Digitised Collections

While LSHTM remains closed and most of our archives are out of reach in Keppel Street, we thought we would highlight some of our digitised collections, available to researchers from the comfort of their own homes… 

Student Registers  

Our collection of student registers are an excellent resource for researchers interested in tracing the life and careers of past students. The registers detail the name and address of each student as well as their prior qualifications and country of origin and any institution or organisation they were affiliated with, such as a specific mission or colonial service. The registers also state the career of each student on leaving LSHTM. This is particularly interesting given the colonial history of the School. The registers document the role LSHTM played in supporting the British Empire, with many students going on to work in the colonies after studying tropical medicine at the School. 

 On occasion the registers provide a little more colour. For example, in one entry for a Ralph Storey who studied at the School in 1900, the record states that the unfortunate Mr Storey was ‘killed by an elephant’ in Uganda in 1905. 

The page from the Admissions Register detailing the fate of Ralph Storey

We currently have eight student registers – from 1899 to 1924 – digitised and available to researchers.

Staff and Student Photographs 

Staff and Students from the School’s 63rd Session, May-July 1920

Students and staff members attending the School were immortalised in class photographs taken during each new session. We have a number available as digital resources, showing students and their lecturers between the years 1901 and 1935. The photographs, which detail the names of the students and staff members depicted, are another useful means of tracing an individual’s history at LSHTM. Equally, the images show the changing demographics within the school – such as the gradual inclusion of more women and people of colour. 

Nutrition Collection 

A recipe card from the Second World War

The Nutrition Collection is an especially rich and varied archive. The collection consists of material concerned with the study and research of human nutrition in the twentieth century, created and collected by LSHTM staff between the 1940s and 1990s. Material includes recipe cards produced by the Ministry of Food during the Second World War, obesity research, diets of prisoners of war and diaries documenting research trips undertaken by nutrition researchers. Parts of the collection have been digitised and can be made available to researchers. 

Ronald Ross Collection 

Sir Ronald Ross

This collection is made up of correspondence, manuscripts, reprints and newspaper cuttings collected by Ronald Ross himself – acclaimed for his work on the transmission of malaria. The papers include Ross’s research on malaria captured in his notebooks, diagrams and thousands of letters from medical scientists, as well as information on the major malaria control campaigns he was involved with during his career. 

A watercolour painted by Ross

Ross was also a keen watercolorist, and several of his paintings feature in the collection, alongside greetings cards and correspondence from dignitaries and royalty from across the globe. A significant amount of this material has been digitised, such as the notebook in which Ross made his famous discovery regarding the transmission of malaria by mosquitoes. Discover more about Ronald Ross and his work here

Maps 

The map collection consists of maps mostly concerning malaria and sleeping sickness in Africa as well as many other maps that relate to subjects such as population distribution, vegetation and geological features. Maps originate from all across the world, including Great Britain, Europe, Australia and much of Africa. They date from 1858 to 1973. 


Map shows distribution of Anopheles Funestus. c.1936.

The maps within the collection were used by School staff in the planning of expeditions overseas, in spatial investigation of tropical diseases, recording research results and in prevention programmes.  96 maps have been digitised and are available to view. 

 

HIV/AIDS collections 

AIDS Awareness Illustrated information collectable card

The LSHTM Archives Service contains seven collections relating to HIV and AIDS and we have digitised material from these collections including 95 posters from the Centre for Sexual and Reproductive Health Collection, leaflets and press releases from the AIDS Social History Programme and an assortment of material from the other collections. More information on these collections here

Piot Collection: Ebola 

In 1976, Peter Piot was one of a team sent to Zaire (now DRC) to investigate an emerging hemorrhagic disease, which was named as Ebola. Digitised material within the archive includes fieldwork material created by Piot, plus reports. (This material remains copyright Peter Piot.) 

For more information on any of these collections or how to access them digitally, please contact the archives 

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18 – 24 June

A snapshot of media coverage on COVID-19

Peter Piot

(24/06) On The China Current, Peter highlights the importance of mass behavioural change as a “second line of defence” against COVID-19 in the absence of an effective vaccine. Peter said: “As long as there’s one person on earth carrying this virus, it’s a risk for the rest.”

(23/06) Peter gives a personal account of his experience with COVID-19 on BBC News. Peter said: “Loneliness is a very big burden on this disease … This is a very nasty virus and I myself underestimated what it can do to the body.”

(21/06) Peter states that he is in favour of reducing the two-metre rule as long as it is accompanied by the mandatory wearing of face masks, on The Andrew Marr Show on BBC One (from 37:00). Peter said: “It created a false sense of security – it’s not as if beyond two metres there’s no risk. I’d rather be at one metre of someone who is infected, but if both of us wear a mask than at two metres without a mask.”

John Edmunds

(24/06) On BBC Radio 4’s Today Programme (from 1:51:18), John emphasises that an effective test and trace system will be vital to stopping the spread of COVID-19 after the easement of lockdown measures in the UK. John said: “There’s a risk that transmission might take off again so we have to be really vigilant. This is where the test and trace systems needs to be really working well to make sure we stamp out any infections that occur.”

(23/06) John discusses the easing of lockdown restrictions in the UK, in The Guardian. John said: “The social distancing rules that have been in place since March have had two effects: first, the number of contacts that we make has been drastically reduced; and second the nature of these contacts has also become safer, as we seldom meet inside and we have been maintaining two metres of distance wherever possible. Relaxing the two-metre rule at the same time as opening bars and restaurants does run the risk of allowing the epidemic to start to regain a foothold.”

Sally Bloomfield

(24/06) On BBC News, Sally highlights the importance of an effective track and trace system to curb COVID-19 spread. Sally said: “If we do get a spike of outbreaks, we’ve now got the track and trace situation up and running, so we should be able to sit on those little fires and stamp them out before they become more general increases that lead to another lockdown.”

(23/06) Sally cautions that the pandemic is not over yet on BBC Radio 5 Live (from 45:08). Sally said: “We’re not through this and we’ve got to stick to the basic rules, and adapt.”

(19/06) Sally explains how we can shop safely at supermarkets during the pandemic, on BBC Two’s Keeping Britain Fed (from 47:10). Sally said: “There’s a possibility that within 1ml of saliva, we could have seven million virus particles, and it only needs maybe 100 to 1,000 to infect us. So one of the key things we have to do in supermarket is to respect the two-metre rule.”

Martin Hibberd

(24/06) Martin discusses how we can trace asymptomatic COVID-19 patients on BBC Two’s Newsnight (from 25:10) Martin said: “The only way we find those is by either systematically testing everybody or by serological surveys. Some people probably have a very mild infection in the upper airways and may not notice at all. If we can manage to find out how they contain the virus so effectively, maybe we can learn how to progress that on to other people so that everyone could be protected.”

(24/06) Martin reinforces that antibody tests are an important component of the public health response to COVID-19 in BBC News. Martin said: “If used successfully, the data generated will be important surveillance information for understanding the effectiveness of control measures put in place.”

Martin McKee

(22/06) Martin discusses recent COVID-19 outbreaks around the world on Sky News. Martin said: “The outbreaks in meat packing factories in Germany and in Wales highlights the risks that are occurring. We have got cases going up – a recent outbreak in Beijing and more cases in Spain and in South Korea. So the risk is very clearly there, and we can anticipate that we will continue to have localised outbreaks.”

(18/06) Martin speaks about the regional differences in COVID-19 transmission in the UK, on LBC. Martin said: “The nature of the epidemic in London is different to the North East or the North West, so we need to look at the local epidemiology.”

Other LSHTM experts

(24/06) Graham Medley cautions that contact rates need to be kept low during the epidemic on BBC Two’s Newsnight (from 28:42). Graham said: “The only thing that stops COVID-19 is some kind of immunity, either vaccine generated or potentially infection generated. We don’t know whether the immunity will wane or whether it will last forever, but we have to stay in a secure environment and keep contact rates low.”

(24/06) David Heymann is quoted in The Telegraph (£) about the importance of rapid testing to curb a second COVID-19 wave. David said: “A second wave is not inevitable if countries, such as the UK, begin to contact trace … They need to then be rapidly diagnosed – and that means within hours rather than in days – and then contacts of those patients need to be identified and they need to be asked to self-quarantine.”

(24/06) In The Times of India, Finn McQuaid discusses LSHTM modelling research that estimates at least 110,000 additional tuberculosis deaths could occur in China, India and South Africa due to health service disruptions from COVID-19. Finn said: “Given that health service disruption far outweighs the benefit of social distancing, it is crucial to maintain and strengthen TB-related health services during, and after, COVID-19.”

(24/06) Julian Peto is quoted in The Telegraph (£) about the feasibility of weekly testing at a population level to control the spread of COVID-19. Julian said: “If one in 2,000 people are infected at any one time, and we can test and identify them, we only have to lock down one in 1,000 households.”

(22/06) In The Telegraph (£), Liam Smeeth comments on a Nature Medicine study that suggests immunity to COVID-19 rapidly declines. Liam said: “We need larger studies with longer follow-up in more populations, but these findings do suggest that we cannot rely on people having had proven infections nor on antibody testing as strong evidence of long term immunity.”

(21/06) James Logan explains how a dog’s acute sense of smell could potentially aid the detection of COVID-19, in The Observer. James said: “We could detect a spoonful of sugar in a cup of tea, but a dog could detect a spoonful of sugar in two Olympic-sized swimming pools.”

(21/06) Adam Kucharski discusses the possibility of a second COVID-19 wave in BBC News. Adam said: “The evidence is the vast majority of people are still susceptible, in essence if we lift all measures we’re back to where we were in February.”

(20/06) Roz Eggo talks about the role of children in COVID-19 transmission, in NPR. Roz said: “What we found was that people under 20 were about half as susceptible to infection as people over 20 … Looking at the global picture if this was like flu, you would ordinarily expect places with more children to have more intense epidemics.”

(20/06) Preliminary LSHTM research that projects a worst-case scenario of up to 85,000 COVID-19 deaths in Yemen, based on an unmitigated epidemic, features in ITV News.

(18/06) In The Guardian, David Leon discusses the geographic variation in COVID-19 deaths in the UK. David said: “This epidemic has clearly had a serious impact on many local authorities that are not highly urbanised. Going forward, understanding the reasons for this substantial geographic variation will be crucial in drawing lessons for the future.”

Further LSHTM coverage

(24/06) Amid rising temperatures in the UK this week, LSHTM’s research which found that up to 90 per cent of heat-related deaths occur before the official alert thresholds are reached, features in The Telegraph (£).

(24/06) Heather Wardle comments on UK betting firms’ decision to reroute £100m of funds to tackle problem gambling in The Guardian. Heather said: “This situation whereby the industry controls who to fund, when to fund and what the level of funding should be is untenable.”

(19/06) In The Telegraph (£), Ian Roberts discusses the findings of a large-scale study showing that tranexamic acid, commonly used to prevent deaths from gastrointestinal bleeds, does not work. Ian said: “A lot of what we think we know, we don’t know. A lot of what we do is based on the collections of small trials – if we did big trials we would get a few surprises.”

On social media

This week’s social media highlight comes from Twitter, where we marked World Refugee Day.

From Ebola to COVID-19: How Uganda Can Adapt its Response to the Current Crisis

By Federica Margini, Anooj Pattnaik, Angellah Nakyanzi (authors affiliated with ThinkWell)

In this blog series we are giving a voice to practitioners, implementers and policy-makers involved in national COVID-19 responses in low- and middle-income countries.  These posts seek to facilitate timely cross- learning by sharing opinions, insights and lessons on the challenges and actions taken by those on the COVID-19 front line.

How countries are responding to the COVID-19 pandemic is not only driven by technical and sociopolitical considerations, but also by their recent histories.  Uganda is an example of a country whose government’s response has been greatly informed by their recent battles with Ebola.  This influence can be tracked through how they have funded and channeled money for their COVID-19 response through their health system.

The Ugandan Government promptly responded to the introduction of COVID-19 by locking down the country and limiting the cases entering.  These measures seem to be successful in limiting the introduction and spread of the virus.  Still, the Government’s health financing response to COVID-19 presents some risks of not being able to fully adapt and respond to the unique threat this virus presents.

There is growing consensus that it is not just the total funding a country devotes to their response that is important, but where those funds go and how they are managed.  In Uganda, external and domestic resources were rapidly mobilized to finance the response.  Yet, out of a request of UGX 464 billion from the Ministry of Health, only UGX 104 billion was allocated to the health sector.  This investment focused on strengthening the specialized end of care, rather than testing and tracing through the primary health care (PHC) system; 41% of the overall health allocation was directed to the procurement of medical equipment for intensive care and emergency units, 21% for case management, 15% for health workers and only 6% to surveillance and laboratories.

Given that before the outbreak there were only 55 ICUs in the country, it would be quite difficult for Uganda to increase its ICU capacity effectively within a few weeks.  Preliminary evidence seems to indicate that only 20% of COVID patients require oxygen therapy and ventilation. Uganda’s youthful population may further reduce these proportions, even with highly prevalent diseases like HIV/AIDS and malaria.  It may also be true that low utilization of routine services, like those related to reproductive, maternal, newborn, and child health (RMNCH), may result in more deaths than from the virus itself.  Thus, balancing investments in highly specialized treatment with those that ensure health workers’ safety, improve testing and tracing, and in routine services may prove to save more lives not only now, but in post-COVID Uganda as well.

Another key challenge was the nature and scope of the Uganda Government’s budgetary allocations. These were formulated using an activity-based approach that was quite prescriptive about the spending modalities.  Instead, greater flexibility could have been granted to use these funds in the way that authorities deemed to be best fit to respond to the extremely fluid situation in their jurisdictions caused by COVID-19.

Much of this strategy was from the Ugandan Government’s management of the Ebola outbreaks.  However, Ebola presented a very different threat – it spread in a much less dynamic way (e.g. symptomatic transmission, slower proliferation) and demonstrated a much higher case-fatality rate.  Hence, it was easier to track down cases and made sense to prioritize treatment.  The current, positive response in Uganda could be made even more effective by tailoring to the specific threats COVID-19 presents, while incorporating the key lessons learned from Ebola.

Accordingly, we recommend the following steps the Ugandan Government can take to adapt their response:

  • Adapt funding priorities to the characteristics of COVID-19: increase the investment and operational/technical guidance for community-based testing, tracing, and isolation, as well as health workers’ safety (from community health worker to facility).
  • Find ways to improve utilization of routine health services, like those related to RMNCH, immunizations, and HIV/AIDS. Experimentation with task shifting or telemedicine could be part of the strategy.
  • Make funding and purchasing mechanisms more flexible for local authorities and providers by increasing the non-wage recurrent funding to districts, without developing itemised or activity-based budgets. Concurrently, adapting expenditure tracking mechanisms to ensure a more rapid release of funds (e.g. frontloading funds to regional referral hospitals to ensure liquidity), adjusting expenditure reporting mechanisms (e.g. creating a special code for expenditures related to COVID-19) and introducing proper accountability mechanisms after the allocations have been made.

In this way, the Government of Uganda can move to the next stage of its response: from its effective, highly centralized Ebola-based response that prioritized lockdown and treatment to one that meets this virus in the field to control transmission.  This means through strengthened investment in PHC systems that test, trace, and isolate cases and that also ensure pro-poor access of essential services like RMNCH and immunizations.  By investing more in its PHC systems and addressing the public financial management (PFM) challenges that are constricting the flexibility of their response, the Ugandan government can clamp down on COVID-19, while at the same time, bolstering its health system to be more resilient to future pandemics, beyond both Ebola and COVID-19.


Image credit: Wikipedia Commons (Empty roads in Uganda due to the Covid crisis that resulted into the lockdown)

COVID-19 Alumni Stories: Laura Ferreira

Laura Ferreira (MSc Public Health – Environment and Health, 2011) is the Scheme-Manager at Home-Start Wandsworth. In this blog piece, she speaks about how she is helping vulnerable families through this pandemic. 

How has the COVID-19 outbreak affected your work?

At Home-Start Wandsworth we deliver early intervention in the form of tailored practical and emotional support for families with children from pregnancy to age 5. This early-years support improves parent-infant bonding, family relationships, physical and mental health, child development, and living circumstances. We work specifically with families facing difficulties that impact on the health and wellbeing of both parents and children, including long term health conditions, homelessness, lack of support networks, lack of self-confidence, and mental health issues including anxiety and post-natal depression.

Because of COVID-19 we have seen the profound effects of loneliness and isolation and worsening mental health. Families that rely on the National Health Service to manage long term conditions have found their care disrupted. We have more families than ever before experiencing food poverty, and some parents are struggling to cope at home with their children for such a long period.

The social distancing measures in the UK mean that we are currently unable to offer our usual intensive home visits, face-to-face peer support, and wellbeing activities.

How have you been responding to the outbreak?

Our staff and network of trained volunteers adapted quickly to offer support remotely. We have moved our weekly visits and peer-support groups online to connect with people via text, phone, and video calls. Remote support is proving effective, and as lockdown eases, we are also offering outdoor visits where appropriate.

We have also begun directly sourcing and delivering essential supplies for families, providing packs of art materials to nurture creativity and connection, and compiling accessible resources to support parenting and inform those in need about local services including domestic abuse and crisis services.

The power of kindness and connection to combat the effects of fear, anxiety, isolation and loneliness is apparent in our work, and is needed during the pandemic, now more than ever. Regular connection with a trusted service also acts as an important safety net for families facing more and different challenges as lockdown goes on.

How has your county’s response to the outbreak affected your work?

We have been able to follow the published government guidance, and new provisions for families facing financial difficulty have been useful, but overwhelmingly the most vulnerable families that we support are relying on the voluntary and community response network to get through this crisis. The grassroots community mobilisation we have seen in the UK since the outbreak has been astonishing.

How has LSHTM’s training helped you during this outbreak?

It has been hugely beneficial. A solid understanding of a range of public health issues, critical analysis skills, systems thinking, and an evidence-based approach, all nurtured by LSHTM, have been a huge advantage in defining our role in the response and shaping our strategic direction. It has also been helpful in engaging effectively with the health service and wider community response.

I regularly use the research skills and analytical thinking gained at LSHTM to understand problems, measure our impact, and inform decision-making for the benefit of our community. Being able to do those things at speed as part of the pandemic response, and meet ever-changing challenges, has been a true asset.

It is hugely inspiring to read about the pandemic-response work of LSHTM and alumni across the globe, and a privilege to remain connected to this network. I wish everybody well!

If you are an alumnus and would like to share your COVID-19 story, please click here to find out more.

Information about how you can support, promote and share LSHTM’s COVID-19 Response work is available here.

What will it cost to prevent violence against women and girls in low- and middle-income countries?

By Sergio Torres Rueda (London School of Hygiene & Tropical Medicine)

The scale of the problem

At the end of 2018 we presented findings of our cost analysis of programmes to prevent violence against women and girls (VAWG) in a meeting in Kathmandu. Professor Charlotte Watts, one of the pioneers of research on VAWG, chaired our session. In her opening remarks she mentioned that in some areas of VAWG research, such as the study of the effectiveness of prevention strategies, the scientific community was already halfway up the mountain. However, when it came to understanding the economics of VAWG, we were still very much at the foothills.

Nearly a third of women worldwide have experienced physical and/or sexual violence during their lifetime. That is hundreds of millions of women. Yet, to date, only two economic evaluations of VAWG-prevention programmes have been published (IMAGE and SASA!). Momentum has been building for states to take greater action in preventing violence and we now have a better understanding of the kinds of prevention interventions that work. However, governments seriously considering investing and scaling up violence-prevention initiatives have scant evidence to understand the resources needed to do so. The body of research in this area is simply not commensurate with the scale of the problem.

What will it cost?

We present the costs involved in developing, adapting, setting up, and implementing six violence-prevention interventions across six countries in sub-Saharan Africa and South Asia. The interventions vary in terms of their delivery platforms, settings, and target populations. The cost data collection was carried out alongside randomised controlled trials and was part of the What Works to Prevent Violence against Women and Children (‘What Works’) programme, a DFID-funded multi-country effort to build the evidence base on violence prevention.

We found that the total costs of violence prevention programmes vary greatly depending on the types of activities involved, platform of delivery and intensity. The cost per beneficiary reached varied between US$4 in a community-based intervention in Ghana and approximately US$1320 for a counselling intervention in Zambia. VAWG-prevention interventions are staff intensive: staff costs made up the greatest share of costs across all interventions, and total costs were highly sensitive to staff salaries. Substantial costs had to be spent before intervention could be rolled out. Training of staff was a large investment; ensuring retention of staff is therefore important. We found that adapting interventions to the local context could be resource-intensive and costly, yet necessary, when implementing behaviour-change interventions originally developed elsewhere.

We used cost data at the pilot level to model costs of scaling up five interventions at the national level. We found that the cost per beneficiary would change when interventions are scaled up. These unit costs would likely decrease for community-based and workshop-based interventions as fixed costs got spread over a larger number of units (in other words, economies of scale). However, the cost per beneficiary may increase in interventions with fixed platforms (such as those rolled out in schools) when the average ratio of students per school is lower at the national level than at the pilot level, due to high fixed costs at the delivery site.

Our findings help fill some of the evidence gap needed to make policy decisions, but they also raise further questions, particularly when thinking about costs at scale and over time. While the programmes costed had different delivery sites within one country, this variation will not capture the full degree of heterogeneity that could be expected should the programmes be expanded to the entire country. When expanding to the national level, programmes may need to overcome constraints that were not encountered in the pilot. For example, potential workers and volunteers may have different skill levels and may therefore require greater training or more remuneration. Beneficiaries may be located in more remote areas and thus increased transport costs may be incurred. Cultural and linguistic variation may require re-adapting curricula. Overcoming these types of constraints will require additional resources. We advocate that, as programmes expand, implementers build cost data collection into their monitoring and evaluations in order to shed light into some of these key question. Partly with this in mind we developed a set of publically-available cost data collection tools that could be useful to implementers.

Another area of uncertainty relates to how costs may also change over time. Several of the interventions costed rely largely on volunteer labour. Training costs are high and total programme costs are highly sensitive to the useful life of training, in other words to how often training needs to take place. In order to keep costs low, it will be important to ensure that volunteers are retained in service in the long term. To do so, we need to understand what kinds of financial and non-financial incentives have the greatest impact on volunteer motivation.

It is, of course, important to mention that understanding costs only gets us half-way there. Costing studies are helpful to understand the resources needed to invest in programmes. But on their own they do not tell us whether a programme presents good ‘value for money’ compared to another violence-prevention programme, or compared to other possible investments within the health or other sectors. The next logical step for our team has been to combine the cost data presented here with the effectiveness data that emerged from the six trials to understand the cost-effectiveness of the different interventions. We look forward to published our findings very soon.

Conclusion

VAWG is an enormous problem. Everywhere. But we know that VAWG is preventable—and now we have a better idea of how much it is going to cost to prevent it. We hope that our work takes us one step further up the mountain and helps inform policy decisions that have positive impacts on women’s lives.


Image credit: Indashyikirwa intervention in Rwanda. The photo shows women making baskets in a ‘Women’s Space’ in a rural area, a component of the intervention. These were safe spaces where women could participate in group activities and receive sensitisation and support.

Challenges of engaging with Universal Credit system impact on the health and wellbeing of people experiencing homelessness

King’s College London, the London School of Hygiene and Tropical Medicine and Groundswell explored experiences of Universal Credit (UC) to understand the welfare reform’s impact on people who are homeless, and how this might affect their health. The research was of exploratory nature and conducted in 2018 and 2019.

Three core areas were highlighted by the research that need to be considered in future reforms so that UC supports health and welfare of people who are homeless:

First, the UC system assumes capacities of spare time, computer skills, internet access, a bank account and being able to self-advocate. Such capacities are especially challenging for people facing multiple health and social challenges linked with homelessness, and contrary to the reasons people need to claim benefits in the first place.

Second, the current system can be uncertain and unclear with regard to payment, sanctions and delays. This in turn can generate stress, anxiety and challenges in securing shelter and other essentials for life.

Third, the processes to demonstrate ill-health, and so the access to UC, are experienced as cumbersome, arbitrary and unfair. Consequently, people struggle to access appropriate support for their health conditions. The researchers furthermore found that little allowance is made within the system for physical and mental health issues, especially long-term ones.

The report Universal Credit: The health impacts for people who are experiencing homelessness can be found here. A blog post by the researchers on how the COVID-19 pandemic poses both challenges and opportunities for making the system fairer in the future can be found here.

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COVID-19 Alumni Stories: Anis Kazi

Anis Kazi (MSc Public Health, 2012) works within the Western Pacific Regional Office (WPRO) World Health Organization (WHO) as an Information and Planning Consultant for the Health Emergencies Program. He shares what his role in Emergency Response has been like since the start of COVID-19.

How has the COVID-19 outbreak affected your work?

Working in Emergency Response, the sheer volume of work has increased and is all encompassing. Additionally, with the lockdowns and travel restrictions in place, modalities of work have changed. It has been at times a challenge to acclimatise and find a work around. This involves core functions of planning coordination, surge deployment and logistics.

How have you been responding to the outbreak?

I am part of the information and planning pillar of the Incident Management Support Team for COVID-19 at the WPRO, WHO. Besides epidemiological intelligence, a significant part of my work is supporting setting up and streamlining multi-source surveillance systems to inform response strategies for the countries of the region.

How has your countries response to the outbreak affected your work?

Before my recent transition, I was the Incident Manager and National Rapid Response Coordinator of Pakistan’s Polio Eradication Program. With immunisation activities suspended due to COVID-19, the whole program was retooled to support the country’s response activities. The polio program was critical in setting up a surveillance system, managing information and training personnel across every district in the country.

How has LSHTM’s training helped you during this outbreak?

The course at LSHTM was a great enabler. The degree enhances social and professional mobility, besides serving as a means of technical credibility and attestation. The exposure at the school was important for critical thinking and developing deeper interests in working towards existing health challenges, especially in one’s own context.

I would like to thank all the School staff and colleagues for a memorable experience, something I treasure and cherish. It is great to be a part of the LSHTM family.

If you are an alumnus and would like to share your COVID-19 story, please click here to find out more.

Information about how you can support, promote and share LSHTM’s COVID-19 Response work is available here.

Dr Neil Hamilton Fairley

Renowned for his work on Malaria during the Second World War, Neil Hamilton Fairley, who held a lecturer position at LSHTM in the 1920s, dedicated his life to the research of parasitic disease. This blog explores his life and work. 

Born in Australia in 1891, Neil Hamilton Fairley was one of four surviving brothers to enter the medical profession. He qualified as a doctor in 1915, graduating with First Class Honours from the University of Melbourne.  

On qualifying, Fairley took up a residency at Melbourne Hospital where he soon became involved in treating an outbreak of Meningococcal Meningitis. A disease that threatened to overwhelm the armed forces as the living conditions of the troops made them particularly vulnerable to infection. 

After the outbreak of the First World War Fairley joined the Australian Army Medical Service and was posted to Egypt in 1916 as a pathologist to the 11th Australian General Hospital. It was during his time In Egypt that Fairley first became involved in both the treatment of Typhus Fever and Schistosomiasis – a parasitic disease found in fresh water that posed one of the most significant threats to the health of the troops in Egypt during the war.  

Neil Hamilton Fairley

His expertise in Schistosomiasis would prove invaluable once the war was over and he was appointed as Medical Research Officer in Bombay. Amid concern that soldiers returning from Egypt would introduce the parasite to India, Fairley conducted further research into effective treatment of the disease. While in India he went on to develop his knowledge of parasitic disease, investigating Guinea Worm Fever and Tropical Sprue, a digestive disorder affecting the small intestine’s ability to absorb nutrition. Fairley himself, succumbed to the disease, forcing him to leave his post in India. 

On his recovery, Fairley returned to Australia and in 1927, worked for the Walter and Eliza Hill Research Institute as Commonwealth Research Officer where his research included a study on snake bites. 

By 1929, Fairley had once again left Australia, this time to take up a post as both Assistant Physician at the Hospital for Tropical Disease and Lecturer at LSHTM. Fairley continued his fervour for research while working at the School, exploring conditions such as Filariasis and Black Water Fever. 

However, it was his contribution to the treatment of Malaria during the Second World War that would define Fairley’s career. In 1940 he rejoined the Australian Army Medical Service as colonel and was appointed as Honorary Consultant in Tropical Disease. His wartime medical interventions included encouraging the army to change its plan to deploy troops to Macedonia in 1941, as Fairley was concerned this would coincide with Malaria season. Most significantly, Fairley’s work during this time focused on researching, and then implementing, a regime of prophylactic malaria treatment which was rolled out across the allied forces with great effect.

The end of the war saw Fairley return to Britain where he took up the newly created role of Wellcome Chair of Tropical Medicine at LSHTM. However, ill health led to his resignation in 1950. In his latter years Fairley was a highly respected ‘Elder Statesman of tropical medicine’ and was a member of various prominent boards and societies, until his death in 1966. 

The archives holds some papers relating to Neil Hamilton Fairley. Including press cuttings written by Fairley on “tropical medicine and some of its problems”.

To view these papers, or any of our collection, please contact the archives.

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11 – 17 June

A snapshot of media coverage on COVID-19

Since 1 January, LSHTM has featured in more than 55,000 pieces of coverage on the coronavirus outbreak across print, broadcast and online.

Many thanks to colleagues who are sparing the time to conduct media engagement in a period when it is vital for the public to receive informed, clear and accurate information on COVID-19.

David Heymann

(17/06) David discusses China’s response to the fresh outbreak of COVID-19 cases in Beijing, on BBC News. David said: “They are looking at the virus to see if it’s genetic sequence is similar to viruses that have been in China in the past, or if it has come in from somewhere else. They have honed in on an area in the market that sells fish, in particular salmon, and they found in the cutting boards some positive specimens. They are doing a very thorough investigation and trying to prevent this from spreading further.”

(15/06) David says the upward trend in COVID-19 cases could be a result of more testing and a reflection of countries’ different strategies, in New Scientist. David said: “It’s really apples and oranges in the same basket because some countries are doing additional testing for contact tracing and throwing positives into the basket, and other countries aren’t doing that.”

Roz Eggo

(18/06) Roz discusses the role of children in COVID-19 transmission in the Daily Mail. Roz said: “We are very certain that children are less likely to have severe outcomes and there are hints that children are less infectious but it is not certain.” Roz’s comments were also covered in Reuters.

(16/06) Roz talks about the implications of new findings that suggest under-20s are around half as susceptible to COVID-19 compared to those aged 20 or over in Sky News. Roz said: “School closures may be less effective for COVID-19 than for example, influenza. This doesn’t mean that school closures are completely ineffective.”

Adam Kucharski

(16/06) Adam is quoted in ITV News about new findings that suggest a combination of self-isolation, extensive contact tracing and moderate physical distancing is required to keep the COVID-19 pandemic under control. Adam said: “Our findings reinforce the growing body of evidence which suggests that we can’t rely on one single public health measure to achieve epidemic control.”

(13/06) Adam discusses whether current COVID-19 mutations could affect the success of a potential vaccine on BBC World Service (from 27:35). Adam said: “Although this virus is picking up new mutations, these aren’t changing the virus in a way that makes them dramatically different.”

Other LSHTM experts

(17/06) Brendan Wren discusses the likelihood of a second COVID-19 wave in China, following a fresh outbreak of cases in Beijing, on Sky News. Brendan said: “Rather than a second wave, I believe these are peaks because we’re having one continuous wave. We’re in one pandemic at the moment so these localised outbreaks are a real concern.”

(16/06) Peter Piot talks about balancing the competing interests of science, politics and economics during the COVID-19 pandemic on PBS. Peter said: “We need to approach it as a risk management, because we can’t close society forever … On the other hand, if this epidemic is not under control, we simply can’t restart the economy at full speed. So, as societies, we will have to learn how to live with COVID-19.”

(16/06) Andrew Clark is quoted in the New York Times about new estimates that suggest 1.7 billion people globally have at least one underlying health condition that could increase their risk of severe COVID-19. Andrew said: “Increased risk is not equivalent to high risk. Even if they are infected with the coronavirus, not everyone with a condition will progress to a hospital.”

(16/06) Tim Russell explains what the infection fatality rate is in Nature. Tim said: “The studies I have any faith in are tending to converge around 0.5–1%.”

(14/06) Liam Smeeth discusses the “open question” of asymptomatic COVID-19 transmission in BBC News. Liam said: “The uncertainties involved emphasise the importance of lockdown measures in massively reducing the numbers of people infected.”

(14/06) Chris Bonnell tells The Guardian that financial aid needs to be given to individuals that are being told to self-isolate. Chris said: “There is a concern that individuals will not adhere to self isolation if there are financial or other material barriers to this. So individuals need to be properly compensated for lost income, and statutory sick pay will, in many cases, not be sufficient.”

(14/06) In Fortune, Sunil Bhopal highlights the importance of acknowledging the impact of COVID-19 on society’s most vulnerable members: children, migrants and the homeless. Sunil said: “It’s crucial that a variety of voices are heard—those who are voiceless or powerless.”

(13/06) Mark Jit discusses initial lessons learned from the COVID-19 pandemic on CNN. Mark said: “In terms of patient management, we know the main pressure points will be in the ICU and on ventilators … So we are a bit more prepared for what’s going to happen. We know PPE is crucial to prevent spread of COVID-19 in hospitals, which is very important. We do know a bit more of how to handle this. But on the treatment front, we still don’t have that magic bullet yet.”

(13/06) Martin McKee discusses the effectiveness of face coverings in reducing COVID-19 transmission, in The Telegraph (£). Martin said: “There is growing evidence that face coverings are effective, as part of a package of measures, but crucially in protecting other people rather than the wearer. The clear implication is that there is a strong case for making them compulsory when in indoor spaces with other people, including public transport”

(12/06) In CNN, Gwenan Knight discusses the settings linked to the transmission of COVID-19, in light of recent protests around the world. Gwenan said: “We have not found protests to yet be associated but we are really looking at settings rather than events. I would imagine that protests might not be so risky as they are outdoor but then the individuals may be involved in shouting (which may be risky for transmission) and they may be in close contact for long periods of time.”

On social media

This week’s social media highlight comes from Twitter, where we posted our latest Viral podcast episode with Lioba Hirsch, who discussed some of the challenges faced by Black, Asian, and minority ethnic people during COVID-19.

Think Malawi. Think tobacco. Think again.

By Ronald Labonte, PhD (University of Ottawa), Raphael Lencucha, PhD (McGill University) and Takondwa Moyo, BSc (Lilongwe University of Agriculture and Natural Resources)

When you think Malawi and agriculture, you think tobacco. Why wouldn’t you? While not the biggest tobacco leaf producer on the planet, Malawi remains the country with the highest dependency on this one product for its GDP and public revenue. Malawi is one of the few countries worldwide that has not ratified the Framework Convention on Tobacco Control (FCTC). It still argues in international forums that the Convention is more about robbing poor tobacco farmers of their livelihood than curbing tobacco use. Long regarded as one of the last African governments still in thrall of Big Tobacco, that image now needs a bit of a rethink. As our most recent country study finds, Malawi is ever-so-slightly shifting into a more pro-tobacco control direction.

New policy directions?

There is growing government recognition of the need to reduce the country’s tobacco dependency. This doesn’t mean that its historic policy rhetoric on tobacco as an essential tool for economic development has disappeared. Or that tobacco’s supply-chain legacy as one of the only crops offering some income guarantee for small-holder farmers, however paltry it might be, is under serious challenge. But it does mean that discordant voices are now being heard, and national level development and investment policies are expressing the need for diversification. There is no longer a singular tobacco policy discourse dominating the country but, rather, conflicting policies in search of some resolution or coherence. Such a resolution seems unlikely, however, unless Malawi is able to crack the same nut that keeps other tobacco growing countries in the region similarly addicted: how to ensure profitable supply chains for alternative crops.

The quest for viable alternatives to tobacco

True, there is now more evidence of viable alternatives: soybeans, pigeonpeas, groundnuts, legumes, cotton, and tea, amongst others. But their viability depends on financial support to reduce the risks faced by farmers facing initial out-of-pocket input costs, uncertain end-of-season prices and access to markets. Tobacco transnationals and the leaf-buying companies that supply them with product solved that problem through their contract farming system: provide tobacco farmers with inputs on credit at the start of season and guaranteeing a sale with cash-in-hand at the end of the season. It is true that contract tobacco farmers in Malawi do better than those who farm independently and rely on auctioning off the fruits of their labour to uncertain global market prices.

But for both groups of farmers, tobacco fails to provide a step up from a grinding rural poverty, and the more so when the large amount of unpaid household labour required to grow the crop is given a monetary value. As many tobacco-growing farmers in Malawi’s country neighbour, Zambia, complain, if a cash-paying less laborious crop was available they would shift in an eye-blink. Some have, and some are doing financially better as a result. Our recent Malawi study heard similar sentiments expressed both in government circles, and in the farmers’ fields.

Global markets and fair dealings

The global reality for Malawian farmers, however, is that wealthier high- and middle-income countries are better able to offer subsidies to their farmers, regardless of what crop they may be growing. Can Malawi ever expect to compete in global market price the heavily subsidized industrial-scale soybean production in Brazil? It makes it difficult for (current) tobacco farmers to consider switching to a different crop unless the supply and value chains that Malawian development policy would like to diversify and strengthen are firmly in place. That is not something a low-income country like Malawi can do without generous and unconditional international assistance.

Such assistance is likely to be in short supply while the COVID-19 pandemic continues to wreck economic havoc worldwide. But as countries eventually emerge from the pandemic’s wake, there is a new opportunity to consider global solidarity for agricultural policies that give less precedence to economic growth and competition, and more to population health equity and environmental sustainability.


Related paper:

Image credit: Donald Makoka