Could you explain the concept of South-South collaboration in scientific health research and how you see it developing with icddr,b?
It is important to realize that research on diseases affecting populations in low and middle income countries has involved collaboration between scientists in the Global North and scientists in the Global South for centuries. However, the nature of these collaborations has changed considerably over the years. Professor Peter Piot, Dean of the London School of Hygiene and Tropical Medicine, has perceptively divided these changes into four phases, which he calls Global Health 1.0, 2.0, 3.0 and 4.0, much in the manner in which academic courses at a university are termed.
Global Health 1.0, the first phase, was characterized by medical scientists in the North trying to save the lives of their compatriots who lived in the tropics during the colonial era. In the second phase, Global Health 2.0, people in the North were concerned about alleviating disease in people in the South, but did so often with Cold War geopolitical overtones and motives. Global Health 3.0 is the era we live in now, in which a good deal of lip service is given to equal partnership in scientific collaborations between the North and the South. But in most such collaborations, the reality is that the research is often driven by thought leaders in North and the nature of the collaborations entails subcontracting the work of the research from scientists in the North to those in the South, rather than forging genuine intellectual collaborations.
Professor Piot foresees the future of Global Health as Global Health 4.0 , when the scientific agenda will be driven by scientists in the South, ‘Southern led science’. Of course, this would not exclude participation by researchers in the North, who will of course continue to collaborate, but they will not constitute the majority of leaders of this research.
[caption id="attachment_260033" align="alignleft" width="300"] Prof John D Clemens, Executive Director of icddr,b
Global Health 4.0 has been the theme of the South to South collaborations led by icddr,b in order to generate evidence for policy on the introduction of many innovations developed at icddr,b. Examples include bubble CPAP -(continuous positive airway pressure) to support the ventilation of children with severe pneumonia; a maternal birthing mat to help monitor maternal haemorrhage, which lead to maternal death; and RUTF (ready to use therapeutic food) to treat children with severe acute malnutrition, a cause of some one million childhood deaths each year. All are low cost, simple, feasible interventions that have been developed by our scientists, who understand the realities of successful introduction of new interventions into public health programs in low resource settings like Bangladesh.
All of these products are simple, but potentially lifesaving. Our scientists have the experience not only of developing the products, but also of actually using them in real-life settings. We have tested Bubble CPAP in supporting ventilation in children with severe pneumonia admitted to our hospital in a rigorous randomized clinical trial and found it to be life-saving. Because of these results, we now use bubble CPAP routinely in our intensive care unit, and have treated nearly a thousand patients with this approach. This equips our scientists with unique skills to work with scientists in other low and middle income countries to introduce this in their settings. We are currently engaged in implementation research on bubble CPAP to inform policy on the use of this approach in Ethiopia and Bangladesh and are planning further research in Nepal. And in each of these South to South research collaborations, icddr,b scientists are taking the lead.
You mentioned Ethiopia and Nepal, where else you can see these working?
We are exploring several possibilities. We’re new to the business but we want to do what we can to make our life-saving innovations developed in Bangladesh available not only to Bangladesh, but to as many people in resource limited settings as possible. We are thinking big but starting small.
Are there any obstacles to the innovations you create here working in other countries?
Of course, every location has its own culture and healthcare system and other contextual features, which very much determine how one designs this collaborative research to inform policy. It cannot be assumed that just because an intervention works here in Bangladesh that it will work elsewhere too. So each collaboration is also a new learning experience.
Do you think there will ever be a time when southern developed science going to influence the science of the north as the healthcare cost explodes there?
This has already happened. A good example is Oral Rehydration Solution, which is now a staple of the care of both children and geriatric patients with diarrhoea in the US and elsewhere. I am sure there are many other examples as well.
What does Bangladesh have to gain out of collaboration with other countries?
We are an international institute generously hosted by the Government of Bangladesh, and supported by many other donors. The global community is committed to the development of low and middle income countries. To the extent that our work benefits this large group of nations, it reflects very well on Bangladesh and its enduring commitment to global development goals.