Training neglected populations to use the tool of research

What did your early career look like?

I left school at 16 and, as luck would have it, I managed to get a job as a technician in the public health laboratory of a local hospital, so I spent my first dozen or so years working for the U.K.’s National Health Service. It’s been an incredibly good foundation in technique - being clean on the bench - because people’s lives depend on it in a hospital laboratory. While working in the laboratory I undertook a series of part-time higher education courses and at the age of 22, I became the youngest person in the country to become a fellow of the Institute of Medical Laboratory Sciences. By the age of 26, I was running a teaching hospital laboratory while working part-time on my Ph.D. I completed my doctorate while still in my late 20s.

The town where I grew up outside Manchester, England was not an area that typically sent people to university, so my experience coming up gave me an appreciation for the importance of giving people a break. There’s a lot of potential out there and not everybody has an easy road to get an education, to become qualified and move forward.

How did malaria become an interest?

I went to Papua New Guinea (PNG) with the Voluntary Service Overseas, the UK’s equivalent of the Peace Corp, to set up a training program for rural laboratory testing assistants. Of course, I’d never encountered malaria growing up in England, but in PNG, I could see people dying, the children of people I worked with were dying. You really feel it in the gut; it was no longer academic. I met Dr. Michael Alpers, then director of the PNG Institute of Medical Research (IMR), and he suggested I focus on malaria research. For eight years I worked at Australia’s Walter and Eliza Hall Institute and studied the disease’s molecular mechanisms while going back and forth to Papua New Guinea. Our team made one or two key discoveries; we produced the first transgenic malaria parasite and cloned a gene responsible for adhesion to the placenta.

What did you achieve as leader of the IMR?

The institute is unique with fantastic research capabilities and a rich history that included conducting some of the first malaria vaccine trials. Unfortunately, the institute did not have an equally rich bank account in 2000 when I became its director, so it was my job to get funding. I also made putting in satellite internet a priority and pushed hard to accelerate the advancement of young Papua New Guineans at the institute, which was needed for sustainability. I eventually handed my position off to the first Papua New Guinean director.

What are TDR’s goals?

Like Fogarty, we aim to ensure that good science makes a difference and we focus on increasing capacity. Over the past few years, TDR has emphasized training for implementation science - others are driving for creative innovation within countries but there’s a massive gap in delivery science. We work closely with product development partnerships as well.

TDR also aims to democratize research, all while making sure it’s done to an appropriate standard so we can rely on the evidence. We’ve got a real interesting program called the Social Innovation and Health Initiative where we work with grassroots projects - for instance, people who train teachers to test school children for malaria. And the idea is not to drive the projects but instead put the tool of research in their hands and help them strengthen their case for a fantastic idea that otherwise might not get scaled up due to a lack of research expertise. The absolute truth is we miss so much innovation if we don’t listen to the voices of the people on the ground.

What about neglected tropical diseases?

I’ve started talking about neglected populations rather than neglected tropical diseases (NTDs). The key to these diseases is a lack of interest because the populations they affect do not have the political power to drive advancements. If you look at drugs in development, this is the bottom end where no one is really working even though the population sizes are immense. Not all NTDs have high mortality rates, but all have enormous socioeconomic and well-being impact.

Some issues are common to many, if not all, these diseases. While we need to be specialists about certain aspects of disease - for example, we will always need people who know every single thing about the biochemistry of a specific parasite - we also need to keep in mind that the issues of implementation science are often similar. Whether it is river blindness or malaria, some thing, some therapy, must be delivered to the neglected population.

Do you miss your days at the bench?

The way I see it is if you’re a virtuoso musician, it’s great fun and you can play your violin or whatever but if you get the chance to pick up the baton and conduct a whole orchestra, you can do so much more. I feel my current role at TDR is picking up the baton.

I hope to someday look back and see that less people have a disease or a problem because of work we’ve done together. It isn’t the individual performance that you might get at the bench but at a bigger scale you can look at your career and think, I did my best work then.