Commentary

Medical services in Japan are public. This health system ensures free access to medical facilities for all Japanese citizens under universal insurance coverage and, as a result, the life expectancy of the Japanese population has become the world's longest (mean, 81.8 years). The cost of medical services now accounts for 7.7% of the gross domestic product of Japan, and is the second lowest in the developed world, after the UK. In 2000, the World Health Organization ranked Japan's medical services as the most efficient in the world.

Overweight and obesity, the main drivers of type 2 diabetes, have long been regarded as health risks associated with affluence. Over the last decade, profound changes in the quality, quantity and source of food consumed in many developing countries, combined with a decrease in levels of physical activity among the population, have led to an increase in the prevalence of diabetes and its complications. Here, we present quantitative estimates of the epidemiological and economic impact of obesity and diabetes on developing countries. We provide the economic rationale for public policy action. We stress the importance of creating a roadmap to guide the development of comprehensive policies involving governments and private companies, and emphasize the need for experimentation in building the evidence while testing theories.

The objective of the multidisciplinary expert Consensus Panel on Research with the Recently Dead (CPRRD) was to craft ethics guidelines for research with the recently dead. The CPRRD recommends that research with the recently dead: (i) receive scientific and ethical review and oversight; (ii) involve the community of potential research subjects; (iii) be coordinated with organ procurement organizations; (iv) not conflict with organ donation or required autopsy; (v) use procedures respectful of the dead; (vi) be restricted to one procedure per day; (vii) preferably be authorized by first-person consent, though both general advance research directives and surrogate consent are acceptable; (viii) protect confidentiality; (ix) not impose costs on subjects' estates or next of kin and not involve payment; (x) clearly explain ultimate disposition of the body.

Traditional boundaries among basic research, clinical research and patient-oriented research are yielding to a single, continuous, bidirectional spectrum commonly termed 'translational research' or 'translational medicine.' These encompass (i) the definition of guidelines for drug development or for the identification and validation of clinically relevant biomarkers; (ii) experimental nonhuman and nonclinical studies conducted with the intent of developing principles for the discovery of new therapeutic strategies; (iii) clinical investigations that provide a biological foundation for the development of improved therapies; (iv) any clinical trial initiated in accordance with the above goals; and (v) basic science studies that define the biological effects of therapeutics in humans. Although these goals are essentially no different from those of traditional academic clinical research, translational research emphasizes strategies to expedite their successful implementation. Unfortunately, several barriers that delay this process need to be surmounted to make translational research more than just an interesting concept.

Preventive vaccines are widely acknowledged as the best hope for protection against infectious pathogens such as avian flu, HIV and SARS. As a result, they have received much recent attention in the media that has exposed some of the challenges involved in optimally using vaccine technology.

The challenges of vaccine development are not limited to identification of suitable antigens, adjuvants and delivery methods, but include regulatory, technical and manufacturing hurdles in translating a vaccine candidate to the clinic. Process development is the technological foundation that underlies the manufacture of new vaccines and is central to successful commercialization.

Infectious diseases are thought to account for nearly 25% of all deaths worldwide, and extract a disproportionate toll in developing countries¹. Moreover, infectious diseases are now appreciated to be major causes of the poverty and economic underdevelopment that characterize the world's poorest countries². Development and deployment of new vaccines to prevent infectious diseases in developing countries have therefore become high priorities in the global health agenda.

This special supplement of Nature Medicine, directed at the topic of emerging infectious diseases, is very timely. Recent high-profile outbreaks have highlighted the global risk that infectious agents, both new and old, represent for society. The experience of severe acute respiratory syndrome (SARS) shows the risk posed by emerging infectious diseases, but also the power of strongly coordinated global surveillance and public health measures, coupled with scientific research, to keep infection under control^1,2. Diseases such as drug-resistant malaria continue to be threats. There is a need to enhance global resources to investigate, detect and respond to emerging infections, and to appropriately coordinate and direct research efforts to meet the challenges presented by these diseases.

Much progress has been made in recent years to strengthen local, state, national and international capacities to detect and respond to bioterrorism events and naturally occurring outbreaks of disease. New tools and systems are available to estimate the potential impact of a biological event and predict resource needs for effective response, enable earlier detection of an attack or outbreak, enhance diagnostic capacity and facilitate rapid intervention to mitigate the impact of an event on a community. These advances have required new approaches to preparedness, planning and surveillance, as well as new partnerships and collaborations across a range of disciplines. We examine some of these developments, discuss potential uses and limitations of these approaches, and identify priorities for the future.