Manhiça Health Research Centre (CISM) and ISGlobal: A Tale of a Partnership and Shared Mission

[This text has been written by Denise Naniche, Scientific Director at ISGlobal. This is the second of a series of articles to commemorate the 25th anniversary of the Manhiça Health Research Centre (CISM)]].

As we celebrate the 25^th anniversary of the foundation of the Manhiça Health Research Centre (CISM) in southern Mozambique, we also reflect on the co-evolution of CISM and ISGlobal and how CISM and ISGlobal have interacted and collaboratively shaped both institutions’ scientific research agendas. As the founders of ISGlobal, Pedro Alonso and Clara Menendez summed up the crux of the matter in their earlier post: “if not for CISM, there would be no ISGlobal”.

In the mid-nineties, the pioneering professionals described in Pedro Alonso’s and Clara Menendez’ post made it their mission to help create a research institution in Mozambique to tackle diseases impacting the poorest and most vulnerable communities in the world. At the time, the concept of research as a path to bridging health inequity contrasted with the dominating trends present throughout most of the 20^th century which advocated for humanitarian aid as the mainstay for tending to gaps in health care among vulnerable populations.

Humanitarian aid took the form of non-governmental organizations providing much needed relief and health care to many communities, but rarely including research. The investigators working in the Hospital Clinic and CRESIB, precursor institutions to ISGlobal, and CISM investigators, along with a few other pioneering institutions in sub-Saharan Africa, advocated for research as an impactful tool for combatting health inequities. Indeed, over the twenty-five years of its existence, CISM has shown that research and training for generating and translating knowledge is a powerful path towards improving population health and wellbeing, and helping it escape from the vicious cycle of poverty and disease.

CISM has shown that research and training for generating and translating knowledge is a powerful path towards improving population health and wellbeing, and helping it escape from the vicious cycle of poverty and disease

Shared Mission

Both CISM and ISGlobal share the ultimate goal of promoting and safeguarding the health of vulnerable populations through research and translation. ISGlobal strives to help close the gaps in health disparities between and within different regions of the world. One of the main pillars has been research and training in infectious disease control and prevention. ISGlobal has sought solutions to control and eliminate the major infectious diseases present in the poorest regions in the world by teaming up with institutions in low- and middle-income countries including the CISM in the 1990s.

Both CISM and ISGlobal share the ultimate goal of promoting and safeguarding the health of vulnerable populations through research and translation. Photo: Magude, Maputo province (Mozambique).

At that time and to this day, the Manhiça setting has placed research within the stark reality of high child mortality, a preponderance of infectious diseases including diarrheal and respiratory infections in children as well as malaria, HIV/AIDS and tuberculosis. CISM has focused on research at the service of tackling the main causes of morbidity and mortality in Mozambique and, as such, in many low- and middle-income countries. The long-lasting partnership between ISGlobal and CISM has provided the framework and synergies necessary for research to advance by leaps and bounds: generating evidence, training the next generation of scientists, and translating research into policy.

The Manhiça setting has placed research within the stark reality of high child mortality, a preponderance of infectious diseases including diarrheal and respiratory infections in children as well as malaria, HIV/AIDS and tuberculosis

A Few Examples

The Malaria research programme, ISGlobal’s largest, spans the whole value chain of research from understanding the Plasmodium parasite lifecycle to vaccine research and implementation of malaria elimination strategies. ISGlobal’s Malaria programme works in many areas of the world, but it has grown from seeds sown long ago in Manhiça. The history of malaria research at CISM is intertwined with the clinical development of the RTS, S malaria vaccine. The collaboration between CISM and researchers working in the Hospital Clinic and CRESIB, precursor institutions to ISGlobal, generated the scientific evidence crucial for licensing the first malaria vaccine. Moreover, these early successes boosted the long-standing CISM-ISGlobal partnership and consolidated their shared research agendas in malaria prevention, control and elimination.

The collaboration between CISM and researchers working in the Hospital Clinic and CRESIB, precursor institutions to ISGlobal, generated the scientific evidence crucial for licensing the first malaria vaccine

ISGlobal and Hospital Clinic epidemiologists and pathologists have maintained a decades-long collaboration with CISM and the Maputo central Hospital in investigation of causes of maternal and child mortality through the use and validation of post-mortem autopsy approaches, starting with complete diagnostic autopsies, and more recently through the validation and implementation of the minimally invasive autopsy. CISM was among the first partners to explore the social and community acceptability, crucial to its widespread use. The groundbreaking research into causes of death has literally reframed the way dozens of countries approach mortality surveillance, and is paving the way, by providing strong and reliable evidence on causes of death, to rethinking child survival strategies.

CISM-ISGlobal collaborations with many other institutions led to generating the evidence needed to push for Haemophilus influenzae type B, pneumococcal conjugate vaccines to be included in Mozambique’s expanded programme on immunization. This has contributed to reducing the incidence of bacterial pneumonia and meningitis, significant killers of children under five and culminated in the first ever Global Forum on Childhood Pneumonia held early 2020 in Barcelona.

These are a few examples among many more on how CISM and ISGlobal have jointly defined -in many aspects- a shared research agenda.

Mass drug administration (MDA) for malaria in Magude (Mozambique), within the framework of a study led by CISM-ISGlobal.

Evolving Global Health Challenges

But causes of poor health are not static; they evolve over time and space. Over the past decade, Sub-Saharan African countries including Mozambique, while still harboring a high burden of infectious diseases, have been also faced with a rapidly rising incidence of noncommunicable conditions such as cardiovascular and chronic lung disease, diabetes, hypertension etc. Rapid urbanization and climate change also present health threats to the most vulnerable populations. A transition in causes of morbidity and mortality was first described in a simplistic manner fifty years ago by Omran who coined the “ Epidemiologic transition model”, whereby with economic growth, urbanization and advances in education and medicine, the burden of disease in a population shifted from a preponderance of infectious diseases to one of human-made non-communicable diseases.

Causes of poor health are not static; they evolve over time and space. Over the past decade, Sub-Saharan African countries while still harboring a high burden of infectious diseases, have been also faced with a rapidly rising incidence of noncommunicable conditions

Historical data have illustrated that this transition occurred at different speeds in European and other high-income countries starting in the late 18^th century. The transition was accompanied by decreases in child and maternal mortality and fertility, in parallel with an increase in life expectancy. This is of course a simplification and the model has undergone many revisions but can still serve as a framework for research on changing patterns of disease and mortality.

The merging of two research institutions (CRESIB and CREAL) in 2016 into what is the present ISGlobal, brought together dedicated investigators working to reduce disease and health inequities all along the epidemiologic spectrum of wellbeing from infectious diseases to non-communicable diseases and the environment. Thus, ISGlobal’s trajectory of research in environmental and non-communicable diseases in high- and middle-income countries, who have long since transitioned to chronic health conditions, now provides a base for present and future opportunities for further ISGlobal and CISM synergies.

Manhiça Health Research Centre (CISM).

Global Health Leaves No One Behind

Manhiça is a tiny dot on a map and most of the world population ignores where it is located. That is exactly the point. That is what makes Manhiça and the CISM so unique. ISGlobal started its mission with Manhiça and together we have sought solutions to the many health inequities endured by vulnerable populations; leaving no dots on the map behind. The COVID-19 pandemic and extreme climate events we have witnessed worldwide over the recent years has reminded us that human health and well-being have no geographical boundaries.

ISGlobal started its mission with Manhiça and together we have sought solutions to the many health inequities endured by vulnerable populations; leaving no dots on the map behind

CISM has contributed to shaping ISGlobal’s scientific agenda over the past 25 years and vice-versa. As we move into the next 25 years, a new generation of scientists at CISM and ISGlobal will forge ahead to continue developing solutions for diseases which affect Manhiça, Mozambique, Sub-Saharan Africa and the world. They will continue the path that advocates for research, generation of scientific-evidence and collaboration as key pillars in global health. A tale of two research centers, that have grown to maturity over the last 25 years, and serve as a model for the many great advances that close partnerships can stimulate.