icddr,b has combined both the insights of modern biomedical science with detailed population surveillance to advance scientific understanding of infectious disease, and other public health concerns, within one of the poorest countries in the world.
icddr,b was originally established in 1960 as a cholera research laboratory, in what was then known as East Pakistan. In its first 15 years, the laboratory played a central role in the development of oral rehydration therapy (ORT); the treatment for diarrhoeal diseases, such as cholera, which is based on the oral administration of balanced sodium-glucose solutions. This cost-effective intervention is estimated to have prevented over a million infant deaths a year, and has been referred to as the most important medical advance of the 20th century.
Following its ground-breaking work in ORT, icddr,b’s research agenda quickly broadened from its initial focus on diarrhoea, to encompass a wider range of public health concerns. The centre has continued its focus on infectious disease, examining pneumonia, influenza and HIV, in the context of Bangladesh and other resource-limited settings. However, its researchers have also brought the clarity of empirical reasoning to topics as seemingly diverse as malnutrition, family planning and gender violence.
icddr,b’s research agenda has increased alongside an expansion of its institutional resources. Pens and clipboards have given way to tablets and cloud computing. The tools of molecular biology and genomics have supplemented the insights of pathology and clinical medicine. The work enabled by these resources has allowed icddr,b to become a singular nucleus of scientific collaboration at the interface of public health, basic biology and clinical practice. icddr,b’s research demonstrates the tremendous value of applying cutting-edge science to the health concerns of the global South. Studying these phenomena in their native context enables the organisation’s researchers to make unique and often profound insights. An exceptional example is the work of icddr,b scientist Dr Shah Faruque. In collaboration with Dr John Mekalanos at Harvard Medical School, Faruque has conducted a series of seminal studies on the natural history of Vibrio cholerae, the causative agent of cholera. Faruque’s team isolated wild V. cholerae strains from both local rivers and patient stools, and through genomic analysis was able to elucidate the genetic basis of virulence in wild V. cholerae. These findings have revolutionized our understanding of the evolutionary processes by which benign environmental microbes can turn into deadly pathogens with pandemic potential.(1)
icddr,b scientists have also conducted landmark work on the effects of malnutrition on early childhood development. Recent meta-genomic analysis carried out by Dr Tahmeed Ahmed, in collaboration with Dr Jeffrey Gordon at Washington University St Louis, has demonstrated a key role for gut microbiota (the ‘microbiome’) in mediating the stunting effects of malnourishment.(2)
These topics—the microbiome in human disease and the evolution of pathogenicity—are at the frontiers of biological science. Long-term support for icddr,b from governments including the UK, Sweden, Canada and Bangladesh, and private sector sources such as the Bill & Melinda Gates Foundation, has enabled researchers to conduct world-leading science in the heart of an underdeveloped South Asian country. These efforts are helping to re-balance the global North-South divide in scientific knowledge, and improve the lives of some of the world’s poorest people.
1. Hassan F, Kamruzzaman M, Mekalanos JJ, Faruque SM. Satellite phage TLCphi enables toxigenic conversion by CTX phage through dif site alteration. Nature. 2010;467(7318):982-5.
2. Subramanian S, Huq S, Yatsunenko T, Haque R, Mahfuz M, Alam MA, et al. Persistent gut microbiota immaturity in malnourished Bangladeshi children. Nature. 2014;510(7505):417-21.
Photo: icddr,b / Graham Judd