Botnar Research Centre’s vision on implementing tangible solutions for child health

The 10-year research and application programme of the Botnar Research Centre for Child Health (BRCCH) brings together scientists and clinical researchers from a variety of disciplines. The Centre aims to develop tangible results in paediatrics to prevent diseases, improve diagnosis and develop new treatments for global use in child and adolescent’s health.

Why is Tansania the initial target country for healthcare solutions, what are the measures of success put in place and what are the challenges in transferring research findings from the lab to the patients? In this second part of a 2-part interview, the BRCCH Director Georg Holländer, Professor for Paediatric Immunology at the University of Basel and head of the Department of Paediatrics, University of Oxford, and his Deputy Sai Reddy, D-BSSE Associate Professor for Systems and Synthetic Immunology, ETH Zurich, reply to the various questions surrounding the ramping up of research activities of the 2018-founded Botnar Research Centre.

Tansania will be an initial target country for healthcare solutions developed by BRCCH. Why Tansania?

Georg Holländer: Tansania is a country for which we have – through the Swiss Tropical Institute (Swiss TPH) – networks well established. But in many other ways Tansania is very interesting because they have embraced digital approaches to address challenges in health care provision. With the Centre’s specific goals, we already find a prepared environment for some of the kind of studies that we wish to be realised.

Will the findings the Centre gathers in Tansania be transferrable to other low and middle-income countries?

GH: Let’s take the example of predictive and preventive measures. Predictions of diseases are driven by a number of factors. For example, one concerns the disease in its molecular nature, one is the environment by which disease manifestations become obvious and are recognised, and one aspect relates to the cultural context as certain diseases are taboo to be talked about. So, any disease identification and predictions established, let’s say in the Northern hemisphere will need to consider these parameters and test their usefulness in low and middle-income countries For sure some will be upheld, others will probably be less informative and yet other parameters may not be relevant at all because other influences may have a decisive impact. We will therefore learn how robust a method is in predicting and assessing disease states and how transferrable this approach can be. Any differences in preventing disease in two locations that contrast geographically and/or societally will therefore inform us of the nature of the challenge and can be fed back to the researchers that initially did develop the method and carried out the analysis. So, we expect that some of these processes will be iterative regarding data assessment and analysis in one country, transferability to another country, new testing of the paradigms and the algorithms and then going back to the original country and establish which of the criteria initially chosen are predictive and transferrable.
Considering, for example, diagnostic devices, I could see that the robustness of a device designed for use in low or middle-income countries will become apparent when being tested in site. If the device is not sufficiently robust we should receive relevant feedback from the users and will be asked to engineer it better.  

The ultimate goal of BRCCH research is to upscale the findings to the rest of the world. What challenges are involved with upscaling?

GH: Upscaling – or scaling in general –, constitutes an additional challenge we and others face, wherever and for whom this is being carried out. Indeed, scaling has for many digital solutions in healthcare been an unanticipated challenge. A fair number of programmes heralded as useful and essential have not kept their promises when being scaled. We will therefore pay significant attention to the question if a method is indeed scalable, and, in fact, scaling is one of the conditions in the current call for project proposals that we explicitly assess.

A key element of BRCCH is translational research. Could you describe the concept of translational research within BRCCH?

Sai Reddy: An ideal scenario will be “bench-to-bedside”. We would be very happy if we could get that far! The goal is to essentially have products that make an impact in translation in the sense that an individual’s health is impacted in the programme’s lifetime within the 10-year arc of this first period of the Centre. We are not aiming to fund projects that discover a brand-new mechanism in a mouse model. Instead we are really looking for innovative solutions that are able to impact child health in the foreseeable future.

Going further than from “bench-to-bedside” would mean to impact the wellness of whole populations rather than of individuals. This the visionary goal of BRCCH, right?

GH: If you look at the practicality of low and middle-income countries where hospital infrastructures are particularly resource-poor compared to industrialized nations, and where families still provide - within these structures - the daily care for patients, we would think that a great deal of contribution to fair health-care provision and the quality in that space will come from providing solutions that can be adopted at home, that can be embraced under a large variety of social structures and don’t require an institution such as a hospital, health-care centre or school. If we can provide the monitoring of health and wellbeing in a setting that is not requiring additional infrastructure beyond the nucleus of a family then we have achieved a big goal.

What happens as a project matures: will each project be evaluated and the data transferred back to Switzerland so that the impact of a given project can be determined?

GH: That is the most straightforward blueprint of a path that we see a project can take. We might support projects that progress to low and middle-income countries already in their second or third year; or we might have projects that are just about to be ready by the end of the initial period we support.

SR: Or it could be data from Swiss clinical trials that eventually informs us how to translate the findings globally.

GH: The global application of findings realised in Switzerland as part of a BRCCH grant will require partnerships in countries for its dissemination to low and middle-income countries. The timeframe for this is project-dependent but we expect that such a translation is an integral part of the concept. We are therefore not interested in supporting very basic science projects where its translation to realistic clinical application will take many years or remains an aspiration during the entire granting period. The translational quality of projects needs to be tangible or best part of the application itself.

Exporting health-care data from other countries might be an issue…

GH: Yes, there are legal aspects that will need to be considered. The present law of certain countries prohibits the exchange of health-care data. Other countries allow it in principle but will address issues of data ownership. Importantly, many organisations including BRCCH anticipate the need of a clear legal and ethical framework – in addition to national laws - that regulates the use of data collected abroad. Many big international organisations such as the Welcome Trust or globally active universities have now put Task Forces in place to address important questions related to data ownership, sharing and use including issues related to who is the actual owner of information collected from the public; and how can this data be made publicly accessible despite the fact that its collection may have been paid for by a non-governmental monies. In addition, aspects of machine learning governance and ethics of AI- (artificial intelligence) based activities will need to be addressed, not unlike the discussions that lead to our present understanding of medical ethics where there are now broadly accepted rules BRCCH will pay very close attention to the legal and ethical aspects of “big data” and machine learning.

The initial funding period is 10 years. Which measures are put in place to estimate the success of BRCCH activities?

SR: Obviously, the overall mission of impacting child health is the priority. But it will be difficult to quantify the number of children that benefitted from BRCCH research findings or developments. As we are academic institutions, we also need to be aware that academic criteria will be part of the evaluation process. Thus, measures include papers, patents, students that graduated or post-docs that were trained.

GH: It is extremely difficult to quantify the impact of such a Research Centre. Hence, we will use a number of different metrics as none of these taken individually will reflect the impact of a given programme on child health and wellbeing. Impact factors of journals in which research results were published, number of publications, number of grants awarded by another funder to that research consortium, number of individuals recruited as part of a BRCCH supported research programme and changes in health policies and practice resulting from BRCCH research will be some of the measures that allow us to conclude a programme’s impact – together with many more, not least specific ones that relate to the scientific focus of the research programme itself. Hence all of these examples are an important part of the overall comprehensive understanding whether the research supported by BRCCH has an impact. As so often, once we can look back, it will be obvious whether we had an impact because we have changed the landscape in health-care for children and adolescents - be it in areas that concern prediction, prevention, diagnosis, therapy, or outcome, thus decreasing the burden of disease in this age group.

Researchers submitted proposals within the areas “applied health care for children”; “intelligent systems for medical decision support” and “translational research from cellular to health control”. Research area No. 4 on “legal, ethical, economic, health systems and capacity building” is not addressed by this year’s call. How will BRCCH ramp up activities in this area?

GH: First of all, in research area No. 4 there are already a number of relevant activities ongoing and evolving in Switzerland. And we want to make sure that within that changing landscape we can provide our resources as effectively and as focused as possible. Here we wish to get first a detailed understanding of the many efforts undertaken by Universities and organisations, especially in Switzerland, so we understand how the BRCCH can contribute most effectively to issues concerning the legal, ethical, and economic aspects of health systems and capacity building. For example, ethics concerning big data and machine learning, to name just two, or health economics are of immense societal interest and relevance. Together with the Fondation Botnar we will dedicate resources to looking into these topics to provide good, practical and sustainable solutions.


Thank you!