London School of Hygiene & Tropical Medicine

The strength and depth of world-leading research at the London School of Hygiene & Tropical Medicine (LSHTM) has been acknowledged in the results of the government's Research Excellence Framework (REF 2021).

LSHTM is ranked first for the key measure of impact and joint 10^th overall of all universities in the UK, in tables published by the Times Higher Education.

It was also one of only three institutions found by the REF to be providing a world-leading environment for public health research in the UK.

All of its 20 impact case studies covering clinical medicine and public health were considered to be world leading or internationally excellent in terms of originality, significance and rigour, with 15 awarded the highest 4* grade. The case studies show the strength of research activity and partnerships over many years, and their impact on people’s health, public policy and society around the world.

Research by all eligible staff at Assistant Professor level or above was submitted. This equated to 531 members of staff (451 FTE), with 55% female and 19% who self-identified as Black, Asian or minority ethnic.

Overall, 93% of the research submitted for public health was graded as world leading or internationally excellent in terms of originality, significance and rigour. For clinical medicine, the figure was 87%.

Professor Liam Smeeth, Director of the London School of Hygiene & Tropical Medicine, said: "I am proud of each and every person who has contributed to our research activities. Working to improve health worldwide is a true team effort with researchers working with colleagues and partners to make a real difference to lives through high quality studies and evidence to shape policy and practice.

“The REF is an important process for our institution, and I am confident these results will accelerate our progress to a successful and sustainable future working with partners to tackle many of the world’s major challenges and opportunities in human health. We will keep reflecting and making improvements as we embed our new strategy for the next five years.”

Professor Anne Mills, Deputy Director and Provost, who is responsible for LSHTM’s REF submission, said: “It’s reassuring to see our world-leading research acknowledged in this way. LSHTM has grown since the last REF in 2014 and many of the results show improvement or sustained achievements. I am very pleased that our world leading research environment has been acknowledged in this way. It’s vital that we continue to nurture the diversity and strengths we have across our community. Providing a supportive environment and focused strategy with equitable research partnerships is critical to supporting colleagues to fulfil their potential.”

The Research Excellence Framework (REF) 2021 is the system used by the four UK Higher Education funding bodies for assessing research in UK universities. It was first conducted in 2014, and replaced the previous Research Assessment Exercise (RAE). The REF 21 exercise is the first assessment since the 2014 round and covers the period to 2020.

For each submission, the following elements are assessed:

• The quality of research outputs (e.g. publications)
• The impact of research beyond academia
• The environment that supports research

Research England will use the REF 2021 outcome to calculate LSHTM’s annual research funding allocation, which is expected to be announced later this year. This provides an important contribution to LSHTM’s overall annual income. It is used to support academic and other salaries and helps with the costs of running buildings and providing other infrastructure and services to support LSHTM’s research. 

Research and partnerships at LSHTM focus on improving health worldwide and reducing inequities, drawing on a broad set of skills. These range from the molecular to the global, the theoretical to the applied, the analytical to the political.

Research impact highlights

Prevention of epidemic meningitis in Africa

LSHTM research underpinned the rollout of the novel group A meningococcal conjugate vaccine (MenAfriVac), which halted the scourge of epidemic meningitis across the African meningitis belt and prevented over 100,000 deaths. More than 300 million people aged one to 29 in this area and in neighbouring countries had the vaccine. The clinical trial showed for the first time that MenAfriVac was highly effective at preventing meningococcal disease and carriage. This accelerated the move to implement mass vaccination campaigns, which ultimately led to group A meningitis virtually disappearing from the entire region.

Read the full case study: Prevention of epidemic meningitis in Africa

 

Smartphone technology for innovative targeted treatment of poor vision and blindness

Peek Vision, a social enterprise born out of LSHTM research, introduced innovative research-defined technology in eye health programmes to address the huge burden of visual impairment worldwide and lack of access to treatment. By providing programme implementers with expertise and apps to deliver data-driven and coordinated quality eye health care, Peek created powerful new solutions for approaching and delivering access to care. The Peek vision check app, Peek Acuity, was used in over 100 countries and was downloaded over 50,000 times. Peek Solutions (product and service package) delivered health system improvements in Kenya, Botswana, India, Zimbabwe and Pakistan. Peek’s ground-breaking system and national programmes have enabled an entire generation of schoolchildren in these countries to access eye care and improve eye health.

Read the full case study: Smartphone technology for innovative targeted treatment of poor vision and blindness

Vaccination to reduce the global burden of invasive pneumococcal disease (IPD) and pneumonia in communities

Clinical trials and modelling studies led by investigators at LSHTM, especially in Africa, established the safety and effectiveness of pneumococcal conjugate vaccine in preventing invasive pneumococcal disease and pneumonia, one of the leading causes of death in children under five years of age. This led to the life-saving vaccines being licensed and introduced worldwide, with approximately 225 million children vaccinated by the end of 2019. The research also played a leading role in establishing the importance of vaccination against pneumococcus to reduce morbidity and mortality from pneumonia, and in protecting whole communities in low-income countries via herd immunity.

Read the full case study: Vaccination to reduce the global burden of invasive pneumococcal disease (IPD) and pneumonia in communities

Preventing newborn mortality due to syphilis

LSHTM research played a key role in supporting efforts towards global elimination of congenital syphilis and putting this neglected disease firmly on the agenda. During the REF period, the sustained impact of this research resulted in syphilis screening as part of antenatal care in all low- and middle-income countries, ensuring diagnosis and treatment of more pregnant women, fewer infant deaths attributed to syphilis, and elimination of mother-to-child transmission of syphilis in 13 countries. LSHTM studies in Africa provided key evidence of the health burden arising from pregnant women passing the infection to their babies while in the womb, and demonstrated the effectiveness of benzathine penicillin treatment. Further research evaluated new point-of-care tests (POCTs) for screening pregnant women for syphilis, as well as the feasibility and cost-effectiveness of these rapid diagnostics, leading to World Health Organization prequalification of POCTs and wide commercial availability.

Read the full case study: Preventing newborn mortality due to syphilis

 

Eliminating trachoma via azithromycin

LSHTM-led research found that mass treatment with a single oral dose of the antibiotic azithromycin can eliminate trachoma, a significant cause of blindness, from affected communities. As a result, the manufacturer agreed to donate azithromycin for trachoma control. More than 900 million doses of azithromycin have been donated, 397 million of which were given since 2013. The World Health Organization (WHO) estimates that the number of people at risk of trachoma was reduced by 91% between 2002 and 2020. Since 2013, 10 countries (from Africa, the Americas, Asia and the Middle East) eliminated trachoma as a public health problem with WHO validation, and a further four reported meeting elimination targets.

Read the full case study: Eliminating trachoma via azithromycin

Repurposing tranexamic acid as a life-saving treatment for severe bleeding

Researchers from the Clinical Trials Unit at LSHTM found innovative ways to repurpose an existing drug as a life-saving treatment for major blood loss. Their findings demonstrated that early administration of tranexamic acid in patients with acute traumatic bleeding or post-partum haemorrhage could reduce deaths from bleeding by one third, without adverse effects. This resulted in the drug being included in the World Health Organization Essential Medicines List for both trauma and post-partum haemorrhage and the WHO recommending its use on a global scale. Advocacy campaigns from the lead researchers led to it being used to prevent haemorrhage in the NHS in Britain, the UK and US militaries, and by international health bodies worldwide. The drug was found to be highly cost-effective in high, middle- and low- income settings.

Read the full case study: Repurposing tranexamic acid as a life-saving treatment for severe bleeding

 

Informing the UK response to COVID-19

Multidisciplinary research at LSHTM was at the forefront of informing the UK response to the COVID-19 pandemic. Researchers presented key mathematical modelling and social and behavioural science to underpin government decisions such as curtailing mass gatherings, closing schools and full lockdown. These decisions avoided an unmitigated epidemic scenario of 16 to 30 million symptomatic COVID-19 cases and 250,000 to 470,000 deaths, and prevented the NHS from being overwhelmed. By tracking the R number to assess the rate of transmission, LSHTM research informed the safe easing of restrictions, reinforced by positive messaging to encourage people to comply with the measures. This case study is UK-focused, but research products and educational resources were used worldwide.

Read the full case study: Informing the UK response to COVID-19

Controlling Ebola in West Africa: innovative and pragmatic solutions for a major epidemic

Fuelled by its strength and depth in research, education and action, LSHTM’s response to the 2013-2016 Ebola virus outbreak in West Africa helped save lives and control the epidemic. It was ground-breaking in the way it mobilised the global health community to work together for a sustained, long-term and far-reaching impact on disease preparedness. Mathematical modelling experts confirmed the scale of the outbreak and provided crucial evidence about the resources needed to help contain, control and treat the disease, and to prepare for future outbreaks. In an innovative trial, LSHTM researchers showed that a new vaccine was safe and effective, directly informing the World Health Organization’s immunisation strategy recommendations in 2017.

Read the full case study: Controlling Ebola in West Africa: innovative and pragmatic solutions for a major epidemic

Uncovering and addressing gaps in care for adolescents with HIV

LSHTM researchers highlighted significant gaps in HIV testing and coverage of antiretroviral therapy (ART), and poorer outcomes, for older children and the adolescent age group. They identified barriers to HIV testing, such as the fact that children needed to have consent from their guardians. The research directly influenced both the World Health Organization and national governments in Africa to include adolescents in their HIV-related policies – marking a shift change from the previous focus on testing and care for infants and younger children only. As a result, HIV testing and care strategies were tailored to address the clinical and psychosocial circumstances of adolescents who had been infected with HIV from birth.

Read the full case study: Uncovering and addressing gaps in care for adolescents with HIV

Making HIV self-testing available to millions as a diagnostic strategy for low- and middle-income countries

People need to know their HIV status so they can seek treatment. LSHTM-led research — built up over decades of expertise in the field — showed self-testing kits were safe and effective, and could make a huge difference. This evidence led to the World Health Organization developing policy and guidelines to support HIV self-testing and to the global health initiative Unitaid supporting rapid scale-up of the strategy. LSHTM also led implementation research to optimise delivery of self-testing kits, which made ethical, effective and efficient HIV testing widely available across the world, and influenced global and country-level policies. These activities allowed millions of people to learn their HIV status and access appropriate care, resulting in progress towards the UN 90-90-90 targets and the wider Sustainable Development Goal 3.3 to end AIDS by 2030.

Read the full case study: Making HIV self-testing available to millions as a diagnostic strategy for low- and middle-income countries

Methods for malaria control: evaluation of vector control products to improve personal and community protection from malaria

Research by LSHTM and partners helped protect people from malaria through extensive and innovative testing of ways of controlling mosquitoes in homes and communities. Their methodology to test the effectiveness of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) led to rigorous criteria for WHO to use to evaluate and validate vector control products. As a result, over 20 new products were approved, accelerating the market for LLINs. Since 2014, 1.3 billion safe and effective nets have been distributed by malaria programmes to those in need. LSHTM staff expertise and research also underpinned the implementation of crucial insecticide resistance monitoring on a global scale.

Read the full case study: Methods for malaria control: evaluation of vector control products to improve personal and community protection from malaria

Lay health worker interventions to treat mental health disorders

 

There is a significant gap between those who need mental health care and those who receive care in low- and middle-income countries (LMICs) due to a major shortage of psychiatrists and psychologists. LSHTM-led research from 2013 onwards showed how lay health workers could help people with common mental health disorders. This played a key role in informing, promoting and scaling-up new evidence-based approaches to mental health care in LMICs, including training lay health workers, and developing national policies to improve access to treatment in Africa and India. For example, the ground-breaking Friendship Bench intervention, which trains elderly community health workers, has been expanded across Zimbabwe, reaching 80,000 people in over 50 communities, and replicated in other countries.

Read the full case study: Lay health worker interventions to treat mental health disorders

New methods to review deaths and improve quality of care in the NHS

Research by LSHTM experts prompted major changes in the way preventable deaths are measured and assessed in the NHS, leading to better and safer patient care. Their seminal Preventable Incidents, Survival and Mortality (PRISM) studies identified the true scale of avoidable deaths in hospitals and highlighted problems with existing measurement. The research shaped more effective and targeted policies. This included adding ‘deaths attributable to problems in care’ as an indicator of progress and shifting from hospital-wide measures of death rates for performance management to a more meaningful assessment of care. The impact of the research was evident in 2016, when a national programme of mortality reviews was introduced in English NHS hospitals – the first systematic programme of its kind in the world and a pillar of the Learning from Deaths policy.

Read the full case study: New methods to review deaths and improve quality of care in the NHS

Generating data and solutions to save newborn lives

LSHTM researchers brought newborn deaths and stillbirths onto the global agenda, publishing the first national estimates of the causes of newborn deaths and the numbers of stillbirths around the world. Nearly all (99%) of the 5 million neonatal deaths each year were in low- and middle-income countries (LMICs), yet were invisible on the global health and political agenda. LSHTM research made them visible, leading to targets for preventing these deaths being included in the United Nations Sustainable Development Goals, and innovations in communities and hospitals saving babies’ lives daily. The Every Newborn Action Plan, informed by LSHTM research, has been integrated into the national health strategies of 78 countries with high newborn mortality and stillbirth rates.

Read the full case study: Generating data and solutions to save newborn lives

Developing a new seasonal approach to malaria prevention in children

Millions of children in Africa benefited from a life-saving approach to malaria prevention, following research by LSHTM and partners showing its benefits. The studies demonstrated that taking antimalarial treatments every month during the rainy season, when the risk of malaria is highest, provided very high personal protection with no serious side-effects. It could also be delivered at scale by community health workers at moderate cost. As a result, the World Health Organization recommended ‘seasonal malaria chemoprevention’ (SMC) for children in malaria-affected Sahel areas. Evaluations revealed high coverage: 13 countries had national SMC programmes treating about 21.5 million children in 2020. During the LSHTM-led ACCESS-SMC project supporting scale-up in 2015-16, an estimated 60,000 deaths were prevented.

Read the full case study: Developing a new seasonal approach to malaria prevention in children

Prioritising and addressing the health needs of human trafficking survivors

Ground-breaking research by LSHTM put the physical and mental health of trafficked people firmly on the international agenda. The work generated the first guidance for healthcare providers on caring for victims of trafficking, and internationally-recognised ethical and safety recommendations from the World Health Organization. As a result of the research, over 23,000 trafficking victims benefited from an extended period in the UK for reflection and recovery. Internationally, research describing the health implications of trafficking in Europe and the greater Mekong sub-region contributed to a growing field of practice, training and policy-making to support the health and safety needs of trafficking survivors.

Read the full case study: Prioritising and addressing the health needs of human trafficking survivors

Using mathematical modelling to inform policy decisions on vaccination

Evidence from LSHTM research has influenced many high-profile decisions about new vaccines, and how and when people in England are immunised against a range of diseases. Health and economic modelling specialists regularly presented analysis of the impact of potential changes to the UK vaccination schedule to the Joint Committee on Vaccination and Immunisation. This directly informed recommendations to introduce new vaccines or change the way existing vaccines were used to improve coverage and efficiency throughout 2013 to 2020. LSHTM research underpinned key changes, such as introducing meningitis B vaccination, influenza vaccination in children, and HPV schedule changes, saving lives, reducing morbidity, and saving millions of pounds of NHS resources.

Read the full case study: Using mathematical modelling to inform policy decisions on vaccination

Shaping public health strategies by monitoring and building public trust in vaccines

The research conducted by LSHTM’s Vaccine Confidence Project (VCP) put vaccine hesitancy on the international policy agenda as a major threat to disease control and health. Its work shaped the activities of key organisations, including the development of national strategies and the formation of mechanisms by the World Health Organization and European Union to tackle the problem. The VCP research identified emerging issues and was used to inform trust building strategies and counter anti-vaccination discourse. Lessons and VCP expertise were applied to new outbreaks, for example to build trust in the Ebola vaccine in Africa in 2014, and to monitor public sentiment around COVID-19 vaccines and the overall COVID-19 response.

Read the full case study: Shaping public health strategies by monitoring and building public trust in vaccines

Saving lives and money: encouraging male circumcision to prevent HIV

New preventive measures to reduce the spread of HIV are needed to tackle the evolving global epidemic. Research by LSHTM showed circumcised men had a much lower risk of HIV infection, and modelling studies estimated that male circumcision programmes in priority countries in sub-Saharan Africa could prevent 4 million HIV infections by 2025. This informed policy recommendations by WHO and UNAIDS, and led to the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention programmes. Approximately 27 million VMMCs for HIV prevention were conducted between 2008 to 2020 in 15 priority African countries, averting an estimated 340,000 HIV infections, with over 21 million VMMCs taking place in this REF reporting period.

Read the full case study: Saving lives and money: encouraging male circumcision to prevent HIV

The Zika virus emergency: informing the international response

Research led by LSHTM during the 2015-16 Zika virus outbreak in Brazil formally identified the link between Zika virus and microcephaly and defined the clinical presentation of Congenital Zika Syndrome (CZS). The discoveries made an immediate impact, informing the national and international response and outbreak surveillance. Researchers provided expert advice to UK government departments, NGOs, academic organisations and industry on how to control the mosquito vectors and avoid the disease. The researchers also rapidly developed a free online course, with over 18,000 people participating in more than 189 countries. Since the epidemic ended, LSHTM staff have been building capacity to manage future outbreaks, developing new control methods, and assessing the impact of CZS on affected families and communities.

Read the full case study: The Zika virus emergency: informing the international response