Trudie Lang: The Global Health Network

My name is Trudie Lang, I'm the Professor of Global Health Research at the University of Oxford and I lead a programme called The Global Health Network.

The Global Health Network is a huge community that exists across the world. It works to connect health researchers with health research organisations. It actually doesn't do research, we do a bit of methodology research to work out where the problems are, but actually what The Global Health Network does is it works in person, in healthcare settings across the globe and online, and it connects research organisations with health workers and researchers, and it moves knowledge. Because it doesn't matter what disease you're working on or what type of research, the barriers to doing that research are the same. The Global Health Network works to move information across diseases, across healthcare settings and between organisations, to try and move how to do research from areas of high expertise to low expertise.

Our dream scenario is you're a researcher in Nepal, you're working on, say, leishmaniasis but you haven't got a big research centre that your work’s based in, but you can see the problem, you know what research you want to do. We would really like that researcher to have access to the exact same knowledge, tools and training, resources, ability to do research, as somebody in Oxford or Harvard. That's what The Global Health Network does: we try and get that knowledge and ability and confidence to that researcher, so it doesn't matter where they are in the world, they can do the same standard research.

The Global Health Network exists to support research where research isn't happening. It's all around moving information from people who have expertise and lots of confidence and experience doing research, to places where they want to do research but they feel it's something that's not for them. There's often this perception, I call it the pyramid, and what we're trying to do with The Global Health Network is literally flip the pyramid. You've got the kind of hierarchy of research that operates in the top of that pyramid, the perception that you need a two million Wellcome grant, or it's just for the top clinicians in the hospital. This is what we need to turn over and really encourage every healthcare practitioner that research is something they can do. The whole point is to connect people in the whole of the pyramid but really in the base, which is where the strength of a pyramid is, to be able to believe that research is something they can do and that it can change the practice of whatever is in front of them, and literally to give them the skills and resources to do that. By connecting them with each other, by connecting them with research organisations and by providing them with access to the training, the knowledge, the tools and resources that they need to then do that research, they've now got the confidence to do.

Some of the biggest questions that we're facing globally now are, obviously there's a whole load of activity on the Network: what's the next pandemic? What's the next COVID? We did some research recently with Wellcome about what health workers in low-resource regions of the world believe is the next likeliest infection to emerge, and the results were quite surprising. Because there's been a lot of focus on the next pandemic being something that pops up again, we were expecting maybe a respiratory pathogen, but actually what we were told very clearly by over 3,000 researchers across Africa, Asia and, Latin America that it's still the big three – malaria, HIV, TB, really actually all the diseases of poverty – that are the biggest threat. Because they still persist and because they're driven by poverty, they're driven by climate change and also things like antimicrobial resistance, so you've got really the vector-borne diseases are the biggest burden.

The biggest thing that we can do to make an impact is to do pragmatic research in the base of that pyramid, on those diseases that have been with humanity for as long as humanity really, help nurses, junior doctors, every level of the healthcare workforce to see research as something that they should be mandated to do and supported to do in their workplace, so they can do the really pragmatic things: to spot where these infections might be arriving where they hadn't before, or to come up with new ways to tackle them that are very pragmatic. Often you don't need gazillion dollar research programmes all the time, you can do very pragmatic research on measuring what's in front of you, and so that's really what we're trying to shift.

For every disease we need a whole ecosystem of health research to get all the answers to the questions. I always use Zika as an example because we knew much less about the Zika outbreak than we did about Ebola or COVID or anything else. For those moms that were having those babies, you know really awfully disabled babies, we needed to answer all those questions, all at once. So, if you can place research into the most impoverished communities where healthcare is really hard to access and there's such low investment in healthcare, by enabling pragmatic research in those settings then you can impact patients immediately. It might be looking at different ways to refer mothers to where they have their babies, or looking at malnutrition outcomes or use of antibiotics – that's a really key one at the moment – and if you do that pragmatic research in that frontline context, then you can literally change outcomes immediately because you learn about better ways to manage those patients, or access care, or find interventions that work, or detect that there's a disease that's causing a problem you didn't know before, it's a real immediate impact on practice because you're learning by doing in the healthcare setting.

It matters because every disease needs this whole ecosystem of health research. Lots of the funding is often siloed into the kind of ‘sexy’ end of science, maybe sequencing the genomes or developing a vaccine, and of course we need that, but there's a whole massive piece of research at the base of the pyramid that isn't easy to fund. The hardest bit is the piece of research we're doing, enabling, giving people the skills to do research, building research confidence and expertise in healthcare settings, and that's what's really hard to persuade funders that it's worth the investment. They love funding the big vaccine trials but they're not so good at funding teaching people to do those trials or building the research system in that healthcare setting. So, I spend a lot of my time trying to persuade funders that's a really good investment to, say, across one country or even in one healthcare setting, let's support these nurses to learn to do research, let's put a research system in the laboratory, let's build that structure in the base of that pyramid. That's where we really try and persuade funders that it's a much better investment in the long term, to generate that really pragmatic evidence that can change practice straight away. And then you've got those teams trained up and they're able to run their own studies and be independent. So, it's hard to fund but is a good investment.

This interview was recorded in July 2024.