Brexit casts doubt over Uganda development project on lung disease

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A Ugandan woman cooking indoors using wood fuel - a common cause of COPD. [FreshAirUganda]

The UK’s vote to leave the European Union has come at a crucial moment in the development of an international medical project that throws into sharp relief the state of flux Brexit has cast over collaborative research, says Jack Barton.

Jack Barton is a journalist with a background in international development and human rights law research.

The Fresh Air project, a collaboration between medical research centres across Europe, is set to roll out in rural communities across the world after five years of trials in Uganda enabled researchers to secure €3 million of funding from the EU’s Horizon 2020 programme late last year.

The two-stranded project aims to prevent and treat chronic obstructive pulmonary disease (COPD), the world’s third-largest cause of death according to the WHO, the prevalence having risen 35% in Africa in the past 10 years.

One-in-five adult Africans

90% of deaths linked to COPD occur in developing countries and one in five adults across Africa suffer from the condition.

This prevalence is a result of a range of factors, including smoking and poor ventilation in kitchens where low-income families often rely on wood for fuel.

It also has a high rate among young people in deprived areas, due to respiratory vulnerabilities left over from childhood illnesses.

According to researchers from the International Primary Care respiratory group (IPCRG), COPD also has secondary implications on the health of people who are unable to work and pay for food or medicine, and by extension this affects wider families and communities who are forced to take up the slack.

The stigma of coughing

This can be further complicated by stigma associated with coughing, which is often perceived as a sign of infectious diseases such as tuberculosis. This has led to COPD being hidden and overlooked which exacerbates the lack of understanding around the condition compared to other widespread illnesses such as cancer or heart disease. This isolation and inability to work also contributes to widespread depression, itself the leading cause of disability worldwide, according to the WHO.

Following the prevalence study, researchers at universities in the UK and Netherlands initially launched a two-pronged initiative aimed at education, with materials and training assisted by the Ugandan government, and pulmonary rehabilitation treatment.

The success of the treatment is hard to question: a combination of group and individual exercise, alongside nutritional and health education is relatively affordable and accessible. This has allowed the centre in Uganda to establish training so that it can expand into Tanzania and Zambia initially, while there is similar demand in other low and middle-income countries.

The team behind Fresh Air Uganda, which has greatly expanded from through the IPCRG, is preparing to roll it out in mountainous areas of Crete and Kyrgyzstan as well as Vietnam, thanks to the EU’s Horizon 2020 funding.

This funding is secured, meaning that for now, these plans are not under threat. However, enormous doubt lies over the prospects of broadening the availability of COPD treatment in the future.

According to Dr Rupert Jones of the University of Plymouth Medical the success of the project both due to the scale of the problem and the effectiveness of relatively inexpensive treatments.

“The initial prevalence study was truly shocking,” he says, adding that it quickly becomes evident the damage this can have on communities.

“It’s cyclical. COPD prevents people from working so they become reliant on people around them and this depresses families and broader communities, causing further deterioration of health and economies.”

The prevalence of COPD among young people makes this problem particularly degrading for rural communities as those suffering would otherwise be the family members expected to pick up the slack due to illness.

The other side to this is that the pulmonary rehabilitation treatment developed in the project has been hugely effective.

Collaboration across European centres of expertise, established long before securing the Horizon 2020 funding, has been key to the foundations of the project. The ability of researchers to draw on medical research specialists in centres including the Universities of Plymouth, Crete, Groningen and Copenhagen, as well as  Makerere University in Kampala, has created a network which the project relies upon as much as the EU funding.

“In future Brexit will severely reduce our ability to work with our European colleagues – the basis of our success this far,” says Jones, adding that the threat to the project is “short-sighted”, both for the infrastructure lost and the risks COPD poses.

“The problem is growing,” he stresses, “this throws up at least two purely practical problems straight away due to the strain this will put on aid budgets and the way it feeds into the refugee crisis – already young people whose families suffer and become dependent on them are desperate for better-paid jobs in wealthier countries.”

The specific project is coordinated by the University of Leiden, based on research conducted by researchers from the University of Plymouth, in partnership with other European institutes and those in target countries, including the University of Ho Chi Minh and Ministry of Health of the Kyrgyz Republic.

There has also been participation from the Universities  of Washington and Harvard, as well as the UK National Centre for Smoking Cessation and Training and the European COPD Coalition.

If anything, the announcement made by UK Chancellor Philip Hammond last week casts further doubt over international projects such as Fresh Air.

As well as heavily emphasising protection of domestic UK research and infrastructure projects, the statement did nothing to assuage the fears of researchers that Brexit will present serious obstacles to collaborating across European borders.

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