination strategy that led, in only four years, to the global eradication of the disease. It is one of the greatest achievements in human history.

Because public health advances are rarely celebrated, their creators are often forgotten. Today, few people recall the work of Dilip Mahalanabis, an Indian pediatrician who developing and deployed Oral Rehydration Solution, an inexpensive treatment that has prevented millions of deaths from cholera and other severe diarrheal diseases. Richard Doll, a British epidemiologist, was the first to find that cigarette smoking causes lung cancer and heart disease. His work laid the foundation for public health countermeasures that spared millions early deaths from cancer, heart disease, and emphysema. Nicholas Wald, another British doctor, determined that neural tube defects such as spina bifida are mainly due to a lack of folate – an essential vitamin – in the mother’s diet. He then showed that most cases can be prevented by supplementing a mother’s intake of the vitamin before pregnancy or, better yet, fortifying staples such as flour and rice to ensure that all women get sufficient folate. This prevents 8 out of 10 cases of spina bifida. Later, Wald compiled evidence that exposure to “secondhand” tobacco smoke causes lung cancer and heart disease. This research led to the elimination of smoking in airplanes, restaurants, and other enclosed public places.

Could A New Prize Be Created?

Because the precedent for creating an additional Nobel prize has already been established, a suitable donor might be able to persuade the Nobel Foundation to establish one more to recognize individuals and organizations who confer the “greatest benefit to mankind” through public health. To estimate the amount of money this might require, I divided the value of the Nobel Foundation’s existing endowment – about SEK 5 billion, according to Sweden.se – by six, converted it to dollars, and arrived at a figure between USD 80-100 million. This is comparable in size to many large gifts to U.S. universities. A gift to the Nobel Foundation would certainly do more for humanity (and the donor’s reputation) than purchasing a super yacht or some other costly indulgence.

Why Now?

Two of the public health leaders I cited earlier are no longer alive, but Drs. Foege and Wald remain eligible. So are many other worthy individuals, including but not limited to: South African husband and wife researchers Salim and Quarraisha Abdool-Karim for their work in HIV prevention; Suwit Wibulpolprasert for establishing robust public health systems in Thailand; Abhay Bang and Rani Bang, Indian rural health activists whose work has saved millions of newborns and children; Jean William Pape, a Haitian doctor whose innovative approaches to treating HIV/AIDS, tuberculosis, and diarrhea saved countless lives and David Heymann, an American that headed the World Health Organization’s successful response to SARS and made many other important contributions to global health.

Despite its track record of success, public health is threatened worldwide by a lack of funding, growing political and religious extremism, and a rising tide of disinformation. The field urgently needs the affirmation that a Nobel Prize would afford.

Conclusion

In 1977, the last year a case of smallpox was diagnosed anywhere in the world, Dr. Foege was appointed director of the CDC. He led the agency until 1983. Afterwards, he established the Task Force for Global Health and later served as a global health advisor to the Bill and Melinda Gates Foundation. To commemorate his service, the CDC placed a statuette of him in its museum in Atlanta. On its base is a quote from Dr. Foege’s farewell address to the agency:

“If the Centers for Disease Control is to maintain the reputation it now enjoys, it will be because in everything we do, behind everything we say, as the basis for every program decision – we are willing to see faces.”

If public health is to succeed in the 21st century, the world must see their faces as well. A generous foundation or donor could help by persuading the Nobel Foundation to establish, in memory of Alfred Nobel, a Nobel Prize in Public Health.