International Rescue

Over 100 years since its inception, Director Janet Hemingway explains why the Liverpool School of Tropical Medicine plays a vital role in health at home and abroad.
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07.01.15
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Time and again, Liverpool’s mercantile background informs its present. The Liverpool School of Tropical Medicine (LSTM) is no different. Were it not for Victorian merchants heading back from the tropics with all manner of exotic diseases, the issue would never have come up, but when the city’s businessmen went to the government with an idea for an institute to deal with these new threats, London wasn’t interested.

Undeterred they returned to Liverpool and invested their own cash; in 1898 the Liverpool School of Tropical Medicine was born. Impressed by the idea, the government opened a second, in London, a year later.

106 years later the School has 400 students hailing from 70 countries around the world — and its origins are obvious in the ease with which is negotiates public and private sectors.

Professor Janet Hemingway CBE

“Because of the origins of the LSTM we’ve always been business friendly and influenced by business — looking at real-life issues and problems,” says Professor Janet Hemingway CBE. “That tradition hasn’t really changed since we first started. We’re not blue-sky; we’re very hands on”

Professor Hemingway, the current Director of Liverpool School of TropicalMedicine and Professor of Insect Molecular Biology, to give her full title, initially trained as a geneticist in Sheffield and ended up in Liverpool via London, south-east Asia, the States and Cardiff.

She describes herself as being steeped in tropical medicine for almost 40 years and is polite, assured and unmistakably British — a dash of no-nonsense and stiff-upper-lip pragmatism.

While the School’s activities are many and varied — spread across a number of sectors and carving out a pivotal role between government, business and third sector —the people of Liverpool may recognise just one of its most public-facing services. “We run a travel medicine clinic,” says Professor Henderson. “We also deal with specialist referrals that GPs can’t deal with — if you do get sick while abroad there’s a good chance you’ll be referred here.” Although the people of Merseyside may only know the School as the place they get their pre-holiday jabs, the LSTM has a much higher profile abroad. “We say that we’re one of Liverpool’s best kept secrets, but if you go into the tropics we’re very well known,” laughs Professor Hemingway.

Price Waterhouse Coopers asked people overseas what they knew about
Liverpool. We were third after football and The Beatles.

The School’s awkward positioning — partially academic, part-business and part public sector — makes it in some respects a de facto NGO; without it, Hemingway believes, much governmental and aid work simply could not happen.

“Without us that process would not begin. We help with catalysing that process and we’ve got the ability to test these products within at-risk populations. We’re about improving health in the tropics and you work out what you need to do, how to do it and where you need to do it. “Once they have them, big pharmaceutical companies will give out millions of drugs for free, but there’s no normal distribution system for getting them out so we have to work with various ministries of health to distribute these drugs. At last count we work with 36 different countries; we have a brand name overseas that most organisations would be delighted with.”

With AstraZeneca, the School was responsible for co-developing one of the first anti-malarial drugs — an example of the role the School plays in bringing real-world products to market. But the School doesn’t work exclusively with one industrial partner.

Student at Liverpool School of Tropical Medicine

“The consortia we work with might be quite large and involve companies, government agencies and NGOs. We work with many different companies because we have the proper firewalls in place; people trust us with their IP and activities. “We’re in that space between research and generating products — medical devices, diagnostics, drugs, agrochemicals, IT systems, policy and practice — and have always worked in industry.”

Professor Hemingway recognises the unique role the School plays is drug formulation, strategy and logistics — yet it does remain fundamentally a place of learning. “Most of our clinical staff are practitioners but that’s because we need to be at the top of our fields and work with patients — you can’t maintain your clinical practice without doing that; they’re all practising clinicians but will need to balance those activities.

“We’ve got clinicians who want qualifications in tropical medicine — a standard clinical degree in the UK won’t equip you for dealing with tropical diseases. We run a three-month specialist course that brings clinicians up to speed in tropical medicine and have about 280 clinicians who will do that course each year.

“We’re also dealing with parasites and insects that transmit the diseases we’re concerned with and have specialist courses for biologists who want to be on the parasitology or entomology side; public health people who are interested in distribution; nurses coming here who want to work in tropical environments; midwives who will work in resource-poor settings, where you will not be attended by a doctor if you’re having a baby, to reduce the phenomenal maternal and child mortality that still happens in many countries.

“We also run a number of programmes in humanitarian assistance; we train people to go into situations of developing-world conflict and natural disaster because if you don’t know how to deal with the politics and logistics of those situations you’re a hindrance, not a help.”

Professor Hemingway sees the LSTM as a model for how academia and industry can better work together. “I don’t think there’s a great model out there for academia working with industry — we’re different because we were set up wanting to do something in terms of improving health. We’ve always been in that translational space; the drivers coming from government now are pushing academia into that space that we inhabit. It means that we’re a lot more used to talking that industrial language.

“There’s been a push for a very long time for academia and business to work together but it’s been very slow because the drivers for success are poles apart. “Because science in universities tends to be driven by people being inquisitive about how things work, academics in industry are seen as unfocussed; going off at tangents because they happen to be interesting, rather than the most direct route from A to B. You have to get those two cultures understanding each other’s language and drivers.”

The School has recently normalised its relationship with the government to receive its funding and reward degrees directly, rather than through the University of Liverpool — a natural development of the School’s original independence.

Hemingway believes the move will improve the School’s profile nationally and internationally and allow for continued growth and expansion. It comes at a time when the LSTM is expanding into a new building and pushing into new areas after winning millions of pounds in grants to expand its life-saving work — including £650m from the foundation set up by Microsoft founder Bill Gates.

“The Gates Foundation realised that industry, off its own bat, wasn’t going to develop these products and if they left organisations like us to develop ties with industry, although it would happen, it would happen way too slowly. So they started giving fairly substantial awards to consortia to develop these new products.

“Because we were already working in that space we were able to react quickly in terms of developing new drugs to combat malaria, tuberculosis, filariasis and worm diseases and new public sector insecticides. We follow the industrial process and take these products through to market — some even came out last year as a result of those partnerships.”

Among other projects, the brand new Centre for Maternal and Newborn Health, due to open in October 2014, is doing pioneering work in tackling the appalling number of deaths that result from childbirth every year. It’s an example of what Hemingway describes as the desire among the School’s staff — from clinicians to cleaners — to do something beneficial.

“We’re there to respond to need, so when you look at the big questions it’s blindingly obvious that there’s a big problem around maternal and child health, with unacceptably high levels of child mortality.

“It’s a case of looking at what skills we can bring — and can we get out there and test it so it’s not simply theoretical. We were getting some very good results coming through from the countries we worked in — now we’re getting more requests than we can actually handle. We wanted to build on the success that we already.”

Hemingway is enthused by the opportunities ahead, with a brand new Royal Liverpool Hospital and bio-campus arriving a matter of yards away — in the heart of Liverpool’s so-called Knowledge Quarter — by 2017.

“Within the Knowledge Quarter you will have co-located the LSTM, the University of Liverpool and the new Royal Liverpool Hospital with a bio-campus sitting in the middle. There’ll be a clinical trials unit that has access to patients, the research base and hi-tech equipment. That’s a potent mix and Liverpool needs to attract the right companies to that area. “We’ve got the biggest concentration of infectious disease research going on here — we need to grow that in an academic and industrial sense. We want to work with SMEs in the area and the larger companies — most obviously companies that are sending large numbers of people overseas and look at their healthcare needs. There’s a feedback loop there.”

The Liverpool School of Tropical Medicine may be a vital cog in the wheels of international health, research, drug development and policy, but it’s heartening to know that it is still looking after the health of locals who are following in the footsteps of those merchants of Victorian Liverpool.

Making it happen

Making It Happen (MiH) is currently the largest programme delivered by the School’s Centre for Maternal and Newborn Health — aiming to reduce maternal and newborn mortality by increasing availability and quality of birth attendant, emergency obstetric and newborn care.

MiH consists of a complex package of interventions including access to a blood bank to anticonvulsant drugs. Also included is an intensive training course held in Liverpool, meaning birth attendants can return to health centres and regional hospitals with the necessary skills.

Making it Happen training session

Making it happen in numbers

3,000 health care providers trained
12,690 still births will be averted
10,490 newborn lives will be saved
9,586 maternal lives will be saved
191,720 maternal disabilities will be prevented
3 million women and babies will benefit from birth care

www.mnhu.org
www.lstmliverpool.ac.uk