So could you just start by saying your name and your title?
So I'm Trudy Lange, and I'm the professor of global Health research at the University of Oxford.
That's lovely. And going back to the very beginning. How did you first get interested in issues to do with health and global health?
And can you give me the the sort of main milestones in your career so far?
Oh, goodness, yes. Well, I did a degree in in biochemistry a long time ago,
and then I got and went straight into the pharmaceutical industry, actually, and was working as a clinical trial monitor.
And so for big pharmaceutical companies, SmithKline Beecham, as it was,
and I then took some time out and I was working in the UK on antivirals and a clinical trial, which is being a clinical trial monitoring.
So that was, that's where I really let my, my stripes really on how trials, how clinical trials operate.
So the pharmaceutical industry, we're running big regulatory trials on sort of valacyclovir actually,
and that was working on different antivirals and they were running the clinical trials across hospitals in the UK.
So I'd go in and literally monitor the trials.
So you just checking that they're recording everything correctly and the trials running according to the
protocol and the data's all high quality so that they can submit it for their regulatory files and,
but at that stage I'd gone straight from from school to polytechnic.
As it was, I went to Kingston Poly, so from a straight into work and I hadn't had I haven't really been travelling or anything very much.
So I'd got a volunteer post with a charity called Rally International,
and I went to Africa and it just blew my mind and we were doing lots of conservation projects,
but the bit that really got me was in the villages we're doing, and I was helping on a surgical expedition project.
But that's where I first came across malaria and the impact of malaria and on communities.
But was it the eyes? Is that trachoma is it was cataracts, trachoma, and there were all sorts of different eye complaints.
And we it's this in a mobile surgical facility I was just helping on.
It was incredible.
But it was because we were in the villages, you saw the impact of all the everyday diseases poverty and malaria, total health issues, malnutrition,
and it just totally blew my mind, having really not even the fear at that point,
just completely that that was definitely my kind of watershed moment in my career.
So I came back and running clinical trials and hospitals are doing it for me quite as much.
But luckily it turned out that SmithKline Beecham had a tropical medicine department who knew?
And so I just pitched up there sort of wide eyed and said, I want to work on malaria.
And they it was just great timing because I was a product that they had that was they wanted to take through regulatory trials.
And also there was a worm treatment. They had the children with worms and they needed somebody with the ability to run that regulatory standard,
clinical trials, but in the context of Africa. So it was perfection for me.
So then I spent the second half of my twenties still working this Long Beach and, and but working across Africa and Asia,
actually trying to facilitate in the sort of international regulatory standards trials in these really challenging settings, which I just loved.
And that's where I first got to work with Oxford actually, and, and,
and working some of the overseas programs, the Oxford half in Kenya, Thailand and Vietnam and Yes, yes.
And then I was going to ask about it because presumably in order to run those trials, you needed to have connections with local healthcare.
Exactly. Exactly. So all of these trials were in local settings where they were all already doing research,
and it was just getting them up to the standard that it was international standard research.
And so training and the quality you need and things like how you use the laboratories and the and data and to that international standard.
And so that was really great skills bringing that sort of skills that I learned in the UK environment.
And and then I actually went in as a comment to the World Health Organisation for a year around this malaria product.
And, and we were looking at how to implement it into the communities once it got approval.
And during that time SmithKline Beecham merged and became GSK as it is now.
And, and I, you know, I've, I've got a degree and you're not a clinician,
which is something that's come through in my whole career and and and I had started doing a PhD part time, which was fantastic.
SmithKline Beecham supported that and but there wasn't really anywhere to go.
Now within the new organisation, they wanted me to move into oncology or different product or product management.
And, and so Oxford persuaded me to leave industry and, and come over to.
Academia, which I did happily. And and that's how I got to Oxford, is what it was.
So that was 24 hours in my early thirties is when I had my two children come along at that point as well.
So it's quite a nice juncture to move to what I thought might be a more flexible job unless I was.
So yeah, I'm not sure that quite worked out as I thought it might, but it was, it was just excellent.
And then I and I worked in Oxford. So while in the vaccine programmes and this is important for the clinical trial story because it was the reason I
was useful in Oxford was because clinical trials have to work to something called good clinical practice standards.
And so that's what you sort of. Absolutely.
Then to the degree in industry, that's the whole, you know, goalpost you're only for is good clinical practice standard trials.
That's how you get FDA approvals and things. And then what changed in 2004 was that a GCP became a legal requirement for every study sponsor.
So academic trials all of a sudden had to apply to that as well.
So the works but tropical medicine team here said, come on, come and join us because we really need you to help us with our studies.
And at that point and then the what's now the DNA group were running phase one vaccine trials in the UK,
but also vaccine trials overseas for malaria, for malaria and tuberculosis as well.
So so I was coming in and helping look at how you could just make sure that the standard so, you know, absolutely at that level,
which was brilliant and really quite challenging, especially some of the settings and then then from there and that the Oxford programme in Africa,
in Kenya and the Can we welcome programme, that was at a point of beginning to do more HIV, TB,
malaria vaccine trials and, and all of the local investigators too with welcome grants or gates funding.
So it was the same story that everybody needed to get up to same standard.
So I actually am swop from the vaccine group to the tropical medicine team and was placed
out in Kilifi with my two small boys and and set up the clinical trial facility in Kilifi,
which is, you know, one of the most fantastic opportunities that ever had and,
and so spent two and half happy years in Kenya and setting up those systems there.
So a lot of what you were doing was training at that point. Exactly. And that was the real switch.
And that's where the Global Health Network came about. It was when I was based in Kenya.
We were working across Africa actually with lots of organisations who were trying to work with
really excellent research centres across Africa to try and really put those teams in place,
because to run a good clinical trial you need and you need nurses, you need pharmacists,
you need laboratory staff, you need research managers as well who could run grants and project knowledge.
And so you need in that whole skill set across the whole team.
And so that's what we put in place and kolisi And so then we were trying to replicate that in, in other centres.
And I really look at that systematic approach. I talk about research systems in health systems quite a lot,
and it was that's where I really began to shift from being a triallist myself to thinking about research methods
and processes and how to implement really quite complex studies in vulnerable populations in difficult settings.
And that's where the Global Health Network came about. So.
Was that? Did that get funding from a particular source?
And it took a while. Yes, it took a while.
It took a long time, actually. And so the ideas began to come together in in when I was based in Kenya and working with
lots of colleagues and we were working with and across different programs in Uganda,
in Malawi and the Gambia, and we were all beginning to think this would be a good idea.
And I came back to the UK and began the process of trying to get funding.
Now the problem was, is that most health research funders are geared up for funding,
you know, a vaccine trial or, you know, basic science or hypothesis driven study.
And you go and say to them, look, you know, what we're wanting to do here is about research capacity building,
training teams, putting the systems in place. So we set enabling and every funder was this is amazing.
Of course we need it is desperately, you know, it's a huge gap, but we're just not set up to fund this sort of thing.
So Oxfam were brilliant and did support me for a couple of years as I was going
round with my begging bowl and pitch and and not really getting anywhere.
And and then Gates and the Bill and Melinda Gates Foundation and really saw the value in it and quite flexible in how they can fund things.
And so they fired me and we got our first award from the Bill Melinda Gates Foundation about 12 years ago now.
And this fundraising has been the biggest challenge and remains the case still because
it's the reason it works is because the things that make health research difficult.
So if you are a hospital in Uganda or Nepal and you want to build your research infrastructure and capabilities,
the barriers you have for doing that and won't vary whether you're working on malaria,
HIV, TB, leishmaniasis, cancer, and that the same issues actually which are the skills you need to to scientifically design your study,
you know, how do you set a question? How do you turn that question into a protocol?
How do you work out what to measure?
I always talk about measuring the the right.
You ask the right question and then measure the right outcome. The answer to that question in the right place, on the right set of people,
and and then turn those findings into something that could be taken into practice.
So that whole ecosystem of how we set it,
that they're really difficult skills that are not taught whether you're in a medical school or nursing college and it's a really particular skill set.
And then on top of that, you also need the ability to win grants, manage budgets, hire people,
do contracts, and also the laboratories or the and the pharmacists and all those pieces around it.
And we also need things like social science. You need to do really good anthropology and social science to understand the context of the disease.
And if people are going to trust you doing this research and you're not going to you know,
you're working with them from the very beginning, right through the process to having it taken up.
And you also need to do health economics and modelling. You know, we you know, we need that whole ecosystem of science to happen.
And so to put all these pieces in place,
what we've what we're doing with the Global Health Network and what we what we've learned
is that it needs to almost be disease agnostic really is it's putting those skills in.
And that's why it's called funders, because they totally get it,
but they really are much more geared for where we want to fund a vaccine or, you know,
to train a thousand nurses to do this and to the sort of more enabling and foundational piece everybody says is brilliant is exactly what we need.
But it's not the turn to be grey.
And utopias are trying to do with a member of the members of the network institutions such as hospitals are the individuals.
So it's and it's, you know, now here we are 12 years later.
And so the Global Health Network is definitely the community of people and organisations that use it.
And so that's a really exciting piece.
That is, it's all research,
big research organisations who want to share their knowledge with the frontline health workers
and research teams that have that that come to it to try and find that knowledge that they need.
And so we have we work with organisations like the World Health Organisation, we're a W.H.O. collaborating centre, which is really nice.
We work with and welcome and gates and organisations like Cepi, the Vaccine Group and some of the really big networks,
they all have a knowledge hub on the global health network for their own work.
And so it's like a kind of massive science park almost where each of these different organisations can have their
own space on this platform where they can disseminate what they want to get across to research teams in Africa,
Asia, Latin America. And then the other side of it is the frontline health care workers and research teams and have staff and pharmacists,
community health workers come because they know that information is there and they can find it.
So it's so that the global network is that community of research teams,
health care workers, and also the research organisations that want to interact with them.
And so it's we have a web platform, but that's just a vehicle, you know, it's very clever and thank you,
the Gates Foundation for investing so much in it and it's really important, but it's really just a vehicle where groups can come.
And then we're also really active in the region through many, many networks exist already across the Global South.
We've got teams of people now embedded in those networks who can operate as research capacity building coordinators.
So they'll actually do that, spreading knowledge from a centre of excellence of somewhere in a hospital.
Maybe it's got really fantastic research expertise.
They can go and run workshops at another hospital or connect up with the expertise might be HIV and they can go and talk to the group working on,
I don't know, orthopaedic surgery and share their knowledge with how they do research.
So there is the fantastic digital platform,
but there's also a huge amount that happens face to face in hospitals and clinics to really try and impart that that knowledge.
And you're the director of all this. Wow.
What's really nice now is it's and we it it's really we describe it as a decentralised franchise so there's no leadership structure.
There's this really nice it's a true network of collaborators.
And so when grants come in as they might, we've got a really lovely new award from welcome around really expanding this in Latin America.
And so that ground that the lead investigator is in Latin America and the accrues and we've had grants and come
from the European Union for some of the work we do across Africa and we'll be a co applicant and support that.
So it's quite an unusual sort of academic approach because I haven't really wanted to have it sort of sat and be led from Oxford ever,
even from the beginning. It's always been this really open, collaborative community.
And so, so the governance and the funding and the structures or the goals in that sort of concepts and, and is research part of the network's remit.
I mean our papers coming out. Yeah, Yeah.
And so the important contribution I think we're making from that perspective, which has been really exciting, is really understanding those gaps.
So, you know, we know that those barriers are what stops groups leading their own research projects,
but we only really need that anecdotally, and we didn't really know what makes things new, what the scale is or which particular problems.
And so the Global Health Network community itself can be part of answering those questions.
So we did a really big study, which we finished about a year ago, is just published as a W.H.O. report and where we said to the global community,
okay, what makes research difficult for you as an individual in your institution and then in your country?
And then from that we had 7000 responses, really comprehensive.
And so we were really able to map, okay, these are the barriers for research at that individual institution on national level.
And so from that, we've come up with a curriculum for health research.
And so we know the component chunks that we need to tackle.
So in a scientific thinking, research management, data science, community engagement,
so we've got this really nice sort of chunked up curricula where we can then take solutions in there for all those component pieces.
So and so that methodology of research pieces is really important.
And the other really key side of that is that health research is changing really quickly.
And, you know, we saw this with Ebola and see care in COVID, but it's it's around how,
you know, when I began my career, we were all used to clinical trials.
You'd have phase three, clinical work, phase one, face to face three.
And now there's much more fluidity between this.
So you'll have surveillance that can shift to running. A trial, can take through those phases almost seamlessly and then straight into implementation.
Now that's fantastic.
And it's been used really effectively in many therapeutic areas over the years, especially things like oncology or cardiology maybe.
And what I am really determined to to pay whatever part we possibly can is that low income settings and diseases are left behind.
In this evolution of methodology. And I think this really exciting things we can do with data science and
technology and to to make the most of of those advances in how we analyse data.
And so, you know, in Bangladesh there might be a big dataset on and I've been giving micronutrients to
lots of children and not really understand whether it's working or if it's even safe.
And so but they've been collecting the data, but there's not the expertise on even to begin to ask questions of those data.
So can we can we look at how the Bangladesh team could collect that data in a in a way this you can then analyse it and then help formulate
the questions and then ask the right questions and get the answers and then do something important with the evidence that you generate.
And so even that process of understanding,
even how you begin to work out what sort of data you've got and how you ask questions about that methodology,
research is really key because if we if we follow how we do that with a Bangladesh dataset and micronutrients,
then that same set of steps can be applied to a dataset on malaria and in Kenya or leishmaniasis in Nepal.
And it's because it always crosscutting, right? There's always the same barriers.
And so that's we're constantly trying to do that and look at and tracking those pathways to to how you do research in the most challenging settings.
And so I think if in my sort of absolute optimistic way,
we could really look at that and and actually even be ahead of of some of these advances methodologies and use these really challenging settings.
But there's an enormous amount of data, really important questions to be asked and really try and use the best available methodologies there
are and and synthetic data analysis or and using real world data and asking quite novel questions.
And that to me is a really exciting potential of the global community is to be part of that and
a huge opportunity to not be left behind in the advances in health research that are here now.
Mm hmm. That's a fantastic introduction to all of that.
So let's get to COVID now. Can you remember how you first heard that there was a nasty respiratory outbreak
going on in China and how soon you realised it was going to have a global impact?
Yeah, I can remember. So there was the first indications through.
So we work in these networks that came about through Ebola first and then we switched to Zika.
And it's, you know, there's outbreaks all the time and we work in all of these networks that are looking at this.
And there was the first discussions and emails coming through saying that something's happening in Wuhan and and, you know, is it real?
What's what's happening? And then, of course, what follows really quickly behind that is in the press interest.
And so you're suddenly, you know, it is beginning to scale up because suddenly you've got the BBC on the phone because, you know,
you're really quite involved with them,
with the press and Zika to focus and they sort of go back to those same groups and say, okay, this is really, really real.
Yeah. And, you know, I think it was quite interesting being in some of these early discussions with the networks,
as you saw, and with any disease, what we have ever known, especially in an outbreak, is an immediate set of unknowns.
I think Zika is always a really interesting comparison because we knew much less around Zika
than we did even around Ebola where So what you want to know in that immediate instance,
and this is what we were all looking at with COVID immediately is and.
What's what's causing the infection? What impact is that having on the patient?
How can we stop the transmission? How how is it being transmitted?
This always very immediate questions about who we understood most of those pieces, but we needed.
But you never know if it's adapted.
And if you're looking at something a bit different than you had before with previous Ebola outbreaks, with Zika, we knew hardly any of those.
So that was a really interesting evolution that the science was had had it looking at.
But how do we do that disease characterisation straightaway? How do we get these data out?
And then as COVID was unfolding, obviously we knew a bit around that the class of virus, but we didn't know.
Yeah, exactly. But what we didn't know is what this particular virus was doing.
And, and obviously there's that information coming out of China was quite complex situation to be working in,
but data was coming out and there was this increasing understanding.
And then of course, we began to get the data from Italy, remember,
and that was the next end to be the jigsaw began to come together on, you know, we're dealing with a respiratory infection.
And it was always you was working with unknowns and it was just remarkable how it was
mobilising those same sets of groups coming together to just write What do we know?
What don't we know?
And being in early meetings in London where and there was a recognition this is going to be intensive care beds and needing oxygen.
But of course,
my perspective on this was then talking to the global networks and and thinking about how to mobilise the research community straight away in
those contexts so that everybody could respond and begin as soon as there were cases begin to to do to embed research in the emergency response,
which is what and we were really keen to do after Ebola, is just make sure as soon as cases were happening,
you were able to to act in a research environment with protocols, rolling consents in place,
ethics approval, so you could capture the data and and use it to understand.
And there's a really important definition around what's health research and what's an order.
And that switch to being able to use the data as research.
So you need a protocol, you need consent,
you need to have all of those things in place so that you can associate your patient record data with prospectively,
deliberately capturing data for the research purposes of research so that you could learn.
And those data are shared, which is a really fundamental thing around learning across the globe as quickly as possible.
So it was that very rapid connecting up across these networks that already exist following previous
outbreaks and trying to mobilise everybody to be thinking about research from the get go.
So fortuitous, but that's not quite fair really.
It was probably providential the fact that you had the networks up and running and set up so that you could get this global perspective.
And I think that's what I think from from my own perspective of how it how it
began and then adjusted over time was it was it was very much a global issue.
And at the beginning for everybody and and at the meetings, it was the same groups who had fought this expertise.
And from our experience, and if you go back even further to the Ebola outbreak and you know,
the people involved with that were all the groups of works in running research in challenging settings.
So it was many of my colleagues from malaria or TB, HIV, they were aware because we knew how to run studies in these challenging settings.
And so we, you know, we were galvanised to pivot and adapt and,
and then here we were where again we'd been through Zika and here we are again at the beginning of COVID as it grew and became a huge issue in the UK.
And, and for me personally, it was a really, it became really bizarre.
I think that's the best word I can use because just like in Ebola and Zika,
I spending an awful amount of time on Zoom, a huge amount of time and real crisis mode, really desperate work,
talking to colleagues who were in awful situations,
trying to set up studies and in really devastating circumstances to these families and communities that were impacted and working through with.
Within big teams about how to design the best questions, how to gather data and all those practical pieces,
and trying to just really make sure they had all the support they needed and all the information.
And then I'd step back and I was still in Oxford and I picked my kids up from school and life is normal.
The most bizarre thing for for me personally, for COVID was I was still having those conversations with my colleagues in Peru, Brazil or or Africa.
And then I step back from my computer and my kids were at home,
obviously doing their homework in lockdown, and it was absolutely catastrophic in the UK as well.
And and and that was obviously an entirely different context.
And some of the hardest bit, I think, is that sort of more it did shift from being global to being quite nationalistic, I think.
And I think lots of the in terms of the the Western policy response.
Yeah, Yeah. And I think the you know, the UK had a phenomenal response from the research perspective,
obviously with the recovery trial and vaccine manufacture and an incredible process and.
And I think the really huge positive through that.
I think the the research system in the UK embedded with the NHS is is an envy to the world, quite rightly.
There's really good research and managerial systems within hospitals.
We could just switch straightaway off the recovery trial went and could be embedded across the NHS,
which is something that's difficult to achieve in many places.
However, I think it's when you look at where research happened and where the funding went,
then we begin to it's not such a it's not such an attractive picture.
And, and I really struggled with, with really trying that and keep a voice in creating this equity in where research was happening,
who was leading the research, where the benefits of the research were going.
So this is what the Global Health Network is all around equity in where research happens.
And so that's, you know, the sort of underlying principles are.
We still have 90% of the world's health research benefits, 10% of the population.
And so even much of the research that led in the global is happens in the global
South is still led from the global north and funds go to the global north.
And there's this huge, huge disparity which is there and that's what the global network is entirely around tackling Covi comes along where it is.
And if you. I did several pieces of work.
Uh, our whole operational shift was to try and enable teams in the Global South to get
research funding to put these protocols in place to do the disease characterisation work,
to do it, engage and take part. And that was, you know, hours and hours on these Zoom calls.
What I was also doing was trying to do some analysis on where the funding was going and what was happening.
And many people did this and published on it. And you could, you know,
there's lots of data out there and you can see that there was and at one point
there was over 500 clinical trials funded asking the same question in hospitals.
And I would say measuring and going back to the beginning of my career, working on antivirals, you know, back in the sort of late nineties, you know,
the rule number one is when you develop an antiviral therapy, you want to try and hit that virus infection as early as possible when it's replicating.
And so you try and, you know, day one three with infection.
Excellent. Day seven, day 14, really, the horse has bolted a long gallop down the road if you're going to give antiviral treatment.
And here we were with all these huge, huge clinical trial budgets, testing antiviral therapies on day 1014 of infection in hospital,
which, you know, where were the community based trials, where was the primary health intervention, where were these happening globally?
And and I was on funding committees.
And what was really I found really quite distressing was that the funding was being awarded to the same criteria as was ever thus.
And this is on track record and track record and track record really, you could argue rather than a, you know, an immediate need to get going.
And there was and we've one of the activities that came out of COVID was to work with the UK government hosted and the,
uh, which was the um, Boris Johnson hosted in Cornwall.
My mind's gone blank on the. It was the big one of the G20.
These are the governments hosting the G20 and the UK, quite rightly were, you know,
just, you know, the vaccine success and the clinical trials really excellent.
And and they wanted to really showcase around clinical trials.
And so I was doing some work with the with Whitehall and the Cabinet Office to prepare for these G20 meetings.
And so my, my input to this was, well, hang on a minute, actually, can we just look at this?
Because if you draw a matrix and you back to what I said at the beginning around if you've got any disease, you need this whole ecosystem of research.
You need a matrix that you can fill.
You need to understand the impact of public health interventions.
You need to understand what the community is thinking. You need to do modelling health economics.
You need to do genomics. You know, we all understand around all these different types of research.
And what would be great is if you had this big pot of money that you're going to give to research and then draw out a matrix.
And when you have these funding applications that you're going to support,
make sure they land across that whole matrix and not just in the bottom right hand corner, which they absolutely were.
And I think it's we really, really needed better diagnostics really early on,
and we needed affordable diagnostics that could be used across the globe.
We really needed antivirals that could be used in a primary healthcare setting,
and we really needed to understand the impact of public health interventions much, much better than we ever did.
And that's true for the UK. But it's really true if you're in a slum in Nairobi and you it was lockdown and you couldn't earn
money and the kids weren't at school and and we didn't really have any good data on on those,
on the effectiveness of those. So, you know,
and it's it's that whole spectrum that just really wasn't happening and and and there
was this huge focus on clinical trials and I at this is a card carrying clinical trial.
It is about my whole career from a clinical trial background.
But what I think we is,
is a bit of a shame to take forward that clinical trials are the most important thing
in health research and they are really important that they don't happen in isolation.
And you need surveillance data, you need the pathogen genomics, you need this whole piece.
And the funding just was not going across that spectrum.
And then you've got the global disparity, which was huge.
And and it just if you if you there's lots of nice papers and graphs on this,
but you can see how the funding immediately flowed to this, you know, the same old, same old, which is great.
They got going and did some brilliant science.
And that's, you know, we've we've got the vaccines and and we've got the big platform trials which which really helped us out for sure.
But then we have this huge tail of information that we didn't get and and the how that followed so much later in the Global South,
which is, you know, it's really quite a history.
Oh, tell us what it is. You know, I think it was the right place to bring this up.
But I had a quick look at the paper you wrote for a government select committee.
Yeah. Where you talked about the the problem of competitiveness.
Yeah. Competition. Yes. So do you think that's what's driving this?
Yeah, it's private sector in the commercial sector and in universal.
Well you've got people competing to be. Yes. Yes.
I think, I think very much so. And I think let's talk about diagnostics,
because I think that's a really interesting area to focus on that if you there was great collaboration in developing vaccines and drugs.
And that's that's you know, W.H.O. showed great leadership.
There was lots of push and public private partnerships across the industry, really great work that was just around sharing evidence,
sharing data, using the platforms, organisations like Cepi that are driving that.
And let's work together. We'll get there faster, really effective.
Then let's look at diagnostics.
And there was some really nice reports out that showed there was something like 25 different companies in the US completely in isolation,
all trying to develop the same technology for some rapid tests.
No incentive to work together. And,
and we it's going to be there are some great advances but really nothing like
the vaccine piece and and an awful lot were actually even purchased with.
They even said that if they were if they were, you know, evidence led.
Absolutely. And as you know, I think some of the huge benefits from, you know, societally from from COVID was the science education.
And I just found the hilarious that my kids were happily talking about, you know, the R number and understood.
And they get across to the BBC stats and go, Mom, isn't it all about the denominator?
Yes, darling, it absolutely is. It's all about what they're not testing.
Many are. They are so proud. And it was really it was just a great education with my children.
I think it's amazing. And but I think that's, you know, if if we had to just the beginning test test test is absolutely right.
Organisation. Yes, yes, yes. You know, absolutely right.
But you need to get the test kits out and have that capability there, which just wasn't in place.
So I think if you had that incentive to collaborate in diagnostics, we would be in a different place.
So then that's academic funding. Well, you know, I, I really you can just see how the best science happens in collaborations and,
you know, the the big EU Horizon grant systems are around working in these huge consortia.
Zeta we the biggest funding came in from Horizon Project Zika.
I was working in funding, yeah. And I was working with 56 partners, which yeah, there was lots of cuts to heard, no doubt.
But the whole funding structure that you had to collaborate and have activities that we were working to to try and draw things from across them.
And it was, you know, that's, that the system made that happen in a really good way and in academic support up to compete for funding for papers.
You know I maybe it's because I came into academia late,
but I've always found that slightly strange that you it's that's that's how you build your research
career by being very pleasant but very sharp elbowed and you know and you have to sort of,
you know, fight for your growth and funding and and so that makes sharing a bit of a difficult thing.
And you've not been brought up to do that in your career. And so these systems, you know, these big lab towards are excellent for that.
But the downside is still a lead applicant and they're still a lead institution,
and especially for trying to get groups in less resourced areas, particularly in the global South, how can they compete?
You know,
how do they how do they get funding is is as quickly and equitably as somebody with that sort of track record from your Oxford and your Harvards,
where they might have a huge need, massively important question,
patient population as all those things I talked about what makes good research, right question Right.
You know, all of that is they're very clever, smart people.
Why do they need a track record?
You know, we can bring in the collaborators to help them and why shouldn't they be the PI or why do we just not have a p I actually.
And why don't we create these flat structures where nobody's the lead?
Why do we need a lead? And why do you need a lead institution? Put the money across all of them.
Set up this these governance system so everybody's accountable, but you create a sort of fair flat structure.
And I think this you know, people talk about team science.
You hear that, oh, we should work in team science, but we have to put the systems in from the funders to to really make that happen.
And we're quite a long way from that, I think, still.
Yes. So depressingly, your efforts despite working.
Yeah whatever didn't steal my right on meetings.
Yeah, yeah, yeah. And so did you feel like a lone voice or.
Yeah. Okay. Yeah, I think yes, I think it's I think it's quite a.
I think in in academia.
And, you know, you need the universities need you to bring in the funds and they need the overheads and and to be.
To be a successful academic it's often seems to be around.
The more grants you when having a building, you know that whole traditional sort of successful academic is rewarded in that sense.
It doesn't you know it's you've got to change it So and that that is the norm still, I think, isn't it?
And I think the over time and, you know, maybe when we do really unpick what's happening with COVID,
seeing if there's different ways to to award funds and have the reward fairly spread out, it needs to be saved papers as well.
You know, having a lead author in the last also,
because that doesn't help with it's really difficult when you've got these huge great collaborative papers.
There have been many great examples. We have just listed everybody in the group, but that is still rare.
And and that's that's the trouble that needs to be the norm.
And now and everybody's equally recognised.
So you, you published your paper on the methodology study across the network, as you said, just about a year ago.
So were you still collecting responses while that was going on, or had you already got all the results by that time for that big paper?
We had already got them, but we did do a big piece of work in the middle of COVID and with um Ukri,
which is the collection of UK funders for global health.
And so the World Health Organisation put their blueprint out for research in the June of the first year.
So kind of six months into it, pretty much just saying this is what we need.
Yes. And so they that and so their blueprint and, and they,
they put out so we've done this obviously in an emergency situation and they would have liked to have had more engagement feed into that and no,
no, no. A little bit through sort of wider groups but not particularly.
And that was one of the things they talked about was that it was quite a rapid and.
Development of this blueprint and the could out quite quickly. So it was, you know, not much input from the Global South and and quite rapidly.
Of course it was an urgent situation and and it it wasn't difficult either.
Of course, we needed vaccines, we needed drugs, we needed diagnostics, and it was probably all fair enough.
But the UK, our friends said to us, Look, could we ask the Global Health Network community if the blueprint was relevant for them in their setting?
And so this was then six months on from that. And so it was, you know,
six months further into the pandemic and really asking really going for that opinion from the frontline researchers across the global South.
Is this true for you now, and is this relevant to what your research priorities would be?
And we had a four and a half thousand responses and we didn't run it really ran it for about a week.
And and it was you know, we were getting saturation of the responses.
And it was really interesting because and whilst of course, there was agreement that we needed drugs and vaccines and and diagnostics,
what came out really clearly was this requirement for evidence around public health interventions.
So be that lockdowns or wearing masks or travel restrictions, all of these public health measures,
which are your first and your first line of defence in an outbreak and what you you know,
if we look back again to Ebola and what we needed to do was educate people about hygiene practices,
looking after the deceased and how communities behaved.
Public health, when you don't know what's going on with you don't have a vaccine, you don't have any drugs, you don't have any diagnostics.
Public health interventions is a first thing that you can roll out.
And so absolutely, we have evidence for it and all, specially when it's going to really impact your community.
Not in the blueprint. It was not really it not it was not anything like as strongly as it came out in in our response.
So it is, you know, it wasn't massively different,
but I think significantly in that voice that came through and and and also that it was about then doing
research so that you absolutely need to do research on those sorts of interventions in that context.
And so the ability to do research, to bring funding and all of those things that cycle around that, and it came through very clearly.
Yes. I mean, are the obstacles to sharing data and experience among countries different than.
No, I and I think. Well. So when you talk actually what I was thinking of was the tape you did about Lusophone countries.
Portuguese. Yeah. Yeah. So I think I think there was well,
there was absolutely a will to share everything as soon as possible and to get
access to information and to and to really make sure everything was mobilised.
So people talk a lot about data sharing and that's really key.
And of course probably the best illustration of that, that is genomic data sharing.
So as soon as people are sequenced, a virus is found, a new variant of concern.
They shouted about it and we all remember what happened in South Africa and then it got called the Cape Town variation or whatever,
you know, and then you get slammed for having been really good science who said and shared their findings.
And, and, and data sharing is the sort of thorny end of that and is discussed in endless meetings and lots of investment and
and and lots of problems still around where to put data repositories having data in a state that you can share it,
the willingness to share permissions and all of that.
Such is such a complicated area, but it's not just sharing the data, it's about sharing methods in the how to.
And even so, it's access to knowledge, really.
And so if you are in Brazil and you and you want to take part in research and you've got an immediate barrier,
especially as as you go through this sort of community,
our own language and some of our fantastic colleagues in Brazil were doing some amazing work in the favelas
around vaccine hesitancy and the doing the vaccine trials and and doing disease characterisation studies.
And, you know, Brazil had a terrible time, as we all remember,
but trying to get the resources translated so that the nurses right out of favelas could use the disease,
characterisation, protocols, the community engagement materials that some groups had developed elsewhere.
Something as simple as translations is such an enabling factor that seems again back to fundraising.
It's not very sexy to go to welcome and say, I need to, you know, we need $100,000 to translate all this materials.
That's not, you know, anything like a sexy saying I need $100,000 to sequencing genome,
but actually really transformational in terms of enabling those amazing community health care workers right on the front line to get data we all need.
And what was going on in that context. Yeah.
I think we've had quite a lot of this. Yes, I think I'm sort of into lessons learned now.
Yeah. I mean, has. Your experience?
I mean, it was it was a I suppose, in a way a kind of brilliant test of of the network and showed up.
It showed up the kind of guy that you that you then helped to identify.
How optimistic are you that that's going to make a difference going forward?
Yeah, I think there's lots of things that worked really well as we were trying to mobilise researchers to work together,
and there's lots of things that we did work really well. We will we are carrying forward even now and, and,
and right now what we're busy doing is trying to work with teams to get their labs back on to being able to diagnose malaria again.
They were, they were shifted on to COVID and now they need to come back.
And so some of the big systems that we we really put in place with these abilities to design studies together, this is a really exciting area.
And we're we're implementing this this right now. So we set up this process where an open protocol decided crowd protocol.
So and groups came together and formed working groups around those different areas.
So public health vaccine hesitancy, disease characterisation there for working groups was different sections.
And then we we set up the system where they could design a protocol together.
So nobody owned the protocol. I mean, that's ultimate team science and it was nobody's protocol.
And they'd so they'd sort of bounce around the ideas for what questions needed and then what outcomes you'd measure,
how you'd measure it, what a consent form would look like.
And so we're taking that forward now because we really want to try and enable nurses, midwives,
community health workers to be researchers, whatever they want to research, whatever is the disease in front of them.
And our hypothesis is that many nurses and community health workers are doing some brilliant things already,
but they haven't got they don't know if it works or not, but they'd like the evidence to know.
So maybe they're working in mental health or that they're just working in the communities,
but they're managing mental health issues and they're probably doing things like setting up little community groups, momentum teams or whatever.
It might be counselling, informal counselling sessions.
It would be brilliant to know if that works, wouldn't it?
And so if if we set up a system where nurses could come together and say, Oh yeah, actually I'm doing this in my group a lot, we're doing this.
Okay, well let's design something together that can test that.
And so we've, we, we've coming out with this challenge for 1000 nurse led study challenge.
And so we want a thousand nurses across the globe to run their own studies.
And it could be this is one study that certain topics they develop and do in how many different countries.
But we don't think it'll cost very much and we think we can just use that same system that we we developed through COVAX,
the protocols for answering the questions that they could adapt to anything they want to.
And so that crowd, one of the hardest things that we we know exists is they don't have access to experts.
So normally when you develop a protocol, if you're sat in Oxford, developing a protocol, you talk to your colleagues,
you have a meeting and you you'll get sort of and you take it to your institutional scientific board and you'll get it thrashed around.
You'll get beaten up and told that's really you can't measure that or this won't work.
And that's how you develop your protocol.
If you're working in a place where there's no research experience, you just don't have access to that scientific refining of your idea.
So why not make that in the community and say, this is what we're which we definitely did in COVID?
And so we really wanted to take that forward.
So we hoping we have a thousand nurses lead their own studies and using the tools we developed around the COVID.
That sounds really inspiring. So let me turn now to a bit more about how you were impacted personally.
And I'm asking everybody this about how to what extent did you feel threatened by the virus itself,
which, you know, I'm in this record, I've never had a positive test, so that's one for me personally.
But if I was going back to March, yes, at the beginning, did you feel about how did I feel and.
I think as we learnt more quite early around it being dangerous for people with underlying health conditions and with respiratory background,
I didn't feel personally worried for me or the family and, and having worked as soon as you were thinking in numbers.
As a scientist, if that sort of, you know, COVID, you got 70% mortality and this is we're looking at, you know, we didn't really know.
I mean, Ebola, you've got 70% mortality and it's horrific and it's young people.
And we also did a lot of work on Disease X in W.H.O., which is our theoretical respiratory virus.
This is what we were all working on before COVID came along, which I think there was a mortality of 60%.
And it was young people, you know, So so straightaway in my mind, I was like, well, this isn't disease X, you know, it's the vulnerable, the elderly.
So I was worried for my parents and my in-laws and and but I really want to end.
And one of my personal things in the I live in a really small village and that and as we learned around how the disease was passed on,
I really remember having a conversation with our vicar because my in-laws went to church every Sunday.
I said, Please stop taking communion. You know, I really think passing that wine between the whole, you know,
this is you have 30 elderly people in front of you every Sunday morning and this is a really bad idea.
And we've all come back from skiing in Italy, by the way. Yes. And this is you know, so it was that was where it really personal.
I was I was really I knew that that was a massive risk, not for me, but for my in-laws and the elderly in the village.
And the vicar didn't want to know. So I was quite cross about that. But and then a week later, ten days later, he was came down from diocese.
So I was quietly smug about that. But yeah, I didn't, I didn't feel personally threatened.
And, and then it was but I was very worried about elderly relatives and trying to keep them safe.
But and, and then it was a sort of practical, you know, trying to get the kids to test all the time.
I was quite. Quite rigorous in making sure.
And you've indicated you were flat out busy. Yeah, well, you were you were working from home by then.
Yeah, absolutely. Yeah, they closed down. I mean, most of your work is there space isn't it.
Yes, exactly. So all of the research we did, all the research report was all out to the regions.
And so we used to travel a lot, obviously, but obviously also still do a lot on on Zoom calls.
So it just moved to my desk.
You were already very experienced at Zoom and calls. Yeah, all the Internet.
Yeah. It was just a different level of intensity because it was, you know, I was I used to be in the office with my colleagues and so you would,
you would have a few Zoom calls a week rather than now for like all of us.
It was I was I absolutely could not do the family zoom calls in the evenings because I was fried.
And I'm sure lots of people had a serious kind of eight in the morning. Yeah, well, and or early mornings or late evening and the meantime times.
Yes. And also colleagues who were running studies in hospital were in hospitals, and then they wanted to speak in the evening or the mornings.
And and I had many really heart rendering conversations and they'd had just the most awful time on the wards.
And then they'd come back and they've since and still in all their care, you know, and, and they'd offload around their day.
And it was just the strangest thing not to, you know, because often, you know, when I've worked on other diseases, you've been there,
you know, I went to Brazil, I went to the the valleys, the up to Fortaleza, where the saw the Zika babies and the mums.
And we walked through the wards and work to do the studies.
And you know, you're, you're part of it and just to be feel so impotent and a distance and then, and then turn from my screen to, you know, my,
I had two boys and they were going through GCSEs, A-levels, so I was,
I was also doing A-level philosophy, English and law and all my and I'm rubbish at cricket apparently.
So yeah. It was that was really, it was really, really intense.
And I didn't want anybody to talk to me about Saturday Lives,
which my friends who were not working seem to be occupying them and I really wasn't interested.
Was there anything you were able to do to support your wellbeing?
Have you talked about being in the village? Could do that, Yeah. Oh yeah. I've got my Labrador bramble and she was my running partner.
So when we could, you know, I've and we've got a nice garden and so, you know, lucky as compared to our colleagues and it was a Yeah.
So out for a run with a dog and throw a cricket ball for my son in the garden and it was a joy their having them, you know,
I kept teasing them, you know, teenagers in the house who's supposed to be offered their mates say, you know, they were forced to go down.
And so you know, there was upsides to it. But and, and the other side was I was I was really keen to look after.
So in Oxford and quite a few students and Young's young team members and we had
those periods where we were allowed to meet in groups of four or six white male.
We could, we could meet outside. And and so we actually adopted one of the cafes in Oxford because they had a nice garden.
And, and what I was really aware of on the Zoom calls, I mean, I have a nice house in the garden,
I could sit and they were knees sitting on the end of their bed, you know, these rules.
So we really set up the system if we would do walking meetings or I just used the
cafe just and then we sat tab up in this cafe and used to just go there and,
and, and meet, you know, students meet up together. We couldn't get out.
And and so that was, you know, that was a really quite a significant worry for me was the sort of youngsters in my team.
And it was really tough for them being by themselves.
Mm hmm. Yeah. When you said students, I really I have a question I meant to ask you, which was about teaching.
Are you involved in teaching as well? So I'm, I'm involved in Green Templeton College as an advisor to the students.
So that was another federal graduate student. Yeah, but they, I mean, for those guys, you know, we had students arrive from,
from China or India and they arrived and they had to do two weeks quarantine in their rooms.
I mean, awful for them. And then on Zoom calls with their teachers.
And I just felt you just couldn't do anything for them.
You know, had this they had a food hamper if they were laughing, shame, You're like, what is this?
It's like they're baked beans. What do I do with this?
Oh, well, delicious. You know, it was just crazy, crazy times.
It was poor souls, you know, had you know, it was their families.
Our expectation they came from a small village in China and they'd got to Oxford
to be just in a room with a tin of baked beans and a kettle and a cup of tea.
It is awful. And, and we had to in reverse.
I had a wonderful woman called Nicole, who worked for us, was from Argentina, and she was stuck here.
And she was in this tiny bedsit in Italy or somewhere, and the landlord was awful.
It was a terrible place. And I and I managed to get I used to take her in.
I was really worried about her. And they had had quite a few students that was there and stuck there.
So at least we got her there.
And then they had this lovely community and they all looked after each other because, you know, people were stuck everywhere.
So it was really, really important to look after them.
And do you think the fact that you were working on something that was important, globally important,
helped to give you a sense of purpose and in that sense, support your own wellbeing and.
Yeah. It's interesting, isn't it? Because I think what to me was obviously the scale was huge.
But I've spent my career working on devastating diseases, and so it was just really bizarre to have it here.
And so it was it was extra busy and it was intense because I had the kids at home,
but it didn't feel more catastrophic somehow than some of the disease areas I've worked in before.
But it was just here. And obviously, when we were living in Kenya and I was it wasn't too different from that either.
I was, you know, spending the day in villages where we were doing the vaccine trials,
but we were bringing back kids every day from hospitals who've had these appalling burns or,
you know, mothers dying in childbirth and just the daily grind of diseases of poverty.
I maybe found that when I was coming home to my very healthy boys bouncing around, I maybe found that more.
Too much. Yeah, maybe. And it was. And I always knew I could go.
And I saw it living it in the UK. It was a very.
It was like. It was. It was. It was all turned on its head.
But I felt, I think, seeing in the UK how it is absolutely off.
Of course it wasn't that and this you know the the old people's homes and the
mistakes that are made and the difficulties on some of the scale of activities were,
I mean, awful. But then I was on record colleagues in Peru and Delhi and and Brazil, and it was off the scale awful.
So it was really humbling talking to them.
And I found it quite hard to. You know, my friends are moaning.
They come back for their 50th birthday. Oh, have you?
You know, I would find that difficult coming off these calls to just sort of, you know, rant industry.
That was I was awful, you know? Yeah, yeah, yeah, yeah.
No, I, I can imagine. So I think I think we've more or less got to the end of it.
Yes. Yes. That was good. So finally, has anything,
had the have you changed anything about your attitude or your or the way you think about yourself and your future as a result of the experience?
Of course I realise that. I mean, it's very interesting that, as you say, you've been working in.
Yeah, the health and, and really serious outbreaks.
Yeah. Long time. So yeah. And I would, so I, I do all the time if I'm giving talks to, to governments or,
and academics wherever it is I group outbreaks and I talk about COVID Zika virus, you know, so I do group them.
And what I really hope is that you know, I've got a slide as well that I used to take when I was doing the talk.
If you go into W.H.O. website, there's a great it's just for Africa.
There's a there's a tracker about how many outbreaks are there's usually about 136.
And so it's just that's what they're dealing with every day.
And what I think is an opportunity and a threat is that we and there's often these phrase about pandemic preparedness.
Yes. Which does my head and and because to be prepared for the next pandemic, if we did a really good job at tackling everyday disease,
poverty and put that research structure in where teens in low income countries
are able to to really understand the diseases that threaten them every day,
then they'll have the skills in place to spot whatever comes up.
And this is what's missing.
And so trying to talk about outbreaks in isolation is is the threat, I think, and is a really, really worries me because there are still diseases.
You know, malaria has been around for a millennia and ten millennia, and we need the same things to tackle that a disease pops up.
We need to do it all at once, sure. But it's exactly the same skills.
And so if you take a rural town in Sierra Leone and we equip those nurses and this health co workers
to think is research is a measure what they do and understand what's going on in their diseases,
then they'll if something odd pops up, they'll go, oh, okay.
And they'll measure it and they'll report it. And then we as a well, we'll find out and they'll be able to stop it.
But if and that's how we'll all be protected in the future from other outbreaks, because we don't know where the next one is going to pop up.
And so I think that is hopefully a really exciting opportunity to think about it in that more global context.
I worry about the nationalistic side. We would just, oh, clinical trials would be brilliant.
Said we should just build on that. Well, hang on a minute.
That's taking it out of context of the real world. And so how it's affected how we're working is really focusing on that ecosystem of
research and trying to train a thousand nurses to do studies and become researchers.
And I, I think that's the best way to prevent the next pandemic is actually tackling all diseases.
And then you can respond, but who knows whether that's going to trickle through or not.
That's brilliant. Thank you very much. It's brilliant.
Thank.