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Director’s Update: Fossil fuel investments are a complex issue on which fair-minded people will disagree

15 Apr, 2015

Dr Jeremy Farrar, Wellcome TrustThe Wellcome Trust holds some investments in fossil fuel companies, which campaigners are asking us to sell. Jeremy Farrar, our Director, explains in an open letter to our community why this is a complex issue on which people who share environmental goals will often reach different conclusions, and why Wellcome is comfortable with a diversity of opinion.


Dear colleagues and friends,

You may well be aware that the Guardian recently launched a campaign urging the Wellcome Trust and the Bill & Melinda Gates Foundation to end investments in fossil fuel companies. While we support the campaign’s ultimate aim of reducing carbon emissions to restrict global warming to 2C, we do not believe this is the strongest contribution we can make to this important goal.

I have explained our view at length in the Guardian and on our website, but in short, it is that we think this issue is more complex than the campaign has allowed, and that there are better ways of maximising our influence as investors. We do this by taking a case-by-case approach that considers individual companies on their merits, including the extent to which they meet their environmental responsibilities.

When we do choose to invest or stay invested (as we have done with 4 of the 200 companies on the campaign’s target list), we then engage actively as shareholders. We use our access to company boards to press for more transparent and sustainable policies that support transition towards a low-carbon economy. We apply this approach both to companies that produce and consume fossil fuels: demand is as important as supply.

We have been asked for evidence of how our engagement has made a difference. This is not as straightforward as it sounds because most of the discussions we have as investors are confidential: we could not expect frankness or access to commercially sensitive information were we to publish details.

It is also rare for discussions with a single shareholder to lead directly and immediately to a clear outcome: our influence works over time, and most powerfully when boards hear similar messages from many shareholders. Divestment would remove a strong voice that takes climate seriously from these coalitions of persuasion, with no likelihood that those to whom we sell our shares would engage the same way. It would not only end our own influence with these companies, but also undermine the influence of other investors who share our views.

One current example in the public domain where this process can be seen at work is in the shareholder resolutions proposed at the forthcoming Shell and BP AGMs, which would require detailed disclosures about their lobbying on climate change, the incentives they offer executives on this issue, and low-carbon investment. We are part of the constellation of investors that has convinced the boards of both companies to recommend these resolutions to other shareholders.

The transparency we are helping to create is not in itself an answer to climate change, but it is a necessary step if not a sufficient one. We have seen no evidence from campaigners that the divestment initiatives that have happened to date have had any comparable influence on any fossil fuel companies. We are being asked to exchange an approach that we know to be effective, if difficult and complex, for another based on conjecture.

I understand that not everyone in the Wellcome Trust’s network will agree with our position. We have thought hard about this issue, beginning long before the present campaign, and are comfortable with the decisions we have reached. But this is an issue on which fair-minded people who share environmental goals are always likely to reach different conclusions. We are also comfortable with this diversity of opinion, and with criticism and challenge, whether those who disagree with us express themselves privately or publicly, and whether they have strong connections with Wellcome or none. We will continue to listen to the full spectrum of views – if you would like to share your view with us, please do email

If you would like to know more about the investments that fund our mission, you can read about them in detail in our most recent Annual Report. Wellcome has also made understanding the connections between environment, nutrition and health one of our five key challenges, and you can read about the work we have started to fund in this emerging field here.




Where are the academic leaders of the future?

14 Apr, 2015
Participants in the 213-14 Leadership Programme

Participants in the 213-14 Leadership Programme

Traditionally, leadership development has been a concept associated with the corporate world, and one often met with scepticism in academic circles. In recent years the scientific sector has changed, and is becoming an increasingly complex business. Claire Fenton, Project Manager for the Wellcome Trust Research Leadership Development Programme, explains why we need to develop the leadership skills of academic research scientists and what the Wellcome Trust is doing about it…

As I head into St Pancras International to catch my train home in the evening, I continue to be taken aback by the sheer size of the building which has risen from the construction site behind the British Library. The Francis Crick Institute, set to become a world-class research centre and one of the most significant developments in UK biomedical science for a generation, is due to open in London in 2015.

Britain has long been at the forefront of scientific discovery, and existing clusters of scientific excellence, along with initiatives like the Francis Crick Institute place it in a strong position to continue to be so in the future.

Hand-in-hand with investments creating the best physical spaces for research, goes the requirement for scientific leaders who drive innovation and discovery today and tomorrow. How deep is the talent pool of academic visionaries to lead the centres and institutes into the future? And are they well enough equipped for the challenge? Investing in great buildings and research hubs is not enough. We also have to invest in the people who will work in them.

Delegates from the RLDP taking the controls of a BA flight simulator to explore exploring how personal reactions to stress impact on leadership persona.

Delegates from the RLDP taking the controls of a BA flight simulator to explore exploring how personal reactions to stress impact on leadership persona.

The majority of academic scientists entered into a research career because of their curiosity and desire to learn more about their subject of choice. Whilst many hoped that one day they would become a leader in their field, it is rare to find a principal investigator, head of department or institute director who began their scientific career with the dream of being a manager. Rather, their upward trajectory on the career path began as they had an exciting and logical vision for their science.

Leadership has often been interpreted as a decorative word for management, with training courses viewed as a waste of time that could be better spent in the lab.

However, increasing global collaboration, capacity building and advances in knowledge exchange, demand that scientific leaders possess a diverse and adaptable set of skills, which extends well beyond their ideas for their research. Leadership also requires more than just good management skills. An excellent leader should be able to set the agenda and inspire people to share and engage with their vision. They are responsible for enabling everyone underneath them to achieve that vision and fulfil their potential.

Leadership development in the scientific community is essential and the talent pool for research leadership is a global market. For the UK to continue to be internationally competitive in the long-term, we need to not only be able to attract the best, but also to nurture, develop and retain the next generation of research leaders.

OLYMPUS DIGITAL CAMERAThe Wellcome Trust recognises the importance of good leadership in advancing scientific knowledge, and as a global charitable foundation dedicated to improving health, we take our responsibility seriously. That’s why in 2013, along with Monitor Deloitte Europe, we launched the Wellcome Trust Research Leadership Development Programme (RLDP), to address the need for leadership development in the academic sector.

The RLDP aims to develop the skills and capabilities of research leaders in the biomedical science, clinical and public health research communities. The programme explores three key elements of leadership: strategy and vision, managing people and leadership persona.

There is no single formula for what makes a good leader, so rather than being a standard classroom-based programme, participants are taken to diverse, new environments and challenged to investigate leadership excellence outside of research, before exploring how to thrive as a leader in the dynamic research environment.

Supporting and developing the research leaders of the future, and building a network of scientific leaders who can learn from and support each other, has the potential to greatly benefit the scientific community as a whole.

The Wellcome Trust Research Leadership Development Programme (RLDP) runs once a year and is aimed at those already in established leadership positions, or who are considering such a role as their next career move. To date, 24 research leaders have participated, with another 14 taking part in the 2015/16 course. Information regarding the nomination of candidates for the 2016/17 delivery will be sent out to universities later this year.

Researcher Spotlight: Dr Thomas Ezard

13 Apr, 2015

Dr Thomas EzardDr Thomas Ezard is a NERC Advanced Research Fellow and holds a Wellcome Trust Investigator award. Based at the University of Southampton, his research looks at the way events such as wars, outbreaks of disease, and legislation affect the growth of populations. Here he shares his desire to advance the use of evidence-based policy, and tells us how stand-up comedy has helped him when he’s face-to-face with funding committees…

What are you working on?

Two things, mostly: My NERC work investigates how differences among individuals create differences among species (the bridge between micro- and macroevolution).

My Wellcome Trust award asks how disturbance changes human population growth. By disturbance, I mean events like agricultural intensification, wars, pandemics, legislation of a National Health Service and many more besides. Even if they’re very short, these events can leave dynamic signatures that persist far into the future.

The second world war, for instance, left millions dead, but the survivors produced a baby-booming generation that are now at an age where their increased relative abundance poses significant financial, social and moral questions for population health. If human civilisation advances by adapting to events, it probably makes sense for us to get a better handle on how these events change populations.

What does your average day involve?

At the minute, each day typically starts by despairing at the often-witless coverage of the opinion polls for the general election!

Most of my days are spent meeting students to talk about their particular projects, or trying statistical or mathematical models for new ideas I’m just starting to try to think about. As I’m based across two campuses, some time is spent cycling the six kilometres between sites. Although less fun in winter, the cycling is a welcome break from staring at computer screens and gives me time and fresh air to think.

Why is your work important?

Exard NHM

Backstage at the Natural History Museum

It’s important because we have the opportunity to make decisions using a robust evidence base, rather than the whims of individuals. I despise a “this is how we’ve always done it, so this is how we’ll do it again” attitude. My Wellcome Trust project isn’t really the ‘Big Data’ cliché – medium data, perhaps. Moving from providing an evidence base to the actual changing of attitudes is a pretty substantial step though.

What do you hope the impact of your work will be?

I’m really excited about working with the public policy team at Southampton to try to convert the mathematical models into something that improves how we plan places where people live.

I can’t wait to see how exceptional, in terms of sheer numbers, the baby boomers are compared to other cohorts responding to other disturbances.

How did you come to be working on this topic/in this field?

Chatting with Stuart Townley about what the demographic consequences of the menopause might be, rather than what we were supposed to be concentrating on (epigenetic inheritance).

How has Wellcome funding helped you/your research/your career?

The Trust has enabled me to recruit a team of researchers working on different aspects of the same problem. As I’m at the start of my career as a Principal Investigator, a number of my PhD students are doing quite opportunistic projects in very different areas. Being able to design roles that complement each other and working with smart people in those positions means our progress meetings are genuinely interesting.

The support from the Trust has also helped take my work in a new direction – I first started thinking about these models as a tool to aid the conservation of threatened species. Whatever humans are, we are not critically endangered.

Image courtesy of Lookcatalog on Flickr - CC-BY

Image courtesy of Lookcatalog on Flickr – CC-BY

What’s the most frequently asked question about your work?

It’s not really a question, but I often hear variants on the “I don’t like maths/equations/statistics” theme. The perception that biology is not a rigorous quantitative science is suboptimal.

Which question about your work do you most dread – and why?

When someone has worked for most of their whole career on a single system and wants to know why my models don’t predict it perfectly. The “why” part is because the follow-up is always, always, a “but you haven’t included X, so of course it doesn’t.”

I’m very much of the “all models are wrong, but some are useful” school of thought: I’m not trying to understand your particular system, I’m trying to benchmark changes across lots of systems, all with their own peculiarities.

Tell us something about you that might surprise us…

I shared an office with Ellen Dowell, who is a brilliant creative producer of science engagement. Ellen “persuaded” me to do research-based stand-up comedy. I tried to convert one of my papers into a stand-up comedy set. The experience was terrifying, but terrifyingly brilliant. It’s also been excellent preparation for keeping it together while pitching projects to funding committees.

What keeps you awake at night?

T6233240407_81131e202c_zoo much blue light from faffing about with statistics on my computer.

What’s the best piece of advice you’ve been given?

Mr Lawrence (my GCSE maths teacher) told me that if I didn’t know what I wanted to do, keep doing maths.

The chain-reaction question, posed by previous spotlightee Dr Julija Kripic is this: When would you advise a person to pursue PhD or a scientific career in general? To put it differently, what does it take to be a scientist?

When interviewing prospective PhD students, I’m looking for a spark of creativity and a different way of thinking about a problem. I’m not interested in whether the person has a 1st class degree or 97% on the ecological modelling module, but how they pose questions. Science should be more about constructive questioning and criticism, not a “this is it” doctrine.

To find out more about Thomas Ezard and his research, you can follow him on Twitter and visit his profile on the University of Southampton website.

Image credits: Provided by author; NHM image thanks to Marina Rillo; Crowd image by Lookcatalog on Flickr, CC-BY; Implicit heart curve, by Duncan Hull – via Flickr – CC-BY


Image of the Week: Endangered Mountain Gorilla

10 Apr, 2015
Nyanjura near its mother. Image courtesy of Gorilla Doctors.

Nyanjura near its mother. Image courtesy of Gorilla Doctors.

Our image of the week this week is of a young gorilla called Nyanjura, part of a small population of mountain gorillas from the Virunga volcanic mountain range in Africa. In 1981 the population size had been drastically reduced to around 253 as a result of hunting and the destruction of their habitat.

There were concerns that such a small group would have a limited gene-pool, and thus be vulnerable to disease or changes in the environment, but the latest research shows that inbreeding has, in some ways, been genetically beneficial to the group.

Despite mountain gorillas being one of the most intensively studied species in the wild, this is the first time an in-depth, whole-genome analysis of mountain gorillas has been possible.

The research was conducted by scientists from a range of centres, including the Wellcome Trust Sanger Institute, home to Dr Chris Tyler-Smith, one of the authors of the study. “Three years on from sequencing the gorilla reference genome, we can now compare the genomes of all gorilla populations, including the critically endangered mountain gorilla, and begin to understand their similarities and differences, and the genetic impact of inbreeding” he says.

Their research found fewer harmful loss-of-function gene variants in the small mountain gorilla population than in larger western gorilla populations. These variants stop genes from working and can cause serious, often fatal, health conditions.

“This new understanding of genetic diversity and demographic history among gorilla populations provides us with valuable insight into how apes and humans, their closely related cousins, adapt genetically to living in small populations,” says Dr Aylwyn Scally, corresponding author from the Department of Genetics at the University of Cambridge. “In these data we can observe the process by which genomes are purged of severely deleterious mutations by a small population size.”

Since the early 1980s, the Virunga population has grown to approximately 480, thanks to conservation efforts led by the Rwanda Development Board and Gorilla Doctors, but they are still critically endangered.

It is hoped that the genome-wide map of genetic differences between populations will enable scientists to identify the origins of gorillas that have been illegally captured or killed. This will mean that more gorillas can be returned to the wild and will make it easier to bring prosecutions against those who poach gorillas for souvenirs and bush meat.

You can read the full paper: Mountain gorilla genomes reveal the impact of long-term population decline and inbreeding, in the latest issue of Science. You can find out more about the work of the Gorilla Doctors on their website.

Image credit: Gorilla Doctors, used with permission.

Sharing Research Data to Improve Public Health

8 Apr, 2015


An international workshop recently held in Stellenbosch, South Africa explored the opportunities and challenges for enabling greater access to (and use of) data generated by public health and epidemiological research in Africa. David Carr, Policy Adviser at the Wellcome Trust, describes some of the key themes that emerged from the productive and lively discussions…

Over recent years, there has been a growing consensus that many of the increasingly rich and complex datasets being generated from health research represent a vast untapped resource. Making data more readily available to researchers and other users enables the data to be used in new and innovative ways, helping to maximise the benefits to health, and improving the efficiency of the research enterprise.

Research funders (including the Wellcome Trust) have responded by introducing policies requiring that data generated by their funded research are made available for access and re-use with as few restrictions as possible. However putting this into practice is far from straightforward, and particular challenges exist in relation to public health and epidemiology research data collected by researchers in low- and middle-income country (LMIC) settings. There are very real fears that the value of data to both the researchers that collect it, and to the populations in the countries concerned, will be threatened if is made rapidly available to better-resourced groups elsewhere in the world.

browser-98386_1280In 2011, more than 20 global health research funders came together to establish the Public Health Research Data Forum – committing to work together to increase the availability of public health and epidemiology research data in ways that are equitable, ethical and efficient, and that will accelerate improvements in public health.

Last week’s workshop in Stellenbosch was a major landmark in the Forum’s work: bringing together around 65 health researchers and other stakeholders from across Africa, with selected international experts, to take stock of the work undertaken by the Forum and to help shape its future direction.

From the outset of the workshop, there was clear consensus around the benefits that could be derived from sharing data, and a strong willingness from all participants to engage in and explore ways in which sharing could be enhanced.

In the course of the meeting, speakers from several major collaborative initiatives and networks – including the INDEPTH and ALPHA networks, H3 Africa and WWARN (the Worldwide Antimalarial Research Network) – described how effective platforms for data sharing had been established which were benefiting researchers across Africa and beyond. It was clear, however, that there was a good deal more nervousness when it came to making data available outside of established collaborations. Here, there was felt to be a critical need to establish fair conditions of use, and mechanisms to ensure that the contribution of those generating the data was properly recognised.

Three further key messages emerged strongly from the workshop. The first was the critical importance of activities to develop capacity and skills in data management, curation and analysis in LMICs and the need to consider how capacity building can be resourced through research funding, and in the context of data sharing agreements.

Secondly, the importance of building and maintaining trust and confidence among all stakeholder groups concerned – including researchers, institutions, ethical review boards and research participants – as a basis for effective data sharing cannot be overstated.

Delegates discussed emerging findings from a major research study funded by the Wellcome Trust on behalf of the Forum, which has explored the views and expectations of key research stakeholders across five LMICs – an area which hitherto has been lacking an evidence base. The study will be published in July, together with an online toolkit to help support future engagement activities in different settings.

Thirdly, there was very strong agreement that data sharing needed to be considered as an integral part of the research cycle, and incentive structures developed to help ensure this occurs. The costs and benefits of sharing data, and the resources and skills required, must be factored in from the earliest planning and design stages of research, not just added in as an afterthought.


Image courtesy of: Dominik Bartsch on Flickr. CC-BY.

Catherine Kyobutungi of the African Population and Health Research Centre likened this need for a holistic perspective to ‘finding the hippo’: identifying the creature as whole, rather than just the part above the waterline – an analogy which captured the imagination of the group and became the catchphrase for the workshop!

In the final session, delegates discussed a new Forum report, published to coincide with the workshop, which explores the benefits and challenges of data linkage in public health research in both high-income and LMIC settings. There was strong support for the report’s key findings, which include the need to shift the tone of the policy discourse on data sharing from “default closed” to “default open”, and the need to create resources and case studies to aid researchers making the case to link data.

The rich discussions at the workshop will play a vital role in shaping the next phase of the Forum’s work, as we look at how we can best work together and with the research community to support data sharing in a manner that is sensitive to different contexts. The Wellcome Trust will continue to play a leading role in this work.

The meeting was also successful in bringing new voices from Africa into this discussion: building upon, and further expanding, this engagement and dialogue will be a key priority for the Forum. A report of the workshop will be developed by the US National Academy of Sciences over the coming weeks. We hope that this will be used by workshop delegates (and others) to spark further discussion and debate across Africa and globally.

Further information about the work of the Public Health Research Data Forum is available on our website. A webinar to discuss the findings of the new Forum report on data linkage will be held on Monday, 13th April at 12:00 to 13:30 BST, please click here to register.

ProMED: An Early Warning System for Emerging Diseases

7 Apr, 2015



The fast and effective communication of reliable information is vital during outbreaks such as the Ebola epidemic in West Africa. Combating infectious disease is one of the Trust’s five focus areas, which is why we are pleased to award five-years of funding to ensure ProMED emails from the International Society of Infectious Disease remain free of charge to users. ProMED Editor Larry Madoff explains the importance of this early-warning system…

This morning I received this e-mail and then searched your archives and found nothing that pertained to it. Does anyone know anything about this problem?

“Have you heard of an epidemic in Guangzhou? An acquaintance of mine from a teacher’s chat room lives there and reports that the hospitals there have been closed and people are dying.”

– from a ProMED report 10th February 2003

If you are a public health professional, odds are you first heard about the newly discovered SARS epidemic from ProMED-mail. ProMED (the Program for Monitoring Emerging Diseases) recently marked its 20th anniversary serving as an early warning system for emerging diseases and outbreaks around the world. ProMED pioneered the use of nontraditional sources – such as media accounts or firsthand clinician reports – for disease surveillance. It also made early use of the internet for collecting and distributing public health information.

ProMED healthmapMore recently, the public health world learned of outbreaks of avian influenza, Ebola, MERS coronavirus, Chikungunya, cholera, measles and many other threats from ProMED. Its readers received reports and daily updates on ongoing outbreaks 365 days per year.

A program of the International Society for Infectious Diseases, ProMED is available to all, free of political constraints and currently counts more than 70,000 participants representing every country on the planet. In addition to its main global service, ProMED’s regional networks serve both Francophone and Anglophone Africa and provide Spanish and Portuguese language services in Latin America. New networks have been developed for the Middle East and South Asia. These regional ProMED networks help improve disease surveillance in areas that are often hotspots for disease emergence, but are poorly served by traditional public health systems.

ProMEpromedlogo_trans3D offers reports with expert commentary via email, web and social media. It has a staff of 50 located in over 30 countries and provides all of its services free of charge. Since its inception, ProMED has endorsed a “One Health” or ecological approach to understanding disease emergence recognizing that human health depends on the health of other species, both plant and animal. ProMED encourages dialogue among a diverse global health community, promoting communication among its readers.

Through its recognition of ProMED as a public good, the Wellcome Trust is helping to sustain ProMED’s essential mission while allowing for technical enhancements and research initiatives that will improve detection and allow for mitigation of infectious disease threats.

To access reports, or sign up for a free subscription, go to ProMED-mail’s website.

Image of the Week: Easter Bunnies

3 Apr, 2015

V0046794 Sketched of Rabbits

With the Easter break upon us we’re full of the joys of spring – and what better way to put a spring in your step but with some bunnies?

Our image of the week is from the Wellcome Images archive and is a 19th century Japanese sketch of some rabbits. The origin of the Easter bunny is not entirely clear, with some believing it stems from the pagan celebration of the spring goddess Eostre whose animal symbol was a rabbit. Others link it to the German tradition of Osterhase – “Easter Hare” – who judged whether children had been good and delivered baskets of coloured eggs the night before Easter.

Whatever you believe, we wish you a nice break, and will see you next week. If you’re looking for something to keep you (or your children!) busy, check out our April events listing or print yourself a free copy of the antique Game of the Golden Goose that we featured last year.

Wellcome Images is one of the world’s richest and most unusual collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. Over 100,000 high resolution images from our historical collections are now free to use under the Creative Commons-Attribution only (CC-BY) licence.

Rolling back malaria: A journey through space and time

31 Mar, 2015
©Access to Understanding, Design Serial/Trash

©Access to Understanding, Design Serial/Trash

On Friday the winners of the Access to Understanding competition were announced at an event celebrating communication of scientific research. Aimed at PhD students and early-career postdoctoral researchers, the competition challenged entrants to take a cutting-edge research paper and explain it to a non-specialist audience, covering what the research entailed and why it of importance. Philippa MatthewsThis year’s winner, Philippa Matthews, is from the Peter Medawar Building for Pathogen Research, at the University of Oxford. Her winning entry summarises a paper on the risk of malaria infection in Africa, conducted by researchers at the Kemri Wellcome Trust Research Programme in Kenya. We would like to extend our congratulations to Philippa, and share her winning article with you…

Plasmodium falciparum is the most deadly of all malaria parasites. Children are particularly vulnerable to the devastating consequences of this infection: the World Health Organisation estimates that a child in Africa dies from malaria every minute. In recognition of this crisis, malaria has become a headline priority for global health, with campaigns such as ‘Roll Back Malaria’ spearheading a huge international effort to tackle the disease.

Noor and colleagues set out to assess how much progress has been made across Africa in the ‘Roll Back Malaria’ era. Have the immense resources deployed made a real difference to some of the world’s most vulnerable populations? How has the burden of malaria altered in the decade since 2000? And can we identify whether infection risks have changed by country or region? With these questions in mind, this research team developed a sophisticated analytical method to measure, as precisely as possible, changing patterns of malaria risk in Africa.

The symptoms of malaria can mimic those of many other infections, and suspected cases of malaria are often treated without a certain diagnosis and without attending a hospital or clinic. For these reasons, trying to get a clear picture of the scale of the malaria problem in Africa is a major challenge. Noor’s team chose to measure malaria by the most accurate method available, by looking for studies that had actually identified Plasmodium falciparum parasites in the blood of study participants in the community. Their final analysis draws on data collected from 3.5 million individuals represented in over 26,000 surveys spanning 49 regions of Africa, with each piece of information linked to its precise geographic origin by satellite technology.

The researchers fed this vast mine of data into a carefully constructed computational analysis. Each piece of information was adjusted to account for exactly when and where it was collected, and to apply it to a particular age group of interest – the highly vulnerable population of children aged 2-10 years. They also factored in a host of complex influences on malaria transmission, such as urbanisation and climate. The final output was a measure of malaria risk for each individual square kilometre of Africa, first in 2000 and then again a decade later. Each of these tiny squares was classified into one of eight different malaria risk categories.

Malaria prevalence in Africa, 2000-2010

From this sophisticated analysis, Noor’s team report several substantial and encouraging improvements in the patterns of malaria in Africa. Strikingly, they calculated that 217 million people in Africa were living in a lower risk area in 2010 than they did in 2000, as well as finding an overall reduction in malaria transmission in 40 of the 44 African countries that they assessed in detail. Four territories, South Africa, Eritrea, Ethiopia and Cape Verde, successfully reduced malaria into the lowest risk category by 2010. By this time, the majority of the transmission in the highest risk category was occurring in just ten countries.

Noor’s study also sounds several important notes of caution. A population explosion in Africa has contributed hugely to the total numbers of people at risk of malaria; over 50% the continent’s total population still live in regions of substantial risk. Soberingly, this effect of population growth somewhat dilutes other gains that have been made in reducing malaria risk. Rates of infection in certain countries remained unchanged or even climbed between 2000 and 2010: Malawi and South Sudan are highlighted as areas for increasing concern, and high transmission has continued across many parts of Nigeria and the Democratic Republic of Congo.

The researchers also highlight some areas of difficulty. Despite a data collection effort that spanned eight years, they were still unable to identify enough information to assess the malaria risk for certain regions of Africa. And of course the vastly complex nature of malaria transmission cannot be completely captured or measured by a computer-based method.

Overall, however, the results of this meticulous analysis provide valuable feedback for improving population health in many parts of Africa. As well as amassing all possible information about malaria parasite distribution, the study team also thought hard about the impact of the rapidly changing social and geographical landscape of Africa, ranging from urbanisation to rainfall. Their detailed mapping of malaria patterns highlights how the risks of an infection can wax and wane, reminding us that the ‘Roll Back Malaria’ campaign and its allies need to be constantly re-assessing the best way to keep pace with changing patterns of disease. The authors conclude with cautious optimism about the progress made since 2000, but provide a timely warning that the challenge of malaria is far from over.

This article describes the research published in the Lancet in 2014 paper entitled: The changing risk of Plasmodium falciparum malaria infection in Africa: 2000-10: a spatial and temporal analysis of transmission intensity.

The Access to Understanding competition is run by Europe PubMed Central and the British Library. You can find out more about the competition and read the other entries on the Access to Understanding website.

Image credits: Rolling back malaria – ©Access to Understanding, Design Serial/Trash; Philippa Matthews – c/o author; Africa maps – image courtesy of paper authors, Noor et al.


Wellcome Trust Research Round-up: 30.03.15

30 Mar, 2015

Our fortnightly round-up of news from the Wellcome Trust community…

New insight into TB immune evasion

B0004331 DNA sequenceA new version of a gene, that may help to explain why some people are more susceptible to TB than others, has been identified in a Wellcome Trust-funded study.

Although TB infects an estimated two billion people worldwide, only a small proportion of these cases ever progress from the latent (without symptoms) phase, to the active form of the disease. Recent studies have highlighted the role of a person’s DNA in determining whether they become infected, and on the progression of the disease.

By analysing entire genomes, the researchers identified a new version of a gene, present on chromosome eight, called ASAP1. This gene holds the genetic instructions for a protein that is highly expressed in certain specialised cells of the immune system. Following infection with TB, ASAP1 expression is reduced, however researchers found that patients with a particular variant of the gene showed a more marked reduction.

The reduction in ASAP1 protein affects the mobility of immune cells, which slows their migration around a patient’s body. The TB bacterium can more easily evade these slow-moving cells, contributing to increased susceptibility to TB for patients carrying this gene variant.

“Our study provides a new insight into biological mechanisms of TB,” explained Dr Sergey Nejentsev, Wellcome Trust Senior Research Fellow from the University of Cambridge, who led the research. “TB is a major global health problem and the threat of drug-resistance means that we urgently need to develop new ways of fighting back. In future, it may be possible to target immune pathways that involve ASAP1 to design efficient vaccines for TB prevention.”

This study was originally published in Nature Genetics.

Vitamin A helps keep the doctor away

4398689374_82c847830c_zWe may be one step closer to understanding the cause of certain autoimmune conditions, with a new study identifying a key role for Retinoic Acid, a type of vitamin A, in regulating T cells.

Wellcome Trust-funded researchers have found that retinoic acid can ensure T cells change to become a certain type of T helper cell, the Th1 cells, rather than Th17 cells, which have been implicated in several human autoimmune diseases.

T Helper cells (or CD4+ cells) are a subset of T Lymphocytes that, as the name suggests, assist other immunological processes. Upon activation the helper cells differentiate further into several subtypes, each of which helps to activate a different type of immune response.

During the initial stages of T cell priming, it is important for them to be able to switch fate between the subclasses. However at later stages this plasticity is dangerous, and certain types of Th17 cells are implicated in human autoimmune diseases including rheumatoid arthritis and inflammatory bowel disease.

Researchers found that the binding of retinoic acid to its receptor enhances expression of genes required for Th1 type cells, while repressing genes that regulate the Th17 cell fate. The research was published in Immunity.

By identifying a point at which improper regulation of T-cell differentiation could occur, this work has highlighted a potential pathway for intervention in certain autoimmune diseases.

Breastfeeding linked to higher adult IQ

11581822006_ed46bb8777_mA new long-term study has identified an association between the length of time a child is breastfed and IQ, schooling and earnings in adult life.

The Wellcome Trust-funded study, published in the Lancet, involved nearly 3500 babies born in Pelotas, Brazil in 1982 and is one of the first studies to look in-depth at the long-term benefits of breastfeeding. Information on breastfeeding habits was collected in early childhood and then 30 years later participants were given an IQ test.

Researchers found that with all durations of breastfeeding there was an increase in IQ, schooling and adult earnings, but that this increase was significantly greater the longer the child was breastfed for. For example, a child who had been breastfed for at least a year gained a full four IQ points and had 0.9 years more schooling at the age of 30, compared to those breastfed for less than one month.

Studies into the benefits of breastfeeding have often been criticised for failing to disentangle breastfeeding from socioeconomic status, but the Wellcome-funded study addresses this for the first time. In the populations studied breastfeeding was equally distributed across social classes.

Lead author Dr Bernardo Lessa Horta said: “The effect of breastfeeding on brain development and child intelligence is well established, but whether these effects persist into adulthood is less clear. Our study provides the first evidence that prolonged breastfeeding not only increases intelligence until at least the age of 30 years but also has an impact both at an individual and societal level by improving educational attainment and earning ability”.

Bovine bugs hold clue to controlling infectious disease

L0034933 A cow named "Vaccination"Parasites found in African cattle could offer a new insight into ways of combatting serious parasitic diseases in humans, including malaria.

A team funded by the Wellcome Trust has found that cows can be protected from parasites that cause deadly diseases if they have been infected with a closely related, but milder species of the parasite earlier in life.

The health of 500 Kenyan calves was tracked from birth, including whether they had been infected by any viruses, bacteria or parasites. Deaths from East Coast Fever, the biggest killer of African cattle, dropped by 89% in calves that were already infected by another species of parasite that did not cause disease.

As well as the clear economic benefits to African farmers that vaccinating calves with benign parasites could bring, this research could lead to future approaches to human diseases. The study, published in Science Advances, suggests that people infected with a parasite that causes severe malaria may be more likely to survive if they are also infected by a less aggressive species at the same time.

Professor Mark Woolhouse, of the University of Edinburgh’s Centre for Immunity, Infection and Evolution, said: “This discovery suggests a completely new way to control a devastating disease in cattle, while reducing the use of antibiotics and environmentally damaging pesticides at the same time. It may also provide clues to new ways of combatting human diseases such as malaria.”

In Other News

The list of recipients of the Sir Henry Dale Fellowship has just been announced. A collaboration between the Wellcome Trust and the Royal Society, the fellowships recognise outstanding post-doctoral scientists who want to address major biomedical questions. This year’s recipients will be working on a variety subjects including liver regeneration, autism spectrum disorders and female infertility.

Peter Piot has been awarded the Gairdner Foundation’s 2015 Global Health prize. The Director of the London School of Hygiene and Tropical Medicine, and a great friend of the Trust, was recognised for his part in the co-discovery of the Ebola virus and his many contributions to the HIV/AIDS field.

PhD student Oliver Britton, working with Wellcome Trust Senior Research Fellow Professor Blanca Rodriguez, at the University of Oxford, has won the international NC3Rs prize with his research into a new approach to computer modelling of cardiac electrophysiology. It is the first time the prize, which recognises work that has the potential to reduce the number of animals used in research, has been awarded to a PhD student since the prize began in 2005.

There are just a few days left to apply for the British Science Association’s Media Fellowship. This unique opportunity gives practising scientists, clinicians and engineers the chance to spend three to six weeks working in a major news outlet. The application deadline for this year’s fellowship is 3rd April 2015.

Image credits: (From top to bottom) Kate Whitley – Wellcome Images; Vitamin A by Colin Dunn, via Flickr CC-BY; Breastfeeding welcome here, by Leo Reynolds on Flickr – CC-BY-NC-SA, A cow named “Vaccination” – Wellcome Library, London.

Image of the Week: Structure of the dynactin complex

27 Mar, 2015
Structure of the dynactin complex

Image courtesy of Urnavicus et al, made by Janet Iwasa (University of Utah)

This image shows a model of a tiny protein machine that moves things around within our cells. A new study reveals how the motor called dynein (grey) is attached to its cargo via an adaptor protein (orange). The attachment requires the help of another protein complex called dynactin (multi-coloured).

The dynein/dynactin machine drags its cargo along tracks called microtubules that stretch throughout the cell (a short section of microtubule is shown in green in the bottom left of the image). It takes things from where they are made to where they are needed.

When things go wrong with the dynein machinery it can result in neurodegenerative diseases such as motor neuron diseases, dementias or a form of Parkinson’s disease.  This intracellular transport mechanism can also be commandeered by viruses, such as those that cause herpes, cold sores, chicken pox and shingles.

A Wellcome Trust funded team of researchers, led by Dr Andrew Carter at the MRC Lab of Molecular Biology in Cambridge, have used a state of the art cryo-electron microscope to determine the structure of dynactin and show how it helps dynein bind to the cargo adaptor Bicaudal-D2.  Examples of the high-resolution cryo-electron microscopy maps are shown in the background of the image.

A great mystery in the field of cellular transport is why dynein requires dynactin. Carter and his team have revealed for the first time that they both form an intricate complex with the cargo adaptor sandwiched between them. This suggests dynactin acts as an “on switch” that activates dynein to move for long distances along microtubules.

The team expects that each different cargo, for example mitochondria, mRNAs, toxic aggregated proteins and different small transport vesicles, will have different adaptors. Future work will focus on whether they all bind in the same way as Bicaudal-D2, how dynein defects cause neurodegenerative diseases and whether it is possible to block it from carrying viruses.

The team’s research is the cover story on this week’s Science, and you can read the full paper online. To find out more about Dr Carter’s work, visit his website.

World TB Day: what next for prevention and treatment?

24 Mar, 2015


TB remains a global problem with 1.5 million deaths and 9 million cases per year. On World TB Day, Wellcome Trust Senior Science Portfolio Developer Marta Tufet looks back at the history of TB prevention and treatment, explains what the Wellcome Trust is doing to support research in this area, and asks what more needs to be done to make an impact on this stubborn disease…

At 13 I moved to France mid-school term and mid-TB vaccination campaign. All the kids were lined up at the school’s gym and one by one a nurse inserted a needle into our forearms – the Tuberculin skin test to see whether we would mount a localised immune response, an indication that there had been exposure to the bacteria. To this day the memory remains vivid – not speaking a word of French at the time, it presented an excellent communication opportunity. I eagerly held out my arm and gestured other kids to do the same and compare who had the biggest reaction. To my surprise, I had nothing to show for it. A few days later, my newfound friends and I – those of us with still no lump on our forearms – were lined up again at the gym, and this time given the Bacille Calmette-Guerin (BCG) Vaccination, developed in the 1920s, with the aim of protecting us against the most serious form of TB.

BCG vaccination was mandatory for school children in France between 1950 and 2007, before a shift to selective vaccination. Similarly, the UK ran a universal immunisation campaign from 1953-2005. Today the WHO recommends that BCG be given to all children born in countries with a high prevalence of TB. But despite these multiple vaccination campaigns TB remains a global problem with 1.5 million deaths and 9 million cases per year.

image (3)

Marta (centre, wearing a yellow dress) at school in France where she received her BCG vaccination. 

Unfortunately, it would seem that for the past 90 years we have been relying on a vaccine that is far from perfect. Although BCG can protect against the severe extrapulmonary form of TB in children, it is unreliable in protecting against pulmonary TB, which accounts for the majority of TB cases globally. Moreover, BCG’s efficacy diminishes the closer you live to the equator, where TB is most prevalent. The vaccine is also not safe in infants who are infected with HIV, yet HIV is considered the single most important factor in the increase of TB in many countries, increasing the likelihood of a TB infection turning into active disease.

Because of these problems, we need a new more effective vaccine, which is easier said than done.  The complexities of TB disease, comprising both latent (without symptoms) and active states, the lack of adequate animal models, limited financial resources and poor coordination are just some of the contributing factors for why we are not any closer to a modern TB vaccine now than we were 15 years ago.

Most vaccine efforts have focused on the same model of understanding TB immunology as was used to develop the BCG vaccine. However, even the most promising TB vaccine to date, MVA85A, has failed to demonstrate significant efficacy in clinical trials. Since then, many researchers and funders feel the need to go back to the drawing-board to re-evaluate our understanding of what constitutes an essential and sufficient immune response to TB before pursuing new vaccine efforts.

Prevention aside, TB is in fact treatable with a mixture of antibiotics over a duration of 6-9 months. Regrettably, access to drugs in poorer countries is still an obstacle and detecting TB in the first place is not easy. Furthermore, these drugs are now threatened by the emergence of resistance. We can blame poor adherence to courses of treatment, falsified or poor quality drugs, or even the bacteria’s evolutionary prowess, but the reality remains strikingly worrying: in 2013 alone, 480,000 people developed multi-drug resistant TB, and for these individuals there is unfortunately little hope.

Today on world TB day we are being asked to “gear up to end TB” and at the Trust we are committed to support research towards this aim. Putting an end to TB will require more than our traditional investments in basic research towards vaccine and drug development.

To address this, the Welcome Trust, in partnership with the Medical Research Council (MRC) and the Department For International Development (DFID), have also been supporting a number of global health trials tackling multiple angles: from improved diagnosis, to optimized treatment regimens, to socioeconomic interventions:

  • The STAMP trial led by Stephen Lawn at the London School of Hygiene and Tropical Medicine (LSHTM) aims to improve treatment in patients with HIV and TB by determining whether the addition of a new urine-based test to the standard diagnosis strategy can reduce mortality in Malawi and South Africa.
  • The TRUNCATE-TB trial led by Patrick Phillips at University College London (UCL) aims to determine whether treatment for drug-sensitive TB can be improved whilst at the same time reducing the drive towards new cases of multi-drug resistant TB in multiple Asian countries by optimizing regimens at the individual level.
  • The TB fast-track trial led by Alison Grant at LSHTM aims to see whether you can reduce early mortality by using point-of-care technology to rapidly identify individuals presenting for HIV treatment at high risk of TB and ensuring they start TB treatment.
  • Diana Gibb at the MRC clinical trials unit is investigating whether a shorter treatment for children with milder forms TB is just as effective as the currently recommended treatment, which has been largely based on research conducted only in adults. This would not only be advantageous for the child but also for the over-burdened health systems, reducing the number of clinic visits children would need to make to take their drugs.
  • Carlton Evans at Imperial College is evaluating the impact of socioeconomic interventions for reducing poverty, improving access to TB care and consequently reducing the risk of future TB in Peru.

On top of this research, we also need new strategies to reduce the reservoir of latently infected individuals, from which new cases can arise. Current diagnostic tests cannot predict who will develop active disease, and in any case the current treatment options available are not adequate given the scale of the intervention that would be required – a third of the world’s population is currently predicted to be latently infected with TB.

20 years after my BCG vaccination, I was again tested for TB on moving to Seattle. I waved my arm again in front of my American colleagues and this time it was clear that I had the largest skin reaction from the Tuberculin test, a testimony to my BCG vaccination status (the US has never used mass immunization of BCG, relying instead on the detection and treatment of TB instead). A subsequent test, not affected by vaccination status, also came back positive. As I was not showing any signs of active disease it was concluded that between 1994-2014 I had most likely been exposed to TB. The risk of this progressing to full blown disease is about 5-10%. It would seem I have now joined a third of the world’s population in harbouring latent TB.

More information about World TB Day can be found here

Image credit: NIAID, Mycobacterium tuberculosis Bacteria, the Cause of TB on Flickr

Ebola One Year On: a Wellcome Trust Research Round-Up Special

23 Mar, 2015

B0009931 Ebola virus structure, illustration

A year ago today (23 March 2014), the World Health Organization confirmed what many in the global health community had already feared. An outbreak of a deadly haemorrhagic fever that had emerged a few months earlier in Guinea was caused by the Ebola virus. What followed was an epidemic on a previously unimaginable scale, which to date has claimed at least 10,000 lives.

Over the past year, people across the Wellcome Trust have helped to catalyse an unprecedented global response to the outbreak. In many cases this has involved condensing processes that normally would take years of painstaking work into a matter of months.

Our emergency Ebola funding package has now awarded around £11.6 m to research aimed at identifying clinical and public health interventions that could save lives in this, and future outbreaks of Ebola. In this special edition of Research Round-up, we take a look at progress so far.

Since August 2014, the Trust has been working with scientists, industry, governments and agencies around the globe to fast-track the development of two promising Ebola vaccines: Merck’s rVSV-EBOV and GlaxoSmithKline’s ChAd3 (chimp adenovirus type 3).


Support from the Trust has enabled researchers to rapidly set up human trials of these two promising vaccines, first in healthy volunteers to make sure they were safe followed by large-scale efficacy trials of both vaccines, which are now underway in West Africa.

A ring-vaccination trial of rVSV-EBOV started last month in Guinea, and it’s possible that this will be expanded in the coming weeks to incluEbola vaccinede trials of ChAd3 with a ‘boost’ from a different type of vaccine called MVA (developed by Emergent). Initial results from the trial are expected in the second half of 2015 and there’s still a chance that this work could have an impact on the current epidemic, if one or more of the promising vaccines turns is effective at preventing transmission.


Vaccines are the most effective way of protecting individuals and communities against the spread of infectious disease, but there is also an urgent need to develop effective treatments for Ebola.  We set up a £3.2 million treatment platform in September 2014 to help fast-track this process.

The first study set up through this platform, a trial of an antiviral called brincidofovir, unfortunately had to be stopped shortly after it began because of the dramatic decline in new Ebola infections at the study site in Liberia. But Professor Peter Horby and his team at the University of Oxford have now started a second trial of another promising drug called TKM-Ebola. By concentrating their efforts in Sierra Leone, where cases remain high, they will have the best possible chance of finding out whether any of the candidate treatments can stop people dying from Ebola. This approach will also hopefully help to develop protocols to allow clinical trials to be rapidly set-up in similar emergency situations in the future.

Cambridge-based biopharmaceutical company Kymab and Public Health England scientists are also working here in the UK to identify further promising treatment options.

Surveillance and modelling

Understanding how and why infection spreads is a crucial part of any epidemic response. Two projects funded through the Research for Health in Humanitarian Crises (R2HC) programme are working towards this goal. The first, led by the London School of Hygiene & Tropical Medicine, is tracking changes in the spread of the disease in West Africa and evaluating the impact of measures put in place to control the epidemic. As second project at Oxford University is trying to predict the trajectory of the outbreak and produce maps to help the WHO and other agencies in planning their response.


It’s likely that many lives have been saved in the present epidemic through basic public-health measures alone. Isolating suspected cases early and encouraging people to seek treatment are key to this process, but this can prove challenging in communities where there is no established system of healthcare. Researchers from Umea University in Sweden have been working on a social marketing strategy with the goal of developing tailored public health messages specific to the cultural and societal context of this epidemic.Ian gf

Another key element of preventing the spread of Ebola in the present outbreak has been the widespread use of personal protective equipment. A team from International Rescue Committee UK is devising strategies to make sure health workers stick to the strict protocols for wearing and removing the equipment that are required for it to be effective.


One of the challenges facing health workers in the three Ebola-affected countries has been the difficulty in quickly establishing a diagnosis, as symptoms of the early stages of infection are shared with many common diseases. Two diagnostic tests being developed with R2HC funding could revolutionise this process by delivering a rapid point-of-care diagnostic test for Ebola. One is developing a device to test for Ebola virus in saliva, while a second will create a solar-powered mobile suitcase laboratory capable of confirming a diagnosis within 15 minutes.

Societal factors

In the early stages of the epidemic, it is likely that certain cultural practices, such as preparing the bodies of victims for funerals when they are still highly infectious, contributed to the spread of the disease. Changing these practices requires a thorough understanding of the society in which the outbreak is taking place. The London School of Hygiene & Tropical Medicine has set up an anthropology platform to provide clear, practical, real-time advice about how to engage with crucial socio-cultural and political dimensions of the outbreak, and how best to build locally-appropriate interventions.

To find out more about the Wellcome Trust’s Ebola rapid-response research fund visit our Ebola funding page, or view  our previous post on What the Wellcome Trust is doing to tackle Ebola

Ebola: One Year On

20 Mar, 2015

C0105595 Dr Felicity Hartnell. Ebola vaccine trial

A year on from the first confirmed case of Ebola, nearly 25,000 people have been infected with the disease. Although the epidemic appears to be slowing down and trials into potential treatments have begun, there are many lessons still to be learnt about our ability to prepare for and respond to epidemics. Director of the Wellcome Trust, Dr Jeremy Farrar, and Seth Berkley, CEO of Gavi, look back over the events of the past year in this opinion piece that originally appeared in the Wall Street Journal on 18th March 2015.

One year ago Monday, scientists confirmed that the cause of a deadly fever in Guinea, which had already killed 59 people and was continuing to spread, was the Ebola virus. Twelve months later, trials for a second promising vaccine have begun in Guinea, with a first trial already underway in Liberia. But this progress doesn’t mean that the Ebola crisis has been solved or that we’re better prepared for future epidemics yet.

The best news is that the epidemic is coming under control. In the week to March 8, 116 new cases were reported from Sierra Leone and Guinea, compared to a thousand or more per week at the height of the outbreak. Liberia reported no new confirmed cases for the second consecutive week. This reduction is mainly thanks to the implementation of basic hygiene and public-health procedures: the rehydration of patients; the separation of the healthy from the sick, the dying and the dead; the use of diluted bleach for washing; and a better understanding of cultural practices so that families and communities can be protected from the risk of, for example, preparing dead bodies for funerals when they are still highly infectious.

Yet applying higher-tech solutions, such as a vaccine, has been much slower going. Several Ebola vaccines were first conceived more than a decade ago but then shelved. Much more could and should have been done in advance of this outbreak, measures that would have enabled trials to begin as soon as the alarm was raised. Critical safety and dosing studies could have been carried out years ago rather than waiting until an outbreak occurred.

The medical-research, pharmaceutical and global-health communities have hardly dragged their heels as the past year’s epidemic progressed, nor did affected governments, donor governments and private philanthropists. But efforts to develop a vaccine were dogged by a lack of consensus on whether clinical trials were necessary or appropriate in an epidemic context. And when agreement was finally reached, trials took too long to get started. A lack of agreement over trial protocols caused further delays.

As a result, no trial was ready to go until the beginning of 2015, and some still have not started. Procedural hurdles are there for good reasons, primarily safety. But delays in this case have likely cost lives and certainly jeopardized trials, which require large numbers of participants. Ebola cases are thankfully now in decline, but one study—of the drug brincidofovir—has already collapsed as a result.

The problem with diseases like Ebola, which kill ferociously but occur only sporadically, is that there is simply no market for related medical interventions. There are usually only a few hundred cases every few years, and typically in poor African countries. Companies would unlikely see any return on the substantial investment required to get a drug or vaccine through trials. The current trials are happening only because manufacturers, philanthropists and donor governments agreed to share the costs. Who will pay for the administration of each dose, if they are approved, remains unclear.

Until we can develop some way to fund research and development related to likely future epidemics and test new drugs and vaccines swiftly during epidemics, we will remain vulnerable to outbreaks. We need to stop waiting until we see evidence of an infectious disease becoming a global threat before we treat it like one.

The medical and scientific community needs to continue identifying other potential disease threats, and develop the necessary tools to estimate how big a risk they pose. There are probably more than a dozen known diseases, including other haemorrhagic fevers like Marburg and Lassa fever, or henipavirus, for which markets are unlikely to ever exist but which could cause Ebola-style crises in the future. There is already modelling to identify the most significant threats: Risk factors include diseases caused by RNA viruses, and diseases that are endemic in animal populations, especially when these have close contact with humans.

We also need further research into the biology of such diseases. Understanding their genetic sequences, their animal hosts and their mode of transmission—from animals to humans and then from human to human—can make it easier to spot and counter epidemic threats sooner. Areas of focus must include these diseases’ interactions with the immune system, and identifying biological signatures that indicate greater transmissibility or virulence.

Public-health authorities need to consider now how best to test drugs and vaccines safely and quickly once the next outbreak occurs. Not only do delays deprive patients of potentially life-saving treatments, they also deny scientists the chance to observe the efficacy of treatments at the height of an epidemic.

Finally, we need to invest in better surveillance to spot patterns in future outbreaks sooner. This Ebola outbreak has differed from previous occurrences not because the pathogen itself has changed but because of the environment in which it emerged. For the first time, Ebola spread in more populated and urban areas, which enabled it to infect and kill more people faster than ever before. Preventing similar outbreaks in the future means identifying such new factors earlier and reacting more quickly.

One year on, this outbreak may now appear to be subsiding. But there will be other epidemics, including Ebola itself. We can’t afford not to learn the lessons of this one.


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