The Search For Solutions

That is precisely what Binka is trying to do. But he is not a guy who spends a lot of time hunched over a microscope. He's the executive director of INDEPTH, a network of 37 research centers across Africa, Asia and Central America. INDEPTH is creating a huge database on virtually every aspect of the lives of patients at these sites: their medical histories, their marriages, even their religions. At Kintampo alone it is tracking 140,000 people. The data, in many cases, are the only official record of their existence. Few Ghanaians register births or deaths with the government; fewer still have ID cards; some don't know how old they are. "Thousands of people are born here, grow up, live their life, retire and die, and no one outside their village even knows they existed," says Binka. "There simply is no information available."

Clinical trials are all about information. Without basic data, high-quality research will never come out of developing countries. Yet trials of vaccines for these countries must be conducted there, so doctors can see if their study subjects will catch whatever disease it is they're trying to prevent. Databases like Binka's can ensure that trials in the developing world live up to the standards set by the developed world. For any vaccine to be accepted worldwide, the trial behind it has to be perfect.

GlaxoSmithKline is currently testing a malaria vaccine in children across Africa. The early results look good. A lot of the credit goes to GSK scientists. But Binka's work—the databases, and also his efforts to improve infrastructure at the trial centers—has strengthened the operation. "This trial is getting the same scrutiny as it would if it were done in the U.S.," says Ripley Ballou, a GSK researcher who helped develop the trial vaccine. "Hiring staff, training them, improving blood cultures, and transportation and infrastructure—it's all being done."

The improvements to the Ghanaian health-care system will last long after the GSK team has gone home. They'll help all patients, not just the ones who take part in this trial or future ones. At least that's what Binka is hoping. He wants consistency—a health-care system that works even when there's no drug company in town. "You want to develop these people into laboratory scientists," he says. "Can you imagine that you'd do a trial in Ghana that brings about a good result, and then it's over and you say, 'OK, now the government can take over everything'?" Binka has allies at the PATH Malaria Vaccine Initiative, a nonprofit that supports promising vaccine candidates. "You can't just parachute into the middle of Africa and then leave," says John McNeil, the group's scientific director: it's not fair to the African people and it also means you lose the infrastructure you've just built. Next year, when GSK begins to announce results from its trial, Binka will probably still be hard at work. That's how he wants it.

Emilio Emini, who oversees vaccine development at Wyeth Pharmaceuticals, is big in every way. He's 6 feet 4 and broad-shouldered, he thinks big and his scientific reputation is one of the biggest in Big Pharma. Still, even he can be humbled by the challenge of getting vaccines to the developing world. It has a way of making people feel small.

Emini, 53, met his lifelong nemesis for the first time in 1983, when he was a vaccine developer at Merck. He's a guy who doesn't so much speak as release a flood of arguments, facts and intimidating technical terms. Most people would not want to be his enemy. But then, his enemy isn't a person. It is a virus: HIV, which was discovered the same year Emini went to Merck.