Liam Smeeth took up his role as director of the London School of Hygiene and Tropical Medicine (LSHTM) at the height of the pandemic, when the institution’s relevance to us all could not have been clearer. Then he was hit with a racism review. ̽����Ƶ spoke to him about his first turbulent year in office.

A political, personal and professional pandemic

When Covid-19 first struck, Smeeth was working as a senior epidemiologist at LSHTM, an institution that was at the heart of the UK’s response to the virus, notable in particular for its that mapped the outbreak from its earliest days and revealed patterns of transmission that informed the global response to the pandemic.

But that was not his only front-line role in those early days of the crisis; he was also working as an inner-city GP in London, grappling with the impact of Covid-19 first-hand. And then, in April 2020, things got personal, when he contracted the virus himself, becoming so ill that he was almost hospitalised. (Smeeth’s predecessor as LSHTM director, Peter Piot, was also very badly affected by Covid, which can only have deepened the reverberations within the institution.)

Two years on, society is finally reaching an accommodation with the virus, and distance allows the opportunity to look back and assess the events of 2020. Smeeth tells THE that he is proud of the impact British scientists had both during those early stages and in helping to guide the world out of the pandemic, noting that “the science done by the UK led the world”. He is, understandably, particularly fulsome in his praise for work led by Dame Sarah Gilbert at the University of Oxford, which developed a vaccine with AstraZeneca and then ensured that it was made available at cost-price to the world for the duration of the pandemic (a move that set it apart from other vaccines developed at the same time). But he also notes other scientific achievements involving UK universities, including the , a national clinical trial that sought to identify effective treatments, and the led by King’s College London, which allowed millions of users to help scientists track disease hot spots in real time and, in doing so, slow the spread of the virus.

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So, Smeeth sees plenty to look back on with pride. But asked how the government handled the pandemic, he has mixed views, noting that policy and implementation did not match up to the world-class science.

Ministers were “brilliant at following the science when they largely agreed with it”, he says, but “some of the response in the UK on a practical end was a little substandard – the procurement, reorganisations and lack of public health infrastructure really came through. So we had really good science going on, but the practicalities were less than ideal.”

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Like many people, Smeeth particularly recalls the government’s behaviour around Christmas 2020, which was later to become the subject of intense media and political scrutiny thanks to the so-called “Partygate” revelations, which were to play an integral part in the downfall of Boris Johnson as prime minister.

His own view is that such flouting of the lockdown rules that the government itself set was ultimately always going to be “politically untenable”.

This may all feel like history two years on, but Smeeth is concerned that the lessons are learned and warns that if action is needed again in the event of a similar public health crisis, politicians must not repeat the mistakes of the past. “We saw time and time again around the world that political action often came a little too late,” he says.

Recovering from a racism row

While Covid has been a dominant theme in Smeeth’s still young tenure as director, it is not the only significant challenge he has had to contend with.

In autumn 2020, LSHTM’s council commissioned a review of racial equality, in response to issues highlighted by the Black Lives Matter movement and to concerns raised by staff and students. It included a survey that received 325 complete responses, of which 75 per cent were from staff employed at the time, and recorded instances of racist behaviour and micro-aggressions experienced by both staff and students.

Some of the focus was on the big picture, such as the finding that “stakeholders perceive that LSHTM had not meaningfully acknowledged and communicated its historic role in upholding colonial interests – which manifests in unequal partnerships and Eurocentric curricula”, while others were much more personal, such as the conclusion that “staff of colour do not have equitable experiences or opportunities to progress at LSHTM”.

In December 2021 – four months after taking up his directorship, and still amid the pandemic – Smeeth publicly apologised for the failings identified by the review.

“The report was a big wake-up call for everyone,” Smeeth explains. “It was [aligned] to my desire to improve things. There’s an acceptance that, of course, we exist as an institution within a society that has a lot of institutional racism around.”

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He has been pleased at how, he says, LSHTM subsequently embraced recommendations from the report, including via an “ambitious” , to which they have committed “enormous resources”.

LSHTM is not the only UK university in its field to have recently received a damning independent report on race equality. This year, the Liverpool School of Tropical Medicine (LSTM) did, too, also finding evidence of a ”dominant Eurocentric approach”.

It also highlighted an absence of senior leaders from BAME (black, Asian and minority ethnic) backgrounds, an issue that Smeeth in part also sees in his own institution: “The number of professors of African Caribbean origin in science medicine in the UK is infinitesimal – particularly in some of our subjects,” he admits.

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So, what is he doing to address this deficit? LSTHM recently launched a scheme to fund 25 new PhD scholars studying tropical diseases and maternal and child health in four African countries, financially supported by global health charity the .

But Smeeth is the first to acknowledge that progress and the impact of such interventions take time. “It’s never going to be as quick as I and many people would like. To create the environment, structures and mechanisms to give people the full ability to thrive in academic health sciences, we’re talking about decades of work.

“It’s really important, in my role, to see the big picture and long term. Yes, a lot of these measures are going to take even two decades to fully see the benefits, but that doesn’t mean we don’t need to do them,” he says.

Future threats

Another major issue for Smeeth’s tenure as director is the changing nature of Britain’s place in the world, and in particular what many see as the backwards steps being taken on international collaboration in research and on issues related to international development.

As an inherently global institution, LSHTM has suffered from last year’s government cut to the Official Development Assistance (ODA) funding provided to promote the economic development and welfare of developing countries.

Smeeth felt ODA funding was paying “the most enormous dividends worldwide”, despite receiving a “tiny proportion” of governmental money, and as such he decries the decision to cut it.

“The UK is an absolute world leader in health research and education,” he says. “It brings huge benefits in terms of economic investment, upskilling and education training, and contributing to health around the world. To not value that is enormously short-sighted. It took decades to achieve.

“[The cuts] stopped projects that were just getting going,” says Smeeth. They were “galling and misguided” and “dented people’s faith and trust in the UK as a partner”, he adds.

In a similar vein, the impact of Brexit on Horizon Europe worries him. “I assumed politicians would be so keen not to throw this full research partnership with Europe away that they would find a way for [universities such as LSHTM] to still be full partners,” he says. But now he has doubts about a future within the scheme and warns that even now – with no decision made – UK research is in limbo.

“We’re not in a position to lead new collaborations,” Smeeth says. “We can play a part – and that’s fine with trusted partners – but in terms of developing new partnerships, would you, if you’re in a high-quality institute in Paris, Stockholm, Berlin or wherever, be thinking of the UK?”

In terms of the impact of Brexit on recruitment, Smeeth says that LSHTM has not yet seen a haemorrhaging of researchers, but he predicts that more will leave over the next few years. He also expects LSHTM to recruit less from Europe at all levels (its students are postgrads only). “This would be losing all round,” he says. “The UK is in danger of being seen as wanting to go alone. If you’re the next generation of scientists, this isn’t what people are looking for.”

Quick facts

Born: Hull, 1965
Academic qualifications: medical degree from the University of Sheffield, and MSc and PhD from LSHTM
Academic hero: Saraladevi Naicker, nephrology professor emeritus at the University of Witwatersrand School of Clinical Medicine
Lives with: his partner, with random visits from his largely grown-up children

This is part of our “Talking leadership” series with the people running the world’s top universities about how they solve common strategic issues and implement change. Follow the series here.

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