Integrating multiple disciplines

JHU has a strong record of multidisciplinary collaboration, usually between a few university divisions. You can learn more about JHU existing multidisciplinary programs here.

However, to generate further groundbreaking research and innovative health solutions, we must engage and unite our best minds across the entire university - in medicine, nursing, public health, international relations, engineering, education, business, the creative arts, social sciences, and bioethics.

Intentional Collaboration Across Sectors

Within the Alliance for a Healthier World, we work together to identify and harness the unique yet intertwined contributions our united disciplines can make. In addition to the technical inputs of each discipline, they will all be used in an integrated way to contribute to research design, implementation, analysis, and knowledge translation. The overall approach includes adaptive research designs and mixed methodologies that involve critical stakeholders throughout the research process, including communities facing the issues as well as policy-makers, implementers, and local universities in low-middle income countries. You can read more about our efforts to actively facilitate and support cross sector teamwork here.

Examples of how the different disciplines and schools at JHU could each contribute to a solving a difficult health problem is illustrated below.

A Whole of University Approach to Address Antimicrobial Resistance (AMR)

Overview of the Problem

Biochemist decants fluid in flask

Biochemist decants fluid in flask

Antimicrobial resistance (AMR) undermines the ability to prevent and treat a growing range of infections around the world caused by bacteria, viruses, parasites, and fungi.  AMR threatens to reverse the gains of modern medicine and public health responses to infectious diseases, raising fears of a “post-antibiotic era” where common infections and minor injuries can kill.  Around the world, high rates of resistance have been found to infections acquired in the community (e.g. pneumonia, diarrhea, and gonorrhea) as well as those commonly found in hospitals (e.g. wound infections, urinary tract infections and pneumonia), and among major infectious diseases including malaria, tuberculosis (TB), HIV and influenza. The direct results of AMR can be severe, and include longer and more severe illness, increased mortality, inability to for patients to safely undergo operations and other medical procedures.  Antimicrobial resistance is also drain on the global economy, with losses due to reduced productivity caused by illness in people and animals, and the higher costs of treatment.

Drive for Johns Hopkins Community to Work Together

There are large gaps in understanding of the scale and complexity of the AMR problem and how to intervene, with opportunity for JHU to make change.  Research and supportive policies and interventions will rely on multiple disciplines and approaches at local, national, and global levels, and are sorely needed to make new antimicrobials available and sustainably used.  This demands a more comprehensive approach involving a full range of disciplines to both understand these phenomena and intervene effectively.  JHU has many capabilities to address AMR in a multiple disciplinary way.  For example, JHU hosts the North America section of the ReAct global network to address antibiotic resistance (https://www.reactgroup.org/), leading the work on Strategic Policy, while many faculty and students across the University work on specific areas related to AMR.

Expertise Contributions from all JHU Divisions 

JHU has expertise in the following area disciplines that can be brought to bear to address AMR (JHU entities with expertise are indicated in parentheses):

  • Basic sciences to address the molecular and genetic mechanisms of antibiotic resistance, and to provide a basis for product development, such as new drugs and vaccines, rapid and affordable diagnostic testing (SOM, KSAS, Whiting School, JHSPH, APL);
  • Behavioral, communications, educational sciences and creative arts to understand and intervene with health providers, health care organizations, medicines retailers, and the demands of patients that lead to the inappropriate use of antimicrobials (JHSPH, SON, SOM, SOE, KSAS, SAIS, Jhpiego);
  • Epidemiology, biostatistics and computational sciences to characterize the risk factors and population effects of antimicrobial resistance, and to manage and analyze large scale surveillance data (JHSPH, APL, Whiting, KSAS);
  • Economics to provide insights into the incentives and influences on healthcare, livestock and pharmaceuticals markets, and implications for the poor (KSAS, SAIS, JHSPH, Carey Business School);
  • Sociology and anthropology to understand and unlock community capabilities and facilitate participatory research on interventions to address AMR (KSAS, JHSPH, SON, Berman Institute);
  • Humanities and the liberal arts to understand the role of culture, language, and the perspectives of the disadvantaged and their connections to AMR (KSAS, Berman Institute, Peabody Institute, School of Education, JHSPH);
  • Engineering to provide technical interventions to better diagnose disease, identify substandard drugs and drug resistance, and provide new opportunities for service delivery, regulation, and communications (Whiting School, APL, SOM, KSAS, JHSPH);
  • Management and business expertise to optimize implementation approaches and to test new models of social enterprise to address AMR (Carey Business School, JHSPH, KSAS);
  • Political sciences to grapple with the policy challenges in the face of powerful stakeholders and the need for new and ethical institutional arrangements for antimicrobial product development and regulation (KSAS, SAIS, Berman Institute, JHSPH)
  • Systems scientists and modelers to clarify the pathways and assumptions of multi-level interventions in a complex environment, and to provide insights on areas for potential interventions and their effects (Whiting School, APL, JHSPH, SOM, KSAS).

Background

Antimicrobial resistance (AMR) undermines the ability to prevent and treat a growing range of infections around the world caused by bacteria, viruses, parasites, and fungi.  AMR threatens to reverse the gains of modern medicine and public health responses to infectious diseases, raising fears of a “post-antibiotic era” where common infections and minor injuries can kill.  Around the world, high rates of resistance have been found to infections acquired in the community (e.g. pneumonia, diarrhea, and gonorrhea) as well as those commonly found in hospitals (e.g. wound infections, urinary tract infections and pneumonia), and among major infectious diseases including malaria, tuberculosis (TB), HIV and influenza. The direct results of AMR can be severe, and include longer and more severe illness, increased mortality, inability to for patients to safely undergo operations and other medical procedures.  Antimicrobial resistance is also drain on the global economy, with losses due to reduced productivity caused by illness in people and animals, and the higher costs of treatment.

AMR develops when an organism adapts and grows in the presence of the antimicrobial medicine. The development of resistance is linked to how often the medicines are used. Many antimicrobials belong to the same class of medicines, so that resistance to one specific agent can lead to resistance to a whole class of medicines. Resistance that develops in one organism can spread quickly and unpredictably, and can affect treatment of a wide range of infections.  Drug-resistant organisms spread among and between people and animals, as well as through water, food, and the environment.

The problem of AMR affects all countries, and involves multiple sectors of society. The transmission of resistant organisms is influenced by trade and market forces, travel and the migration of people and animals, as well as agricultural and health care practices.  There are significant complexities in how AMR can be addressed. The causes and solutions to do not lie solely in the health system, but involve an inter-connected set of social and political systems described by the Sustainable Development Goals.

For example, the challenges in bringing new antibiotics to market demonstrate the entwined influence of public policy, institutions, science and technology. Few new classes of systemic antibiotics have been discovered and brought to market in over three decades, in part because of the scientific challenge in discovering novel classes of antibiotics. Yet the more an antibiotic is used, the greater the drug resistance and the shorter its effective lifecycle in the market and its eventual returns on the investment.  In a market system where revenues come from selling more of a drug, conserving life-saving antibiotics till their use is absolutely necessary is not a good business proposition for a firm.  Charging a higher price for an antibiotic might ration its use, but create a prohibitive barrier to those in need of the drug.  Structural factors affecting AMR include how science and technology are funded, and how markets are regulated and intellectual property rights are rewarded. The barriers to access to a drug are not only related to its distribution in a healthcare system, but also how appropriately it is used. Drug use is influenced by technological factors, as well as behavioral factors of the public, healthcare providers, and the institutions financing and regulating health services. Without an effective diagnostic technology, an antibiotic may be used more frequently when there is not a documented evidence of the specific infection.  This happens, for example, when someone’s sore throat is treated by an antibiotic when the cause is a virus that is unaffected by the antibiotic, increasing the chances that other bacteria will become resistant to the drug. Substandard and counterfeit medicines compound the problem of AMR.  Since infections do not respect national boundaries, the challenges of bringing a novel antibiotic to market are not geographically limited, but shared by both wealthy and poor countries.