Parasitic and parachute research in global health
Authors: Meru Sheel, Martyn D Kirk
Journal: The Lancet Global Health (2018)

In their Editorial, the Editors of The Lancet Global Health discuss two categories of research: primary and secondary research using open-access data.1The Lancet Global HealthClosing the door on parachutes and parasites.Lancet Glob Health. 2018; 6: e593Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Most global health researchers are motivated to improve the health of vulnerable populations. As Tedros Adhanom Ghebreyesus voiced at the 71st World Health Assembly, "ultimately, the people we serve are not the people with power; they're the people with no power".2Director General's OfficeClosing speech for the 71st World Health Assembly.http://www.who.int/dg/speeches/2018/Closing-71st-World-Health-Assembly/en/Date: May 26, 2018Date accessed: June 11, 2018Google Scholar However, with increasing pressures of academic models that incentivise a culture of publish or perish and when resources to undertake applied research are limited, sustainable development of public health might become a secondary objective and contribute to the authorship debate.1The Lancet Global HealthClosing the door on parachutes and parasites.Lancet Glob Health. 2018; 6: e593Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Parachute research is not limited to long-term research but is a recurring theme during health emergencies. It hampers collaborative public health response and can generate conflict and confusion among all responders.3Heymann DL Liu J Lillywhite L Partnerships, not parachutists, for Zika research.New Engl J Med. 2016; 374: 1504-1505Crossref PubMed Scopus (21) Google Scholar The idea of so-called rooted research and building long-term research collaborations in the affected host country for pathogen surveillance and rapid outbreak response has been proposed before.4Yozwiak NL Happi CT Grant DS et al.Roots, not parachutes: research collaborations combat outbreaks.Cell. 2016; 166: 5-8Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar However, epidemic responses are complex and challenging because of the reality of working in the field and the unexpected nature of disease outbreaks. It is particularly difficult in settings where an outbreak is caused by disease of unknown origin, might have reappeared after several years, or might only be a subset of an unexpected humanitarian emergency, as was observed during the recent diphtheria outbreak in Cox's Bazar, Bangladesh, after the sudden influx of more than 800 000 Rohingya people.5WHO Disease Outbreak NewsDiphtheria—Cox's Bazar in Bangladesh.http://www.who.int/csr/don/13-december-2017-diphtheria-bangladesh/en/Date: Dec 13, 2017Date accessed: June 11, 2018Google Scholar Nevertheless, it is important to engage host-country staff in preparedness activities and in leading the response and investigation, curation of data, analyses, and interpretation, and publication of results. As global health researchers working on epidemic response and infectious disease transmission, we have trialled practical models that underscore capacity building. We advocate for spending time in the field with a focus on building strong relationships as well as educating and training local staff during and after an outbreak response. Local staff are crucial for planning and logistics, study design, and investigation as they understand the local context best. Once results are available, populations under study should receive full access to results and assist in their interpretation and in implementation of interventions, where relevant, all of which must be prioritised before publication of reports. These processes are likely to have a greater and sustainable impact on public health. Similarly, for secondary research, involvement of local staff is crucial if host countries are to become self-sufficient. Although using open access data might not be ethically incorrect, using data without acknowledging or sharing credit with local researchers would seem unfair to those working on the ground,3Heymann DL Liu J Lillywhite L Partnerships, not parachutists, for Zika research.New Engl J Med. 2016; 374: 1504-1505Crossref PubMed Scopus (21) Google Scholar quite often in challenging environments. Cloud-based remote conferencing platforms have made collaborative research and providing training achievable. Empowering local staff in resource-limited settings can be slow and can delay the publication process but is imperative for capacity strengthening in low-income and middle-income countries. Finally, global health success should be measured by the outcomes of improved health and not by the publication outputs. We declare no competing interests. Closing the door on parachutes and parasitesNo one likes a parachute researcher: the one who drops into a country, makes use of the local infrastructure, personnel, and patients, and then goes home and writes an academic paper for a prestigious journal. At The Lancet Global Health, we look extremely unfavourably on papers submitted by authors who have done primary research in another country (particularly a low-income or middle-income country) but not included any author from that nation. For research involving patient recruitment, treatment in existing facilities, and follow-up, the notion that no locally based individuals made a "substantial contribution" (per authorship criteria) to the acquisition of data is pure fiction. Full-Text PDF Open Access