Health on a global scale

It takes a village

With an interest in going beyond traditional bench science, Dr. Friedman and her colleagues focus on clinical epidemiology — the study of disease patterns in patient populations. They do this using a team science model championed by Brown, and Friedman wouldn’t have it any other way.

"We have people like me who worry about recruiting patients and think about the outcomes for vulnerable populations all over the world,” says Friedman. “Then the group in the lab works with us to understand what mechanisms are causing diseases, which informs optimal treatment strategies and how to develop vaccines and other therapeutics. We put it all together in a way that I think is unique…I also think it moves things along a lot faster."

Friedman highlights the cascade of discoveries in the lab that must be translated into ways of treating human populations. This is very long-haul work for most interventions, but since her team is working together, they are able to execute the discovery and translational processes in parallel rather than step by step, which leads to greater and quicker impact.

"We also can bring in trainees and students — whether those are Ph.D. students, postdocs, or junior faculty — and those folks have the opportunity to contribute and learn in their own space," says Friedman. "Some of them also bring unique tools to help us."

Warren Alpert Medical School students also participate in this work through the Global Health Scholarly Concentration program, which is an incredible opportunity for hands-on research experience in low- and middle-income countries. “If you're a pediatrician,” says Friedman, “the global health of kids and the future generation is really in your hands. That is why I'm supportive of anything we can do to get our young students to the field.”

Friedman says that having faculty from different departments engaged at Brown helps define the interdisciplinary model. Whether it’s engineering, public health, or the Medical School, working together has always been part of the mission.

“It's what keeps me here [at Brown],” says Friedman, “and I think it helps us recruit great people because they know that Brown is behind that mission and will support that work.” As an alumna herself, she knows firsthand how the institution emphasizes a global vision. “I think most [alumni graduate] with the ethos in mind that we must engage as partners globally to maximize our impact.”

The community that supports international health research at Brown is helping us leave the world a better place, says Friedman. And with the training they do, they’re making sure that they leave it in the best hands.

Distanced learning

A big part of Brown’s impact on global health is involving the next generation of researchers and clinicians. That’s why collaboration abroad is another important facet of the team science model. Friedman and her team work with groups in the Philippines and Uganda, and the education goes both ways. Foreign teams come to Brown to learn and teach, and teams from the University travel there to do the same. The center also sends residents and medical students to sites in Kenya, Uganda, and the Philippines. Hopefully, says Friedman, they're all getting inspired to do global health and teaching each other what they have to share.

Bringing researchers and clinicians together and recruiting new faculty members that bring different expertise can magnify the impact, Friedman says. Take Brown’s research group doing malaria vaccine discovery work, led by Dr. Jake Kurtis, where they must go to the field, bring samples back to the lab, and return to the field to study newly discovered vaccine candidates.

One team is looking at people's varying immune responses to potential vaccine candidates — who’s more vulnerable, who’s less vulnerable — and then identifying what's unique about those people who seem to be protected from infection. Then they come back to the lab and try to mimic that protective immune response, which rationally identifies new vaccine candidates.

An alternative approach is transmission blocking, led by Dr. Chris Nixon. In this approach, a vaccine would target the malaria parasite stage that is ready to jump to the next human host through a mosquito bite. This stops the parasite from moving to the next human, a form of “altruistic” vaccination. Dr. Nixon ultimately envisions a multivalent, multi-stage vaccine that will include vaccine candidates from all parasite stages.

Malaria genomics and drug resistance is another area, led by Dr. Jeff Bailey, which involves looking at the parasite in the field and trying to understand what it’s doing to evade existing drug therapies. This will then provide an “early” alert that we might need to use a different drug in that region and inform the development of new drugs.

People with interests in different parasites and pathogens, those with different methodologic skill sets, and those with expertise in big science or computational biology all bring something to the table. This variety of approach, says Friedman, is crucial to the future of this work.

Helping those who need it most

CIHR believes that global health encompasses populations all over the world, both within our borders and internationally, as all populations are susceptible to diseases of poverty. Friedman says there is much we can do about morbidity and mortality and the overall burden of disease, especially among young children and pregnant women. But she admits it’s no easy task.

Given the disparities in health care delivery in the U.S., it's tough to convince the National Institutes of Health and other groups to pay for resources to benefit populations overseas. But, Friedman says, it’s one of the most important things we can do for people globally, and even relatively small investments have huge impact. If we invest wisely, she says, even in the basics like clean water and sanitation, it would go a long way to minimizing the impact of many infectious diseases of childhood.

Friedman also says there are so many understudied areas and ways to intervene. A disease like COVID is a great example. “We have great vaccines, but who's going to pay for it and deliver it to those living in settings where there is no primary care framework?” she says. “The whole health care infrastructure is so difficult that even if we could deliver millions of doses to sub-Saharan Africa, just getting them into arms is a huge undertaking.”

But Friedman and her colleagues at Brown are motivated to press on.

“I don't know if I would've been inspired to continue to do global health if I hadn't — very early in my career — gone to Kenya and seen how vulnerable these kids are,” she says. “There were so many things we knew how to do that weren't very costly, and yet the under-five mortality rate where I was working was 25%. That's unacceptable. I'm really hoping that the work we're doing now for drug treatment of [children] will keep me in that space for the rest of my career.”