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Global Health

“We can only solve problems together”

Infectious diseases and antibiotic resistance spread around the world via trade and travel routes. Together with partners in India and Uganda, the infectious diseases specialist Jan Fehr is looking for solutions to global health problems.
Roger Nickl/Translation: Caitlin Stephens
Infectious diseases specialist Jan Fehr
"When it comes to health challenges like antibiotic resistance, we are all in same boat, no matter which part of the world we live in", says infectious diseases specialist Jan Fehr.

Jan Fehr, you conduct research on global health. How global is our health these days?

Jan Fehr: It’s getting more and more global, with far-reaching consequences, as we saw with the Covid-19 pandemic. I’m currently planning a collaborative project with researchers in Bangalore, India. We’re aiming to improve our understanding of antibiotic resistance in infectious diseases and, in particular, tuberculosis. Antibiotic resistance is a big problem and is not just a local phenomenon. It needs to be understood in the context of One Health and Global Health, because it is spread around the world by people traveling. When it comes to health challenges like this, we are all in same boat, no matter which part of the world we live in. And therefore, we also need to work together to find solutions.

You have been researching diseases such as HIV/Aids, hepatitis and tuberculosis for many years now. How widespread are these diseases today?

They are still very much around and claim huge numbers of lives, especially in Africa. At the same time, these infectious diseases, in particular hepatitis and TB, are not much talked about, meaning we could call them “silent pandemics”. Covid-19 pushed them even further into the shadows. Nevertheless, the World Health Organization (WHO) aims to eradicate HIV/Aids, hepatitis and tuberculosis globally by 2030 and 2035 respectively. To achieve this, we need to start with the hotspots, the places with particularly virulent outbreaks.

How can global health research help to tackle these diseases effectively?

By covering all the bases. That means not just fighting disease outbreaks, but also taking strong preventive measures. I’ll give you an example from Switzerland, as a local microcosm: with the SwissPrEPared prevention program we managed to reduce the number of new HIV infections. For the first time, we were able to say the HIV epidemic was over in Switzerland – in the 1990s, such an achievement was unthinkable. As pioneers in this area, we now also have global responsibility.

Global health requires researchers all over the world to work together. Who do you work with abroad and why?

We have various partners in different parts of the world. One example is our longstanding cooperation with Makerere University in Kampala, Uganda. My team works with Makerere’s Infectious Diseases Institute on specialist research into tuberculosis and HIV. We do this because we are convinced that global challenges can only be tackled if the Global South and the Global North work together. It’s important to stress that it is not a case of partners from the Global North “exporting” solutions to the South. That’s not the idea at all. To find real solutions, it’s necessary to harness all the expertise possible, from all four corners of the globe. We need to approach problems with an attitude of “we can all learn from each other”. That way, all partners benefit.

What criteria do you use when selecting research partners, and how important is their scientific reputation?

Reputation is not the top criterion, although it does of course play a role. It is much more important to understand whether potential partners are active in the same academic field and share our values and view of the problem, as well as whether the innovation and expertise brought by both sides will be mutually beneficial. We also place great importance on following the 11 principles formulated by the Swiss Academy of Sciences’ Commission for Research Partnerships with Developing Countries. They require, for example, that scientific achievements are honestly shared. At the end of the day, mutual trust is the be-all and end-all of successful cooperation.

What specific benefits does such cooperation bring?

It enables different worlds to get closer together through dialogue. This is the basis for developing good sound solutions that are also sustainable. In our subject area this means solutions based on top-level research that can be used in clinical practice – and which have clear benefits for people in the Global South and in the Global North. The findings can then also be fed back into teaching.

The old ‘white savior’ image is more deep-seated than we sometimes think.

Jan Fehr
infectious diseases specialist

Can you give an example?

In Uganda, many people still die of tuberculosis. The treatments currently available were developed in the 1960s and 1970s. The pills have to be taken for more than six months and patients often stop taking them early because they cause severe side effects. We have now, together with our Ugandan colleagues, investigated whether it would be possible to shorten and improve TB therapy using the existing medicines. If our idea works, it will benefit not only people in Uganda, but also in many other places.

Academia isn’t always the most cooperative place – as a researcher, you are also competing with other scientists around the world. How do you see the relationship between cooperation and competition?

Well, we’re not the only partners working with teams in Uganda, of course. That leads to competitive situations and conflicting interests. But the various national and international research groups all have their specific areas of expertise, such as pharmacokinetics, or genetics. For example, if a question comes up in our research about whether genetic factors also have an influence on the concentration of a drug in a patient’s blood, the geneticists’ data could help us. Then we have to try to find a mutually acceptable agreement with that research team.

How important is it for you as a researcher to be part of renowned research networks such as Horizon Europe?

These networks are hugely important for collaboration on very large-scale projects. They can also be a powerful lever to galvanize the search for solutions to important societal problems. They enable us to take part, not just as Swiss hangers-on, but in a leading position. That’s why I hope the situation for Switzerland with regard to Horizon Europe will improve soon.

Is it important for junior researchers from Switzerland to get experience abroad?

Absolutely. But the experience is only really valuable if one develops and maintains a reflective attitude and understanding of cooperation between north and south. Well-intentioned projects in the Global South can sometimes even be counter-productive if participating researchers from other parts of the world do not critically examine their history and their own attitudes. The old “white savior” image is more deep-seated than we sometimes think.

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