COUNTDOWN at the Royal College of Pathologists: Emerging and Neglected Tropical Infections

By Professor Russell Stothard

A dear departed colleague of mine from the London School of Hygiene & Tropical Medicine (LSHTM), Dr David Ellis, often used to tell me his favourite medical joke – 

“What’s the difference between a physician, a surgeon and a pathologist? The physician knows everything and does nothing. The surgeon knows nothing and does everything. The pathologist knows everything, but always a week too late”.

David died in 2012 aged 90 but throughout his varied career, he was a proud member of the Royal College of Pathologists.

In life, David had many colourful stories and as a young man he worked with the eminent pathologist Howard Florey during the first trials of Penicillin in Oxford during WW2. He danced ballet with Marlene Dietrich in the opening scene of Hitchock’s Stage Fright in 1950 (but that’s another story), and whilst in charge of LSHTM’S Electron Microscope Unit from 1975 made many important discoveries. David was one of the very first to characterise Ebola virus, a pathogen that many of us in COUNTDOWN now know well and was regularly seconded to Porton Down to provide biosecurity advice to the UK Forces.

With this in mind, I was very honoured to be invited to present at the Royal College of Pathologists on their emerging and neglected tropical infection day. The meeting echoed many of David’s interests, from use of antibiotics to emerging viral diseases, and I was delighted to present our recent COUNTDOWN research.

The first talk by Dr Colin Brown (Public Health England), introduced key topics in the practice of medical bacteriology in the UK: epidemiology of Mycobacterium chimaera associated with open heart surgery, the UK-rise of scarlet fevers with group A Streptococci, outbreak vaccination strategies for pertussis control and emerging antimicrobial resistance in general. Taking a more international perspective, emerging viral diseases were discussed by Professor Daniel Bausch (LSHTM), who now heads the UK Public Health Rapid Support Team, as he recounted his experiences in West Africa, providing support during the recent Ebola Virus Disease outbreak. As many of us know, this was supported by UK-AID and many staff from both UK Schools of Tropical Medicine. The theme was also expanded on by Lieutenant-Colonel Emma Hutley (Royal Army Medical Corps), who helped oversee setting up diagnostic laboratories in Sierra Leone. These provided essential services for patient blood screening, transfusion needs and pathogen detection illustrating the cornerstone role of effective pathology services in real time needs. The latter was especially important to confirm or exclude viral infection.

A later talk by Professor Mathew Fisher (Imperial College London), shed new light on the current problems of antifungal management and treatment of fungal disease either found in the blast wounds of servicemen from soil-contaminated shrapnel or in the lungs and bodies of those with opportunistic infections in London. Mat highlighted his airborne sampling apparatus for fungal spores sited on St Mary’s rooftop, a few floors above Sir Alexander Fleming’s laboratory where he first discovered mould juice to have antibacterial properties, although it was Florey et al. who pioneered its clinical implementation.     

A key but often an under-appreciated part of pathology is study of medical parasites, especially those in the tropics. In contrast to the acute nature of either bacterial or viral infections; medical parasites on the other hand are often chronic, difficult to control and inflict disease in tens of millions. I presented on recent work within COUNTDOWN and highlighted the importance of female genital schistosomiasis (FGS). A quick show of hands of revealed only 3 of the audience had heard of the condition, but one reported she had seen it several times in the UK upon referral from perplexed surgeons who had encountered suspicious cancer-like masses in the Fallopian tubes and uteri of their patients undergoing surgery, which later turned out to be schistosomiasis granulomata (neoplastic masses around trapped schistosome eggs).

The discussions, reminded me of David’s joke, so I made extra effort to feature our work in of FGS in Ghana, Cameroon  and the importance of the international workshop we organised in South Africa three years ago. All of which is starting to raise more awareness, hopefully outside of pathology to FGS; and allow NTD programmes to change tactics through more enlightened discussions and better align themselves with key sustainable development goals, leave no one behind.

Making change happen does not come quickly and there is no short route to rapid policy change but a quick review of our recent activities in Ghana reveal there is much to be hopeful for. Furthermore, this year at our annual partners meeting in Liverpool I hope to see our carefully nurtured seedlings of COUNTDOWN research start to flower, to bear fruit and to nurture lasting policy change with more equitable NTD interventions.     

Press Play for Women pushing for progress on Global Health

by Pamela Bongkiyung, Prof Sally Theobald, Julie Irving, Rachael Thomson & Eleanor MacPherson

“Only 31% of the world’s ministers of health are women, and among the chief executives of the 27 health-care companies in the 2017 global Fortune 500, only one is female.”

The Lancet, Nov. 2017[1]

With this knowledge, we are ushered into this year’s International Women’s Day, whose theme is charging us to #PressforProgress on gender parity. In the COUNTDOWN programme, we are pushing for  gender analysis to be a critical part of policy and practice to address Neglected Tropical Diseases (NTDs), to ensure their equity and effectiveness whilst promoting social justice.

#PressforProgress 2018 International Women's Day

The Department for International Development (DFID) released its strategic vision on gender equality on 7th March 2018 titled ‘A Call to Action for Her Potential, Our Future’. DFID’s vision on gender equality emphasises a need for all to challenge and change unequal power relations, build inter-linked foundations that will have a transformational impact for girls and women, protect and empower girls and women in situations such as conflict, protracted crises and humanitarian emergencies among others. Most importantly, this strategy urges that we leave no girl or woman behind by integrating gender equality across board and build an evidence base that uses data reflective of all groups. This is critical for the NTD response and in COUNTDOWN we have a strong focus on research and action to promote inclusive NTD strategies and approaches.

The COUNTDOWN programme which is multidisciplinary in nature, has been working with women who are leaders in health research and implementation. They have made it their life’s mission to spearhead access to leadership positions, representation of women in health systems research and recognition for women’s contribution to the health system; where women constitute the majority of the health workforce, but are sadly under-represented in leadership positions.

But what prevents the rise of women is bottlenecks in institutions and rules that hinder career advancement, sometimes due to gender bias and discrimination in the workplace and preconceived notions about difficulties of balancing family responsibilities with work.[2]

Regardless of the obstacles they encounter, women still strive for progress as exemplified by our Social Science lead in Ghana, Prof Margaret Gyapong. She decided a year ago to take up the mantle of leadership at a young university – University of Health and Allied Sciences in Ho, Ghana as Director for the Centre for Health Policy & Implementation Research. Prof Gyapong will give her inaugural lecture titled “From the stomach to the skies: Lay perceptions of disease causation and implications for disease control” on 15th March 2018.

Margaret Gyapong Inaugural Lecture

Globally, there has been some progress in promoting gender equity at leadership representation tables and in gender pay gaps. Early this year, we saw Iceland take the lead in enforcing gender equal pay. The UK is getting tough on the issue by asking companies to provide evidence of efforts being made to ensure this gap is bridged. The Bank of England in its Gender Pay Gap Report acknowledges more needs to be done. We need to ensure initiatives promoting gender equity in human resource for health extend to all contexts and all levels of the health systems including amongst community-based drug distributors who play a critical interface role linking NTDs programmes and communities. We need to promote gender transformative approaches in health systems strengthening across the board, and we welcome DFID’s publication highlighted above.

We encourage you to read a paper recently published in the British Medical Journal of Global Health by our colleagues and great women leaders from wonderful organisations on “20years of Gender Mainstreaming in Health: Lessons and reflections for the neglected tropical diseases’ community”.

Happy International Women’s Day and aluta continua!