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Can you just start by saying your name and your position? I'm Janelle Wentworth and I am a postdoctoral research associate at the Faculty of History.

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Thanks very much. And without telling me every stage in your life history,

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can you just give me a brief outline of how you first got interested in public health and and the main kind of staging points in your career so far?

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Sure. Yeah. So I, I think I'm the definition of an unintentional interdisciplinary researcher.

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So I, I did my bachelor's actually. I was I was pre-med originally, and I decided I was more interested in population health than clinical medicine.

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I took some alternative medical history classes that gave me lots of ideas, you know, about the medical marketplace and this sort of thing.

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So I actually did my bachelors in both History of Science and in Biology,

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and I did bench work at the time, and I was that at University of Wisconsin-Madison.

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So after that, I went straight into a Ph.D. program, which I hated that was in bench work.

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So infectious disease and parasitology, so very immunological.

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And I like the theory of immunology and I realised I just was not meant to to spend my life at the research bench.

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So I actually left there with a master's in epidemiology and then I taught high school

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for a little while and I then taught in Bangladesh public health for for a year.

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And then I went back and got a master's in history of medicine at Newcastle University.

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So I got Wellcome Trust funding. I'd never been to the UK before and that was back in 2011 and I finished there.

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I really enjoyed it, but I also thought I didn't really want a doctorate in history.

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I wanted something a little more policy applied and I was doing quite earlier history like earlier 20th century history at the time.

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And then I moved back and I did some work in global health programme management for a while.

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So I worked at the American Society for Microbiology in D.C. doing a lot of kind of biosafety and global health security work,

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especially in India and Egypt. And then I decided I missed academia.

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So I went to the University of Edinburgh on a Wellcome Trust fellowship there and with Debbie Sri Task Group in Global Health Governance.

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So we were looking at the influence of the World Bank and global health.

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So it was a great kind of opportunity to combine my interest in history of medicine, my experience in epidemiology and my interest in policy.

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I was looking at the kind of anchor to crisis control program.

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So 1970s, eighties, nineties, two twins developments in the world banks infectious disease control program.

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That's a parasitic parasitic disease. Yes. And neglected tropical disease that impacts your eyes, causes blindness.

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So there's a lot of links to economics and the idea that you could develop Africa this way by controlling a

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disease and really the banks investment in health ideology kind of tracking the spread of that since the 1970s.

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And so I finished my Ph.D. in 2020.

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And while I was finishing because my scholarship ended, I moved back to the States and I took a job in global health security.

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So at the Henry Jackson Foundation, where we were doing training for field hospitals, particularly in Uganda and Senegal.

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So I was there, their training lead there. I do not recommend to anybody trying to finish your Ph.D. while travelling every few weeks to Africa.

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But I managed I defended my Ph.D. right after COVID hit.

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I think I was the first person at the University of Edinburgh to have to do a zoom viva.

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So that wasn't great timing, but I finished. And then later that year I started working at the National Academy of Sciences and

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Medicine in D.C. and I was working on a as a study director for a COVID project.

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There kind of lessons learned from COVID for pandemic influenza vaccination.

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So a very global governance and coordination study. And while I was finishing that kind of a theme, taking on too much work,

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I was a visiting professor at the University of Iowa teaching global health, ethics and politics.

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And then I accepted this position here, wanting to kind of segway back into academia.

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And I started in January of 2022, so about a year ago now as the Cop Cove trial historian.

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So looking at a clinical trial run by the University of Oxford in collaboration with Mahidol University in Thailand.

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So that's that's a long kind of description. Good.

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That's a great summary. But we're going to go into that in much, much more detail.

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So but let me just jump back for a minute because I'm asking everybody this question.

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Can you remember when you first heard that there was a pandemic in the offing?

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And how soon was it before you realised that actually with your background,

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this was something that you could take an either a policy or an academic interest in?

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That's a good question. I actually remember the moment that I saw this I was in.

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Uganda doing a field hospital training in Jinja, Uganda.

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And I was there with a bunch of US military doctors and we were sitting at the hotel bar in an evening.

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What you do when you do international development work and I remember seeing on the TV, we were kind of reflecting, oh, there's some cases in China.

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And to be honest at the moment, kind of like, oh, you know, this stuff happens.

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I, you know, you're familiar with coronaviruses, you know, birds and stuff as a corona virus,

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but things like murders never really materialised into something that at least impacted, you know, the United States and stuff as much.

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And SaaS was before my time, you know, I was a child, you know, when that was happening.

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So I guess I kind of thought, oh, interesting.

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I'm sure Debbie, my former supervisor, will write about this, but I didn't see it, you know, at the time.

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I guess this was probably in January of 2020.

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I didn't see it as being some, you know, obviously massive years long pandemic.

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I would suppose it was a little bit later that that spring I was then back in Senegal when everything got shut down.

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And that's when it really hit me that, oh, this, this is going to get bad.

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And I remember talking with some epidemiologists in Senegal because we were there for a training and they were like,

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oh, why are people even wearing masks? Because, you know, clearly they're not N-95 masks.

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They're not going to do anything on the plane. So you were you were not judging, but you're kind of looking at people literally.

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When I flew to Senegal, no one was wearing a mask. When I flew back. You were starting to have them creep in just a few days later.

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And I remember thinking like, oh, you know, what are you doing? This doesn't seem necessary.

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And I guess, yeah. So that's early March 2020 I think is when you really realised it would be a problem.

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At the time I wasn't entirely sure how I could help.

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I was working at the job again that was doing field hospital stuff within within Uganda and Senegal.

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So I had a feeling we would integrate this in. We were doing some infection prevention and control training,

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but it turns out that actually wasn't the best venue for integrating in COVID training

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because we we were used to going there in person and we tried to do some trainings in,

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you know, by Zoom early on within Africa. And we had a lot of challenges in terms of just Internet access and stuff.

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So that particular program, I would say, probably was not the solution, you know, early on for engaging in COVID control.

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Yeah. Yeah. And so your your your job here that you started at the beginning of 2022, how did that come to be?

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I mean, I think what I'm interested in getting at as we as we as our discussion continues,

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is why a history faculty should be interested in something that's actually taking place right now and is a a complex public health and policy issue.

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But this is a history faculty. And why why did anybody think that this was an appropriate thing for a historian to take a look at?

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Well, that's an interesting question.

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I would say I'd like to take credit for this and say that I you know, I was brilliant and I thought early in the pandemic historians should do this.

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Actually, my understanding is that Professor Nic White, who is one of the clinical directors at the Mahidol University in the Meru in Thailand,

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they basically they started this type of program very early on in the pandemic.

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And because which I'm sure we'll get into the the clinical trial of hydroxychloroquine hit a lot of political issues.

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They actually had a bit of funding remaining within their Wellcome Trust grant for the trial,

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and they were expecting to recruit a lot more participants.

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And so it was actually initially their idea that I believe and I don't want to speak for Nick White and Will Schelling,

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but my understanding is they actually contacted Mark Harrison here at Oxford thinking,

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you know, we need to have more collaboration with the humanities history.

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I mean,

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it's so easy to think and a lot of historians do this history is like pre 1960s and part of it is because we don't know what to do with records today.

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It's really, really hard. I mean, right now I'm trying to curate emails and I think it leads itself to so many more issues with

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sources and ethics that I think historians often kind of push themselves away from it a little bit.

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And so in this case, to an extent, I think it was because Mark Harrison was involved in Oh,

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I'm forgetting the name of the group right now, but the advisory group for the UK around COVID and science.

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And I think because they knew he was involved in this and he was interested

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in contemporary issues and the link between history and infectious diseases,

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they contacted him and that's how we move forward. And there was an advertisement put out, which I responded to,

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because I've been in this realm for a while of thinking we need to have more historians who

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are doing modern history and have one foot in global health policy and one foot in history.

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And I think the idea is you want to have people that are trained to try to avoid like the lessons learned approach.

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And I think that's what historians can offer sometimes. I think it's so easy for people who are not in history to think, oh, what?

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How do we use history? Well, we go back and we look at the Spanish flu or something,

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and we look out for a couple of tangible lessons learned to apply to this particular epidemic.

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And it very rarely works like that.

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And so I think more dialogue can try to prevent that approach and not remove not remove historical stuff from its context.

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And I think that's the power of doing a modern history is, you know,

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you can do the oral histories with everybody who was involved in the trial and you can kind of promote that side of history.

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But I will admit that some days I wonder if I'm a historian.

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You know, you have a bit of an identity crisis. Am I a story and am I a political scientist?

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Am I a governance person? I suppose in the end it doesn't matter that much.

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I mean, you're doing your research and you're telling a story and you're looking for themes which most approaches do.

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But I did. It's a rounded kind of way of answering your question.

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In short, it was not me that made the decision initially to advertise the position, but I think it was a great idea,

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and I think it's some people thinking innovatively about how to document best

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document and use historical skills and things like oral histories to to provide,

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you know, ideas for the future and how to address pandemics. Right.

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So let's now just give a quick introduction to the topic of trial itself.

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So what was the background and what was it setting out to do?

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So Amaru in Thailand, the Mahidol Oxford Research Unit.

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Yes, within Thai, within Bangkok, there's a series of I believe they go back to the 1970s, most of them,

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they have basically a collaboration, a field network with a number of South Asia sites, and this is one of them.

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So there's one in Hanoi, etc. And then and there's one in Cambodia and there's one in in Bangkok downtown.

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And so my understanding and what I've got through my own oral histories with a lot of the staff is that hydroxychloroquine, they're looking early on.

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There's a lot of conversation, I should say. I've had multiple people talk about Oxford or Old Boys Club.

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You know, when you have a pandemic, often people fall back, for better or worse, on to networks that they're comfortable with and trusted people.

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And so people like Nick Whyte have a long standing relationship with people like Peter Horby,

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who did the recovery trial, and people like Jeremy Farrar,

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who now heads the Wellcome Trust, but formerly like Peter Horby, was based in part of the south east kind of Oxford network.

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And so they actually have a lot of discussions among themselves as early as late January and early February of 2020.

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So quite early in the pandemic where they're talking among themselves, what kind of drugs could we repurpose?

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And one of the first drugs, as I understand it, that comes up is hydroxychloroquine.

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And that's partly because more so in Bangkok, they have years of experience in working with hydroxychloroquine for malaria.

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They have a malaria research centre there.

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And so it has a really strong safety profile and early on they're thinking it's going to be a long time if we get vaccines.

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This is way before we knew M RNA technology would work for this.

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If we get vaccines, it's still not going to roll out quickly. We'll still have issues with equity like we saw.

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And so if we can repurpose a generic drug, something that's inexpensive, it's easy to produce, this could really save lives.

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And so I think that that's the early on is looking for potential solutions and thinking, well, we do have some clinical trial experience.

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We do have networks in Southeast Asia. They've done trials in Africa in the past for other drugs out of Meru.

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And so it's thinking, you know, we can apply the skills.

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And and it's also, again, using this old boys network in a sense, in a positive way of contacting people like Jeremy Farrar,

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who is the head of the Wellcome Trust, who was putting out grants for these kind of clinical trials.

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And so from that perspective, it kind of falls into place pretty quickly.

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I think the first week or two of February 2020, they already have a proposal together, which is actually slightly earlier than the recovery trial.

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And they're already trying to get funding and they're already contacting their networks.

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They're looking for how you could produce this generic drug, hydroxychloroquine or chloroquine,

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which is very similar within Thailand and within the UK, and they move forward quite quickly.

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So the recovery trial was looking at hydroxychloroquine and a number of other repurposed drugs in hospital patients,

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but the design of the trial was rather different. Yes, it's a prophylaxis, so I should have mentioned that.

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So the difference is that they are looking at giving it to health care workers.

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So people on the front lines again before they're getting vaccines for any.

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Things available like that as a prophylaxis, though, is something to take before they're exposed to COVID,

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something that might prevent them from actually developing either developing any kind of viremia so any

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getting infected or more likely preventing them from having an infection that has bad force symptoms.

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Severe, severe symptoms, exactly. So those were the endpoints.

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I think the most important endpoint, as I understand it, was severe COVID and preventing preventing that and hospitalisation and death, obviously.

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So it is different from the recovery trial and they often kind of get tied together that way.

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But we're looking at a very different stage of infection and this is something that people like Nick Whyte realised quite quickly is that, you know,

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you have the exposure window and then you have the early viral replication within patients bodies and then you have the later effects basically.

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And so you kind of want to see them as different.

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Windows and Recovery is looking specifically at that post infection later window when people have already become ill.

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So and how were they looking to recruit and how widely were they looking to recruit health care workers into the trial?

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So early on, they were hoping to get 30000 to 40000 recruits.

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And this actually could have been very possible. They they were looking to go into the United Kingdom.

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They were really looking at sites like in Italy. Italy had really early COVID cases.

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And so this would have been a great potential venue.

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They hit some kinks partly due to Brexit, perhaps risk aversion within Oxford and their ability to actually recruit within Europe.

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And they were looking to go into Southeast Asia, a number of different countries India, Bangladesh, Pakistan.

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They had contacts there, places like Vietnam. They were looking to go into Latin America.

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That was a little harder because a lot of clinical trials is about your network and

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more itself had not previously done clinical trial research within Latin America.

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So that was a little more complicated, but really it was a world wide kind of trial and they they didn't it's not like in clinical trials,

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you think there's some formula of exactly how you reach out to patients. But it's not, as I understand, usually that simple.

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You you use your contact networks, you know, if you know of a physician that might be interested in a certain place, you contact them.

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They did have some people when the trial got registered with the registry, clinicaltrials.gov,

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some people reached out directly to them asking if they could be involved.

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They had certain criteria. You know, you can't just have five patients for a prophylaxis trial from a single hospital.

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So if you had a very small like nurse and doctor staff, that wouldn't be a good cause for a prophylaxis trial.

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You actually, if you think about it, the actual number of cases of COVID that you're going to get will likely be relatively low.

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And so you need a lot more patients to be able to show an effect size in the end than you would for a treatment

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trial where people are already sick because a lot of people will never get COVID within within your cohort.

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So from that perspective, this is why they wanted 30 to 40000 people and this is why they were trying to

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geographically expand because you just didn't know where COVID would come next.

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You can't say, oh, we're going to go into law.

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And sometimes by the time you got the approvals that you needed to go into Lao PDR or into Vietnam, the infection curve would have descended.

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And at that point, you know, ethics, bodies and universities or wherever you're trying to run the study,

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whatever hospital you're at are no longer going to want to recruit if you think that there will not be cases for a while.

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And so so basically, yeah, no obvious formula but a lot of contact network, then a ton of work goes into contacting people.

190
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I mean the number of just I get a small number of the emails that people share with me and you just

191
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see how hard it is because for each site you have to go to the ethics and regulatory authorities,

192
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you have to get insurance.

193
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I mean, there's this whole list of bureaucratic steps you have to do even to be able to finally, you know, dispense the prophylaxis.

194
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And then, you know, you don't know how many cases you'll get or how progressed the COVID will be in the country,

195
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or whether you'll be able to get the material transfer agreements to get the samples out in the end.

196
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So in the end, they ended up recruiting just under 5000 people out of the 30 to 40000,

197
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which actually is still a very large trial as they go during COVID.

198
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So, I mean, it sounded like a fairly simple design, you know, give this drug to these health care workers and see if they get sick or not.

199
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But in fact, the it wasn't simple at all.

200
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It was much more complicated because, as you say,

201
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if the the need to be constantly chasing waves of the disease in order to see whether it was effective or not.

202
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Yes. And also presumably and I mean, this, I think is something that's come up elsewhere.

203
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I mean, hydroxychloroquine. Sorry, I shouldn't tell you. In the meantime, hydroxychloroquine had quite a high profile.

204
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So there was yes, it was it was available anyway.

205
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And this is something I'm trying to unpack. To what extent does politics impact the ability to run a trial like this?

206
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And this is a very good trial to look at this for, because in March 2020,

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you have people like Elon Musk tweeting a Google document by day who's or associated hero who used to be quite a famous infectious disease researcher.

208
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He's hit a lot of legal problems and stuff in France due to his clinical trial designs,

209
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or sometimes not observational trial designs and perhaps to an extent, fabricated data.

210
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There have been allegations of this at least.

211
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And so basically you have this idea, can you trust randomised controlled trials at all that's coming up during COVID,

212
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but then you also specifically for hydroxychloroquine,

213
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you have the idea that this is a miracle cure that's being put forward, especially starting in mid-March 2020,

214
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and that it's unethical to wait for clinical trials and results before just doling it out widely.

215
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And so actually you have people like Modi in India, the president,

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who puts a halt on some of the export of their generic active pharmaceutical

217
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ingredients or hydroxychloroquine drugs because they want to keep it for themselves.

218
00:21:20,680 --> 00:21:25,600
At the time, there's there's really no clinical trial evidence pointing to whether it would be effective or not.

219
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I mean, we know it has a pretty strong safety profile at certain doses for things like from rheumatoid arthritis and from malaria.

220
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But you didn't know how it would interact other than limited in vitro studies, which are very different than human studies.

221
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And so yeah, starting in March, just things get crazy that way.

222
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I mean, Bolsonaro and Trump are tweeting about it. Certain countries are trying to hoard it.

223
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There were some issues in Australia, I believe as well, with trying to have certain politicians and others talking about hoarding Australian drug.

224
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And this really did impact the trial.

225
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I think I recently put in a Freedom of Information request for the MHRA, so the Medical Health Regulatory Agency of the UK.

226
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So they're the ones who are responsible for kind of deciding if a drug goes to market and deciding if clinical trials can be approved.

227
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And it was interesting that basically with all of these politics around hydroxychloroquine,

228
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a group published in The Lancet in it came out on May 22nd,

229
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2020, a paper purporting to use a big observational study of thousands of hospitals worldwide.

230
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I guess actually, I think it was hundreds of hospitals worldwide, thousands of patients saying that hydroxychloroquine has links to cardiotoxicity.

231
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So heart symptoms from this you had a big ripple effect and this directly impacted the clinical trial.

232
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So very poor timing literally that day on the 21st when the Medical Health Regulatory Agency got information about this paper,

233
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which was published in The Lancet by a big name researcher, this corporation called Sir Just a Harvard professor.

234
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When this came out very quickly, we find literally that day the Medical Health Regulatory Agency was meeting and

235
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they discussed this paper and they discussed halting hydroxychloroquine trials.

236
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That was the day they started recruitment in the UK. So very poor timing like literally the 21st, 22nd they had BBC interview that was cancelled.

237
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The BBC did not want to interview the moral staff anymore and promote this, and I think that that was quite a fatal blow to the UK.

238
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As I've understood from my own interviews. I don't think that you ever got momentum.

239
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So it had been in Bournemouth. They had a couple of sites in Oxford as well.

240
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They had a long waitlist actually.

241
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A lot of people at Oxford in Nuffield Field here that were wanting to participate, starting again, you know, the 21st, 22nd.

242
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And this is something I'm trying to unpack, like what happens behind the scenes at the MHRA?

243
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It's really hard. I mean, there's very little transparency that's required and even doing a Freedom of Information request for this, you know,

244
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you can only have them work for X number of hours per request and you know,

245
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trying to get emails to understand what's happening behind the scenes, what data do they actually have?

246
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Are they being really risk averse or is there some data that they have that we don't know about?

247
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Just finding this out is really hard. Like for me, they asked what what email, what days of emails do you want?

248
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And it's like, I don't know, I don't I don't know what I can't see.

249
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And so I'm trying to unpack what was happening because Recovery Trial was allowed to continue its hydroxychloroquine arm at the time.

250
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But cough, cold and some other trials like the COVID on the Crown Coordination trial,

251
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they were told that they had to halt and I what what I'm trying to I get to I get the COVID shield and crown coronation trials and had

252
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mixed up them had the Cambridge trial right that had a hydroxychloroquine arm so basically other trials beyond recovery within the UK.

253
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We're told that they had to halt and there was hedging for a few weeks and it was only in late June that they were allowed to recommence.

254
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And as you can imagine, when you have a lot of politics around hydroxychloroquine already and even when this article was retracted from The Lancet,

255
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the MHRA still didn't allow the trial to continue right away.

256
00:25:23,790 --> 00:25:29,280
There were still about two weeks of hedging after that. I don't know still exactly what was going on.

257
00:25:30,110 --> 00:25:36,089
The people running the trial of the trial were never able to be pointed to particular new evidence

258
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other than this Lancet trial that was making them concerned about cardiovascular cardiotoxicity.

259
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But it had a ripple effect.

260
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And then later, you see in certain countries, like in Ethiopia during cop club, them asking for EKGs and stuff to look at cardiac function,

261
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which the trial team would say is really not necessary from a medical perspective.

262
00:25:55,350 --> 00:26:00,120
But you see this lingering idea that there's something about hydroxychloroquine that is dangerous,

263
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that could cause cardiotoxicity, which has never, has never been demonstrated.

264
00:26:05,220 --> 00:26:12,360
But those kind of irresponsible science, frankly, combined with politics, can create these ripple effects.

265
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And Capcom saw that. And then around that, it was around the same time, around June,

266
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I think that the recovery trial came out with the result that it was ineffective in severely ill patients.

267
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Yes. Did that have an effect as well, do you think? I imagine so.

268
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I mean, it's not something that I've seen documented specifically as I've talked with some of the country investigators for COV.

269
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But I think it's part of this whole general distrust of hydroxychloroquine.

270
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I mean, when so the MHRA is a stringent regulatory authority, which basically means that a lot with through regulatory reliance,

271
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a lot of less well funded or newer regulatory agencies, particularly places like Africa,

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Latin America, etc. Thailand to an extent will rely on the MHRA or the United States, FDA,

273
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the Food and Drug Administration or Health Canada or Swiss authorities as stringent regulatory authorities.

274
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And so they definitely have a big impact. And so it's hard to tease out, and I'm still trying to figure out how to do that.

275
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As a historian, I definitely am looking for references to specific, you know, MHRA or FDA decisions and their cascade effects.

276
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I would say recovery doesn't help because a lot of people kind of subsume prophylaxis and

277
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treatment and assume that that means that it wouldn't be as effective in prophylaxis,

278
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but you actually would have expected it probably to be more effective as a prophylaxis.

279
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So I think from that perspective, it's it's unfortunate timing, but also recovery was a very well-designed trial.

280
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So I think people were very trustful of that result. And I think that was very good that they got that out so quickly.

281
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Right, because you could focus on other things like dexamethasone and other steroids, etc., that might be more effective.

282
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I think that the the thing that was more of I don't want to use the word deathblow,

283
00:28:01,110 --> 00:28:07,709
but far more of a challenge for cov was the World Health Organisation's guidance that was released around,

284
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I think, the end of March 2021 that really conflated treatment and prophylaxis and had a

285
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strong recommendation against both for hydroxychloroquine that was much harder.

286
00:28:18,420 --> 00:28:25,620
And you see some countries like the DRC, the Congo, that their regulatory authorities actually refused the trial because of that.

287
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So the W.H.O. kind of that I think did have a strong effect.

288
00:28:31,230 --> 00:28:34,890
And I think that that some of that recommendation was based on recovery.

289
00:28:35,790 --> 00:28:38,399
And I'm not the best person to talk to about this.

290
00:28:38,400 --> 00:28:43,020
But, you know, people like Nick Whyte and others, you know, we're trying to unpack the W.H.O. decisions as well.

291
00:28:43,020 --> 00:28:52,559
Why do they release a strong recommendation against hydroxychloroquine on relatively limited evidence and one misquoted study and that still stands.

292
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So they haven't adapted that even though couple of investigators did put out a letter of concern.

293
00:29:01,150 --> 00:29:08,309
I'm trying to kind of poke in there and understand what was happening behind the scenes and the politics or bureaucracies,

294
00:29:08,310 --> 00:29:14,879
etc., around guidance development. I think those are just two areas that are so understudied in global health,

295
00:29:14,880 --> 00:29:20,160
governance and history are how guidance is produced at organisations particularly

296
00:29:20,160 --> 00:29:25,170
like the W.H.O. and how guidance is produced at regulatory authorities.

297
00:29:25,170 --> 00:29:29,160
And the big thing about studying them is you just have very little transparency support.

298
00:29:29,970 --> 00:29:35,100
Again, you don't know what you don't know. And like looking at the World Health Organisation when you're trying to study

299
00:29:35,100 --> 00:29:39,240
through their freedom of information kind of laws essentially and policies,

300
00:29:39,810 --> 00:29:44,190
you don't have the right to any guidance committee deliberations.

301
00:29:44,370 --> 00:29:51,839
They're sealed off that way. So I don't have the right as a researcher to request this and to and to demand it technically.

302
00:29:51,840 --> 00:29:54,239
You know, with the MHRA, you do have the right to request it.

303
00:29:54,240 --> 00:29:59,180
But again, when they have, you know, say, 20 hour caps on how long they can spend and you can only put.

304
00:29:59,220 --> 00:30:03,240
In EverQuest every 60 days. That does limit your ability to gather information.

305
00:30:04,860 --> 00:30:11,280
And and yet, as you say, the decisions made by these organisations can have an enormous global impact.

306
00:30:12,210 --> 00:30:18,810
Absolutely. I've just been reading Big Pharma by then, Goldfinger, who's who's also here at Oxford,

307
00:30:18,810 --> 00:30:27,790
and I've been thinking about these issues a lot because they go beyond oh, they go beyond the FDA and they go beyond the MHRA.

308
00:30:28,170 --> 00:30:33,190
And these are longstanding issues. And I personally, as a researcher, I haven't seen a lot of shifts.

309
00:30:33,210 --> 00:30:37,680
I mean, they were very kind to spend some time on the Freedom of Information request at the MHRA.

310
00:30:37,680 --> 00:30:43,950
But when you think about it, you know, 20 hours every you know, of their work and how would you even define this?

311
00:30:44,220 --> 00:30:49,860
You know, is it 20 hours of some intern or is it 20 hours of somebody who is very experienced,

312
00:30:49,860 --> 00:30:52,620
who is on the cusp of trial and would know where to look for emails?

313
00:30:54,870 --> 00:30:59,939
Yeah, it's I think it's an area that I hope more people talk about because right now, I mean,

314
00:30:59,940 --> 00:31:05,850
the public and even nice guidelines and stuff like that in the UK you don't have a lot of rights to information.

315
00:31:05,860 --> 00:31:12,659
So much of this is considered proprietary and it's not just, you know, there's not a big pharma actor in this story in a lot of way.

316
00:31:12,660 --> 00:31:16,649
This is a generic this is not a patented drug any more hydroxychloroquine.

317
00:31:16,650 --> 00:31:20,340
And you're still running into issues of transparency and wondering how decisions are made.

318
00:31:20,550 --> 00:31:26,040
And you have bigwigs like Nick White who have some clout, much more than I would have it requesting things.

319
00:31:26,040 --> 00:31:32,579
And they still don't have windows into how some decisions were made that impacted a lot of people and that perhaps wasted a

320
00:31:32,580 --> 00:31:40,020
lot of money and that perhaps cost lives because if you could have had a trial like this hit the 40,000 people very early on,

321
00:31:40,020 --> 00:31:43,829
if you could have run it quickly if you didn't have this political kind of influence,

322
00:31:43,830 --> 00:31:49,560
if you did have Oxford willing to take a few more risks and approve trial insurance and other applications,

323
00:31:49,800 --> 00:31:53,970
I mean, they wanted to have study results starting to come in after six months.

324
00:31:54,240 --> 00:31:56,940
And instead it's just this week, as I understand,

325
00:31:56,940 --> 00:32:01,079
that they're really getting some of the results from Cop Club and they're finally unblinding go to us.

326
00:32:01,080 --> 00:32:04,080
He said they did manage to recruit 5000 people in India nearly.

327
00:32:04,080 --> 00:32:13,770
Yes. And and did did was that enough were there enough cases in the communities in

328
00:32:13,770 --> 00:32:19,140
which those health care workers lived for 5000 to be enough to get a result?

329
00:32:19,440 --> 00:32:22,889
Time will tell. So. Right. So we don't know the result, you know.

330
00:32:22,890 --> 00:32:31,830
So I'm actually going to Thailand next week. I've been invited as the historian, you know, to sit in on the cup of investigators meeting.

331
00:32:31,830 --> 00:32:34,830
So the grant is the first time you've actually been. No, no.

332
00:32:34,830 --> 00:32:40,800
I spent about six weeks there last spring, and I'll be going back for some more oral histories this spring.

333
00:32:41,460 --> 00:32:45,690
But this is a very short trip, a very long way to go for five days.

334
00:32:45,930 --> 00:32:52,049
But there's a two day meeting happening on the 15th and 16th of December in Thailand, and they're inviting the investigator.

335
00:32:52,050 --> 00:32:57,060
So all of the different people that led or were involved with the different study sites internationally.

336
00:32:57,060 --> 00:33:00,900
So they're bringing them all to Bangkok during the last few weeks of the grant.

337
00:33:01,290 --> 00:33:06,480
So they have to do it by the end of this year and they're scrambling right now to finish, as I understand,

338
00:33:06,660 --> 00:33:13,440
the unblinding process and the statistics process to actually understand what the results have shown and some of the reason that it's taken so long.

339
00:33:13,440 --> 00:33:15,630
But they stopped recruiting last fall.

340
00:33:16,290 --> 00:33:24,359
So it's it's taken this long because the things like material transfer agreements, you have to to export the samples.

341
00:33:24,360 --> 00:33:32,370
So so even if you recruited 40,000 patients, even if we had got in more than this, you know, slightly under 5000, you kind of think, oh, okay.

342
00:33:32,370 --> 00:33:35,699
So you have you have the samples you've collected, you've collected the dried blood,

343
00:33:35,700 --> 00:33:40,380
you've collected the swabs that you can do PCR and stuff on to find out if people actually had the virus.

344
00:33:40,530 --> 00:33:46,859
You have the information that they've recorded for each each participant about whether they had symptoms.

345
00:33:46,860 --> 00:33:49,620
You think, okay, you know, can you do a couple of months? You'll get this analysed.

346
00:33:49,890 --> 00:33:53,430
But the reality is when you're doing a study in so many different places,

347
00:33:53,730 --> 00:34:00,809
you have to get material transfer agreements to actually legally get the samples from, say, Indonesia.

348
00:34:00,810 --> 00:34:03,810
That's a very complicated country for this into Thailand.

349
00:34:04,020 --> 00:34:08,129
And then you have to go through the process of having the lab analyse them and then you

350
00:34:08,130 --> 00:34:11,280
have to go through the process of the statistician looking at all the evidence and data.

351
00:34:11,460 --> 00:34:16,230
And so actually those material transfer agreements can add months on to the timeline,

352
00:34:16,230 --> 00:34:23,280
which is why we're only just now getting is it vulture vulture research or vulture work where you you fly into another country,

353
00:34:23,280 --> 00:34:31,560
you take blood and you fly out with it. And I gather a lot of I mean, I understand a lot of countries of of have got quite.

354
00:34:33,900 --> 00:34:37,710
You have tightened up that procedures a lot on on that kind of thing.

355
00:34:37,720 --> 00:34:44,220
The idea that overseas countries, particularly Western countries, can just go and blithely take blood samples from.

356
00:34:44,700 --> 00:34:51,450
Yes. Populations. And and it's all the harder during like COVID when flights aren't running as much and stuff to you know,

357
00:34:51,450 --> 00:34:55,889
there's some interesting stories there of trying to get drugs out of Australia and how complicated it was.

358
00:34:55,890 --> 00:34:59,400
But yeah, I mean that's a good point about this vulture kind of concept.

359
00:35:00,060 --> 00:35:05,850
When I was working at the National Academies last year, we talked a lot about the pandemic influenza preparedness program.

360
00:35:06,060 --> 00:35:10,590
And so this was launched in 2011, and this was after some issues,

361
00:35:10,980 --> 00:35:16,520
particularly around countries like Indonesia, wanting access and benefit systems which which is quite fair.

362
00:35:16,530 --> 00:35:21,900
So basically there's the argument that, look, it's our property, our bio samples that we're collecting.

363
00:35:22,050 --> 00:35:26,760
And if in the past, whether it's the W.H.O. or on behalf of wealthier countries,

364
00:35:26,970 --> 00:35:31,590
have had through their global influenza surveillance network in their laboratories,

365
00:35:31,590 --> 00:35:38,460
if they're taking these samples and they're using them to produce a vaccine, but then the countries cannot afford to purchase that vaccine.

366
00:35:38,670 --> 00:35:44,100
There's a there's a discouragement there, and that's unfair. And so that's the origin of things called access and benefit systems.

367
00:35:44,100 --> 00:35:49,559
And so a lot of this does, as I understand it, quite date back to like 2008 and nine and influenza.

368
00:35:49,560 --> 00:35:50,820
There were some inflection points.

369
00:35:51,540 --> 00:35:56,969
And so you'll have like the pandemic influenza preparedness framework, they use material transfer agreements as part of this.

370
00:35:56,970 --> 00:36:00,870
They've become much more widespread, as I understand, over the last 20 years.

371
00:36:02,160 --> 00:36:10,379
But with them can be delays because if countries don't have a lot of regulatory capacities for issuing some of these import permits,

372
00:36:10,380 --> 00:36:14,640
for instance, and export permits, you can have quite a long time.

373
00:36:14,640 --> 00:36:18,600
And even just material transfer agreements, you imagine doing a pandemic, you think, okay, it's a form, right?

374
00:36:18,930 --> 00:36:26,250
But sometimes regulatory authorities will say you have to have a physical stamp or it has to be notarised or we have to have a wet signature.

375
00:36:26,460 --> 00:36:31,200
But during pandemics, when flights aren't necessarily going and you're working with multiple countries,

376
00:36:31,200 --> 00:36:36,870
getting a wet signature and transporting it between two different organisations can be really complicated.

377
00:36:37,140 --> 00:36:42,870
And so sometimes that physical paper trails that are required for these can create real bottlenecks.

378
00:36:42,870 --> 00:36:46,290
And this is something that I think a lot of regulatory authorities and the W.H.O.

379
00:36:46,710 --> 00:36:49,890
hasn't quite come up with a system for dealing with these kind of delays.

380
00:36:49,890 --> 00:36:56,580
They're unintentional. It's not because anybody wants to do this, and it's not necessary to have, you know, a part of access and benefit systems.

381
00:36:56,580 --> 00:37:01,200
It's not this isn't part of, you know, making sure that we have protections for people.

382
00:37:01,200 --> 00:37:07,109
Exactly. I mean, it's this is literally just bureaucratic delays sometimes that can create big problems.

383
00:37:07,110 --> 00:37:09,989
And that's something I'm trying to document. I'll be talking, I think,

384
00:37:09,990 --> 00:37:13,799
next week with some people about material transfer agreements and some of their experiences

385
00:37:13,800 --> 00:37:18,330
and understanding where the bottlenecks were and whether they were really part of a necessary

386
00:37:18,330 --> 00:37:24,120
ethics system or whether sometimes it's just steps for the sake of having steps to tick certain

387
00:37:24,120 --> 00:37:28,319
boxes that can create huge problems when you're having a time crunch during a pandemic.

388
00:37:28,320 --> 00:37:31,470
Because, again, you know, the argument is we don't know, right? I don't know.

389
00:37:31,710 --> 00:37:36,630
Perhaps Will Schilling and Nick right now know whether they had enough numbers to get

390
00:37:36,630 --> 00:37:40,800
the effect size that they needed to actually see a statistically significant result?

391
00:37:40,800 --> 00:37:46,170
We don't know that yet. But if there was a statistically significant event,

392
00:37:46,170 --> 00:37:51,659
ideally you would have found this out a year ago because at this point it could still be helpful for the future.

393
00:37:51,660 --> 00:37:55,710
But there is a lot of disappointment that, you know, you had a trial that was thinking ahead,

394
00:37:56,040 --> 00:38:00,959
wanting to start this in November 2020, and that because of politics, because of bureaucracies,

395
00:38:00,960 --> 00:38:06,780
because of other risk aversion and insurance and material transfer agreements and all of these complications,

396
00:38:06,990 --> 00:38:14,520
they might have missed some of the waves and also are having results out after vaccines are available and when they might be less valuable.

397
00:38:15,450 --> 00:38:22,740
I mean, you've been you've been hinting at this all the way along, but so part of your job as a historian is simply to find out what happened.

398
00:38:23,250 --> 00:38:30,000
But along with that narrative, presumably you've got some major research questions that you're seeking to answer.

399
00:38:30,000 --> 00:38:37,440
What would you say those were? Yeah, you know, it's it's a hard project because, you know, when you design your own research, study,

400
00:38:37,710 --> 00:38:42,750
you know, if I was going and putting in a proposal to do this, I would have to think of those at the start.

401
00:38:42,840 --> 00:38:47,280
Yeah, for me it was kind of the reverse. I would said Study of history.

402
00:38:47,430 --> 00:38:53,520
There'll be interesting stuff here and then you really just start trying to find out what the story is by talking to a lot of people.

403
00:38:53,520 --> 00:38:56,940
And so I feel like I'm still really formulating the research questions.

404
00:38:56,940 --> 00:39:05,220
And I think as I'm going, you know, I'm asking questions like, what is the role of bureaucracy within modern history of global clinical trials?

405
00:39:06,390 --> 00:39:15,420
And I mean that that's a big one. What is the role of risk in making decisions about clinical trials and, you know,

406
00:39:15,510 --> 00:39:20,460
both institutional kind of risk aversion perhaps, and also multilateral organisations.

407
00:39:21,210 --> 00:39:25,590
How does politics impact clinical trials during pandemics?

408
00:39:25,590 --> 00:39:30,050
You know, how can we tease out kind of the impact there?

409
00:39:30,090 --> 00:39:33,240
How do you guidance kind of.

410
00:39:33,890 --> 00:39:39,260
Bodies operate, particularly during times of pressure during pandemic.

411
00:39:39,260 --> 00:39:45,379
So these are the kind of questions I'm working with. And I think if I had to ask an overarching kind of question right now,

412
00:39:45,380 --> 00:39:49,370
it really is starting to pinpoint more on how do the commercial determinants of

413
00:39:49,370 --> 00:39:54,769
health and commercialism impact the modern conduct of global clinical trial?

414
00:39:54,770 --> 00:39:58,040
So this is looking at things like the International Conference on Harmonisation,

415
00:39:58,940 --> 00:40:04,429
which is mostly dating back to the mid 1990s and this particular trial.

416
00:40:04,430 --> 00:40:07,579
You know, it's not having big pharma actors involved as much,

417
00:40:07,580 --> 00:40:12,560
but they've been very involved in setting the infrastructure, setting the rules and norms in this sphere.

418
00:40:12,740 --> 00:40:17,600
So it's kind of looking at how those play out and how they have played out during modern pandemics.

419
00:40:17,600 --> 00:40:21,230
I'd say that's kind of my my most my widest question.

420
00:40:21,530 --> 00:40:29,209
So I've kind of defined this as a risky business, as I would put it. You know, we're how do you locate bureaucracy within modern clinical trials?

421
00:40:29,210 --> 00:40:37,370
Is this something that is intrinsic to running clinical trials internationally or where is it coming from and whose purposes is this serving?

422
00:40:37,370 --> 00:40:42,169
And so it's kind of using Cape Cod as an example and the vantage point,

423
00:40:42,170 --> 00:40:47,420
a window into these kind of complex forces that are often operating beneath the scenes.

424
00:40:47,420 --> 00:40:53,510
And I think everybody kind of knows that they're there, but they're hard to locate and commercialisation is a big one.

425
00:40:54,080 --> 00:40:59,750
Oh, well, tell me a bit more about your your methods. I mean, again, you've mentioned Freedom of Information request.

426
00:40:59,750 --> 00:41:04,639
You mentioned oral history. And to talk me through that a little bit, yeah.

427
00:41:04,640 --> 00:41:11,420
So, you know, nobody really trains you and as you would know, you know, for how to do this kind of modern history.

428
00:41:11,420 --> 00:41:16,280
And, you know, I use oral histories, but they're a little less formal than your older history.

429
00:41:16,280 --> 00:41:19,160
You know, I would use it as more of a semi-structured interview.

430
00:41:19,430 --> 00:41:29,030
So I have a lot of I meet almost every week with Will Schilling, who is the one of the copies control investigators based in Bangkok.

431
00:41:29,300 --> 00:41:33,920
He's a British physician who's really involved in pretty much all of the day to day work of Cobb.

432
00:41:33,920 --> 00:41:38,629
Cobb. And so I kind of explore different themes with him each week, and that's kind of how you got to this commercialisation thing.

433
00:41:38,630 --> 00:41:42,530
You know, you'll talk about everything from, you know, the role of shipping and logistics,

434
00:41:42,530 --> 00:41:46,129
these worlds I never thought of world career and how they have a bit of a monopoly at

435
00:41:46,130 --> 00:41:49,580
the World Health Organisation and other places now just in terms of shipping samples.

436
00:41:49,790 --> 00:41:56,540
And so I would say mostly what I've done so far is have these targeted talks that will shape different.

437
00:41:56,540 --> 00:41:59,719
I go into it thinking, okay, this is this person's background.

438
00:41:59,720 --> 00:42:03,560
I know this was their role in the trial. What are some questions I have for them?

439
00:42:03,560 --> 00:42:08,750
What are some themes I think we could explore? Maybe it's the commercial determinants of health, maybe it's material transfer agreements,

440
00:42:08,750 --> 00:42:14,570
maybe it's their particular work in trying to recruit Guatemala, etc.

441
00:42:14,780 --> 00:42:22,040
And then you just you talk like we're doing here, and I often ask for documents when I'm talking with them.

442
00:42:22,670 --> 00:42:29,659
That's always dicey. I still haven't fully worked out, you know, confidentiality agreements around this.

443
00:42:29,660 --> 00:42:33,049
You know, people are willing to share emails with me, obviously.

444
00:42:33,050 --> 00:42:39,200
You know, often they were forwarded these emails. Sometimes at the bottom of these emails it says only intended for the original recipient.

445
00:42:39,200 --> 00:42:43,670
And they landed in my inbox. So that's something I'm still working through.

446
00:42:45,110 --> 00:42:52,759
So I would say a lot of what I would call digital archive kind of formulation, which is mostly emails or even Google teams chats.

447
00:42:52,760 --> 00:42:55,030
That's a horrible one because you can't export those.

448
00:42:55,030 --> 00:43:01,970
So you just have to literally scroll through and see all the different meeting kind of chats that were happening during Cop Club.

449
00:43:01,980 --> 00:43:09,800
So it's things like that. They've very kindly given me access to the meeting minutes for the strategic and operational meetings during Cop Cove.

450
00:43:10,040 --> 00:43:18,920
So I've worked through those. The big piece that is missing that is really hard to get is access to what's happening

451
00:43:19,610 --> 00:43:24,319
for either the pharmaceutical companies or the contract research organisations.

452
00:43:24,320 --> 00:43:30,860
So they try to partner with a CRO contract research organisation based in Florida called Bio Rossi,

453
00:43:31,520 --> 00:43:37,100
which was going to potentially open up Ukraine and Russian sites for the trial.

454
00:43:37,250 --> 00:43:41,060
And this is obviously pre, you know, war in Ukraine.

455
00:43:41,750 --> 00:43:47,690
And so, you know, I've tried to contact some people from more of that world.

456
00:43:47,690 --> 00:43:53,239
And that is hard. It's hard to have regulatory authorities.

457
00:43:53,240 --> 00:44:00,080
It's harder to get people to want to do oral histories with you there. It's harder to get private entities like contact research organisations or,

458
00:44:00,950 --> 00:44:04,549
you know, insurance firms and stuff to have a reason for wanting to talk to you.

459
00:44:04,550 --> 00:44:08,450
So that's a bit of an area that I struggled with, and the more I've read, the more you've seen.

460
00:44:08,450 --> 00:44:14,420
Even researchers in the 1990s that were trying to do this, it's really, really hard to get that aspect.

461
00:44:14,630 --> 00:44:19,610
So so far my oral histories have been mostly with, you know, professors and the like.

462
00:44:20,480 --> 00:44:28,670
I've been talking with the World Health Organisation, African Secretariats Ever AFF, which is the vaccine forum.

463
00:44:28,670 --> 00:44:33,170
So there are harmonisation initiative that we're helping with regulatory approvals and.

464
00:44:33,240 --> 00:44:36,000
Ethics in the African continent. I've talked with people like that.

465
00:44:36,450 --> 00:44:40,710
I've done oral histories with some of the site investigators, and I'm doing more of those.

466
00:44:41,070 --> 00:44:44,910
And then again, a lot of the different staff, both locally and internationally,

467
00:44:44,910 --> 00:44:50,880
the participants, trial participants, that is that is dicier because of ethics.

468
00:44:51,630 --> 00:44:55,740
It's a two year project. And this is actually something that's come up when I talk with other people as well,

469
00:44:55,740 --> 00:45:01,260
is to what extent do you want to go into the impact on communities and people's personal reflections?

470
00:45:01,590 --> 00:45:07,500
I would say I would need a separate ethics process which could take a while to really talk more with participants.

471
00:45:07,510 --> 00:45:12,300
It's something I've thought about, but I haven't done yet. It's also hard.

472
00:45:13,050 --> 00:45:18,140
I mean, again, I don't have list of participants. I mean, they haven't given their consent to share this.

473
00:45:18,150 --> 00:45:23,400
So I think it would be more likely to be able to talk with local staff members.

474
00:45:23,400 --> 00:45:25,710
So on each site, for instance, in Thailand,

475
00:45:25,920 --> 00:45:34,530
you'll have a group of nurses and physicians that we're actually going to be meeting with the patients, recruiting, collecting the data.

476
00:45:34,830 --> 00:45:38,480
Those are people I would like to speak with in Thailand to understand their experience.

477
00:45:38,610 --> 00:45:45,540
You know, it always comes down. There's language barriers, there's ethics of speaking to them when they have regular day jobs and not a lot of time.

478
00:45:45,540 --> 00:45:50,610
And I'll have to get local ethical approval. So I am hoping to do that in the spring when I go back.

479
00:45:51,210 --> 00:45:57,630
But there are layers of kind of protections for people involved in the trials that you do have to work through.

480
00:45:58,410 --> 00:46:02,580
And I think it's a common issue in history. I mean, when you're on to your projects,

481
00:46:03,180 --> 00:46:08,549
you want to talk to a wider group of people and often you end up talking to some of the more powerful people

482
00:46:08,550 --> 00:46:13,740
within the program because that's who you have access to and then you have time limits and then the project ends.

483
00:46:14,160 --> 00:46:21,120
I had the same problem during my PhD. I didn't spend enough time talking to local participants on the Disease Control program that I was studying.

484
00:46:21,120 --> 00:46:30,239
So the it's a convoluted answer, but I would say I hope to talk more to local study teams as I enter the next phase of my research,

485
00:46:30,240 --> 00:46:32,190
which is looking more at specific sites.

486
00:46:32,430 --> 00:46:41,610
And so far I've looked more at the kind of bird's eye view from the view of principal investigators and the court team when in terms of other methods.

487
00:46:41,610 --> 00:46:51,479
Yeah, I mean, kind of oral history compilation Freedom of Information requests and a lot of interviews with stakeholders involved at multiple levels.

488
00:46:51,480 --> 00:46:54,540
I am. How many people do you think you have talked to so far?

489
00:46:54,570 --> 00:47:01,530
So far, oh, maybe about 30 people and but multiple times.

490
00:47:01,530 --> 00:47:05,250
So but some of them, especially the core group multiple times.

491
00:47:05,850 --> 00:47:09,150
And so I do need to expand out a little bit more geographically,

492
00:47:10,650 --> 00:47:17,790
and I am hoping to spend some time in Geneva to talk to the people involved, the W.H.O. guidance,

493
00:47:17,790 --> 00:47:23,699
and also talk to people involved in sample shipping and perhaps something called the Magic Ecosystem Foundation,

494
00:47:23,700 --> 00:47:29,189
which is kind of this relatively obscure player that is in what, the Magic Ecosystem Foundation.

495
00:47:29,190 --> 00:47:35,160
Yet I see it's making great. The irresistible choice is what it stands for.

496
00:47:35,190 --> 00:47:40,020
Magic. It's basically great is this way of setting guidelines.

497
00:47:40,400 --> 00:47:46,350
It supposed to be very evidence based and it's really been developed since the mid 2000s and it's been rolled out very widely,

498
00:47:46,350 --> 00:47:50,810
places like the World Health Organisation. So I'm wanting to talk to them about some of their methodologies,

499
00:47:50,820 --> 00:47:59,129
about how they actually what evidence goes into and what people go into forming recommendations at the dose.

500
00:47:59,130 --> 00:48:04,290
And sometimes they are even if they're evidence based, they politics can enter.

501
00:48:04,800 --> 00:48:09,690
So I'm trying to go there and unpack this a little further and then I'm hoping to go to Indonesia

502
00:48:09,940 --> 00:48:15,420
and potentially a couple of the actual sites to talk with more local investigators in the spring.

503
00:48:16,080 --> 00:48:20,850
So that's the trajectory. But I'm one year into the project now, so I only have a year left.

504
00:48:20,850 --> 00:48:26,040
And as a postdoc you always have all these things on your mind in terms of, you know, getting out your publications.

505
00:48:26,040 --> 00:48:30,929
And I'm hoping to do a book proposal for this to to release in the spring.

506
00:48:30,930 --> 00:48:35,580
But you do have to move pretty quickly with actively moving pieces, which makes it even harder.

507
00:48:35,820 --> 00:48:38,580
You know, you're moving quickly when you don't even have the trial results yet.

508
00:48:39,270 --> 00:48:43,830
And when they're having active meetings each week that you should be thinking about meeting minutes for.

509
00:48:44,430 --> 00:48:52,680
So it is challenging that way. I guess that's the problem with being a historian of the contemporary world, that it's a constantly moving target.

510
00:48:52,980 --> 00:48:58,110
Yeah, thinking about sources, you know, more than traditionally you'd have archive sources,

511
00:48:58,110 --> 00:49:02,999
which clearly you can't use for this kind of project because most of them are ten plus year access requirements.

512
00:49:03,000 --> 00:49:07,950
So, you know, the, you know, 15 or 20 years, you can only see things that are 15 or 20 years old.

513
00:49:08,670 --> 00:49:13,170
So archives, traditional archives are kind of out. You can create your own archives.

514
00:49:13,170 --> 00:49:14,489
Again, we talked about the ethics of that.

515
00:49:14,490 --> 00:49:20,399
You can do oral histories and then a lot of it is also just like looking at the news and looking at what events you can crash,

516
00:49:20,400 --> 00:49:25,320
you know, like they have with the African Vaccine Forum and some of the regulators,

517
00:49:25,320 --> 00:49:33,120
for instance, in mid-December, they're having some meetings and seeing if I can virtually tune in on that, even if I'm not asking questions.

518
00:49:33,310 --> 00:49:37,990
That can be a source as you learn about what's happening with harmonisation around regulatory.

519
00:49:39,310 --> 00:49:46,420
You're looking at all sorts of blogs. I've been looking at the Wayback Machine and looking at old versions of web pages like Twitter.

520
00:49:46,990 --> 00:49:50,600
And frankly, it gets overwhelming because anything can be a source.

521
00:49:50,640 --> 00:49:54,280
You know, when I did, you know, I used to study the Spanish influenza pandemic.

522
00:49:54,580 --> 00:50:01,510
You could be relatively confident if you went to a handful of archives that I've actually I've seen everything there is at these archives.

523
00:50:01,720 --> 00:50:04,959
There's no more photos here, and maybe somebody has them in their attic somewhere.

524
00:50:04,960 --> 00:50:11,650
But I've kind of covered my bases. This project, you never feel like you've covered your bases because there's always somewhere else you could look.

525
00:50:11,650 --> 00:50:15,520
You could always be on PubMed or you could be on Scopus, so you could be reading the newest blog.

526
00:50:16,210 --> 00:50:21,400
There's so many reports coming out, having worked at the National Academies, they have new reports coming out on COVID.

527
00:50:22,540 --> 00:50:28,210
There's so many advisory groups, the Wellcome Trust, the Lancet commissions, and you can't read it all.

528
00:50:28,720 --> 00:50:33,460
But so many of the themes that you're looking at, it would be really valuable if you could.

529
00:50:33,880 --> 00:50:41,530
So I think that's my challenge right now, is it's focusing in and honing in on a few themes and trying to do those well and cover your source as well.

530
00:50:41,530 --> 00:50:46,479
Because the sources, I mean, they're just exponential. So you use the phrase bird's eye view.

531
00:50:46,480 --> 00:50:55,510
And I'm really getting a sense that you're the only person who has looked at all the all of this material that probably the you know,

532
00:50:55,510 --> 00:50:57,670
that people like Nic White will know a lot of it,

533
00:50:58,480 --> 00:51:06,040
but you will certainly end up being the only person who has got this complete perspective on the on the whole thing.

534
00:51:06,970 --> 00:51:13,810
And that's I mean, presumably that's the value of having a historian do that, that you can take that step back.

535
00:51:13,840 --> 00:51:18,190
Yeah. And try to see how the whole machine fits together.

536
00:51:18,580 --> 00:51:24,340
And so what do you what do you hope in a perfect world, what do you hope will come out of this?

537
00:51:24,850 --> 00:51:32,020
Because in some ways it's immaterial whether the trial works or not, whether the trial for me turns out to be a positive result or not.

538
00:51:32,320 --> 00:51:35,500
It's the case study is of how the trial has functioned.

539
00:51:35,500 --> 00:51:41,350
Not it's not about whether hydroxychloroquine turns out to be a good prophylaxis for COVID or not.

540
00:51:42,490 --> 00:51:46,209
Now that that's a really interesting question. I ask myself this sometimes too.

541
00:51:46,210 --> 00:51:52,510
I I've been a bit inspired by like Adrianna, Petrina and others who have looked at like outsourcing of clinical trials and they've

542
00:51:52,510 --> 00:51:56,620
talked about how people haven't really studied the clinical trial as an object.

543
00:51:57,370 --> 00:52:01,990
And I think from an anthropological view, because a lot of what I do in the end,

544
00:52:02,140 --> 00:52:06,670
there's a fine line between medical anthropology and history and political science, political economy.

545
00:52:07,600 --> 00:52:10,840
I guess I'm hoping and I haven't gotten here yet, but I have a year.

546
00:52:10,930 --> 00:52:17,889
You know, I'm hoping to really look more critically at what we mean by bureaucracy, like even speaking with Will Schilling lately,

547
00:52:17,890 --> 00:52:22,240
he was telling me he and Nick White were even talking about they've used the word bureaucracy with me a lot,

548
00:52:22,450 --> 00:52:25,660
this horrible bureaucracy of clinical trials. So what does that actually mean?

549
00:52:26,200 --> 00:52:29,290
What are ways of looking at bureaucracy and what are some ways of looking at risk?

550
00:52:29,290 --> 00:52:30,519
And I think that's the advantage.

551
00:52:30,520 --> 00:52:36,820
I mean, Will Schilling and Nick Whyte and all the others involved in the trial know so much more than I do about the science of it.

552
00:52:37,090 --> 00:52:42,190
They know so much more than I do about the day to day interactions. I mean, there's there's only so much that they could tell me.

553
00:52:42,190 --> 00:52:49,120
And I'm not a medical professional, but I do think I have the flexibility of having some time, like you said,

554
00:52:49,120 --> 00:52:55,779
to think more strategically about like, how do we locate bureaucracy in the system we're throwing around this word.

555
00:52:55,780 --> 00:52:58,960
What does it mean in terms of clinical trials? Where does it come from?

556
00:52:59,110 --> 00:53:04,450
Whose interest is it promoting? And I think that's what I mean about looking at the clinical trial as an object.

557
00:53:04,450 --> 00:53:06,490
And again, I don't have the answers yet,

558
00:53:07,120 --> 00:53:13,449
but that's that's what I'm trying to do is be able to use this case study and to think about these bigger themes.

559
00:53:13,450 --> 00:53:16,960
I mean, people really haven't studied much about contract research organisations.

560
00:53:17,170 --> 00:53:21,790
How do they actually influence what happens to a trial during a pandemic?

561
00:53:21,790 --> 00:53:26,019
And if you can document some of this, you know you're not going to solve all the world's problems.

562
00:53:26,020 --> 00:53:31,780
I don't want to have a lessons learned chapter where I just like tick off boxes of here are 16 different lessons that are learned.

563
00:53:32,050 --> 00:53:39,370
But I think you can say something about some of the bigger forces and how they play out during these acute kind of times.

564
00:53:39,370 --> 00:53:45,730
And hopefully the audience would actually probably not be as much historians as much as I'm hoping

565
00:53:45,910 --> 00:53:53,410
policymakers will read some of this and and and see that there are things that need to change.

566
00:53:53,890 --> 00:53:57,160
And, you know, I'm not going to be the person that says exactly what they need to be.

567
00:53:57,160 --> 00:54:04,750
But I think by showing the consequences during a trial of some of these wider ideas of bureaucracy and risk aversion,

568
00:54:06,190 --> 00:54:13,749
hopefully that that can provide the small evidence piece that can be used to to reformulate some of these approaches.

569
00:54:13,750 --> 00:54:16,959
So I think there is a lot of momentum behind trying to reformulate.

570
00:54:16,960 --> 00:54:21,280
I mean, sometimes money doesn't follow, but I do think there is a window.

571
00:54:22,090 --> 00:54:26,170
You know, there's a lot of talk about adaptive clinical trials and ways for the future.

572
00:54:27,070 --> 00:54:31,660
And hopefully this sheds light particularly on multi-country clinical trials.

573
00:54:31,660 --> 00:54:33,549
Because what you need for a clinical. Trial.

574
00:54:33,550 --> 00:54:39,070
When you're working within Africa and Asia and you have a single trial that's operating in multiple countries,

575
00:54:39,070 --> 00:54:42,340
might be very different than saying, oh, the recovery trial, this model works.

576
00:54:42,700 --> 00:54:46,689
You know, Recovery International's had a lot of problems, as I understand,

577
00:54:46,690 --> 00:54:51,339
similar to COV with what happens when you try to almost outsource this model,

578
00:54:51,340 --> 00:54:59,049
what might work as an adaptive trial where you are having real time results that are then changing which arms of the study you have?

579
00:54:59,050 --> 00:55:02,530
It might work really well when you're in a single country like on the NHS,

580
00:55:02,530 --> 00:55:08,709
but maybe we need to have pause before trying to write that large and use it as the model internationally.

581
00:55:08,710 --> 00:55:13,480
So I hope it can be a bit of a piece of that evidence base that policymakers can use

582
00:55:13,480 --> 00:55:17,889
when they're thinking about how to design clinical trials and how to harmonise them,

583
00:55:17,890 --> 00:55:22,480
and what's perhaps less successful, what could be revisions.

584
00:55:22,480 --> 00:55:28,360
And hopefully, you know, like Ben Gold Diggers Work, you know, he really harps on transparency, transparency and transparency.

585
00:55:28,360 --> 00:55:38,290
And hopefully this can be one more kind of call for some of the big things like registries and transparency that are just flagrantly not working well.

586
00:55:39,250 --> 00:55:42,820
And perhaps this can kind of contribute a little there.

587
00:55:43,810 --> 00:55:47,890
And for you personally, I mean, COVID has been a horrible thing for the world.

588
00:55:48,220 --> 00:55:53,080
But I mean, do you acknowledge that for you,

589
00:55:53,080 --> 00:55:59,290
it's it's actually taken you in a new direction in your in your career and give you interesting things to think about?

590
00:55:59,320 --> 00:56:04,750
Yeah, for better or worse, it's turn to be more modern. You know, I thought I was a modern historian before, like, in the eighties.

591
00:56:04,750 --> 00:56:08,829
Now I've really gone off the deep end that way. Yes.

592
00:56:08,830 --> 00:56:14,860
I think that I don't know that I'll continue to work on COVID era projects in the future,

593
00:56:14,860 --> 00:56:18,159
but I think it definitely it's put the spotlight on global health.

594
00:56:18,160 --> 00:56:23,350
And I think that, you know, global health has always struggled to attract a lot of funding.

595
00:56:23,740 --> 00:56:29,860
And, you know, I think, you know, you often think, oh, we have things solved us is number one in terms of global health security index.

596
00:56:29,860 --> 00:56:33,009
And clearly that did not materialise, you know, on the ground.

597
00:56:33,010 --> 00:56:39,040
And so I do think, like, absolutely, you know, you're seeing a lot of calls about democratising and decolonising global health

598
00:56:39,040 --> 00:56:42,609
and position ality within global health and ethics of vaccine distribution.

599
00:56:42,610 --> 00:56:48,640
It doesn't mean things are going to change really quickly, but I do think there is a bit more world spotlight on it.

600
00:56:48,940 --> 00:56:53,169
There probably is. The more funding that comes, I mean, look like the Pandemic Science Institute and stuff is launched.

601
00:56:53,170 --> 00:56:56,079
So that is not I mean, this is partly because there is momentum here.

602
00:56:56,080 --> 00:57:03,520
So I do think from a career perspective, as an early career researcher, you know, I will probably stay in pandemic preparedness.

603
00:57:03,520 --> 00:57:08,950
I was a bit there before, but I think, you know, there are there will be a lot of opportunities to contribute that way.

604
00:57:08,950 --> 00:57:13,960
These are not going away. I mean, you look at climate change. I mean, pandemics are here to stay.

605
00:57:14,320 --> 00:57:19,030
And I think it's I hope to continue working on kind of the interface of history and policy,

606
00:57:19,030 --> 00:57:24,850
whether it's in academia or it's back in global health, kind of program management and policy.

607
00:57:25,480 --> 00:57:33,070
So I do think there's a lot of terrain for people with social sciences, skill sets and stuff for having policy recommendations.

608
00:57:33,220 --> 00:57:35,080
So basically the short answer is yes.

609
00:57:35,080 --> 00:57:42,670
It's definitely taken me in a slightly different direction in my career and I think it will probably keep me somewhat in that direction,

610
00:57:43,240 --> 00:57:47,620
although I was sort of getting there previously as well.

611
00:57:47,620 --> 00:57:51,849
So but like at the National Academies in the project that I'm doing, yeah, these wouldn't exist,

612
00:57:51,850 --> 00:57:55,090
the particular studies and they would not have had the funding they had without COVID.

613
00:57:55,960 --> 00:58:02,890
Yeah. So I usually ask a few questions about the the impact of the pandemic itself on you, on you personally.

614
00:58:03,910 --> 00:58:09,340
So I mean in the UK everybody talks about 23rd March 2020 when the lockdown happened.

615
00:58:09,340 --> 00:58:12,400
But you would you were in the US. I was.

616
00:58:12,550 --> 00:58:16,210
And did you have lockdowns. I mean what did how did it. Oh yes.

617
00:58:16,600 --> 00:58:22,209
So no, not the same way as the UK. So my sister was over here and I felt horrible for her.

618
00:58:22,210 --> 00:58:28,520
She's a post-doc at the University of Bristol and she's single and living on her own and she had no outdoor area and just locked in,

619
00:58:28,520 --> 00:58:33,220
you know, and it was nothing quite as awful as that, although maybe it should have been.

620
00:58:33,230 --> 00:58:42,910
And we didn't. I wouldn't say that Washington, D.C. and the US took things perhaps as seriously as I would have liked in that sense.

621
00:58:42,910 --> 00:58:48,160
I mean, we had mask mandates in Washington, D.C. You know, you'd wear a mask when you went out.

622
00:58:48,160 --> 00:58:53,500
You know, you always did. And we were first we were spraying things down, you know, when you thought you might be getting something from,

623
00:58:53,500 --> 00:58:58,809
you know, touching the handrail and stuff in your house. Yeah, you just felt so isolated.

624
00:58:58,810 --> 00:59:03,400
I mean, it I was and I was working 100 hour weeks at my old job.

625
00:59:03,400 --> 00:59:07,090
I mean, frankly, it was it was pretty awful. I've never been that stressed out, you know, working on it.

626
00:59:07,090 --> 00:59:11,230
Consensus study at the National Academies on COVID, you kind of get thrown into it.

627
00:59:11,560 --> 00:59:16,209
Yeah. Yeah. So I was I was working insane hours, not really going outside much.

628
00:59:16,210 --> 00:59:22,120
I would just take my hammock out in the afternoons just to, like sit outside a little bit and read and stuff and then go back in.

629
00:59:22,870 --> 00:59:29,949
So I would say, you know, as a young person, you kind of feel like two or three years of your life just evaporated before you knew it.

630
00:59:29,950 --> 00:59:37,120
You know, you're just working all the time kind of in a bubble. I took it seriously, even though legally I could have seen more people.

631
00:59:37,350 --> 00:59:40,479
You felt like you needed to COVID test before seeing people.

632
00:59:40,480 --> 00:59:44,590
And in the States, you know, tests were not very available and they were expensive.

633
00:59:44,590 --> 00:59:50,530
I mean, just getting to that test was $22 and then they sold out.

634
00:59:50,530 --> 00:59:56,650
So I remember calling a bunch of our CDs, which is, you know, like boots calling a bunch of them, like, you know.

635
00:59:56,680 --> 01:00:00,760
Do you have any? Oh, no, we have. We released them 2 hours ago and people had just come and bought them all.

636
01:00:02,410 --> 01:00:07,780
So you were kind of saving your tests up. Is this person really worth seeing, you know, if they have to use a test for this?

637
01:00:08,680 --> 01:00:15,129
So that was definitely frustrating. And then in the States, you know, my mom was a health care worker and she got COVID and she's about 60.

638
01:00:15,130 --> 01:00:22,090
So she got it after the Thanksgiving wave in 2020 when some of her co-workers, frankly, were kind of irresponsible in seeing a lot of their family.

639
01:00:22,090 --> 01:00:25,899
And we, of course, hadn't done that. She got it. She gave it to my brother before vaccines were out.

640
01:00:25,900 --> 01:00:31,420
My brother got long COVID, and he still has that. So, you know, there are just a lot of stressors, you know,

641
01:00:31,420 --> 01:00:36,399
between work and trying to be responsible when the when the US wasn't really mandating

642
01:00:36,400 --> 01:00:40,570
it and probably getting a little resentful of people who weren't being responsible,

643
01:00:40,570 --> 01:00:45,040
feeling like you're spreading this around and we could all just enjoy our lives more sooner.

644
01:00:46,030 --> 01:00:51,429
And then I was quite lucky though I got vaccinated pretty early because my mom,

645
01:00:51,430 --> 01:00:54,489
I got it through my mom's work and that's kind of how you had to do it.

646
01:00:54,490 --> 01:00:59,139
I was like her plus one. They had an extra dose one day and I remember driving down there to make it in

647
01:00:59,140 --> 01:01:02,660
time because my mom was so paranoid I'd get COVID after giving it to my brother,

648
01:01:02,680 --> 01:01:07,390
so she felt horrible. So the short answer is, yeah, it was.

649
01:01:07,540 --> 01:01:15,010
It was rough there. I was very lucky. I don't know anybody directly in my family or friends who died or anything like that,

650
01:01:15,880 --> 01:01:23,260
but I know a lot of very stressed global health people that were trying to be responsible and just, you know, working around the clock.

651
01:01:23,260 --> 01:01:26,560
And it just didn't end, you know, and it still hasn't ended.

652
01:01:26,950 --> 01:01:32,830
You know, we're still well, I mean, when you arrived back here in 2020 this year,

653
01:01:33,160 --> 01:01:37,150
there was a we were in the middle of a wave at that point when we we were.

654
01:01:37,420 --> 01:01:40,450
Yes. And yeah, we were still wearing masks around here.

655
01:01:40,450 --> 01:01:42,580
And it wasn't the warmest welcome to Oxford.

656
01:01:42,690 --> 01:01:48,819
Not anyone's fault, but you know, you arrive and I arrive with my cats exhausted, you know, from the from the States.

657
01:01:48,820 --> 01:01:50,350
And it was during Comic-Con when I came.

658
01:01:50,350 --> 01:01:56,839
So actually even just moving here, I almost got stuck in France because of travel restrictions I was flying through and the stressors of,

659
01:01:56,840 --> 01:02:00,309
you know, getting, you know, there's so many regulations for international travel.

660
01:02:00,310 --> 01:02:06,700
And in the States last Christmas it was almost impossible to find PCR tests for travel.

661
01:02:06,940 --> 01:02:10,870
And so I ended up having to pay something like $200 for antigen tests,

662
01:02:10,870 --> 01:02:17,709
which they decided to accept at the airline just to be able to get an appointment so that I could do that within 72 hours before flying.

663
01:02:17,710 --> 01:02:25,030
And then you had to get your flying through France. You had to get their approval forms and their passenger locator forms and get the UK ones.

664
01:02:25,030 --> 01:02:30,870
And so, I mean, it was just a marathon, just moving for a job to see, you know, exactly, exactly.

665
01:02:30,890 --> 01:02:34,540
You don't know how much that really helped and now it's just kind of gone away.

666
01:02:34,810 --> 01:02:39,340
And they decided, I guess, that that's just not something they want to do anymore.

667
01:02:39,340 --> 01:02:42,480
So I just went to Germany this week and, you know, no restrictions anymore.

668
01:02:42,520 --> 01:02:46,089
They don't even ask for your your COVID passport or your vaccine test anymore.

669
01:02:46,090 --> 01:02:51,799
So things have changed very quickly the last few months. And did you I mean, did you yourself feel threatened?

670
01:02:51,800 --> 01:02:57,860
I mean, given that it came that close to you, your mom and your brother both have it. Did you did you feel anxious about actually catching it?

671
01:02:58,040 --> 01:03:01,120
I think I felt a lot more anxious after my brother got long COVID.

672
01:03:01,130 --> 01:03:03,770
I will admit, being a younger person, I mean,

673
01:03:04,430 --> 01:03:09,200
and somebody who's never been particularly susceptible in the past to respiratory infections for whatever reason,

674
01:03:09,470 --> 01:03:15,050
you know, I wasn't I was definitely concerned about getting it. I was more concerned about passing it to someone like my mom if I had gotten it.

675
01:03:16,250 --> 01:03:20,930
But I guess I was where they were less worried than my mom or brother because I thought, okay, I don't see that many people.

676
01:03:20,930 --> 01:03:23,390
I'm younger, I'm healthy, I probably be fine.

677
01:03:23,990 --> 01:03:29,600
I almost they actually got diagnosed on Christmas Eve the night before my mom's 60th birthday two years ago.

678
01:03:29,600 --> 01:03:34,100
So it was not great timing and they were waiting for their tests because they both felt a little sick.

679
01:03:34,100 --> 01:03:37,459
And I almost went over for Christmas because like, I don't want to spend Christmas alone, you know?

680
01:03:37,460 --> 01:03:41,210
And so I guess you can see I wasn't as worried as I should have been at that moment.

681
01:03:41,210 --> 01:03:45,200
Even as a public health person, I thought I'd probably be fine, but I was very glad in the end.

682
01:03:45,200 --> 01:03:51,379
I didn't go over there for Christmas and spent it alone because, you know, they did come up positive and watching someone like my brother,

683
01:03:51,380 --> 01:03:56,210
who was only 30 at the time, get long COVID and not be able to work full time for a while.

684
01:03:56,780 --> 01:04:00,620
And just the symptoms he had, you know, he's a runner and not being able to exercise.

685
01:04:00,620 --> 01:04:06,529
And he went to the doctor finally and having some cardiac symptoms and having, you know, some pulmonary symptoms.

686
01:04:06,530 --> 01:04:12,380
And his fear, you know, maybe you'll never he said, maybe I just have to expect I'll only ever be 80% better in the future.

687
01:04:12,590 --> 01:04:15,950
That instilled quite a bit more fear at the time.

688
01:04:16,340 --> 01:04:22,670
But then, you know, now I guess you just start thinking, I, I don't think I've had it yet.

689
01:04:23,030 --> 01:04:28,880
Who knows if I've been exposed? I'm one of those small percentage of people, I guess, now that doesn't know if they've had it yet.

690
01:04:29,270 --> 01:04:37,399
And I guess your fear is going down over time, which maybe isn't a good thing, but I guess you think if I'm going to get it, I'm going to get it.

691
01:04:37,400 --> 01:04:41,210
And at least now I've been vaccinated and boosted once. Maybe that'll help a bit.

692
01:04:42,980 --> 01:04:46,700
But yeah, I, I was never particularly worried about dying, let's put it that way.

693
01:04:46,910 --> 01:04:53,570
But maybe I should have been because, you know, you just there's no formula for knowing who will get a worse case to an extent.

694
01:04:53,870 --> 01:04:58,160
Yeah. So I think finally we've covered a lot.

695
01:04:59,690 --> 01:05:07,249
Has your experience of living and and working through and in association with this pandemic changed anything

696
01:05:07,250 --> 01:05:13,370
about your attitude or your approach to your work or your life attitude or approach to my work or life,

697
01:05:14,120 --> 01:05:20,479
um, working that long hours during a pandemic and feeling, you know,

698
01:05:20,480 --> 01:05:25,430
a lot of early career researchers now are on short term contracts and you're working

699
01:05:25,430 --> 01:05:31,670
crazy hours and you're not feeling like you have the same appreciation of your employer,

700
01:05:32,270 --> 01:05:35,929
you know? And that did shift me a bit. At first I thought, okay,

701
01:05:35,930 --> 01:05:38,930
I need to find a job like in academia where I have a little more time off at least

702
01:05:38,930 --> 01:05:42,980
so I can charge because they don't give that to you places like Washington, D.C. in policy work.

703
01:05:44,180 --> 01:05:46,790
I think now, believe it or not, this is probably impacting them.

704
01:05:46,790 --> 01:05:52,010
Now, the history department represents represent representative for the UCU, the university in college union.

705
01:05:52,790 --> 01:05:55,939
And so I do think that it wasn't a strike date. No, today wasn't it?

706
01:05:55,940 --> 01:05:58,940
Wasn't it was Wednesday, you know, and last week.

707
01:05:59,390 --> 01:06:02,959
So we picketed I kind of supervised the picket outside of the history faculty.

708
01:06:02,960 --> 01:06:13,310
I don't know that I did myself any favours with the administration there, but I think that it does make you more acutely aware of some people that are

709
01:06:13,310 --> 01:06:16,879
more marginalised in the world and there's lots of layers of marginalisation.

710
01:06:16,880 --> 01:06:21,980
So I would say I'm not one of the most marginalised people in the world, but early researchers in general hardly make enough to get by on.

711
01:06:21,980 --> 01:06:25,700
In Oxford and in Washington, D.C., you know, you feel abused.

712
01:06:25,700 --> 01:06:31,489
It's one thing if you're working for an organisation and you have an indefinite contract and you have crazy long hours.

713
01:06:31,490 --> 01:06:35,479
But as a woman in STEM, you know, in science, technology, engineering and medicine,

714
01:06:35,480 --> 01:06:38,570
I actually had to I wrote a letter to them when I left the academies.

715
01:06:38,570 --> 01:06:43,129
They're saying like, this was not okay to treat women in STEM this way.

716
01:06:43,130 --> 01:06:47,300
You know, you say you're promoting people. I mean, you're promoting women in these fields.

717
01:06:47,300 --> 01:06:52,640
But in reality, you know, if people can't even have basic mental health services and you're told to go on headspace,

718
01:06:52,910 --> 01:06:55,459
you know, if you're stressed, that's not adequate.

719
01:06:55,460 --> 01:07:01,070
And I think I have become much more wanting to recognise that, whether it's Dphil students, early Kirby Searcher, support staff,

720
01:07:01,070 --> 01:07:06,379
administrators, I mean, so many people have been squeezed so much and I think COVID made that worse in a lot of circumstances.

721
01:07:06,380 --> 01:07:13,100
And I don't think it's abated, you know, and I think work from home can blend the home and life a lot more remote work.

722
01:07:13,760 --> 01:07:26,720
So I think I'm still recovering personally from the stress of I just the COVID lifestyle and just again my work kind of blending in and I have become,

723
01:07:27,170 --> 01:07:27,590
you know,

724
01:07:27,590 --> 01:07:34,610
and even just seeing, you know, the lack of vaccine access and how lucky I was to get a vaccine early knowing that I had good insurance in the States.

725
01:07:34,610 --> 01:07:39,230
And if I had gotten long COVID, I would be able to have some kind of care.

726
01:07:39,890 --> 01:07:44,150
My brother was not on as good of insurance at the time and that complicated his decision to seek care.

727
01:07:44,150 --> 01:07:49,040
So observing a lot of this definitely does change your perspective and it changes your career path.

728
01:07:49,210 --> 01:07:49,420
A bit.

729
01:07:49,480 --> 01:07:57,730
You know, I definitely want to pick a career where I feel like I can have access to a bit of time off and where you can try to do very ethical work,

730
01:07:57,730 --> 01:08:01,570
policy oriented work, but also take care of yourself because so many of us weren't doing that.

731
01:08:02,740 --> 01:08:11,050
So I guess in your life you do think about your priorities that way a bit and think about, you know, your position ality within global health.

732
01:08:11,740 --> 01:08:15,950
So the idea is that definitely I'm kind of in a not a crisis mode right now,

733
01:08:16,050 --> 01:08:23,140
but definitely more in tune with with what I want to get out of life this way and what pathways I can use to support others too.

734
01:08:23,140 --> 01:08:28,030
And and kind of again, how to protect the common man, how to protect, you know,

735
01:08:28,030 --> 01:08:34,900
social services and stuff that were just so lacking for a lot of people, including me, but not nearly as much for me as a lot of other people.

736
01:08:36,250 --> 01:08:38,650
Great. Thanks very much. Of course.