Typhoid fever is caused by a highly virulent and invasive enteric bacterium, Salmonella Typhi (S. Typhi) and presents a significant public health problem in LMICs. Multidrug resistant strains of S. Typhi emerged in the late 1980’s and since then, strains have emerged which are resistant to the majority of available antibiotics, leading to an increased proportion of people experiencing treatment failure and complications.3 The urgent need for a change in typhoid management has led to the development of two World Health Organization (WHO) prequalified conjugate typhoid vaccines, driven by the collaboration of multiple global stakeholders. Post-vaccine development, research continues to prove the vaccine is safe, effective and appropriate to administer in children, resulting in 23 million doses of conjugate typhoid vaccines being used in the public sector since the end of 2017.
Decolonising Global Health
The modern setting of global health is steeped in coloniality, defined as the long-standing patterns of power that emerged from colonialism. Global health evolved from medicine ‘designed to control colonised populations and make political and economic exploitation by European and North American powers easier’.4 This power imbalance remains within many global health interventions, with the majority of key organisations responsible for the allocation of funding and agenda setting in modern global health being Western-based. During the conference there were multiple approaches discussed on how we can support the decolonisation of global health, both individually and collaboratively.
During his talk on non-governmental organisations (NGOs) and decoloniality, Benjamin Edmans, Medical Student at the University of Cambridge, discussed how individuals can engage a ‘Decoloniality in Practice Framework’; a three-step process which is centered around awareness of colonialism, deliberation of how to challenge and dismantle these frameworks, and actioning these.
The importance of self-awareness and recognition of coloniality for successful global health partnerships was emphasised further by Dr Sarah Loftus and Dr Laura Hobbs, Anaesthetic Trainees and Global Health Fellows in the East of England, who discussed learnings from the SCALE project. The project supports Ugandan healthcare professionals (HCPs) to undertake long-term placements in UK healthcare settings. From their personal experiences as fellows and their research, they concluded that actively addressing power imbalances and allowing the Ugandan HCPs to lead their own learning and development was crucial for successful collaboration.
The requirement of grounding global health initiatives in a contextual understanding of the needs of LMICs was also noted by Chimweta Chilala, Research Assistant at the University of Cambridge, in his talk on global health fellowships. Chimweta described how initiatives such as fellowship programmes present bidirectional learning opportunities, however, these opportunities can be stifled when fellows demonstrate limited social and cultural understanding of the clinical setting. To be successful and achieve benefits for both funding and lower-income countries, global health initiatives ultimately need to be centred on understanding the needs of the relevant community or institution and use the skills and experiences of partners to address these needs.
A consideration was shared by Dr Sridhar Venkatapuram, Deputy Director of the Global Health Institute and Director of Global Health Education and Training at King’s College London, on the importance of regarding global health through the concepts of justice and equity. These have implications to how global health initiatives should be structured, funded and delivered, to support interdependent relationships between partners rather one-sided dependency.
Protecting healthcare in conflict zones
The targeting of HCPs and facilities is a growing tactic in conflict zones which violates international humanitarian law and has a devastating impact on the wounded. Healthcare in conflict zones is of interest to the global community since the implications of destroying a population’s access to healthcare stretch far beyond the given conflict zone, causing displacement of people and increasing resource pressures on healthcare providers in alternative settings.
Dr Saleyha Ahsan, Presenter, Physician, Journalist and PhD student, described how the United Nations Security Council (UNSC) have repeatedly condemned the attacks against healthcare and medical facilities, however its impact has been limited and there remains a significant unmet need for effective measures to protect the delivery of healthcare in conflict zones. Dr Ahsan has previously worked to expose these challenges through producing films in conflict zones, that document the targeting of HCPs and medical organisations. Now, Dr Ahsan is using research to solve this challenge by conducting a PhD to understand and quantify the impact of destroying access to healthcare on patients. Not only will these data provide insight into what is required to respond appropriately to attacks on healthcare, but it could raise awareness on the gravity of the issue, sparking collaborations between state, humanitarian and academic sectors, which are crucial to overcome this challenge.
Demonstrating the impact of research
In his talk on financing global health and the role of the UK’s National Institute of Healthcare Research (NIHR) within this, Mike Batley, Deputy Director of Research Programmes at the Department of Health and Social Care, described how financial instability is a key challenge for progressing research and long-term goals in global health.
Mike discussed the role of the NIHR’s Global Health Research (GHR) programme, which was established in 2016 to address unmet needs of people in LMICs through generating high-quality applied global health research and training. The programme has worked with a wide breadth of partners globally, including 283 unique LMIC institutions, and has delivered over 700 funding awards. The GHR programme faced a budget cut of 50% due to the implications of COVID-19, which impeded the programme and its partners to deliver their long-term goals. Mike concluded that, in order to minimise the risk of budget cuts and maintain focus on research delivery, there is a need for the research community to convene and demonstrate the positive impact of research for the wider global community.
The 2022 East of England Global Health Conference highlighted both the varied and pressing challenges within the global health sphere, as well as the positive steps which are being taken to rise to these challenges. The importance of establishing communities and building partnerships to bring perspectives and experience together was emphasised throughout the sessions. There are various mechanisms by which this can be achieved such as:
- Collaboration between global partnerships and international organisations to progress efforts to minimise the impact of AMR
- Collaborations between state, humanitarian and academic sectors to implement effective measures to protect the delivery of healthcare in conflict zones
- Convening of academics to demonstrate the positive impact of research and to minimise the risk of unstable research funds
A key conclusion of the conference was that, to be successful, partnerships in global health must be driven and delivered at the local level which requires a mutual understanding between funding and local parties of their needs and what they can contribute to the partnership. To ensure that global health initiatives achieve benefits for lower-income countries, it is essential that partnerships are equal and the collaborative relationship is one that promotes equity and justice. Solutions to challenges must be informed by an understanding of the cultural context and community needs which is especially relevant for challenges that emerge in the community. For example, to address the challenges of AMR, local level interventions, adapted to the requirements of the community, are necessary.
- Koplan JP, Bond TC, Merson MH, et al. Towards a common definition of global health. Lancet 2009;373:1993-5.
- Kickbusch I. The need for a European strategy on global health. Scand J Public Health 2006;34:561-5.
- World Health Organization. Typhoid vaccines: WHO position paper – March 2018. 2018.
- Khan M AS, Aloudat T, Capobianco E, Hawkes S, Rahman-Shepherd A. Decolonising global health in 2021: a roadmap to move from rhetoric to reform. BMJ Global Health 2021;6:e005604.