Partnerships for the world

The Scottish and Malawi universities teaming up to tackle public health

By David Cox

Malawi’s Kamuzu University’s new clinical research partnership with the University of Glasgow will see experts from each country sharing knowledge on cardiovascular disease, vaccines and more.

On the face of things, there might not seem a lot in common between the west of Scotland and Malawi, a landlocked east African country traversed by the Great Rift Valley, one of Earth’s most renowned geographical wonders.

But the two nations share a past and concerns for the future. They are linked by a place name – Blantyre. It’s Malawi’s financial hub and second largest city, and also the name of a small town just outside Glasgow, and now a joint research laboratory has taken on the moniker, the Blantyre-Blantyre Clinical Research Facility based at Malawi’s Kamuzu University of Health Sciences (KUHeS).

The history between Scotland and Malawi began with David Livingstone, the 19th-century Scottish physician, missionary and explorer who is well regarded in Malawi for initiating the country’s first trade partnerships and championing the abolition of slavery. “He’s respected a lot in Malawi, as his work had an impact on ending the slave trade, and also improving the educational system,” says Mwapatsa Mipando, associate professor at KUHeS.

Now, more than 150 years after Livingstone’s death in 1873, a scientific collaboration forged between the two countries is hoping to address some of Scotland and Malawi’s most pressing public health problems. Headed by Mipando and Prof Paul Garside of the University of Glasgow, the concept of the Blantyre-Blantyre facility first began more than a decade ago, when Garside spent a mini sabbatical in Malawi.

Initially, Garside’s idea was to forge a collaboration, with the aim of using Glasgow’s research expertise to help tackle malaria, the mosquito-borne parasitic illness that is endemic in more than 95% of Malawi. But while Malawi’s public health concerns have traditionally been focused on infectious diseases, Garside began to realise that diet and lifestyle-related illnesses such as cardiovascular diseases, cancer and other inflammatory conditions, which are so prevalent in Scotland and much of the western world, are becoming pressing health problems across Africa.

Glasgow is the cardiovascular disease capital of Scotland and “it’s a huge problem along with similar diseases of deprivation like rheumatoid arthritis and many cancers”, says Garside. “And what’s unfortunate but interesting, is that with urbanisation, those diseases are now a problem in Africa. You have this tidal wave of non-communicable diseases that are now pushing up against this existing issue of infectious disease, which makes it even more complex.”

Recent research has shown that obesity rates in Malawi are now at 18.5% while 16.7% of the population have hypertension. Mipando explains that the new facility aims to collect more detailed information over time on these chronic conditions and get an idea of why they are developing so quickly, particularly in younger populations. This could also yield valuable information on potential lifestyle alterations that can reduce the prevalence of these illnesses and the kinds of guidelines that could prove most impactful both in Malawi and Scotland.

Some of the most intriguing insights could be gained through studying the differing immune responses to respiratory pathogens in Malawi. During the Covid-19 pandemic, it was noted that while Malawi is one of the world’s poorest nations, ranking 174 out of 189 on the Human Development Index, there were far fewer excess deaths compared with nations with well-funded healthcare systems such as the UK and the US.

Garside suspects that while many Covid patients in higher-income nations died from internal organ damage, due to the excessive inflammatory reaction induced by the virus, the Malawian people were more resilient, because their immune systems are already tuned to coping with a high infectious burden.

“By understanding the molecular and genetic basis of that regulation, we could perhaps understand how we can induce that with vaccines in the northern hemisphere,” he says. But at the same time, studies have shown that responses to many common vaccines are impaired in Malawi and other African countries, which has made it difficult to control infectious diseases. As an example, one study found that while 100% of infants in the UK elicited the desired immune response to the tuberculosis vaccine within three months, just 53% of infants in Malawi responded as effectively.

“We’re attempting to learn more about that and how we can improve this in populations in Malawi that have malaria exposure,” says Garside. “We’re also about to start a small Covid vaccine study out there in vulnerable populations. But at the same time, understanding why the immune system isn’t being switched on as well could lead to new approaches for diseases where you want to turn it down, like rheumatoid arthritis, and that could benefit both the UK and Malawi.”

The creation of the Blantyre-Blantyre facility is a particularly remarkable example of what can be achieved even in a time of resource scarcity. The facility and its research projects have been directly supported by a five-year £1m grant from the Scottish International Development fund, a sum that represents 10% of the annual budget.

While these funds are dwarfed by the UK government’s official development assistance budget – which has been estimated to be £8.3bn for 2024/25 – the Blantyre-Blantyre project represents how significant impact can still be achieved through a relatively small investment.

And in a world where the cost of new treatments continue to rise, and healthcare systems are increasingly having to figure out how to make do with less, it is hoped that the research projects themselves will yield new insights when it comes to maximising resources.

In particular, Garside says that Glasgow can learn much from the achievements of Malawi’s greatly under-resourced public health system. “Malawi is one of the countries that drove down mortality in under fives more than anywhere else in Africa over the last 10 years, which is amazing,” he says.

With the collaboration being recognised by the European Commission as an exemplar of best practices between African and European institutions, both Garside and Mipando are optimistic that it will inspire similar partnerships as a new way of addressing some of the world’s most urgent challenges.

“Glasgow has been a partner that has respected us,” says Mipando. “I think there is much that we can both learn from each other. In Malawi, you’re always having to make decisions based on limited resources, but there is a lot which can be learned from that, in terms of how to get the best out of every dollar.”