Working life: Sir Brian Greenwood
Sir Brian Greenwood of the London School of Hygiene and Tropical Medicine has worked in clinical tropical medicine for 50 years, reinventing field research and making discoveries that have led to sharp declines in illness and death from malaria, meningitis and pneumonia. Yesterday we recognised these achievements with our MRC Millennium Medal, and here Brian tells us about his working life, the joys and challenges of working in Nigeria and The Gambia, and why he’s most proud of the scientists he’s trained along the way.
Career in brief
- Clinical training, followed by three years in Nigeria
- Wellcome Trust fellowship in clinical immunology
- Ten years in Nigeria followed by 15 years directing MRC Unit, The Gambia
- London School of Hygiene & Tropical Medicine and many projects in Africa
- 2008 Hideyo Noguchi Africa Prize for outstanding achievements in medical research
Some people thought I was throwing my career away when I went to Africa. I was a bright student and was on track to become an eminent doctor via the standard pathway when I applied for a registrar position at University College Hospital Ibadan in newly independent Nigeria. This was 1965 and the hospital was incredibly well equipped then – it was as if Hammersmith Hospital where I’d been working had been transplanted into Africa.
I spent about three years in Ibadan. The Biafran war started during this time and I went from being a junior doctor on a ward with eight doctors to having to help out in paediatrics and the emergency room as many doctors left the hospital during the war. It was a very steep learning curve.
I realised I needed some more research training and came back to the UK. I considered applying to both the MRC and the Wellcome Trust for a fellowship but the MRC wanted lots of forms filling in, whereas I was invited in for a cup of tea with the Wellcome Trust, which then had only a small office in Queen Anne St! I ended up doing a three-year Wellcome Trust fellowship in clinical immunology at the MRC Rheumatology Research Unit at Taplow and at the Middlesex Hospital.
I went back to Nigeria in 1970 to help set up a medical school at Ahmadu Bello University in Zaria. It was very different to Ibadan – the war was over but the hospital was just being established and everything was very run down. I enjoyed it immensely – you had to be a Jack of all trades. We ended up setting up a lab in the kitchen of a colleague. It was in there that we developed the latex test for meningitis, which is still in use today.
It was the seasons in Zaria that dictated the diseases I ended up focusing on. The three-month rainy season brought malaria, but we had to work on something in the dry season too. We had meningitis and cholera epidemics within about a year of arriving Zaria. These were incredibly challenging but exciting as well – I won’t forget making up intravenous fluid in our kitchen lab and testing it on ourselves.
Zaria is in Africa’s ‘meningitis belt’ – a broad swathe of the continent where rates are high. There I conducted one of the first meningococcal polysaccharide vaccine trials in Africa, vaccines which have since saved many lives.
I began directing the MRC Unit, The Gambia in 1980. I loved working in Zaria, but I didn’t want to get bogged down in the administration of a big department of medicine as I was asked to do, and I wanted to continue to do research. During my 15 years in The Gambia I increased the size of the unit from something like 200 to 800 staff.
A big focus of my research in The Gambia was on malaria and one of the first projects was on bed nets. I was wandering around the villages near our field station in Farafenni, on the north bank of the Gambia River, when I noticed that nearly everyone had a bed net in their house. This was strange as you rarely saw a bed net in rural Nigeria. People were using the nets to stop mosquito bites but I wondered whether anyone had ever looked formally at whether they reduced rates of malaria and, surprisingly, very little research had been done on this.
We started out comparing rates of malaria between people who did and didn’t use nets, and found that those who slept under nets did indeed experience less malaria. But this could simply have been an association rather than cause and effect. So we did intervention trials comparing no nets with standard bed nets, and then with insecticide treated nets (ITNs). We found that if everyone used an ITN, the village gained 50-70 per cent protection against malaria. When we did a bigger trial, we found this led to a 30 per cent reduction in child deaths. The results of this trial helped get ITN nets widely adopted.
Malaria deaths halved between 2001 and 2013. Modellers have put around 70 per cent of that change down to use of ITNs. I feel proud knowing that our research in The Gambia played an important part in generating the policy recommendations that have brought about this dramatic reduction.
A big part of the success of the bed nets work was that we involved economists and social scientists. It seemed a natural thing to do but it was fairly innovative at that time. You wouldn’t think of doing field research or trials without that input now.
There are risks from working in Africa, less now than they used to be. Several of us contracted hepatitis in Zaria from collecting blood samples and a young colleague of mine died from the disease which, fortunately, can now prevented by vaccination. I had another colleague die from Lassa fever and I think I had that myself too, though this was not proven. Working in Nigeria during the war and subsequent coups had its dangers, and we experienced violence in The Gambia too.
I’ve got a big shelf of scientific publications but when I look back on my career, I think I’m most proud of all the young African scientists whose careers I have been able to help. I used the prize money linked to the Hideyo Noguchi Africa Prize to set up a scholarship fund for African scientists to do a Masters in the UK or Japan, 30 of whom have now had scholarships. It’s been very rewarding.
There used to be very few African scientists involved in malaria research but now they run the show. That’s a great change to have been involved in. There’s still a role for expatriate scientists in Africa, and there are still some African countries that have very little in the way of expertise or infrastructure, but I feel our role now is more supporting than running things.
As told to Sarah Harrop.