Fact vs. Fiction
Rebuilding Trust with the Scientific Community in a Global Pandemic
Interview by Cuthbert Sperryn
Motivated by the loss of almost a whole generation as a result of HIV and TB infections in her hometown in South Africa, Clare now works primarily on infectious disease immunology and vaccine development. Since the outbreak of the pandemic, the lab Clare works in has been using coronavirus patient samples to look at the determinants that influence the severity of the immune response between adults and children. We ask Clare how the sector has shifted to focus on the global outbreak and where the opportunities are to once again, take expert opinion seriously in our efforts to become a more socially and ethically conscious community.
Clare, why did you get into working in immunology and infectious disease?
I grew up in South Africa where there are a lot of deadly infectious diseases. My hometown is in the province of Kwa Zulu-Natal, the epicenter of the global HIV, TB syndemic. A substantial percentage of deaths are people dying of HIV & TB infections. It is especially important that vaccines that can prevent disease, rather than treatments, are developed. Prevention is better than cure. I grew up seeing the damage these diseases did to the community and I wanted to do something about it.
It really seemed unfair to me that there was a generation of grandparents raising their grandchildren because so many of the parents had died. It was really difficult for elderly, low income South Africans to be able to afford to take care of their children. They thought they were done with raising kids, and now they're looking after sometimes six or seven grandkids, it was heartbreaking.
Infectious diseases are one of those things that really are preventable. It's not like cancer or diseases of old age that aren't really something you can stop from developing. Infectious diseases are something that, for the most part, you could prevent or treat. So it just seems like a low hanging fruit in terms of things that you could do that would really improve people's lives.
Since coronavirus, what has been your focus at work?
With coronavirus, we have a great population of infected humans who are exceptionally willing to participate in research given the current crisis. We have samples from hundreds of volunteers who were infected with the coronavirus, and in some cases we've got them to come back and give us sequential samples.
Blood samples are placed in a centrifuge and white and red blood cells are removed, what you are left with is 'serum'. Serum is more stable than blood and lasts longer at room temperature which means we don't have to continually 'bleed' patients. We’re looking primarily at innate immune function, which is the early immune response to the coronavirus, and at the antibody responses to the virus.
We are focusing on the differences in the response between adults and children. In general, it seems that kids don’t get that sick, but there are a couple of kids that aren’t really getting respiratory symptoms, but are developing a multi-system inflammatory condition. We look at differences between the kids that responded well to the virus and those that responded poorly, which gives us an idea of what sort of pathways you could target therapeutically to rein in some of the damage done by the immune response (immunopathology) and potentially help the patients do better.
Patients who are so ill they require ventilation suffer most of the damage to their lungs, in part from their immune response, rather than by the virus itself. The immune system damages a load of lung cells whilst trying to target the virus. If we can identify the pathways that differentiate the people whose immune systems destroy their lungs from the people whose immune systems clear the virus, we can focus on this to try to improve treatments until a vaccine is found.
Do you have any insight into why BAME communities have suffered worse from coronavirus than others?
The hardest hit communities are low-income communities and communities of color. This is probably largely related to lifestyle factors. People in these communities tend to live in poorer areas, in dense neighborhoods. They tend to be more likely to use public transportation. They're more likely to work in essential jobs. They're essentially more at risk in their day to day lives.
Aside from socio-economic factors, do you think there are health traits within BAME communities that might make someone more susceptible to the virus?
You can't really separate the socio-economic factors from health traits unfortunately. The socio-economic conditions create health conditions that cause worse coronavirus outcomes, thus creating a very depressing negative feedback loop. Coronavirus has hit these communities really hard, but only because they were being hit hard before by a variety of other issues that are compromising their health and making it harder to fight the virus.
Part of it is socio-economic, especially in the USA - obesity is heavily related to the availability and expense of healthy food, which is much less readily available in low income communities of color. These communities are also often concentrated in areas with higher pollution, for example, which is associated with higher rates of asthma in children.
How have relationships changed within the scientific community?
The scientific community has really come together to work on coronavirus. People who usually work on other viruses especially, have dropped everything to focus on figuring out what this virus is, what it does, how it does it and how we can stop it. What’s amazing is how these researchers are not funded to do this kind of work. They're funded for what they usually do, and they're using this money to study something different for the greater good.
More academically focused companies have also been really good at collaborating with researchers to get this stuff done as fast as possible. Even some of the biggest pharmaceutical companies, rather than competing with each other, are working together. A really good example is GSK and Sanofi, who are working together to develop a vaccine.
The United States government has not been very supportive of that process. It seems Trump is discouraging US companies from collaborating with overseas researchers unless they give the US first dibs on a vaccine, which is kind of antithetical to how the scientific community works. We have to work together to solve this.
Clearly, judging by the statements of Trump and other politicians, they aren't following your advice.
In the USA, it seems people have largely stopped listening to the medical professionals that Trump put in charge of the coronavirus response. But there are actually really good examples abroad where people did listen to the medical community.
New Zealand's prime minister listened to the scientific and medical communities, did what was necessary, followed their advice and as a result, eradicated the coronavirus. It's sort of a proof of concept that it's possible and that the experts aren't really just making it up as they go along. They really do know what they're talking about and the recommendations that they make have tangible, positive benefits to the communities that adhere to them.
The sorts of measures that need to be taken to restrict the spread of respiratory infections are hard. People are going to lose money and lose jobs, and that's all going to be painful. I totally understand why people struggle with that. But given the alternative is tens of thousands of people dying, I would argue that that pain is worse. People don't like doing what's hard, I understand that, but there's also this long-standing disregard for the opinions of experts.
Is that illustrative of the mainstream perspectives towards science and disregard for expert opinion?
I think climate change is probably the best example where it doesn't matter how much data there is, or how convinced scientists are, the politicians have decided that the scientists are unreliable. There is a general political benefit to taking things that you hear from scientists that you don't want to hear now and just deciding that they aren't true.
Boris Johnson is a good example. A couple of years ago, he told everyone that we had all “had it” with experts. So as part of this community, that was worrying. Since this life-threatening global pandemic, the scientific and medical communities stepped up to communicate with politicians and give our opinions on what they should do, since we have no power to enforce it. As time has told, when people listened, lives were saved.
There are people for whom it is not politically expedient to support experts. And maybe it's because if you believe the experts on this, you have to argue that it is worth keeping the economy closed; or if you believe the experts on this, you then have to also believe them on climate change, which doesn't suit you to believe it is true.
Where do anti-vaccine communities fit into this discussion?
It'll be interesting to see if the anti-vaccine community will be weaker after COVID or if they will integrate themselves with some of the other communities that didn't like the lockdown, for example those who campaigned to reopen for economic reasons. I think the coronavirus will further challenge the anti-vaccine community when we do get to the stage of a valid vaccine being distributed world-wide and populations being saved.
Mistrust of scientists and the medical establishment was so high last year that there was an outbreak of measles in New York as a result of lack of vaccinations for that disease, and the immunity to the disease dropping below the necessary level. COVID has a reproduction rate (R0, the number of people each infected person infects) of around 1:3. Measles is around 1:16 - it’s massively infectious. The issue is a lot of anti-vaccine believers don't end up getting ill despite not being immunized because so many others in the community are vaccinated that they benefit from herd immunity, which further reinforces their beliefs.
For people that I know, I am more patient and put effort into trying to bring them around, but it’s difficult. Most think because they have read some material off an anti-vaccine website that they’ve done their research. It’s hard convincing people who are tied to their beliefs.
The scientific community hasn't put enough effort into education for the past two or three decades. I remember when I grew up that vaccination wasn't optional, everyone just lined up at school for their shots. Now parents have more power to prevent their children from receiving vaccines, and they think that the information they can access at the click of a button is good information. They don't necessarily have that kind of scientific literacy to filter through what is reliable information compared to what isn't.
The ability to think critically is so important, we should be learning this from day one really.
I'm sure you have been asked this a lot, but have you got any theories on the most effective route governments should be taking to address the transition out of lockdown?
Scientists never wanted or expected lockdown to go on forever. Quarantining people was an emergency measure to allow us to develop a plan for how to properly restrict transmission of the virus so that we would be able to provide the necessary medical care to all of the people who got sick.
Again, New Zealand is a great example. It is the only country to ever eradicate the coronavirus. They made a decision to lock down the country for four weeks. They told everyone how long it was going to be. They told everyone what the determinants of success were going to be. They told everyone what the restrictions were in advance, and then enforced those. Having a limited timeframe, having very clear guidance, having clear communication about the goals really helped people to buy into it and adhere to those restrictions.
Having that plan and communicating it clearly to the people is really what made a difference.
Coronavirus is affecting everyone, including people in rich countries, therefore there is more likely to be kind of a fire underneath people to do something about it. This isn't necessarily the best thing. I don't think that the lives of people in Central Africa who have been dying of the Ebola virus are any less valuable than wealthy white Americans. The extensive outbreak is really what makes a difference for people - this isn't confined to a single region or a single country. It really is a global problem at the moment and unless we work together and all countries really commit to trying to control it, there's always going to be breakthroughs, and people will keep getting sick.