Brazilian hospital raises the bar for health research in Latin America

In the first months of the COVID-19 pandemic, as doctors at Hospital Israelita Albert Einstein in São Paulo scrambled to save one patient after another, scientists in the institution’s research arm shelved their usual projects and focused on sequencing the virus and developing therapies to curb the country’s rising death toll. Less than three months after the first cases were identified in Brazil, the coronavirus had infected 23,955 people in the country, and killed 1,361¹. São Paulo, Brazil’s most populous state, was hit hardest, and the staff at Einstein were determined to help.

After months of research and a clinical trial involving 289 patients with severe COVID-19, in June 2021 the researchers, in partnership with Pfizer, announced a breakthrough. They had discovered that tofacitinib, a drug originally approved to treat rheumatoid arthritis, had reduced risk of death or respiratory failure from COVID-19 by 37%².

The finding changed how Einstein, and hospitals around the world, treated severe COVID-19. “It was very rewarding,” recalls immunologist Luiz Vicente Rizzo, Einstein’s research director. “We could see the patients coming out of the ICU.”

A research ecosystem

Rizzo credits Einstein’s ability to rise to the challenge of COVID-19 to collaboration between the hospital, its research institute and its medical school. Before the pandemic, Einstein had reconfigured itself to create an integrated research ecosystem in which the needs of the hospital and its patients drove scientific research, as well as the education of its students.

“One of the things that makes us different in Latin America is that we have the health-care excellence of the hospital beside us; that provides us with a goal,” says Rizzo. “Doing research in a university, you don't necessarily see the end to what you do.”

Having that collaborative system in place, Rizzo believes, positioned Einstein to respond to the pandemic. “We’d been preparing for that day, in a sense, with a lot of flexibility,” he says. The hospital also bolstered Brazil’s pandemic response by participating in Coalizão Covid, a coalition of Brazilian hospitals evaluating potential therapies.

The pandemic drove the institution’s development in other ways. Perhaps most notably, it spurred the hospital to further extend its reach to those using Brazil’s public health-care system. Einstein — which is best known for its private care, but which has been partnering with the public health system for more than 20 years — now sees more patients using the public system than those with private insurance, Rizzo says.

“People from Latin America come to São Paulo, especially when they have a condition that is difficult to diagnose or treat, because of this hospital,” says vascular surgeon and Einstein vice president Nelson Wolosker, who oversees research and innovation. Wolosker explains that the hospital was established in the 1950s as a philanthropic organization by the Jewish community to “give back after the good reception our grandfathers had here” during World War II, and it is now consistently ranked as one of the world’s leading hospitals. For the past three years, Einstein has been the only Latin American hospital featured in the top 50 of Newsweek’s list of the best health centres worldwide. That wasn’t always the case, adds Wolosker, who first visited the hospital when he was 10 years old, accompanied by his father, also a vascular surgeon at Einstein.

While the hospital focused on providing quality private medical care from the beginning, in 1988 the directors decided that, to better serve the community, it needed to conduct research and provide quality education in medicine. With that in mind, it created a research and teaching institute, and later a medical college. Today, Einstein’s clinicians often split their time between seeing patients, doing research and teaching. Last year, Einstein researchers published 1,300 papers.

Built for the future

Einstein’s four pillars — patient care, research, education and social responsibility — are now melded more closely than ever, thanks to the new Centro de Ensino e Pesquisa (Education and Research Center), completed in 2022. The sustainable building’s layout fosters collaboration, with modular laboratories that allow researchers of different disciplines to easily switch locations. Its proximity to the hospital encourages interaction between researchers, students and medical staff, says Wolosker.

Einstein invested 96.6 million reais (US$18.1 million) in research in 2021, a 30% year-on-year increase. The focus on building a complementary research ecosystem continues to pay off. The institution’s publications in indexed journals grew by 47% in the same year, while citations of articles produced by Einstein researchers rose by 111%.

Einstein’s research initiatives include an effort to harness CRISPR gene-editing technology to treat sickle cell anaemia, which is pervasive in Brazil. Another project is investigating CAR T-cell therapy to treat leukaemia and lymphoma. The process involves extracting a patient’s T cells, engineering them to recognize a tumour antigen, and then injecting the cells back into the patient to mount a targeted defence. These research strands are part of the Brazilian government’s PROADI-SUS programme, which supports projects to strengthen the country’s public health system.

Rizzo credits Einstein’s Scientific Advisory Board, established a decade ago, with elevating its research programme into the emerging powerhouse it is today. The group, comprising scientists from around the world, acts as a sort of peer review body for Einstein’s research-related decisions. “It has been instrumental in helping the institution find its way in science,” says Rizzo. The hospital’s new level of recognition helps it attract top talent and new funding, he adds, which in turn strengthens its research and patient care.

The board contributes expertise across virtually every field of medicine. “We have this amazing group of scientists who have seen, between them, just about everything in medical research for the past 100 years,” Rizzo says. “And they're very generous with their time.” While the board officially meets every four years, members exchange ideas about once a month, Rizzo adds. “They give valuable advice because they have no vested interest whatsoever, and they have seen everything.” The board has helped to ensure that Einstein’s research remains relevant to the hospital’s work.

Einstein Scientific Advisory Board member António Coutinho of the Gulbenkian Institute of Science in Portugal says he has witnessed the tremendous strides of Einstein’s science programme in recent years. “There have been dramatic changes, mostly in the volume and quality of the research.”

Coutinho got the chance to experience firsthand the quality of Einstein’s care a few years ago, when he needed care while visiting São Paulo. Ultimately, it’s the patients who benefit from Einstein’s growing research ecosystem. “They took care of me for a couple of days, and I was really impressed,” Coutinho says. “Quality of research is what separates a great hospital from a good one.”