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.
Thanks very much. And without telling me every stage in your life history,
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?
Sure. Yeah. So I, I think I'm the definition of an unintentional interdisciplinary researcher.
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.
I took some alternative medical history classes that gave me lots of ideas, you know, about the medical marketplace and this sort of thing.
So I actually did my bachelors in both History of Science and in Biology,
and I did bench work at the time, and I was that at University of Wisconsin-Madison.
So after that, I went straight into a Ph.D. program, which I hated that was in bench work.
So infectious disease and parasitology, so very immunological.
And I like the theory of immunology and I realised I just was not meant to to spend my life at the research bench.
So I actually left there with a master's in epidemiology and then I taught high school
for a little while and I then taught in Bangladesh public health for for a year.
And then I went back and got a master's in history of medicine at Newcastle University.
So I got Wellcome Trust funding. I'd never been to the UK before and that was back in 2011 and I finished there.
I really enjoyed it, but I also thought I didn't really want a doctorate in history.
I wanted something a little more policy applied and I was doing quite earlier history like earlier 20th century history at the time.
And then I moved back and I did some work in global health programme management for a while.
So I worked at the American Society for Microbiology in D.C. doing a lot of kind of biosafety and global health security work,
especially in India and Egypt. And then I decided I missed academia.
So I went to the University of Edinburgh on a Wellcome Trust fellowship there and with Debbie Sri Task Group in Global Health Governance.
So we were looking at the influence of the World Bank and global health.
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.
I was looking at the kind of anchor to crisis control program.
So 1970s, eighties, nineties, two twins developments in the world banks infectious disease control program.
That's a parasitic parasitic disease. Yes. And neglected tropical disease that impacts your eyes, causes blindness.
So there's a lot of links to economics and the idea that you could develop Africa this way by controlling a
disease and really the banks investment in health ideology kind of tracking the spread of that since the 1970s.
And so I finished my Ph.D. in 2020.
And while I was finishing because my scholarship ended, I moved back to the States and I took a job in global health security.
So at the Henry Jackson Foundation, where we were doing training for field hospitals, particularly in Uganda and Senegal.
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.
But I managed I defended my Ph.D. right after COVID hit.
I think I was the first person at the University of Edinburgh to have to do a zoom viva.
So that wasn't great timing, but I finished. And then later that year I started working at the National Academy of Sciences and
Medicine in D.C. and I was working on a as a study director for a COVID project.
There kind of lessons learned from COVID for pandemic influenza vaccination.
So a very global governance and coordination study. And while I was finishing that kind of a theme, taking on too much work,
I was a visiting professor at the University of Iowa teaching global health, ethics and politics.
And then I accepted this position here, wanting to kind of segway back into academia.
And I started in January of 2022, so about a year ago now as the Cop Cove trial historian.
So looking at a clinical trial run by the University of Oxford in collaboration with Mahidol University in Thailand.
So that's that's a long kind of description. Good.
That's a great summary. But we're going to go into that in much, much more detail.
So but let me just jump back for a minute because I'm asking everybody this question.
Can you remember when you first heard that there was a pandemic in the offing?
And how soon was it before you realised that actually with your background,
this was something that you could take an either a policy or an academic interest in?
That's a good question. I actually remember the moment that I saw this I was in.
Uganda doing a field hospital training in Jinja, Uganda.
And I was there with a bunch of US military doctors and we were sitting at the hotel bar in an evening.
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.
And to be honest at the moment, kind of like, oh, you know, this stuff happens.
I, you know, you're familiar with coronaviruses, you know, birds and stuff as a corona virus,
but things like murders never really materialised into something that at least impacted, you know, the United States and stuff as much.
And SaaS was before my time, you know, I was a child, you know, when that was happening.
So I guess I kind of thought, oh, interesting.
I'm sure Debbie, my former supervisor, will write about this, but I didn't see it, you know, at the time.
I guess this was probably in January of 2020.
I didn't see it as being some, you know, obviously massive years long pandemic.
I would suppose it was a little bit later that that spring I was then back in Senegal when everything got shut down.
And that's when it really hit me that, oh, this, this is going to get bad.
And I remember talking with some epidemiologists in Senegal because we were there for a training and they were like,
oh, why are people even wearing masks? Because, you know, clearly they're not N-95 masks.
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.
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.
And I remember thinking like, oh, you know, what are you doing? This doesn't seem necessary.
And I guess, yeah. So that's early March 2020 I think is when you really realised it would be a problem.
At the time I wasn't entirely sure how I could help.
I was working at the job again that was doing field hospital stuff within within Uganda and Senegal.
So I had a feeling we would integrate this in. We were doing some infection prevention and control training,
but it turns out that actually wasn't the best venue for integrating in COVID training
because we we were used to going there in person and we tried to do some trainings in,
you know, by Zoom early on within Africa. And we had a lot of challenges in terms of just Internet access and stuff.
So that particular program, I would say, probably was not the solution, you know, early on for engaging in COVID control.
Yeah. Yeah. And so your your your job here that you started at the beginning of 2022, how did that come to be?
I mean, I think what I'm interested in getting at as we as we as our discussion continues,
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.
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?
Well, that's an interesting question.
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.
Actually, my understanding is that Professor Nic White, who is one of the clinical directors at the Mahidol University in the Meru in Thailand,
they basically they started this type of program very early on in the pandemic.
And because which I'm sure we'll get into the the clinical trial of hydroxychloroquine hit a lot of political issues.
They actually had a bit of funding remaining within their Wellcome Trust grant for the trial,
and they were expecting to recruit a lot more participants.
And so it was actually initially their idea that I believe and I don't want to speak for Nick White and Will Schelling,
but my understanding is they actually contacted Mark Harrison here at Oxford thinking,
you know, we need to have more collaboration with the humanities history.
I mean,
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.
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
sources and ethics that I think historians often kind of push themselves away from it a little bit.
And so in this case, to an extent, I think it was because Mark Harrison was involved in Oh,
I'm forgetting the name of the group right now, but the advisory group for the UK around COVID and science.
And I think because they knew he was involved in this and he was interested
in contemporary issues and the link between history and infectious diseases,
they contacted him and that's how we move forward. And there was an advertisement put out, which I responded to,
because I've been in this realm for a while of thinking we need to have more historians who
are doing modern history and have one foot in global health policy and one foot in history.
And I think the idea is you want to have people that are trained to try to avoid like the lessons learned approach.
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?
How do we use history? Well, we go back and we look at the Spanish flu or something,
and we look out for a couple of tangible lessons learned to apply to this particular epidemic.
And it very rarely works like that.
And so I think more dialogue can try to prevent that approach and not remove not remove historical stuff from its context.
And I think that's the power of doing a modern history is, you know,
you can do the oral histories with everybody who was involved in the trial and you can kind of promote that side of history.
But I will admit that some days I wonder if I'm a historian.
You know, you have a bit of an identity crisis. Am I a story and am I a political scientist?
Am I a governance person? I suppose in the end it doesn't matter that much.
I mean, you're doing your research and you're telling a story and you're looking for themes which most approaches do.
But I did. It's a rounded kind of way of answering your question.
In short, it was not me that made the decision initially to advertise the position, but I think it was a great idea,
and I think it's some people thinking innovatively about how to document best
document and use historical skills and things like oral histories to to provide,
you know, ideas for the future and how to address pandemics. Right.
So let's now just give a quick introduction to the topic of trial itself.
So what was the background and what was it setting out to do?
So Amaru in Thailand, the Mahidol Oxford Research Unit.
Yes, within Thai, within Bangkok, there's a series of I believe they go back to the 1970s, most of them,
they have basically a collaboration, a field network with a number of South Asia sites, and this is one of them.
So there's one in Hanoi, etc. And then and there's one in Cambodia and there's one in in Bangkok downtown.
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.
There's a lot of conversation, I should say. I've had multiple people talk about Oxford or Old Boys Club.
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.
And so people like Nick Whyte have a long standing relationship with people like Peter Horby,
who did the recovery trial, and people like Jeremy Farrar,
who now heads the Wellcome Trust, but formerly like Peter Horby, was based in part of the south east kind of Oxford network.
And so they actually have a lot of discussions among themselves as early as late January and early February of 2020.
So quite early in the pandemic where they're talking among themselves, what kind of drugs could we repurpose?
And one of the first drugs, as I understand it, that comes up is hydroxychloroquine.
And that's partly because more so in Bangkok, they have years of experience in working with hydroxychloroquine for malaria.
They have a malaria research centre there.
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.
This is way before we knew M RNA technology would work for this.
If we get vaccines, it's still not going to roll out quickly. We'll still have issues with equity like we saw.
And so if we can repurpose a generic drug, something that's inexpensive, it's easy to produce, this could really save lives.
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.
We do have networks in Southeast Asia. They've done trials in Africa in the past for other drugs out of Meru.
And so it's thinking, you know, we can apply the skills.
And and it's also, again, using this old boys network in a sense, in a positive way of contacting people like Jeremy Farrar,
who is the head of the Wellcome Trust, who was putting out grants for these kind of clinical trials.
And so from that perspective, it kind of falls into place pretty quickly.
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.
And they're already trying to get funding and they're already contacting their networks.
They're looking for how you could produce this generic drug, hydroxychloroquine or chloroquine,
which is very similar within Thailand and within the UK, and they move forward quite quickly.
So the recovery trial was looking at hydroxychloroquine and a number of other repurposed drugs in hospital patients,
but the design of the trial was rather different. Yes, it's a prophylaxis, so I should have mentioned that.
So the difference is that they are looking at giving it to health care workers.
So people on the front lines again before they're getting vaccines for any.
Things available like that as a prophylaxis, though, is something to take before they're exposed to COVID,
something that might prevent them from actually developing either developing any kind of viremia so any
getting infected or more likely preventing them from having an infection that has bad force symptoms.
Severe, severe symptoms, exactly. So those were the endpoints.
I think the most important endpoint, as I understand it, was severe COVID and preventing preventing that and hospitalisation and death, obviously.
So it is different from the recovery trial and they often kind of get tied together that way.
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,
you have the exposure window and then you have the early viral replication within patients bodies and then you have the later effects basically.
And so you kind of want to see them as different.
Windows and Recovery is looking specifically at that post infection later window when people have already become ill.
So and how were they looking to recruit and how widely were they looking to recruit health care workers into the trial?
So early on, they were hoping to get 30000 to 40000 recruits.
And this actually could have been very possible. They they were looking to go into the United Kingdom.
They were really looking at sites like in Italy. Italy had really early COVID cases.
And so this would have been a great potential venue.
They hit some kinks partly due to Brexit, perhaps risk aversion within Oxford and their ability to actually recruit within Europe.
And they were looking to go into Southeast Asia, a number of different countries India, Bangladesh, Pakistan.
They had contacts there, places like Vietnam. They were looking to go into Latin America.
That was a little harder because a lot of clinical trials is about your network and
more itself had not previously done clinical trial research within Latin America.
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,
you think there's some formula of exactly how you reach out to patients. But it's not, as I understand, usually that simple.
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.
They did have some people when the trial got registered with the registry, clinicaltrials.gov,
some people reached out directly to them asking if they could be involved.
They had certain criteria. You know, you can't just have five patients for a prophylaxis trial from a single hospital.
So if you had a very small like nurse and doctor staff, that wouldn't be a good cause for a prophylaxis trial.
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.
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
trial where people are already sick because a lot of people will never get COVID within within your cohort.
So from that perspective, this is why they wanted 30 to 40000 people and this is why they were trying to
geographically expand because you just didn't know where COVID would come next.
You can't say, oh, we're going to go into law.
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.
And at that point, you know, ethics, bodies and universities or wherever you're trying to run the study,
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.
And so so basically, yeah, no obvious formula but a lot of contact network, then a ton of work goes into contacting people.
I mean the number of just I get a small number of the emails that people share with me and you just
see how hard it is because for each site you have to go to the ethics and regulatory authorities,
you have to get insurance.
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.
And then, you know, you don't know how many cases you'll get or how progressed the COVID will be in the country,
or whether you'll be able to get the material transfer agreements to get the samples out in the end.
So in the end, they ended up recruiting just under 5000 people out of the 30 to 40000,
which actually is still a very large trial as they go during COVID.
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.
But in fact, the it wasn't simple at all.
It was much more complicated because, as you say,
if the the need to be constantly chasing waves of the disease in order to see whether it was effective or not.
Yes. And also presumably and I mean, this, I think is something that's come up elsewhere.
I mean, hydroxychloroquine. Sorry, I shouldn't tell you. In the meantime, hydroxychloroquine had quite a high profile.
So there was yes, it was it was available anyway.
And this is something I'm trying to unpack. To what extent does politics impact the ability to run a trial like this?
And this is a very good trial to look at this for, because in March 2020,
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.
He's hit a lot of legal problems and stuff in France due to his clinical trial designs,
or sometimes not observational trial designs and perhaps to an extent, fabricated data.
There have been allegations of this at least.
And so basically you have this idea, can you trust randomised controlled trials at all that's coming up during COVID,
but then you also specifically for hydroxychloroquine,
you have the idea that this is a miracle cure that's being put forward, especially starting in mid-March 2020,
and that it's unethical to wait for clinical trials and results before just doling it out widely.
And so actually you have people like Modi in India, the president,
who puts a halt on some of the export of their generic active pharmaceutical
ingredients or hydroxychloroquine drugs because they want to keep it for themselves.
At the time, there's there's really no clinical trial evidence pointing to whether it would be effective or not.
I mean, we know it has a pretty strong safety profile at certain doses for things like from rheumatoid arthritis and from malaria.
But you didn't know how it would interact other than limited in vitro studies, which are very different than human studies.
And so yeah, starting in March, just things get crazy that way.
I mean, Bolsonaro and Trump are tweeting about it. Certain countries are trying to hoard it.
There were some issues in Australia, I believe as well, with trying to have certain politicians and others talking about hoarding Australian drug.
And this really did impact the trial.
I think I recently put in a Freedom of Information request for the MHRA, so the Medical Health Regulatory Agency of the UK.
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.
And it was interesting that basically with all of these politics around hydroxychloroquine,
a group published in The Lancet in it came out on May 22nd,
2020, a paper purporting to use a big observational study of thousands of hospitals worldwide.
I guess actually, I think it was hundreds of hospitals worldwide, thousands of patients saying that hydroxychloroquine has links to cardiotoxicity.
So heart symptoms from this you had a big ripple effect and this directly impacted the clinical trial.
So very poor timing literally that day on the 21st when the Medical Health Regulatory Agency got information about this paper,
which was published in The Lancet by a big name researcher, this corporation called Sir Just a Harvard professor.
When this came out very quickly, we find literally that day the Medical Health Regulatory Agency was meeting and
they discussed this paper and they discussed halting hydroxychloroquine trials.
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.
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.
As I've understood from my own interviews. I don't think that you ever got momentum.
So it had been in Bournemouth. They had a couple of sites in Oxford as well.
They had a long waitlist actually.
A lot of people at Oxford in Nuffield Field here that were wanting to participate, starting again, you know, the 21st, 22nd.
And this is something I'm trying to unpack, like what happens behind the scenes at the MHRA?
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,
you can only have them work for X number of hours per request and you know,
trying to get emails to understand what's happening behind the scenes, what data do they actually have?
Are they being really risk averse or is there some data that they have that we don't know about?
Just finding this out is really hard. Like for me, they asked what what email, what days of emails do you want?
And it's like, I don't know, I don't I don't know what I can't see.
And so I'm trying to unpack what was happening because Recovery Trial was allowed to continue its hydroxychloroquine arm at the time.
But cough, cold and some other trials like the COVID on the Crown Coordination trial,
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
mixed up them had the Cambridge trial right that had a hydroxychloroquine arm so basically other trials beyond recovery within the UK.
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.
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,
the MHRA still didn't allow the trial to continue right away.
There were still about two weeks of hedging after that. I don't know still exactly what was going on.
The people running the trial of the trial were never able to be pointed to particular new evidence
other than this Lancet trial that was making them concerned about cardiovascular cardiotoxicity.
But it had a ripple effect.
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,
which the trial team would say is really not necessary from a medical perspective.
But you see this lingering idea that there's something about hydroxychloroquine that is dangerous,
that could cause cardiotoxicity, which has never, has never been demonstrated.
But those kind of irresponsible science, frankly, combined with politics, can create these ripple effects.
And Capcom saw that. And then around that, it was around the same time, around June,
I think that the recovery trial came out with the result that it was ineffective in severely ill patients.
Yes. Did that have an effect as well, do you think? I imagine so.
I mean, it's not something that I've seen documented specifically as I've talked with some of the country investigators for COV.
But I think it's part of this whole general distrust of hydroxychloroquine.
I mean, when so the MHRA is a stringent regulatory authority, which basically means that a lot with through regulatory reliance,
a lot of less well funded or newer regulatory agencies, particularly places like Africa,
Latin America, etc. Thailand to an extent will rely on the MHRA or the United States, FDA,
the Food and Drug Administration or Health Canada or Swiss authorities as stringent regulatory authorities.
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.
As a historian, I definitely am looking for references to specific, you know, MHRA or FDA decisions and their cascade effects.
I would say recovery doesn't help because a lot of people kind of subsume prophylaxis and
treatment and assume that that means that it wouldn't be as effective in prophylaxis,
but you actually would have expected it probably to be more effective as a prophylaxis.
So I think from that perspective, it's it's unfortunate timing, but also recovery was a very well-designed trial.
So I think people were very trustful of that result. And I think that was very good that they got that out so quickly.
Right, because you could focus on other things like dexamethasone and other steroids, etc., that might be more effective.
I think that the the thing that was more of I don't want to use the word deathblow,
but far more of a challenge for cov was the World Health Organisation's guidance that was released around,
I think, the end of March 2021 that really conflated treatment and prophylaxis and had a
strong recommendation against both for hydroxychloroquine that was much harder.
And you see some countries like the DRC, the Congo, that their regulatory authorities actually refused the trial because of that.
So the W.H.O. kind of that I think did have a strong effect.
And I think that that some of that recommendation was based on recovery.
And I'm not the best person to talk to about this.
But, you know, people like Nick Whyte and others, you know, we're trying to unpack the W.H.O. decisions as well.
Why do they release a strong recommendation against hydroxychloroquine on relatively limited evidence and one misquoted study and that still stands.
So they haven't adapted that even though couple of investigators did put out a letter of concern.
I'm trying to kind of poke in there and understand what was happening behind the scenes and the politics or bureaucracies,
etc., around guidance development. I think those are just two areas that are so understudied in global health,
governance and history are how guidance is produced at organisations particularly
like the W.H.O. and how guidance is produced at regulatory authorities.
And the big thing about studying them is you just have very little transparency support.
Again, you don't know what you don't know. And like looking at the World Health Organisation when you're trying to study
through their freedom of information kind of laws essentially and policies,
you don't have the right to any guidance committee deliberations.
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.
You know, with the MHRA, you do have the right to request it.
But again, when they have, you know, say, 20 hour caps on how long they can spend and you can only put.
In EverQuest every 60 days. That does limit your ability to gather information.
And and yet, as you say, the decisions made by these organisations can have an enormous global impact.
Absolutely. I've just been reading Big Pharma by then, Goldfinger, who's who's also here at Oxford,
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.
And these are longstanding issues. And I personally, as a researcher, I haven't seen a lot of shifts.
I mean, they were very kind to spend some time on the Freedom of Information request at the MHRA.
But when you think about it, you know, 20 hours every you know, of their work and how would you even define this?
You know, is it 20 hours of some intern or is it 20 hours of somebody who is very experienced,
who is on the cusp of trial and would know where to look for emails?
Yeah, it's I think it's an area that I hope more people talk about because right now, I mean,
the public and even nice guidelines and stuff like that in the UK you don't have a lot of rights to information.
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.
This is a generic this is not a patented drug any more hydroxychloroquine.
And you're still running into issues of transparency and wondering how decisions are made.
And you have bigwigs like Nick White who have some clout, much more than I would have it requesting things.
And they still don't have windows into how some decisions were made that impacted a lot of people and that perhaps wasted a
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,
if you could have run it quickly if you didn't have this political kind of influence,
if you did have Oxford willing to take a few more risks and approve trial insurance and other applications,
I mean, they wanted to have study results starting to come in after six months.
And instead it's just this week, as I understand,
that they're really getting some of the results from Cop Club and they're finally unblinding go to us.
He said they did manage to recruit 5000 people in India nearly.
Yes. And and did did was that enough were there enough cases in the communities in
which those health care workers lived for 5000 to be enough to get a result?
Time will tell. So. Right. So we don't know the result, you know.
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.
So the grant is the first time you've actually been. No, no.
I spent about six weeks there last spring, and I'll be going back for some more oral histories this spring.
But this is a very short trip, a very long way to go for five days.
But there's a two day meeting happening on the 15th and 16th of December in Thailand, and they're inviting the investigator.
So all of the different people that led or were involved with the different study sites internationally.
So they're bringing them all to Bangkok during the last few weeks of the grant.
So they have to do it by the end of this year and they're scrambling right now to finish, as I understand,
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.
But they stopped recruiting last fall.
So it's it's taken this long because the things like material transfer agreements, you have to to export the samples.
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.
So you have you have the samples you've collected, you've collected the dried blood,
you've collected the swabs that you can do PCR and stuff on to find out if people actually had the virus.
You have the information that they've recorded for each each participant about whether they had symptoms.
You think, okay, you know, can you do a couple of months? You'll get this analysed.
But the reality is when you're doing a study in so many different places,
you have to get material transfer agreements to actually legally get the samples from, say, Indonesia.
That's a very complicated country for this into Thailand.
And then you have to go through the process of having the lab analyse them and then you
have to go through the process of the statistician looking at all the evidence and data.
And so actually those material transfer agreements can add months on to the timeline,
which is why we're only just now getting is it vulture vulture research or vulture work where you you fly into another country,
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.
You have tightened up that procedures a lot on on that kind of thing.
The idea that overseas countries, particularly Western countries, can just go and blithely take blood samples from.
Yes. Populations. And and it's all the harder during like COVID when flights aren't running as much and stuff to you know,
there's some interesting stories there of trying to get drugs out of Australia and how complicated it was.
But yeah, I mean that's a good point about this vulture kind of concept.
When I was working at the National Academies last year, we talked a lot about the pandemic influenza preparedness program.
And so this was launched in 2011, and this was after some issues,
particularly around countries like Indonesia, wanting access and benefit systems which which is quite fair.
So basically there's the argument that, look, it's our property, our bio samples that we're collecting.
And if in the past, whether it's the W.H.O. or on behalf of wealthier countries,
have had through their global influenza surveillance network in their laboratories,
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.
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.
And so a lot of this does, as I understand it, quite date back to like 2008 and nine and influenza.
There were some inflection points.
And so you'll have like the pandemic influenza preparedness framework, they use material transfer agreements as part of this.
They've become much more widespread, as I understand, over the last 20 years.
But with them can be delays because if countries don't have a lot of regulatory capacities for issuing some of these import permits,
for instance, and export permits, you can have quite a long time.
And even just material transfer agreements, you imagine doing a pandemic, you think, okay, it's a form, right?
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.
But during pandemics, when flights aren't necessarily going and you're working with multiple countries,
getting a wet signature and transporting it between two different organisations can be really complicated.
And so sometimes that physical paper trails that are required for these can create real bottlenecks.
And this is something that I think a lot of regulatory authorities and the W.H.O.
hasn't quite come up with a system for dealing with these kind of delays.
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.
It's not this isn't part of, you know, making sure that we have protections for people.
Exactly. I mean, it's this is literally just bureaucratic delays sometimes that can create big problems.
And that's something I'm trying to document. I'll be talking, I think,
next week with some people about material transfer agreements and some of their experiences
and understanding where the bottlenecks were and whether they were really part of a necessary
ethics system or whether sometimes it's just steps for the sake of having steps to tick certain
boxes that can create huge problems when you're having a time crunch during a pandemic.
Because, again, you know, the argument is we don't know, right? I don't know.
Perhaps Will Schilling and Nick right now know whether they had enough numbers to get
the effect size that they needed to actually see a statistically significant result?
We don't know that yet. But if there was a statistically significant event,
ideally you would have found this out a year ago because at this point it could still be helpful for the future.
But there is a lot of disappointment that, you know, you had a trial that was thinking ahead,
wanting to start this in November 2020, and that because of politics, because of bureaucracies,
because of other risk aversion and insurance and material transfer agreements and all of these complications,
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.
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.
But along with that narrative, presumably you've got some major research questions that you're seeking to answer.
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,
you know, if I was going and putting in a proposal to do this, I would have to think of those at the start.
Yeah, for me it was kind of the reverse. I would said Study of history.
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.
And so I feel like I'm still really formulating the research questions.
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?
And I mean that that's a big one. What is the role of risk in making decisions about clinical trials and, you know,
both institutional kind of risk aversion perhaps, and also multilateral organisations.
How does politics impact clinical trials during pandemics?
You know, how can we tease out kind of the impact there?
How do you guidance kind of.
Bodies operate, particularly during times of pressure during pandemic.
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,
it really is starting to pinpoint more on how do the commercial determinants of
health and commercialism impact the modern conduct of global clinical trial?
So this is looking at things like the International Conference on Harmonisation,
which is mostly dating back to the mid 1990s and this particular trial.
You know, it's not having big pharma actors involved as much,
but they've been very involved in setting the infrastructure, setting the rules and norms in this sphere.
So it's kind of looking at how those play out and how they have played out during modern pandemics.
I'd say that's kind of my my most my widest question.
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?
Is this something that is intrinsic to running clinical trials internationally or where is it coming from and whose purposes is this serving?
And so it's kind of using Cape Cod as an example and the vantage point,
a window into these kind of complex forces that are often operating beneath the scenes.
And I think everybody kind of knows that they're there, but they're hard to locate and commercialisation is a big one.
Oh, well, tell me a bit more about your your methods. I mean, again, you've mentioned Freedom of Information request.
You mentioned oral history. And to talk me through that a little bit, yeah.
So, you know, nobody really trains you and as you would know, you know, for how to do this kind of modern history.
And, you know, I use oral histories, but they're a little less formal than your older history.
You know, I would use it as more of a semi-structured interview.
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.
He's a British physician who's really involved in pretty much all of the day to day work of Cobb.
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.
You know, you'll talk about everything from, you know, the role of shipping and logistics,
these worlds I never thought of world career and how they have a bit of a monopoly at
the World Health Organisation and other places now just in terms of shipping samples.
And so I would say mostly what I've done so far is have these targeted talks that will shape different.
I go into it thinking, okay, this is this person's background.
I know this was their role in the trial. What are some questions I have for them?
What are some themes I think we could explore? Maybe it's the commercial determinants of health, maybe it's material transfer agreements,
maybe it's their particular work in trying to recruit Guatemala, etc.
And then you just you talk like we're doing here, and I often ask for documents when I'm talking with them.
That's always dicey. I still haven't fully worked out, you know, confidentiality agreements around this.
You know, people are willing to share emails with me, obviously.
You know, often they were forwarded these emails. Sometimes at the bottom of these emails it says only intended for the original recipient.
And they landed in my inbox. So that's something I'm still working through.
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.
That's a horrible one because you can't export those.
So you just have to literally scroll through and see all the different meeting kind of chats that were happening during Cop Club.
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.
So I've worked through those. The big piece that is missing that is really hard to get is access to what's happening
for either the pharmaceutical companies or the contract research organisations.
So they try to partner with a CRO contract research organisation based in Florida called Bio Rossi,
which was going to potentially open up Ukraine and Russian sites for the trial.
And this is obviously pre, you know, war in Ukraine.
And so, you know, I've tried to contact some people from more of that world.
And that is hard. It's hard to have regulatory authorities.
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,
you know, insurance firms and stuff to have a reason for wanting to talk to you.
So that's a bit of an area that I struggled with, and the more I've read, the more you've seen.
Even researchers in the 1990s that were trying to do this, it's really, really hard to get that aspect.
So so far my oral histories have been mostly with, you know, professors and the like.
I've been talking with the World Health Organisation, African Secretariats Ever AFF, which is the vaccine forum.
So there are harmonisation initiative that we're helping with regulatory approvals and.
Ethics in the African continent. I've talked with people like that.
I've done oral histories with some of the site investigators, and I'm doing more of those.
And then again, a lot of the different staff, both locally and internationally,
the participants, trial participants, that is that is dicier because of ethics.
It's a two year project. And this is actually something that's come up when I talk with other people as well,
is to what extent do you want to go into the impact on communities and people's personal reflections?
I would say I would need a separate ethics process which could take a while to really talk more with participants.
It's something I've thought about, but I haven't done yet. It's also hard.
I mean, again, I don't have list of participants. I mean, they haven't given their consent to share this.
So I think it would be more likely to be able to talk with local staff members.
So on each site, for instance, in Thailand,
you'll have a group of nurses and physicians that we're actually going to be meeting with the patients, recruiting, collecting the data.
Those are people I would like to speak with in Thailand to understand their experience.
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.
And I'll have to get local ethical approval. So I am hoping to do that in the spring when I go back.
But there are layers of kind of protections for people involved in the trials that you do have to work through.
And I think it's a common issue in history. I mean, when you're on to your projects,
you want to talk to a wider group of people and often you end up talking to some of the more powerful people
within the program because that's who you have access to and then you have time limits and then the project ends.
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.
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,
which is looking more at specific sites.
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.
Yeah, I mean, kind of oral history compilation Freedom of Information requests and a lot of interviews with stakeholders involved at multiple levels.
I am. How many people do you think you have talked to so far?
So far, oh, maybe about 30 people and but multiple times.
So but some of them, especially the core group multiple times.
And so I do need to expand out a little bit more geographically,
and I am hoping to spend some time in Geneva to talk to the people involved, the W.H.O. guidance,
and also talk to people involved in sample shipping and perhaps something called the Magic Ecosystem Foundation,
which is kind of this relatively obscure player that is in what, the Magic Ecosystem Foundation.
Yet I see it's making great. The irresistible choice is what it stands for.
Magic. It's basically great is this way of setting guidelines.
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,
places like the World Health Organisation. So I'm wanting to talk to them about some of their methodologies,
about how they actually what evidence goes into and what people go into forming recommendations at the dose.
And sometimes they are even if they're evidence based, they politics can enter.
So I'm trying to go there and unpack this a little further and then I'm hoping to go to Indonesia
and potentially a couple of the actual sites to talk with more local investigators in the spring.
So that's the trajectory. But I'm one year into the project now, so I only have a year left.
And as a postdoc you always have all these things on your mind in terms of, you know, getting out your publications.
And I'm hoping to do a book proposal for this to to release in the spring.
But you do have to move pretty quickly with actively moving pieces, which makes it even harder.
You know, you're moving quickly when you don't even have the trial results yet.
And when they're having active meetings each week that you should be thinking about meeting minutes for.
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.
Yeah, thinking about sources, you know, more than traditionally you'd have archive sources,
which clearly you can't use for this kind of project because most of them are ten plus year access requirements.
So, you know, the, you know, 15 or 20 years, you can only see things that are 15 or 20 years old.
So archives, traditional archives are kind of out. You can create your own archives.
Again, we talked about the ethics of that.
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,
you know, like they have with the African Vaccine Forum and some of the regulators,
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.
That can be a source as you learn about what's happening with harmonisation around regulatory.
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.
And frankly, it gets overwhelming because anything can be a source.
You know, when I did, you know, I used to study the Spanish influenza pandemic.
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.
There's no more photos here, and maybe somebody has them in their attic somewhere.
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.
You could always be on PubMed or you could be on Scopus, so you could be reading the newest blog.
There's so many reports coming out, having worked at the National Academies, they have new reports coming out on COVID.
There's so many advisory groups, the Wellcome Trust, the Lancet commissions, and you can't read it all.
But so many of the themes that you're looking at, it would be really valuable if you could.
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.
Because the sources, I mean, they're just exponential. So you use the phrase bird's eye view.
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,
that people like Nic White will know a lot of it,
but you will certainly end up being the only person who has got this complete perspective on the on the whole thing.
And that's I mean, presumably that's the value of having a historian do that, that you can take that step back.
Yeah. And try to see how the whole machine fits together.
And so what do you what do you hope in a perfect world, what do you hope will come out of this?
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.
It's the case study is of how the trial has functioned.
Not it's not about whether hydroxychloroquine turns out to be a good prophylaxis for COVID or not.
Now that that's a really interesting question. I ask myself this sometimes too.
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
talked about how people haven't really studied the clinical trial as an object.
And I think from an anthropological view, because a lot of what I do in the end,
there's a fine line between medical anthropology and history and political science, political economy.
I guess I'm hoping and I haven't gotten here yet, but I have a year.
You know, I'm hoping to really look more critically at what we mean by bureaucracy, like even speaking with Will Schilling lately,
he was telling me he and Nick White were even talking about they've used the word bureaucracy with me a lot,
this horrible bureaucracy of clinical trials. So what does that actually mean?
What are ways of looking at bureaucracy and what are some ways of looking at risk?
And I think that's the advantage.
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.
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.
And I'm not a medical professional, but I do think I have the flexibility of having some time, like you said,
to think more strategically about like, how do we locate bureaucracy in the system we're throwing around this word.
What does it mean in terms of clinical trials? Where does it come from?
Whose interest is it promoting? And I think that's what I mean about looking at the clinical trial as an object.
And again, I don't have the answers yet,
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.
I mean, people really haven't studied much about contract research organisations.
How do they actually influence what happens to a trial during a pandemic?
And if you can document some of this, you know you're not going to solve all the world's problems.
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.
But I think you can say something about some of the bigger forces and how they play out during these acute kind of times.
And hopefully the audience would actually probably not be as much historians as much as I'm hoping
policymakers will read some of this and and and see that there are things that need to change.
And, you know, I'm not going to be the person that says exactly what they need to be.
But I think by showing the consequences during a trial of some of these wider ideas of bureaucracy and risk aversion,
hopefully that that can provide the small evidence piece that can be used to to reformulate some of these approaches.
So I think there is a lot of momentum behind trying to reformulate.
I mean, sometimes money doesn't follow, but I do think there is a window.
You know, there's a lot of talk about adaptive clinical trials and ways for the future.
And hopefully this sheds light particularly on multi-country clinical trials.
Because what you need for a clinical. Trial.
When you're working within Africa and Asia and you have a single trial that's operating in multiple countries,
might be very different than saying, oh, the recovery trial, this model works.
You know, Recovery International's had a lot of problems, as I understand,
similar to COV with what happens when you try to almost outsource this model,
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?
It might work really well when you're in a single country like on the NHS,
but maybe we need to have pause before trying to write that large and use it as the model internationally.
So I hope it can be a bit of a piece of that evidence base that policymakers can use
when they're thinking about how to design clinical trials and how to harmonise them,
and what's perhaps less successful, what could be revisions.
And hopefully, you know, like Ben Gold Diggers Work, you know, he really harps on transparency, transparency and transparency.
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.
And perhaps this can kind of contribute a little there.
And for you personally, I mean, COVID has been a horrible thing for the world.
But I mean, do you acknowledge that for you,
it's it's actually taken you in a new direction in your in your career and give you interesting things to think about?
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.
Now I've really gone off the deep end that way. Yes.
I think that I don't know that I'll continue to work on COVID era projects in the future,
but I think it definitely it's put the spotlight on global health.
And I think that, you know, global health has always struggled to attract a lot of funding.
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.
And clearly that did not materialise, you know, on the ground.
And so I do think, like, absolutely, you know, you're seeing a lot of calls about democratising and decolonising global health
and position ality within global health and ethics of vaccine distribution.
It doesn't mean things are going to change really quickly, but I do think there is a bit more world spotlight on it.
There probably is. The more funding that comes, I mean, look like the Pandemic Science Institute and stuff is launched.
So that is not I mean, this is partly because there is momentum here.
So I do think from a career perspective, as an early career researcher, you know, I will probably stay in pandemic preparedness.
I was a bit there before, but I think, you know, there are there will be a lot of opportunities to contribute that way.
These are not going away. I mean, you look at climate change. I mean, pandemics are here to stay.
And I think it's I hope to continue working on kind of the interface of history and policy,
whether it's in academia or it's back in global health, kind of program management and policy.
So I do think there's a lot of terrain for people with social sciences, skill sets and stuff for having policy recommendations.
So basically the short answer is yes.
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,
although I was sort of getting there previously as well.
So but like at the National Academies in the project that I'm doing, yeah, these wouldn't exist,
the particular studies and they would not have had the funding they had without COVID.
Yeah. So I usually ask a few questions about the the impact of the pandemic itself on you, on you personally.
So I mean in the UK everybody talks about 23rd March 2020 when the lockdown happened.
But you would you were in the US. I was.
And did you have lockdowns. I mean what did how did it. Oh yes.
So no, not the same way as the UK. So my sister was over here and I felt horrible for her.
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,
you know, and it was nothing quite as awful as that, although maybe it should have been.
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.
I mean, we had mask mandates in Washington, D.C. You know, you'd wear a mask when you went out.
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,
you know, touching the handrail and stuff in your house. Yeah, you just felt so isolated.
I mean, it I was and I was working 100 hour weeks at my old job.
I mean, frankly, it was it was pretty awful. I've never been that stressed out, you know, working on it.
Consensus study at the National Academies on COVID, you kind of get thrown into it.
Yeah. Yeah. So I was I was working insane hours, not really going outside much.
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.
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.
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.
You felt like you needed to COVID test before seeing people.
And in the States, you know, tests were not very available and they were expensive.
I mean, just getting to that test was $22 and then they sold out.
So I remember calling a bunch of our CDs, which is, you know, like boots calling a bunch of them, like, you know.
Do you have any? Oh, no, we have. We released them 2 hours ago and people had just come and bought them all.
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?
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.
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.
And we, of course, hadn't done that. She got it. She gave it to my brother before vaccines were out.
My brother got long COVID, and he still has that. So, you know, there are just a lot of stressors, you know,
between work and trying to be responsible when the when the US wasn't really mandating
it and probably getting a little resentful of people who weren't being responsible,
feeling like you're spreading this around and we could all just enjoy our lives more sooner.
And then I was quite lucky though I got vaccinated pretty early because my mom,
I got it through my mom's work and that's kind of how you had to do it.
I was like her plus one. They had an extra dose one day and I remember driving down there to make it in
time because my mom was so paranoid I'd get COVID after giving it to my brother,
so she felt horrible. So the short answer is, yeah, it was.
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,
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.
And it just didn't end, you know, and it still hasn't ended.
You know, we're still well, I mean, when you arrived back here in 2020 this year,
there was a we were in the middle of a wave at that point when we we were.
Yes. And yeah, we were still wearing masks around here.
And it wasn't the warmest welcome to Oxford.
Not anyone's fault, but you know, you arrive and I arrive with my cats exhausted, you know, from the from the States.
And it was during Comic-Con when I came.
So actually even just moving here, I almost got stuck in France because of travel restrictions I was flying through and the stressors of,
you know, getting, you know, there's so many regulations for international travel.
And in the States last Christmas it was almost impossible to find PCR tests for travel.
And so I ended up having to pay something like $200 for antigen tests,
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.
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.
And so, I mean, it was just a marathon, just moving for a job to see, you know, exactly, exactly.
You don't know how much that really helped and now it's just kind of gone away.
And they decided, I guess, that that's just not something they want to do anymore.
So I just went to Germany this week and, you know, no restrictions anymore.
They don't even ask for your your COVID passport or your vaccine test anymore.
So things have changed very quickly the last few months. And did you I mean, did you yourself feel threatened?
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?
I think I felt a lot more anxious after my brother got long COVID.
I will admit, being a younger person, I mean,
and somebody who's never been particularly susceptible in the past to respiratory infections for whatever reason,
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.
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.
I'm younger, I'm healthy, I probably be fine.
I almost they actually got diagnosed on Christmas Eve the night before my mom's 60th birthday two years ago.
So it was not great timing and they were waiting for their tests because they both felt a little sick.
And I almost went over for Christmas because like, I don't want to spend Christmas alone, you know?
And so I guess you can see I wasn't as worried as I should have been at that moment.
Even as a public health person, I thought I'd probably be fine, but I was very glad in the end.
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,
who was only 30 at the time, get long COVID and not be able to work full time for a while.
And just the symptoms he had, you know, he's a runner and not being able to exercise.
And he went to the doctor finally and having some cardiac symptoms and having, you know, some pulmonary symptoms.
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.
That instilled quite a bit more fear at the time.
But then, you know, now I guess you just start thinking, I, I don't think I've had it yet.
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.
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.
And at least now I've been vaccinated and boosted once. Maybe that'll help a bit.
But yeah, I, I was never particularly worried about dying, let's put it that way.
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.
Yeah. So I think finally we've covered a lot.
Has your experience of living and and working through and in association with this pandemic changed anything
about your attitude or your approach to your work or your life attitude or approach to my work or life,
um, working that long hours during a pandemic and feeling, you know,
a lot of early career researchers now are on short term contracts and you're working
crazy hours and you're not feeling like you have the same appreciation of your employer,
you know? And that did shift me a bit. At first I thought, okay,
I need to find a job like in academia where I have a little more time off at least
so I can charge because they don't give that to you places like Washington, D.C. in policy work.
I think now, believe it or not, this is probably impacting them.
Now, the history department represents represent representative for the UCU, the university in college union.
And so I do think that it wasn't a strike date. No, today wasn't it?
Wasn't it was Wednesday, you know, and last week.
So we picketed I kind of supervised the picket outside of the history faculty.
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
more marginalised in the world and there's lots of layers of marginalisation.
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.
In Oxford and in Washington, D.C., you know, you feel abused.
It's one thing if you're working for an organisation and you have an indefinite contract and you have crazy long hours.
But as a woman in STEM, you know, in science, technology, engineering and medicine,
I actually had to I wrote a letter to them when I left the academies.
They're saying like, this was not okay to treat women in STEM this way.
You know, you say you're promoting people. I mean, you're promoting women in these fields.
But in reality, you know, if people can't even have basic mental health services and you're told to go on headspace,
you know, if you're stressed, that's not adequate.
And I think I have become much more wanting to recognise that, whether it's Dphil students, early Kirby Searcher, support staff,
administrators, I mean, so many people have been squeezed so much and I think COVID made that worse in a lot of circumstances.
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.
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,
you know,
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.
And if I had gotten long COVID, I would be able to have some kind of care.
My brother was not on as good of insurance at the time and that complicated his decision to seek care.
So observing a lot of this definitely does change your perspective and it changes your career path.
A bit.
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,
policy oriented work, but also take care of yourself because so many of us weren't doing that.
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.
So the idea is that definitely I'm kind of in a not a crisis mode right now,
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.
And and kind of again, how to protect the common man, how to protect, you know,
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.
Great. Thanks very much. Of course.