Many have tried to address this concern by providing scientists trained in the West with “sandwich grants,” grants that require them to return to their own countries and research a problem of local importance. These scientists then return to their training institution to work with mentors in evaluating data and possibly conducting other studies. This experience also has the potential to expose their teachers to the problems and limitations of conducting research in a developing country.

A set of skills that are rarely taught are those of grant writing. Recently, a ten-year project titled the Applied Diarrheal Disease Research Project funded over 150 studies in developing countries where the local scientists were the principal investigators. The Project found scientists who had been well-trained in a developed country on some research methodology but who had nonetheless been unable to secure research funding. No one had bothered to teach them how to write proposals, including timelines and budgets. After a number of workshops that emphasized these skills, researchers were able to write fundable proposals for projects they thought were important to their country.

Ideally, training will be linked to the development of research institutions in developing countries by pairing them with institutions in the developed world. These activities must be adequately funded and researchers from the West must be given time and credit to participate in institution-building. A number of first-rate training and research institutions in the developing world, including the International Center for Diarrheal Disease Research in Dhaka, Bangladesh, have come about through years of collaboration.

The development of high-quality laboratories is a necessity. Greater emphasis should also be given to research on simplifying techniques and equipment. Organizations such as the Sustainable Sciences Institute (SSI) have made this part of their mandate. SSI has, at its core, a number of very well-trained scientists who have undertaken the adaptation of laboratory tests and techniques to local situations in each developing country. For example, SSI developed a simplified and inexpensive approach to conducting Polymerase Chain Reaction (PCR) tests and has since used this technique to draft proposals and implement research activities that address local problems. PCR has been especially helpful in analyzing the recent dengue outbreaks in Latin America.

Institution-building requires a long-term commitment; it cannot be completed in a five-year government funding cycle. Foundations like the Rockefeller Center tend to do a better job of institution-building than governments, which are more likely to be buffeted by the political winds of government programs. There are exceptions to this, especially when there has been a long colonial history, as evidenced by the Medical Research Center network sponsored by the British in Gambia and elsewhere. That said, it is only recently that there has been a concerted effort to develop local research capacity.

If there is to be long-term commitment, there must also be adequate funding for teachers and collaborators to spend extended periods of time in institutions in developing countries. Though it is difficult to make a meaningful contribution in a few weeks, that may be the only amount of time that a parent institution will allow its faculty to be absent. Universities must be willing to allow faculty to be away for longer periods, even if they have to provide some level of financial support. Allowing faculty to spend time away is an indication of their commitment to the process of institution-building. The development of the Indian Institutes of Management in Ahmedabad, Bangalore, and Kolkata, as well as the Indian Institute of Technology, are examples where institution pairing and extended faculty involvement have helped to build world-class institutions.

As recommended by the Commission on Health Research for Development, two percent of health budgets should be set aside for research. The same could be recommended for development projects. Though this has been done by the World Bank, these funds often go unused because of underdevelopment in the country’s research community. If these funds were tied to training programs and linked to sustained activities, it is far more likely that they would be well used. Moreover, global funding mechanisms should establish enduring networks and ensure that there is long-term funding available for research. Too often, donors work at cross-purposes from each other, more concerned with individual credit than with the development of sustainable local capacity.

An enabling environment should be created that allows for a dialogue between researchers and policy makers. Interaction should take place at all levels so that policy makers are aware of studies before they are completed. Thus, any information that is generated has a chance of being locally used. There is also an urgent need to develop viable careers for scientists in their own countries that ensure performance-based advancement, decent wages, benefits, and professional recognition so that their talents and services are kept at home.

Partnerships between institutions, scientists, and participants must be based on equity and equality. It is especially unacceptable to have unequal relationships between scientists. Flying in to collect specimens and then leaving with little or no interaction with local researchers—termed by some as “safari research”—is no longer acceptable. In fact, there were times when local researchers only became aware of a study after it had been published in an international journal. This was a common complaint of local researchers in the early days of the AIDS epidemic in Africa. Blood specimens were taken, but neither information nor skills were left behind. This created resentment and led to charges of scientific imperialism, a charge that in many cases was more than justified.

Research ethics must be a part of the training of all scientists. Ethical review committees in the developed world must become more aware of the differences between societies to ensure that studies are ethically sound. There are a number of ethical issues over which there is honest disagreement between ethical review committees in the developed and developing world. What should be the standard of care against which drugs, vaccines, and procedures are tested? Should this standard allow only the best solution in the world, or should it allow any intervention that is attainable and sustainable? Can the group ever speak for the individual? Is consent really the equivalent of understanding? How do we measure understanding and how do we record it? Should the products of research always be made immediately available to those persons/societies who participated in the study? These and other differences will only be resolved through discussion and dialogue.