Okay, So can you just start by saying your name and what your current position is and your association with Oxford University?
Thanks, Georgina. So I am Sheetal Prakash.
I am an associate professor in the Department of Statistical Sciences at the University of Cape Town in Cape Town, South Africa.
And I'm also the director of the Modelling and Simulation Hub Africa,
which is a disease modelling institute based in the Department of Statistical Sciences at City.
I've had a long running a relationship with Oxford University for the last ten years or so,
with many collaborations in disease modelling over the years,
working with colleagues from Oxford University and in projects that are led by Oxford University around the world supporting malaria modelling.
But more recently from 2017,
I've been appointed as an honorary Visiting Research Fellow in tropical Disease Modelling in the Nuffield Department of Medicine.
That's great. That's very comprehensive. Thank you. So without telling me your whole life story, but going back to the very beginning,
how did you first get interested in science becoming a becoming a research scientist?
So I was I have quite a varied background why I have always been good and good at maths and drawn to,
to to the subject of mathematics and the application of mathematics And one of the most well advertised
routes to apply your mathematics when you're in school is to follow a path of in the finance world.
And that's what I did. I my, my undergraduate degrees were in actuarial science and in quantitative finance and statistics,
but I was very bored in the field, not with the mathematics, but with the application of it.
I didn't find it attractive at all. And when I moved across to these statistics department to do a master's degree in operations research,
I came across a variety of other ways in which one could use maths to do problem solving
and which has which institution where you in at the time at University of Cape Town.
Yes. Yes. And we and at that point I came across a few publications on using disease,
using mathematical methods to manage disease, and that was very interesting.
And I was drawn into public health immediately. I also at the same time was whilst doing my masters,
was working at a health economics unit based at the School of Public Health and Family Medicine at University of Cape Town.
And that gave me my first foray into looking at the into working with public health data and having your work make an impact.
Very early on some of these statistics. The work I did in maternal health was referenced by the W.H.O. in forming guidelines and so on.
And so I got to got to understand that that even quantitative applications in health can make can make a difference.
And that's how I got drawn into data based evidence of evidence making in health.
Mm hmm. So can you give me an example? So, I mean, what what have you.
So malaria has been an area, a big area of interest of yours.
How is data science applied in trying to understand and grapple with the issue?
No. Let's start with another question first. How big a public health issue is malaria at the moment globally still, as a malaria is,
would you believe that malaria is curable and preventable for the last 4000 years or so?
But in the last year, we had 247 million cases worldwide.
Malaria is also not just a problem with morbidity that largely children die from it, but it's a mortality rather.
But it's also a great problem of morbidity in that it's a disease as linked to poverty and it makes one ill.
But you can't go to work and if you can't go to work, you can't earn a wage.
And if you can't earn a wage, there's a vicious cycle of poverty continues.
And so you find malaria is a massive global health problem.
And in the last ten or 12 years, or perhaps actually a bit longer now almost a year, a bit longer, 15 years or so,
we've had a global push of political will towards eliminating malaria from the world because it is preventable and treatable.
One feels like it should be an easy problem to solve. It most certainly isn't.
But because of all of this political will, countries are doing their best to try eliminate malaria.
And so all scientific hands are on board. And in order to support decision making to to achieve this goal.
And yes, I go back to my previous question how does data science and statistics contribute to that goal?
So it so it's not obvious actually. The you know, we have you have data that emerges from the management of malaria.
So malaria in many cases is in many countries is a what you call a notifiable disease.
So anyone who presents with a malaria case has to notify the government and records
are kept probing questions are asked the demographics of the person in question,
they travel patterns and so on are all are all recorded.
But then if we have to make decisions on the many tools that can be used to combat malaria and decrease malaria incidents in country,
it comes down to a question of how best can we spend the lot of money that we have or how, you know,
the resources are one thing, but but from a health perspective, what is the most impacting impacting interventions?
Should we be using bednets? Should we be trying out a certain drug?
Should we be increasing access to health care or improving improving surveillance systems?
These are all questions that we can use mathematics to solve,
and we do that by creating a simulation or a virtual reality of the malaria situation on the ground,
accounting for not just how malaria or malaria transmits from mosquito to human back to mosquito and so on.
But also the health system challenges that a country is faced with and the population behaviour and demographics and so on in the inner country.
So we basically build this whole world, this whole health system and world, all the malaria and on a computer.
And then we try out various interventions. We can ask ourselves if we want to increase bed net coverage, what would the impact on the cost of that be?
And we can do so in a fraction of the time it would take to implement a full clinical trial.
And so there are many savings that one can make by building simulations using mathematics.
And so through through the systems of of equations and computer code,
we are therefore able to generate many cost savings and support better scientific understanding of how malaria transmits.
And so that that enables us to be able to combat it from a more informed perspective.
So you say you've been saying we you yourself are based in South Africa, but there are I understand you're part of a global collaboration.
What what other parts of the world have you collaborated with and have you have you actually been based yourself elsewhere?
I've been based in South Africa for mostly patriotic reasons, but I've worked in the end.
The beauty of collaboration is that you do get to work all around the world.
So with my colleagues at also university and at other universities, we have done malaria investment cases for the 22 countries of the Asia Pacific,
for example, I have led and I've led investment cases in the Guyana Shield.
So the countries at the top of South America, for many countries in Africa, for many other groupings in Melanesia and so on.
So we've actually done a range of malaria investment cases and other disease and disease based work all all around, all around the world.
So in terms of a global consortium, when I say we, I was referring to models in in general, they are groups of malaria models.
They are individual malaria models, a network of Oxford modellers and myself and economists.
And modelling is very much a multidisciplinary field as and as you can understand it.
So we we often band together to perform these investment cases all around the world.
So I think we're moving towards COVID now.
So can you remember where you were when you first heard that there was something going on in China and how
soon you became aware that this was something that your skills were going to be needed to to address?
And it was almost immediately, oh, didn't take more than a week or two before the W.H.O. called me,
and they were assembling a task force of modellers around the world.
And I had previously met the head of the Global Emergency Response at the World Economic Forum in 2019, earlier that year in July.
And we became well acquainted. And so a late in December of 2019, when COVID was still SARS-CoV-2 to a so-called source ncov or something like that.
I should even remember the old name. It had it had an old name,
and it was still very much a zoonotic transmission from from from the wet markets and so
on that I was called up to be one of two Africans who were on the on that task force.
And it was a group of modernism around the world,
all this sort of learning coming together and just understanding what data was being collected on the ground, trying to make sense of it.
And it was still very much a European and an Asian problem at the time.
There was perhaps only one or two cases yet on the African continent did we imagine
that we would be a global pandemic to the extent that we have actually seen?
No, I think no at the time we do that, though, that was the time when you still thought it was by understanding the chain of transmission that,
yes, it would spread, but it wouldn't be quite so catastrophic with so many variants and so many iterations.
But that that was it was very soon that I was involved in Cobra back in December of 2019.
I was in South Africa at the at the time and in the first case arrived in South Africa.
And I say arrived because it was via international travel that the first
detected case was a was was picked up in South Africa on the 5th of March 2020.
At that point, I was also already alerted by my own government to be requested to develop models.
So modellers were among the first people to be to be called because this was exactly the time for when her skillset was was needed.
And my previous work in malaria actually with this African government was the reason that I was I was called on.
I didn't have to approach and showcase my skills to government.
Rather, it was a case of government calling me to say, Can you build us a COVID model?
And and you know, what is it going to take?
And so we started very early in in March with the first few cases.
Still only international no local trials for local transmission was not that yet, but we were already involved.
So what were you putting into your model If you had so few cases, what other factors were you able to build into your model?
So the scientific evolution of the model building and COVID, it's it really did change over time and it changed quite rapidly.
So stage one or stage zero, perhaps we can call it right at the very beginning, we have no local data,
so the best approach of modelling in the setting then is to see what data is available around the world and
then to call on local experts to translate that data as to what should be appropriate for your models.
So very soon in South Africa we established in SAM in March of 2020,
we established what we know as the South African COVID 19 Modelling Consortium, that is the CMC.
It was a group of modellers in-country and local scientific experts,
so local clinicians, public health specialists, virologists, intensivists and so on.
And so we would amass data like for example,
people with severe illness in the Netherlands were spending up to 23 days on average in hospital in an ICU bed.
Now we could put that information into our models and that would take up all our ICU resources very quickly in a
model to consume more resources very quickly for the simple reason that admissions all stay for long periods.
But in speaking to intensivists who are working on the ground in hospitals around the country, they would say that it is a practice.
In South Africa.
We have a much higher threshold of entry into into an ICU setting, and nobody will spend more than eight days in ICU because nobody can afford it.
Even medical aids will not afford it.
So therefore, we can't use 23 days as a reasonable estimate for South Africa, though it is in practice overseas, we will use 7 to 8.
And so we had this process of translation. Of the profiles.
And at that time, there was some some evidence coming from the W.H.O. commission in China to say there's no such thing as asymptomatic cases of COVID.
And then at the same time, there was conflicting evidence from a bunch of other sources to say that 80% of the Diamond Princess,
you might recall that that ship, 80% of the Diamond Princess cases were asymptomatic.
And also sitting basically with a piece of data that says how long is a piece of string?
And you've got to nail it. That. And as a as a model of Lee,
I made it very clear that that is not my responsibility to translate that I
need to I'm not the expert clinician who will know what that best practice is.
I will put it into the models.
So that is where the value of having a multidisciplinary team, like a full consortium with many scientific partners, became so useful.
So that was at the very beginning. Look at what data was emerging quite literally on a daily basis and and, and adapt your models.
And so it became important, number one, to be an experienced modeller.
You couldn't ask a novel, a novel model, a novice model, rather.
You couldn't ask a novice modeller to develop a model for your country with your population demographics on the go.
My colleagues at CMI de in in the United Kingdom had a model, you know,
a respiratory flu model that was in development for 20 years, and they could just, you know, adapt to COVID almost immediately.
In our case, in South Africa being an LMC, we don't have readymade models like that for the simple reason that we don't have
data for the population for 20 years having gone through apartheid and so on.
There isn't reliable data to enable such a model to be developed.
And so I, from my malaria days had a provincial, a model that as a subnational level already quite well developed,
that I could adapt very quickly within a within a few days to then be presenting and incorporating all of this new new information.
And so it became a process of adapting your models every few days in order to bring take into account new papers that
were being that were being generated and then adapting when those papers got retracted because they were errors,
because new information had come out and checking was done.
You know, you you learn quickly about how you that you had to rely on preprints, but you had to be aware,
you know, that that this was that this was grey literature and had not been through a peer review process,
but there was no time to wait for eight months for a peer review process to happen because, because the government needed answers immediately.
And were the government making policy decisions on the basis of your model, even as it was evolving?
Oh, absolutely. And that was that was one of the the the the key takeaways and one of the one of them one of the best parts, I think,
of being part of this modelling consortium, that, number one, it was commissioned by government and coordinated by government.
And so when government takes the first step, there is already that setting up that pathway to decision making,
almost that pipeline of scientific evidence to decision making.
And whilst a you may say, you know,
some governments may be angry that your your your model output keeps changing and your projections and your output will keep changing.
They themselves were aware of the changing situation and appreciated that we would update every single day.
We would update our models every single week and that things would in fact change.
I think they would have been more suspicious if it didn't.
And then the fact that it that it did at the same time, that we would we would put forward our caveats and our disclaimers,
because we also have to protect ourselves professionally as a scientist,
that we would have to say that if we we understand it is necessary at the end to
make a six month projection as to how the entire pandemic would would pan out.
And though you had, you know, only two weeks or three weeks of data in country, we understand that is not enough.
But a decision needs to be made because a tender, a procurement policy,
a a procurement set and a request for proposal needs to go out to purchase ventilators,
to purchase sufficient oxygen to commission hospital resource beds,
to be to be made field hospitals to be commissioned if they need to be to be built.
And these are all things that can be done on a on a two week basis.
They actually need to be long term decisions. And so we have to make those projections.
But put in all the disclaimers to say models are biased simplifications of reality.
They are based on the data that are that are used to inform them and the data are changing.
But we had but that's also where there's constant communication and in-person communication, or at least a virtual communication,
not just submitting a report but having meetings to do the model translation became vitally important.
And how did the the epidemic in within South Africa evolve, and was it different from what we saw here in the UK?
It was it was different. I think the UK and South Africa were among the first two places to detect almost simultaneously variants.
The first time we ever detected variants the UK had in December I think was 14 December or so, had announced the alpha variant.
By the 26th of December we had announced the beta variant, so a different one.
This is 2021, we're talking about the end of 2020 and 2020.
So that's what I mean. Yes, sorry, end of 2020. And so it's been in pandemic state for about a year now.
It's all it's all melded together. But yes, that was we that was the first, but different variants.
And then we had multiple waves it with different timing to the to the United Kingdom.
Our vaccines arrived quite a bit later than the United Kingdom as well.
For the again, I don't think it is any fault of a of of policy and so on.
Rather, we had received a shipment from the from the UK manufacturers of the AstraZeneca
vaccine in December ready to vaccinate our healthcare workers December 2020.
But the AstraZeneca vaccine at that very time,
the results came out of the clinical trial to show that it was simply not effective
against the beta variant whilst being effective against the alpha variant.
So we had a brand new shipment of vaccine that was literally not effective at all against the variant in South Africa
that had taken over and all infection the way the variants manifested because they were each time we got a new variant,
it was more,
it was more infectious, it transmitted with higher efficiency than the that the previous circulating variant or the wild type ancestral COVID,
as we as we knew it in wave one, wave one, that meant that there was a very quick takeover of the variant.
It dominated transmission very quickly. And so there was literally no point in rolling out any AstraZeneca vaccine.
It did a lot of harm to to to to public to public belief in in government and harm towards vaccine hesitancy as well.
But it was we had to wait for forever and another set of vaccines that would actually be effective.
And that came a few months later. So vaccine rollout was different between the United Kingdom and South Africa.
So the Africa was also because of our strength in genomic surveillance having.
Among the best capacity in the world also for genomic surveillance.
We were detecting variants a quite a lot, and so we detected the electron variant in December of 2020.
A Is it about December?
I think December of 2021 would have been a al-Muqrin being being detected,
and that was it was a first detected in South Africa, like Beta was first detected in South Africa.
And so we had in South Africa what was different to the UK,
I would say primarily even apart from vaccination, is that our waves were large, the Delta variant,
and in fact infected a very large number of the population that by the time Omicron had had passed through the country,
up to 80 to 90% of the country had been infected by COVID 19.
So would have had immunity or would it be zero positive for COVID 19 from infection rather than vaccination?
If it took vaccination into account, you would have had a seropositivity of around 97% of the country.
And that came from as on blood bank studies and a set of other studies.
So we were among the first countries in the world with a with almost a fully immunised population from natural infection.
And that. And how did that I mean, were your hospitals overwhelmed?
What was the rate of morbidity and mortality as high, relatively speaking, as it as it had been in the UK?
So two factors. What it would be would need to be taken into account.
One is we have a quite a bit younger population than the United Kingdom and severity
across all variants and ancestral COVID was always highest in the older population.
So from that perspective, the the the, the we had fewer age of, you know, age related, a lower age related mortality.
But but the health system and access to health care is also very different.
So from that perspective, when one looks at excess deaths compared to hospital reported deaths or excess deaths,
taking into account deaths that would have been attributable to COVID.
So a portion of all excess deaths would have been attributable to COVID and, you know,
taken place either at home and not yet recorded as being due to COVID from a reporting system.
The number of reported the number of deaths is estimated to be three times the level of reported deaths.
So so that's the had among the highest excess deaths estimated in the world.
So we suffered considerably from COVID 19, and that happened primarily during the Delta where the Delta wave,
the Delta variant was a more severe variant and therefore having higher mortality than both the beta variant and ancestral COVID.
So by the end of the delta wave, when there was say, around about 70,
70% of the population now being protected or zero positive due to natural infection.
When Omicron hit South Africa, also as a large wave, we saw much reduced severity.
And so our hospitals were not overwhelmed. In fact, they were hardly registering severe cases at all.
Of course, severe cases did happen, and that is always unfortunate.
But on the ground as a whole, at the population level did not manifest anywhere as severely as as the delta and and previous previous waves.
And so we had where we experienced hospital resources being overwhelmed was during wave one and during the beta wave and of the delta wave,
there were scattered reportings all manifesting differently at different geographic levels
because some areas of some parts of the country were affected worse during a certain waves.
It wasn't all at the same time. And were the models able to anticipate some of these changes as they came along?
And what I mean, was it possible to put in place non-pharmaceutical interventions that could at least mitigate the the severity of these waves?
So we the inverse the answer to that is actually yes.
The models were able to anticipate quite a quite a bit of this in the in the sense that and this is where I'll speak a
little bit on modelling methodology and how we changed our thinking between the waves because decision making changed.
Our primary purpose was to support decision making.
During the first wave of COVID, the decision was primarily on, you know, can we flatten that curve,
Can we achieve zero policy of zero COVID, you know, and have a policy towards that?
Will we have enough hospital resources and what will that prediction be?
So we spent a lot of time making projections on on what the wave would look like for for for wave one.
But when wave two happened in wave three and so on,
we changed our modelling methodology to no longer be about trying to forecast or to predict what was going to happen,
but rather to do a what if scenario type analysis to say we cannot predict what the next variant is going to be.
We cannot also predict when it will emerge and what is characteristics are going to be.
So in the face of all that uncertainty, what we can do is to to generate a number of what if scenarios,
to say something like if the next variant arrives in the next few months and it happens to be a have a higher
transmission than prior previous variants and it happens to to have some immune loss potential and or not,
and look at various iterations of those scenarios to make a range of projections as to whether hospital resources would be overwhelmed or not.
That was the key planning information. We were able to then provide, provide government.
And so we did this in advance of the Delta where we did a we released model a report on a hypothetical variant with increased transmissibility.
What would its impact be?
In advance of the al-Mukhtar Way, we released another report on a hypothetical bird with some immune loss, as well as increased transmissibility.
And so. In that way, we were able to actually among those scenario sets, we we actually pre-empted what was what ended up emerging.
And that did help did help decision making.
Coming to you to your point of the last part of your question on pharmaceutical intervention, non-pharmaceutical goods,
non-pharmaceutical interventions, as we know now, public health and social measures to be to be implemented in unlike the UK,
in South Africa, we did not have data that would have allowed us to say the proportion of the population using face masks
is so much and the contribution of social distancing is so much and handwashing and hygiene practices.
And so we were unable to disentangle any of the public health,
the social measure in terms of the utilisation and adoption, but also in terms of the impact.
And so we chose another different methodological approach to address that, to be looking at the relative, the relative compliance, if you will,
or, or it was really a two part process of looking at the relative impact of what the government, the restriction level was at the time, right.
To the lockdown restriction level to say you cannot, you know,
face masks must be worn inside and at outdoor activities and restrictions on capacity in venues and so on,
but then also take into account the population's adoption or adherence to these policies.
So we looked at it all as a single measure. And when we made our scenario projections,
we said we looked at a variety of scenarios as to whether the population would
maintain the same level of adoption of these policies as per previous wave.
And whether that would have been what if it were 20% less or 50% less and so on,
because it gave a sense of relativity and it took into account what we with what we know as NPI fatigue,
that the population were not being as strictly adherent to social distancing and mask wearing
for two years straight because we were all humans and fatigue would set in quite naturally.
And so we adopted that relative approach rather.
Because that was also a lot more understandable to the population and it would have been what we would call spurious accuracy
to try to say there's a 20% contribution from handwashing and a 10% contribution from from face mask wearing and so on.
Mm hmm. And yes.
And to what extent was the community in the public health community in South Africa united in its approach to dealing with the the outbreak?
So there was quite a lot I think there's a quite quite a lot in terms of the sort of the country coming coming together,
I think especially in wave one with regular meetings from the from the presidency,
there was no belief that we could all, you know, work through this together.
Over time. Of course, there will always be dissenting elements.
And, you know, with vaccine hesitancy and, you know, inefficiencies of government,
we had a few corruption scandals in between changes of ministers of health.
And all of that does not speak well to to enable public, you know, public goodwill and so on.
But the way we worked as as models is that we had a very well-established decision making pipeline
in the sense that as even though I was part of the modelling consortium and my group Maisha,
we were leading the model development for the models that I've just described to you.
Now we also I'm, I also sit on what we call the Ministerial Advisory Committee that's akin to to SAGE in the UK.
So this ministerial advisory committee has a direct line to the Minister of Health and we also,
as the modelling consultant, had a direct line to the Minister of Health and the Presidency.
And so we would, we would send through this information on the evolving pandemic.
And, and, you know, and our recommendations as part of the Ministerial Advisory Committee as to what the restrictions should be.
And so the when the presidency would communicate,
there was always that scientific basis and that background that could be spoken to that that could be shared with the with the public.
Was it ideal? No. Could it have been done better also?
No. But were there at least attempts made? Yes.
Was it better than our previous experience with the HIV pandemic ten, 15 years ago?
Absolutely, yes. I think, you know, overall, it was a trying time for everyone,
everyone in government and me being an outsider as a scientist from a from a
public university working with public servants in government on a daily basis,
I will be able to say that they are good people who are doing their best.
And everybody was was was working really hard and, you know,
trying to work through red tape and an impossible system in an impossible situation to to work towards the public, to work towards the public good.
You will not win all battles. And the the the the the sad part of modelling and I think of some of the scientific evidence that was generated is that
if you if you had a model that showed doom and gloom and it is used for advocacy to generate better public health,
a social measure, adoption and policy creation and so on, the doom and gloom may not result.
And then you criticise for having a wrong.
But you know that's a of stuff that that that was almost the point achieved and and that happened multiple multiple times.
It was not it was not always a rosy place to be as a modeller in the, in the public,
you know, where it was publicly known that you were that you are modelling.
We were involved in in court cases by sort of public action groups who are upset.
You know, we were involved in you know, there were many articles in the newspaper,
There were personal attacks on people, not myself personally, but some of my colleagues had articles written about them.
They were often articles in the newspaper attacking us for doing a you know, by even other scientists who would say,
you're doing all the wrong things without actually knowing what on earth you were you were actually doing in the in the first place.
So it took a long a lot of effort to, one,
be scouring the media all the time and then having to write your own reports that responded
to these to these articles and responded to to participate in court cases and so on.
But overall, I think that it was a it was a very positive it was a very positive experience globally for the world,
of course, has been a negative experience, but positive When I say positive here,
I mean from the from a scientific perspective of working with with government and establishing these decision making pipelines,
that that modelling isn't just beneficial to close, it is beneficial to health.
And it is one of these one of these toolkits that doesn't need to just be called upon in an emergency but can be used to support health.
And so what COVID did for health management was to cement this relationship between all the the,
the, the scientific expertise that lies at university around a country and.
And within government, there are many positive externalities that have that have resulted from that,
including a data Science for Health master's internship program that that we've set up where government
data sets are being analysed by master's students and their dissertation for their dissertation projects.
And these data sets wouldn't ordinarily be analysed.
But here we've got to understand where we are and it benefits the students to do something meaningful.
It benefits government because, you know, the data is being analysed and better decisions can be made.
And so there's been a lot of good that has has, has come out of it.
And I think as we as we look back even over, you know, ten, 20, 30 years from now, we will see benefits coming,
not just arising, not just during the pandemic, but actually in terms of years to come.
We are already seeing the formation of pandemic centres around the world in order to support pandemic preparedness,
in order to support the routine health challenges of interfacing with respect to TB and HIV and just general health systems.
I myself am sitting on a on an advisory group for vaccine immunisation with the W.H.O. over Implementation Vaccine Research Advisory Committee,
and we are already overseeing global global work that has that has emerged and accelerated because of the of the pandemic,
but to support other health functions that are not not COVID related.
And I think the wonders that have emerged from vaccine manufacturing at a you know,
at an accelerated pace compared to what we were what we were used to, we will see those benefits for many years to come.
And how's the work that you've done?
Have you been able to share the work that you've done with other low and middle income countries, or is it very specific to South Africa?
And so during the pandemic, I did actually support other other countries as well.
Through the Como Consortium based at Oxford University.
I supported Mozambique during wave one through my own unit.
M.A. supported neighbouring Namibia as well.
And so the the lessons learned have all have been shared, not perhaps in the traditional way of publication those are under underway,
but in more non-traditional settings of networking between between groups of shared seminal shared platforms.
Funders have contributed a lot to the sharing of our of our of our work in South Africa,
which has been seen as quite exemplary globally for the impact that we've that we've had.
And so we've share that with many, many NYC settings around around the world.
Oh, very good. So you have you now gone back to has your focus shifted now back to malaria again?
And my focus, Andrew. And I think it's because of COVID 19 as well, has expanded into a range of range of diseases we have.
And I'm very happy to be back in malaria as well.
But I mean, I work in a number of diseases at the moment, quite a few vaccine preventable diseases.
So we just completed a project in Hepatitis A working on as a project, a global project on alum disease for VAX,
for DTP booster vaccination, DTP being part of the early immunisation programme or schedule.
Diphtheria, tetanus, pertussis. Is that right?
H.A. That's anaesthetists, Yes, Yes.
Whooping cough. So that a booster vaccination and and of course throughout too much of the capacity
building work that I do in in terms of trying to develop sustainable capacity in Olympics,
which is one of my passions is training modellers from their own countries to be the experts in their in their own countries.
And we do a lot of a lot of application in in a range of of countries.
And and in terms of developing modelling capacity, but then also across a range of diseases.
So we saw doing some COVID work, we, you know, completing a bronze.
There is still some analysis to be done in terms of future rollout of vaccines and the need for
booster doses in a in a setting with a high SEROPREVALENCE How long might that immunity last,
if not challenged? What will this new family of own occurrence of variants lead to in the future
Certainly does not seem to be the case that it's going to be severe infection.
But what about long-covid? What about future waves?
Might immunity wane to a point where even protection against severe infection might win?
These are still questions that I'll be asked at the moment.
The the the impetus, though, is much, much reduced and has allowed us to shift focus into into other diseases.
So right now, it's a very healthy place for for modelling, working across a range of diseases,
supporting a number of decision makers across across the world at the at the moment as well.
And you mentioned that you'd been in Oxford just recently doing some teaching.
What course was that?
So I support the modelling for Global Health Master's program in the Nuffield Department of Medicine based in the Big Data Institute,
and I am the module lead on a course called Malaria Modelling for Strategy Design.
So the purpose of the course,
the purpose of the degree is to teach mathematical modelling and the application of such my modules takes the theoretical and
foundational underpinnings of the students would have learnt until that point and provides an application to a particular disease area,
but with one focus only in that we modelling for policy. Now to separate why I say it's a separate focus on modelling in general is that you can have
scientific modelling where you use your modelling to answer scientific biological questions,
or you could be using our modelling to be supporting policy decisions.
And when the type of modelling is a bit different, not just methodologically, but in how we approach the modelling.
When you're modelling the policy, it involves a lot of engagement with policymakers, with reviewing of national documents,
trying to understand what has happened on the ground compared to what is on a piece of paper and and so on.
And so that is the course that I teach, teach the students and how to engage with, with policy documentation,
what it takes to build a malaria model, not just from the biological perspective,
but from the entire systemic or a systems thinking perspective to take into account population behaviour,
geographic setting, environmental consideration and policy setting and health system access.
And that includes economic factors as well as economic factors as well.
Yes. So this is a two week module that was taught for the second year running at at Oxford.
And we had a, we had a wonderful cohort of students from them from around the world who deeply appreciated the course.
MM Wonderful. I'm going to switch now a little bit to focus more on your personal experience of the course of the pandemic.
So first of all, how threatened did you feel personally by the risk of infection?
Um, personally, I am. So I am actually a high risk individual, as in that I'm a diabetic.
And so right up front it was known that, you know, that we would have a weakened immune systems and would be at higher risk.
Um, I guess it was a good thing that I was quite so busy that I actually never left the house for a very long time because we were working from home,
even though it was not a strict lockdown for more than five weeks.
So we, you know, one was able to, to go back into work and and so on and and move around.
I actually I, I protected myself by being at home for for simply being a high risk, high risk individual.
Did I feel threatened necessarily?
No, I would not say Well, not say that I knew, For example, what would allay my fears is that I knew that masks work.
I knew the social distancing works. You know, I had to being being a modeller.
I had no I at no point did I have any disbelief towards public health and social measures in place, nor the that the policies nor the nor vaccination.
And so I was among among the first to be vaccinated being a high risk individual as well.
So in terms of fear and and being threatened, no, I won't say I felt that,
but I was very much aware and and took the to the desired and took the appropriate the
risk appropriate behaviour for my for my personal health condition and what my friends,
colleagues, family members. Were you anxious for their wellbeing?
I yes, I was. I mean I had a it's a I was indeed anxious for, for, for their wellbeing.
Not everyone is a scientist, so not everybody understands the, the benefits of public health and social and social measures.
All of the you know, many would misinterpret what was being communicated for a simple reason.
Not everybody was equipped to be a health, you know, a health specialist.
And so often I was a point of verification to fight all the fake news that was abounding among amongst all the WhatsApp groups.
And I was the. I was I was at point of contact.
I was the point of verification.
And it did become quite, I guess you could say, scary or rather saddening at a point where during the beta epidemic, as I mentioned earlier,
various parts of the country were affected worst during some waves simply because they had not been affected badly in a previous wave,
meaning you had a greater proportion of of the population being susceptible in that space.
So during the beta wave, the on the east coast of the country, in the Guinea or the KwaZulu-Natal province of the country, which is where I am from,
that province is particularly badly hit at the height of December summer by the beta,
by the beta variant, which was transmitting despite everybody being outdoors.
And so the having not having much of a seasonal effect.
And during that time it was a it was a period of where every every day or every one and a half days, somebody I knew passed away.
And being Indian by, by heritage, our familial relationships extend quite, quite a lot further than one's immediate family.
So somebody could be related to you being twice, thrice removed, one might say,
or along with seven or eight familial linkages and still be well known to you.
So by virtue of having a larger community and knowing therefore more people in a lineage,
was it happened that every day or every one and a half days somebody I knew passed away and that was a devastating time.
It was a very bad in your psyche.
At the same time, we were protected in the sense of being so busy that because the whole country's in a panic and death is abounding.
But you know what? Your responsibilities as a modeller, you've got to get at that point of the beach where we were.
My my group, Maisha, we set up the dashboard for the government that would allow the government
planners and the public for the first time to see cases that were the cases,
deaths and hospitalisations around the country.
And up until that point of either been ten months into COVID and everything was at a national and a provincial level,
not at a city sort of level or suburb level.
And the government had no capacity to create such a dashboard. The data were there, but they had no capacity.
And so I approached them to say, Would you like us to do it? And in two weeks we created this national the dashboard for the country.
And so we knew the work and the analysis that had to be done.
We were updating that dashboard three times a week,
so all of this pressure was on us to perform this work so the rest of the country would have knowledge
and be able to plan the day they did their travel and they did their day to day activity better.
And that helps to protect us from some of the grief we might have experienced had we been
sitting at home and waiting for information and not being as involved as we as we were.
And that and I will say that that was a that was actually quite protective for us.
It enabled us to to experience some of that grief just a couple of months after it happened.
I did lose very close family members immediately, sort of shortly after that, within the space of two weeks,
I lost my grandmother and and my cousin, my cousin from a very young cousin at the age of 40 from a COVID related post incident.
My grandmother, actually at the age of 91, had COVID 19, was asymptomatic.
She beat it, and then ten months or so later passed away of old age.
So that was not necessarily a sad, sad generally, but not a COVID related event.
So that was I think of it from a personal perspective that I think was the most trying time of the of the pandemic.
So you said you were you were so busy. I mean, you were working. I mean, you sound to me like somebody who works all the time anyway.
But were you working longer hours than you normally do? Um, yes.
So, so granted, the work that we do is, you know, does mean that we, we do, we, we, we work, you know, all the, all the time.
But I think that that phrase of working all the time, it's it was different pre-pandemic during the pandemic I was working what you would
colloquially call an all nighter and quite literally working throughout the night,
at least twice and twice a week, especially during wave one,
when the Minister of Health or the people directly under the Minister of Health are texting you every morning.
We are the role models. We need it now. Testing you personally not to the coordinating mechanism of your colleagues who are for this consortium,
but you personally having to generate, you know,
the does this work knowing the weight of the country,
of the weight of decision making that's now being placed on almost on your on your head and then the pressure from the media that was on us.
I was working throughout the night several times a week for a period of two years.
It was it was extremely challenging from that perspective.
It was challenging from a psychological perspective.
So in wave one, for the for the first couple of weeks, my my team were assisting me in developing the models.
I have a very young team, so they were assisting me in procuring information.
So reading through papers and having and getting the understanding,
working through the literature in developing on the computing side, developing pipelines and outputs and so on.
But the actual motor development I was doing by my by myself also, it wasn't the kind of weight and the present.
The presentation of such is not the kind of weight I could place on very young individuals.
When you're up against, you know, stakeholders, the likes of the presidency and and so on.
So the idea, however, a few weeks into the pandemic, you could start to see the psychological impact that it was having on my team when we had to.
We had to support some some functions. I guess we never thought as much as we would be doing.
For example, helping people in government plan burial sites during the during the waves
of is supporting the procurement of mortuary containers at hospitals begins.
Representations of people were showing you pictures of bodies in mortuaries that were not
overflowing or just being stacked at the back because there weren't enough enough space and so on.
And it was one morning where that just became too much for my for my team.
And I had a received WhatsApp text saying, I want to be a warrior, I want to be like you, but I can't wake up.
I can't get up. And at that point I said, All right, guys, two weeks you'll all of just just take take a time off.
You will relax. I could not afford myself that that break because I still needed to to pick up the helm.
I then organised and with the I'm very grateful to my university for supporting me
in this that they organised group therapy and individual therapy sessions for my,
for my team to take us through that, to take us through that time.
It was absolutely beneficial. I saw pushed, pushed through and at that from that point on most though I also I held back with my with my team.
I reduced the their involvement in terms of their sort of the day to day horror show that was covered at the at the time.
I took the role myself and just helped them to just adjust psychologically from from from that.
Mm hmm. Did you did you take advantage of any therapy yourself?
I did. When the university provided that. Provided that of service, I did.
I wanted to take advantage of it for longer and to adjust to other times.
I could not I could not find the find the time. But I had my own personal coping coping mechanisms as well.
I think the the fact that we were doing this for a purpose is itself very much a coping mechanism,
that it's for a greater it's something altruistic, it's for a greater good.
We were not ever paid to do any of this covert work.
In fact, when the Chief Directorate of Health of the National Treasury approached me first in early March 2020 to ask me,
will you develop a COVID model? Well, his second question to me was, well, you know, how much will you charge?
What can we pay you? And I said, Oh, no, don't worry, this is a national service.
I'll do this for the for the country. You won't have to pay me taxpayers money to do something like this as a service of the country.
Also not thinking it would be to. Yes, as well. But that being said, no, I would never have taken money.
It was also important for us to be to not be funded by government when you're providing evidence and support to government
because it adds to the objectivity of the scientific process and the and the function that you are that you are serving.
So I wasn't able to take advantage of that coping mechanisms.
I wish I was able to do more exercise. I did not. But I had my my yoga.
I did a lot of a Hindu scientific breathing exercises called Pranayama.
And honestly, I think that's what kept me kept me alive. I'm a devout Hindu.
And so having the the support structure of my faith is really what what kept me going.
I was always I was always cognisant of my health knowing that I had to at the end of the malaria investment case in 2018 that we did in South Africa,
I needed to. This is amusing. I guess now maybe not so much of the time.
I needed to also spend an all nighters in generating it to generate the evidence for by the required time frames.
But my diabetic medication was putting me to sleep at night and preventing me from staying up all night.
So I was keeping my medication to stay up and to perform the work.
And skipping your medication leads to your immune system being compromised.
And I got really sick and I ended up in hospital at the end of 2018 and I learned my lesson.
So all throughout the COVID 19 pandemic, I took my medication judiciously and I still managed to do the all nighters.
And so that's what protected me. In fact, even when my husband at home was asthmatic, when he got COVID 19 during the Delta wave,
I tested it with PCR is highly sensitive test twice and was not.
I had only one Pfizer vaccine at the time and I did not contracted.
So my medication paired with one vaccine was a was working for me.
So I was I was very glad for that. I knew I knew that the sacrifice that was being made that helped me cope,
but it also helped me prior experience with my medication, you know, stunning of my health, helped me to cope responsibly.
That's very good. Very good story.
So I think we've worked through everything unless unless there are any particular anecdotes or stories that you remember from that time that you know,
you'll tell your grandchildren about. Oh, gosh.
I think this is so much, too. There is so much to to reflect.
To reflect on. And one of I think I'll go through a series of reflections.
So one is it's an it was an honour that I will I will always say it was an honour to be able to serve my country and the countries I did.
The other countries that I supported in this way to be able to to make a difference, to be able to be part of this scientific communication.
The goal of modelling is not to have your decision.
A Listen to what your models say and in that though they did it multiple times.
I think the band, the DVD goal of modelling is to have your evidence heard before decision makers and for them to weigh
up your evidence along with all the other sources of evidence that your model is not accounting for.
And then to make an overall decision.
So the fact that we were able to establish that pipeline and be part of that decision making process several times over.
I think is a has has been one of the biggest highlights of my a lot of my career.
And what I think remain remains a hopefully in my lifetime and my working life.
And there isn't another pandemic that I have deal with that would surpass the impact that we've had in this one.
So I will say that that will always be a highlight of my career.
It was additionally a highlight to present to a different set of stakeholders, and one is used to usually when one is doing policy facing modelling,
there is a group of decision makers who are part of government or part of a nai tag, an immunisation advisory group or so on.
In this case you are presenting to a presidency a cabinet of ministers.
I did one very interesting presentation before a panel of High court judges or chief justices,
which was which was an incredible experience because I've never been I've never had
to present in a court setting like that where you're interrogated by a chief justice.
This was with respect to the question of whether we should be hosting elections or not and the ended and
know the impact of rallying and having political campaigns prior to that and the effect of of transmission,
what it would do to transmission and so on.
It was a wonderful experience because I got to be interrogated by a non-scientist in a most thorough way.
And I and it was a wonderful learning experience for me, but also a very enjoyable, enjoyable one.
I think of it on a personal note, a person who come to the personal notes a little bit.
One more scientific note that I think will that will be one of the key lessons that emerged from from COVID
and from this pandemic experience is as a model that one needs to know when is the right time to model?
During the beta, when the beta variant first emerged in December of 2020, the.
We didn't know what it was going to how it was going to manifest, what its characteristics were going to be.
We just knew that it was there. And so government immediately asked us, you know, what will the size of the end of this next wave be?
What can we expect?
And our questions were, we do not think it is responsible to model because we do not know what those features of the variant are going to be.
The modelling that that I do is mechanistic. So it takes cause it is not statistical modelling where one can look at associations and trends in data.
Rather it is mechanistic and causal that a variant that is more transmissible will lead to more to more infections and so on.
And so if you do not know if it is in fact more transmissible and you put in an incorrect assumption,
then you are going to be your model will produce nonsense.
And so we made a decision to change methodology instead of actually using standard mechanistic models to develop a different kind,
set a model that would be more statistical and not reliant on cause.
And that proved very much to our benefit because even prior to the to the detection of the beta variant,
we had to be making developing these, these models and so on.
So knowing when it's a very brave decision to be saying this is the chief tool in my tool kit and I'm electing not to use it.
It's, I think it was Maslow who had said, you know,
that it is it is tempting to that if you have a hammer to treat everything as if it were a nail and without,
we've got to be careful as modellers to not to not employ the same methodologies all the time, regardless of the situation.
It's a lesson that I think will be relevant even in 20 or 30 years time, that every country is different, every situation is different.
And so you have to evaluate each situation individually to know what is the appropriate scientific method to to apply them.
So that definitely, I think is something to to reflect, to reflect on.
I think what's another another highlight is the importance of communication that that modelling and I think it speaks to science in general,
but I'll speak the modelling aspect of the modelling as a package.
Sometimes it's least about the model itself and developing the model, it's about the interaction,
it's about the how you package your, your, your, your, your, your model results.
Gone are the days where someone in government has a time to read a 50 page report,
and if you're generating a presentation, it needs to have your conclusions on each slide.
It can't be a standalone picture where the interpretation is left up to the reader and you know that
we've got to we have to adapt and adjust very quickly with the different and new modes of communication.
We've got to be the whole package. If you want to be a model during this time in this pandemic,
I've done any number of radio interviews and television interviews and the thing that benefited me the most there in being confident to run to do
these press releases and press conferences was in fact my school experience of being a national debater as a national school debating champion.
It served me really well in my experience as a lecturer at university meant that, you know,
being able to to communicate clearly and explain a quite high level science in a in a way
that is digestible to the public and to and to decision makers as well as non-experts,
I think was a was a skill that needs to be developed and inculcated in in the new generation of scientists.
And what is the one that can't cannot be understated.
And so that I think is is definitely something that will still be of relevance in in the next few few decades.
On a personal note, I think looking back on the we will be highly amused to be recollecting what
a wonderful time the pandemic was for all pets at home and my brood at home.
I don't have human children, but I do have seven cats and four dogs, two ducks and three chickens.
And then I brood at home. My cats and my dogs could not have been happier to have had me at home for for two years.
Ordinarily, I'm travelling for at least three months a year in different pockets throughout the years.
So these children were thrilled. And I think we will see the we'll be looking back fondly at at this time for for that for that experience.
I think it's a lovely place to stop. Thank you very much indeed. Thank you, Jodie and it's been wonderful to.