Professor Kevin Marsh on Leadership, Malaria, and the Future of Global Health

In this episode of LSTM In Conversation, Deputy Vice-Chancellor of Liverpool School of Tropical Medicine and Professor of Molecular Virology Professor Jonathan Ball sits down with LSTM alumnus Professor Kevin Marsh, a world-renowned malariologist whose career has helped shape the scientific landscape across Africa.

Professor Marsh reflects on his early inspiration to study malaria while at LSTM, the mentors who guided him, and his journey in establishing the KEMRI–Wellcome Trust Research Programme and co-founding the Science for Africa Foundation. Together, they explore lessons in scientific leadership, the importance of co-creation and long-term investment in locally led research, and the future of global health in the context of climate change, epidemic preparedness, and emerging malaria vaccines.

Please note: there are minor sound issues in the first five minutes of the recording, which are corrected afterwards. We apologise for this and thank you for your understanding.

Transcript

Speaker: 0:06

Welcome to this episode of LSTM This week's guest is a globally also a global health leader with working across Africa. He's an LSTM alum, having Tropical Medicine uh, back in research career started at the the Gambia and then where he Kemri-wellcome Research So his work is focused on malaria immunity but also pathogenesis. And one of the areas he's been particularly interested in is building that African led research capacity. He's advised on malaria. He's chaired the Who Malaria he's also supervised more than Our guest has been an advisor to a founding director of the and also co-director of the His contributions have been recognized with major international honors, including the Prince Mahidol Prize and the Al-sumait Prize for Development in Africa. So I'm really pleased to welcome Uh, Kevin, you've worked at the forefront of malaria research and global health for over three decades. What initially inspired your what really drives your long Basically, uh, attended a series of lectures by Ian MacGregor, who was the doyen of British malariology. And although it seems kind of on Um, after the second match, I just knew what I wanted to do, and that was to understand malarial immunology. And that set the course of my Of course, I ended up, you know, immunology, but getting involved do with malaria that really set That's sort of doing the going to that series of lectures What was it that really put you at the forefront of the research? What made you the scientific A number of things. I think one thing I'm always of other people. Because at that stage I spoke to oh, you need to speak to Brian I was at that time director of And of course, this was in, you know, well before even emails or. And the only way to talk to him was to put in a long distance telephone call booked to the Gambia, and he didn't know me from anybody. I just said, look, I'm a young I'd like to come and work on And he said, well, I'm over in And we did that and it sort of At the same time Brian said, oh yeah, if you're going to do this, you really, uh, need to talk to Lou Miller, who was in the laboratory for Prostate Diseases, NIH. And I did the same thing with I rang him up out of the blue on myself, and he said, oh, great. Well, if you're going to go to The Gambia, get in touch and come over and spend some time in our lab. And when I arrived at NIH, Lou and every morning came in and all the work in his lab. And thinking back since then, I've thought, you know, both are incredibly busy guys, and yet they sort of, without needing too much detail, just decided that the update would really be as helpful as they possibly could. And I think related to that, um, one of your defining legacies is the the fact that you've built scientific leadership in Africa, and that's through programs like the Kemri-wellcome program, also through the science for Africa Foundation. So what do you think are the you've learned and that people sustainable and importantly, If there's one thing that any capacity or any sort of capacity And maybe it may sound so critical in terms of, you know, It is that if you look at the scientific career, on average, I guess the time you finish your first degree, you go through to subsequent degrees, do your research, training, so on and so forth. I guess it's on average twenty training before you reach a really, if you like, substantial course, that sort of midway great stuff and big impact. But in terms of the point at which you're able to sort of, um, have a strong influence on, on international policy, same time, affect other people's careers. Um, you know, it's a long it's a Um, so I think if you don't take hard to do anything substantial. So I think long term view is the The the other things are of course, things like building critical mass. You know, you can't do anything Um, and you do need critical mass, not just in terms of, um, infrastructure, but intellectual critical mass. Um, and then I think the key thing is, ah, the quality of collaborations and interactions with people as things, as things build up. Um, in, in my case, I guess it was quite strange because we originally working in a part of Kenya, which was fairly isolated and did not have a strong scientific kind of, if you like, ecosystem. So it was rather odd because was hard at the beginning, but I is to make sure that the whole not sort of just an idea that it's great, and we'll organise I think it's really important is very carefully co-created So taking into account those things, in fact, it's got to be long term. You do need to build a critical genuinely led by partnerships. I think to me they've been the And do you think that or do you think there's a real or a perceived threat of the current global political situation on a lot of the great work that's gone on over the past few decades in building that capacity? Well, I think there is in the a very strange situation and, funds, I mean, obviously, with USAID and other US funding, in funding, um, for many other Um, uh, and I think. Well, I was going to look at Right now it is a massive It's particularly a problem obviously for delivery is that, you know, sort of the the reduction of funding for HIV programmes is registered disaster. Um, it's having a massive effect in research as well, particularly on African universities. Um UCT um, and in Cape Town, uh, has uh, lost a very large proportion of its total research funding. And that's the truth. The same is true of many other, So there's an immediate big, big One thing you can say about it, though, is that I and I don't know how widely this is felt, but certainly in people I talk to, um, across the continent, there is a real sort of sense of, well, this is a turning point at which we can't just accept this, but things have to change. There's got to be a different Now, it's easy to say that and But I do see a very kind of strong, um, determination to sort of move away from dependence on that kind of funding. As I say, that will be hard to There's massive problems with But but I'm happy that it's not this is a disaster. Far more it's discussions now about okay, so things need to change. We've got to work with We've got to work with private We've got to work with And I think in the long term The problem is the gap between of pain in that gap, I guess. Short term, yes. This is a challenging, uh, climate and landscape, but through all of the capacity building that you've contributed to that others have contributed to that low middle income countries, in Countries, in particular, the sub-Saharan region may well be at a place to face those medium and long term challenges. Yeah, I hope so. And I think the thing that is so striking, um, is just the enormous, uh, capacity and potential building up now across, um, African research landscape. This is reflected in things like when we put out a call, whether it's from Africa Foundation or from other, um, groupings I'm involved with. When we put out calls for like the number and quality of across the continent is sort of time, which why wouldn't it? But it does reflect, you know, that's been over, over the, the So I'm actually very optimistic about the potential across the continent. And I think, you know, where and thinking about this. There's going to be no easy answers to how you bring in additional funding. But I think now at least there the whole ecosystem. So. So I am optimistic, but not in a blasé way. There's a lot of work to do, but I but I think it's an optimistic view. Yeah. And in addition to political to deal with. And not least things like is is having a major impact on also the shifting geography of things like vector borne threats What do you think the research Not only to anticipate, but also Yeah, well, I think in some ways uh, the whole, if you like, because it's so all enveloping. It's an existential thing. Um, it's actually quite hard to kind of get down to the detail of it. What I mean by this is, you on climate and health, climate it isn't as if climate sciences You know, climate science spans everything from kind of, you know, agriculture, meteorology, battery technology. And because it's so all it is actually quite hard, I well, what do we do? Because it's a it's everything. It's everywhere. So in, in that sense, it's the now work and live. And I think obviously what it more than ever. I mean, it's always been true is important, but I think, you challenges we're facing are so Um, you know, between health, say, migration, demographic does emphasize is the need to interdisciplinary approaches to And do you think to some extent that the regions which have more wealth, places like Europe, the US, do you think to some extent this increased threat is really making them sit up and take this issue seriously? Or do you think we still are it's somebody else's problem? Yeah, I don't know. I guess it's kind of scary, will be individuals and these me seriously. One thing that strikes me is when I listen to colleagues in the UK, um, who are involved with, uh, epidemic preparedness and such. Like, I do get a sense that, you failed to learn a lot of lessons know, we're not as prepared as still major gaps. I, I'm not really in a position where I work, as it were. But what does strike me is the through that pandemic. And again, I don't want to generalise because Africa's a big place. I can only talk about the place So, um, is that in fact, the as it were. And in some ways, this this starting without too many infrastructures, things have to So in in some ways I do think, on across the continent about is in the UK. But as I say, I may not be the scene, but I do think across the increased awareness and preparedness and returning to focus and interest. We've heard some really exciting the fight against malaria and in looked, on the face of it, to be to the fore. But how do you what do you see Are these going to be the the, do you think they're still going additional approaches needed? Yeah, I think both um, by which I mean one thing that often strikes me. I often say, you know, uh, when, environments talking about often and it's not just malaria. The focus often is on, as you And, um, whereas in many ways, malaria, but with many health So, you know, if you look around the world, no one has ever eliminated malaria from a country without having a reasonably well developed and reasonably equitable health system. And the the you know, the opposite of that, or the corollary, if you like, is that it will be impossible is whatever magic bullets we have to really, um, uh, get on top of malaria without a good health system. So in some ways, you know, it's system and universal coverage Having said that, obviously the critical and I do think, um, I'm um, very much around malaria Um, and although when I went into the field, everyone was saying there'll be a vaccine in five years. And that was sort of thirty five Um, I am actually now more optimistic than I've ever been about the potential for malaria vaccines, because the vaccines we have, um, and they're out there now are incredibly promising. But I think more importantly, I be better vaccines. And they're in the pipeline So I do think that we are vaccines will have a really controlling malaria, but but with the health systems issues Um. to throw into that interest vector control fit in here? Do you still think that that is to the overall control? And yeah, bringing about the end Oh for sure. I mean, you know, malaria is a And as you know, much of the history of thinking about malaria, um, you know, like the theoretical thinking about it and the modeling, it was based very much on the vector side of things. Um, and I think the other thing again, talk about, is that It's, you know, many, many, many different diseases in many different ecologies. And those ecologies are often things affecting vectors. Um, so, no, there's no doubt that, you know, attacking the vector has always been and will continue to be a really important part of malaria control. So when I say I'm optimistic think therefore we'll be able to The whole I think the whole point about malaria is it's such a protean, um, set of conditions, if you like environmental conditions, social conditions that you need all tools. So, yeah, I think vector control control, um, are going to be And just to move the focus slightly, um, you know, we're clearly, um, the work intersects around various infectious disease threats, and LSTM has work ongoing from things like malaria, but through to emerging viruses, for example, like Ebola virus, coronaviruses. What insights do you think you've drawn about how we should be best prepared for future outbreaks. And how do we go about improving And also how do we build that in surveillance, diagnostics, it might be. Well, I think I think, uh, there needs to be a really concentrated and focused attempt to bring together all the different. Um, we were talking earlier studies in relation to kind of whole issue of epidemics, climate and such like is a So I think there needs to be the very deliberate building up of all the capacities required to do that. And again, I'm fairly I mean, I you probably know that recently, um, science for Africa A foundation, um, in partnership with um Oxford Pandemic Science Institute and and and in funding partnership with the Mastercard Foundation. Um have announced a whole set of new, uh, large scale programs called the Epsilon programs, um, seven of them, uh, across Africa, which the aim is to build up this sort of interdisciplinary capacity across all the different areas of science and policy, which are required to work on, on epidemic preparedness. So I think that's, you know, and promising thing that I mean, So the launching this year, but I think it's going to be really powerful. And do you think we are better the SARS-CoV-2 pandemic? Because I personally am not so more importantly, globally. But but I wonder what your I think you I mean, it's more So if you're not convinced, uh, I'm not going to say I am. No, I agree with you. When we were saying earlier that colleagues in the UK certainly the UK and, and industrialized learnt from, from how they as I do think there's a kind of, across at least parts of Africa interacting with a lot. So and I think one of the things Well, it was from, um, Ebola, the difference between may be rather superficial and it comment, but the big difference, The fact that African ministers of health and research institutes to a very large degree had to work on their own, or at least when they were supported, it was often at a distance, as opposed to the experience in the early Ebola epidemics where, you know, the place was flooded out, as it were, with really well intentioned. It's not a criticism of, of of collaboration, but, you know, to some degree, the whole to some degree there was a problem of the whole decision making being taken over from externally, whereas in, in SARS-CoV-2, because of all the travel restrictions, that just wasn't possible. And certainly my interactions from the African Academy of and um, W.H.O. Africa was that it really pulled together a very strong on the ground and quite flexible response because people had to do it. So I think that's one of the of it as a positive. That's interesting. Um, to, you know, those that strengthening of capacity and that self-sufficiency and that independence is clearly something that African nations are really striving towards and investing heavily in, and it is a significant change in that landscape. How important do you think Lstm's role is within that activity, and how can we as researchers, scientists, clinicians best contribute to that? Yeah, I think LSTM has a really And I'm not saying that because an alumna alumnus, um, I uh, the other sort of, if you centres, um, Liverpool, London. And now I'm based at Oxford and we're also, um, thinking hard about this. I think the role is one of, um, genuinely equitable partnership and getting used to a different Whereas in the past, the agendas from northern institutions. Uh, now I think it's, uh, much colleagues to define and being prepared to be a little sense of not expecting And I think Liverpool's been Um, I think other institutions also are beginning to move in that direction. It's, it's making available the enormous depth of expertise which inevitably resides in any institution which has been working on something for a hundred years or more, but not assuming that it's going to be the same role that we've always played. So I think that's the challenge and for everybody else. But I think, you know, I think talking to colleagues across, uh, those institutions and colleagues across the continent, I think everyone's agreed that that's the direction we're all moving in. And you reminded us then that Um, alum um, can you remember as a student? And I won't say when it was, it was nineteen eighty one, I think. Um, yeah. Oh, yeah. It was a fantastic time. I mean, it was it was very Um, I, as we mentioned earlier, about deciding to go into what was then called tropical medicine. now. I guess we'd say global health. Um, the fact that Liverpool is I trained in medicine in Um, it was a fantastic opportunity and it was incredibly exciting. It was an introduction to a terms of the sheer interest of, more importantly, actually the with a kind of really I mean, it was it was an I think everybody who's been fondly, uh, to whatever their doing the DTM. Um, but yeah, it was a, it was a, it was a life shaping experience, but not just because of the intellectual content, but really because you met so many interesting people from all over the world. Where's it going? It's good to meet you. Very good. Good to meet you too. And no doubt. See you at some point when I'm I hope so.