International impact: MRC-Newton Fund researchers tackling global human health challenges
29 Sep 2016
In the two years since it began, the Newton Fund has grown from strength to strength, expanding to a seven year, £735m UK investment, with partner countries providing matched resources. We talk to some of the globe-trotting MRC awardees to find out how their projects are progressing.
For Dr Alain Kohl, it was a case of joining forces to tackle a very real crisis across the Atlantic. “The credit really has to go to Rafael Franca and Lindomar Pena at the Fiocruz Pernambuco Research Unit in Recife, Brazil. They approached me at a time when the first cases of Zika virus emerged, looking for a Newton Fund collaborator in the UK. I suggested that we should focus on this virus.”
A specialist on arboviruses – viruses transmitted by arthropods – at the MRC Centre for Virus Research in Glasgow, Alain was awarded funding through the Newton Fund UK-Brazil Neglected Infectious Diseases Partnership to study the emergence of the Zika virus in Brazil.
International collaboration is at the heart of the Newton Fund, which is managed by the Department for Business, Energy and Industrial Strategy (BEIS) and forms part of the UK government’s official development assistance (ODA). As one of 15 UK delivery partners, the MRC has awarded funding to 130 projects* across 10 different countries, thanks to a shared vision of strengthening research and innovation between the UK and emerging knowledge economies.
Studying the Zika virus outbreak requires coordinated international activities, bringing together groups of researchers with different strengths. “We’ve brought in clinicians diagnosing and treating people infected with the virus, and molecular virologists who study the virus itself. As a result of this initial funding we have expanded our studies to work with clinicians who study neurological disorders, due to the association of the virus with Guillain-Barré syndrome, and ecologists who know a lot about mosquito behaviour,” says Alain.
Looking at the situation on the ground is very important,” he adds. “I was very much lab-based through a large part of my career, working on the molecular biology of arboviruses. Over the last few years I have been more involved in affected regions, and it’s been a real eye-opener to work where arboviruses are having a huge impact.
Antimicrobial resistance (AMR) is another complex problem requiring global collaborative and interdisciplinary research efforts. “Antibiotic use is a major driver of the transfer of antibiotic resistant bacteria between humans, animals and the environment,” explains Dr Helen Lambert, Reader in Medical Anthropology at the University of Bristol. She secured funding through the Newton Fund AMR-China Partnership Initiative in July, supported by the MRC, the Economic and Social Research Council, the Biotechnology and Biological Sciences Research Council and the National Natural Science Foundation of China.
“Ultimately, why and when people take antibiotics is to do with social, cultural, psychological and economic issues, as well as the political will to tackle them – it’s not purely a microbiological or a bacterial issue.” Helen is aiming to bring all of these perspectives together to investigate how to develop appropriate strategies to optimise antibiotic use in China.
Very little is known about the use of antibiotics in rural environments in China, including what influences practitioners to prescribe or dispense antibiotics without access to microbiology techniques to identify the specific type of bacteria. Helen’s collaborators at Anhui Medical University have conducted some pioneering pilot work on these issues that the Newton-funded collaboration aims to build on.
"Although most countries are developing national action plans to tackle AMR there’s been very little opportunity, until now, to understand how we can tailor interventions to make them appropriate for the particular context,” explains Helen.
For example, reducing antibiotic prescribing and prohibiting access to over-the-counter antibiotics may be an effective approach in Europe. But translating this intervention to resource-poor settings where infectious illness is a really big problem – and where, in many places, buying antibiotics over the counter is a practical way to obtain these life-saving drugs where quality medical care is inaccessible – would not be appropriate.
Helen hopes the project will be a useful learning experience, giving her team the opportunity to work through in practice how they can develop a complex, interdisciplinary solution. “We hope the knowledge gained will be relevant to tackling the problem of AMR in the local setting in China, but also for the UK in terms of learning how to understand a wide range of parameters when we’re working in a very different kind of environment.
Meanwhile, Alain’s team are using their extensive knowledge of the molecular biology of arboviruses, and their facilities in Glasgow, to better understand the Brazilian isolate of the Zika virus. This is important knowledge for helping tackle the virus outbreak on the ground. “We’re now at the point where we’ve developed antibodies against the Zika virus, which we hope to use in lab-based studies as well as for improving diagnoses.” explains Alain.
Diagnosis is the focus of another Newton Fund project, led by Professor of Obstetrics Andrew Shennan at Kings College London. His team has developed a simple device to measure blood pressure and pulse, like the type you might buy from a chemist, designed to be extremely accurate in pregnant women and to detect shock.
Bleeding, infections and blood pressure problems make up the majority of maternal deaths, and 99 per cent of deaths happen in low-income settings. But the main cause of death, as Andrew explains, is not because facilities aren’t available to save lives. “It’s often down to poor recognition. Women are in the wrong place at the wrong time and don’t know they’re getting sick. Our hypothesis is that this device will make a huge contribution to reversing those deaths through early detection of problems in pregnancy."
Suitable for use in low-income settings, it’s taken Andrew and his team the best part of a decade to get the device accurate. Small and compact, robust and cheap, the device has low power requirements and can be charged using a mini USB phone charger. It also contains a traffic light system, with flashing lights that alert the user to problems.
Funding awarded through the Joint Global Research Programme for Women’s and Children’s Health in collaboration with the Department of Biotechnology in India, as part of the MRC-Newton Fund partnership with India, has allowed Andrew to set up a clinical trial, CRADLE 3. It will run across 10 low-income settings and test whether large-scale implementation of the device can save lives and prevent serious problems.
"We want to test the impact it has in large communities where there are a lot of serious problems in pregnancy so that we can work out whether it’s really worth backing with serious funding in the future,” explains Andrew. “The reason we’ve gone to so many different centres across the world, including India, is that we think there will be different implications for different communities.”
A two-way street
Capacity building is a key component of all Newton Fund activities, illustrated well through Alain’s experience. “Knowledge transfer is a huge part of the project. It has really become an exchange on a regular basis where knowledge and tools are going from one side of the Atlantic to the other.”
An important part of Helen’s project is training groups of local researchers in her collaborating university. “Qualitative research, in terms of talking to patients and practitioners about their perceptions of antibiotic use and their actions, is relatively new in health science institutions in China. My co-Principal Investigator Debin Wang and his team are keen to develop expertise in new research approaches and I very much hope that this will be the beginning of enhancing local research capacity in this area. We are also eager to learn about the Chinese health system from our collaborators.”
In Andrew’s case, at each trial site they have been working closely with researchers collecting data for the trial to make sure that the device is implemented properly, and that everyone gets the training they need. But he has also learnt a lot. “I’m working with different specialist leads with varied interests in different healthcare structures. The problems people have in different areas are unique.”
And the device even holds promise closer to home. Andrew recently made a surprise diagnosis, in his own clinic in London, thanks to the device’s flashing yellow light. "I didn't know why it was flashing, I had to think about it, ask my patient some more questions and I eventually diagnosed pneumonia. It was a realisation that the most experienced of us can get things wrong unless something simple alerts you to it."
*Some of these projects received contributions from other funders.
Hear more about Alain and Andrew’s projects in our MRC talks podcast.