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Researcher Spotlight: Prof Vikram Patel

5 Oct, 2015

Vikram PatelVikram Patel is Professor of International Mental Health at the London School of Hygiene and Tropical Medicine, and is based at the Public Health Foundation of India and Sangath, India. He has recently begun and five-year Wellcome Trust Principal Research Fellowship, which follows a ten-year Senior Research Fellowship in Clinical Science. Prof Patel’s work looks at the impact of mental illness in developing countries, and he hopes to find ways to improve access to treatments in low-resource settings…

What are you working on?

Broadly, on research which seeks to reduce the burden of mental disorders in low resource settings. The specific goals of my fellowship are to develop and evaluate psychological treatments for mental health problems in adolescents which can be delivered by non-specialised health workers in routine health care or educational settings.

What does your average day involve?

I don’t think I have had an ‘average’ day since I began my research career in 1995! Broadly, I spend about 70% of my time on core research activities, from designing protocols to writing papers, but the most enjoyable part is always the actual field work. The rest of my time goes into public and policy engagement, teaching and management roles.

Why is your work important?

Because, quite simply, mental health problems are the most neglected of all global health problems, and most people with these problems, particularly in developing countries, do not receive the care and compassion that we know can transform their lives. Truly, mental health is the orphan child of global health.

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

That we can achieve parity in all respects, from allocation of resources to access to care to a life with dignity, with other health problems.

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

Because I found psychiatry the one medical discipline which offered the perfect, and intellectually stimulating, mix of society and science.

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

My work in India has been supported by the Trust continuously since 1995, making the Trust the most consistent funder of my work from the very start of my career. Indeed, it would be fair to say that the Trust was the true pioneer, amongst research funders, in the field of global mental health as much of the early work which laid the foundations of the field was supported by the Trust.

RS Vikram 2
What’s the most frequently asked question about your work?

I used to get asked, is mental health really an important issue for poor countries? No longer, though. Now I get asked, so how will you get the work you have done put into practice? Where is the money and, more importantly, the political will?

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

Aha, you are a psychiatrist? Well then, can you read my mind? I still get stupid questions like this, though thankfully very rarely these days!

Tell us something about you that might surprise us…

You might be surprised that my first choice of career was not medicine, but to become a chef.

What keeps you awake at night?

What if my latest hypothesis, which I have spent years testing, turns out wrong! But, more likely, the continuing conflict and injustice across the world is deeply distressing, not least because of its profound effects on mental health.

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

Make the time to mentor others as I was as this will be the best investment you make in sustaining your research career.

The chain reaction question, from our previous spotlit researcher, Prof Thumbi Ngund’u  is this (actually he asked three!): Who is your greatest mentor? Why?

This is an impossible question as there have been many and I must list many. Tony Hope for the compassion to acknowledge that those whom we seek to heal matter the most. Anthony Mann for the joy of letting my mind grow unfettered. Betty Kirkwood for the value of paying attention to detail. Arthur Kleinman for the courage to question the establishment. Srinath Reddy for the ambition to change the world. But, above all, my mother for teaching me humility.

Who is your best collaborator and why?

The Indian NGO Sangath, whose ability to innovate against all odds has been the cornerstone of my work.

What contribution to science or otherwise are you most proud of?

The demonstration that mental health matters in all societies, in particular for those who are disadvantaged in one way or another, and that we have the knowledge and tools to make a difference even in the least resourced settings.

You can find out more about Prof Patel’s work via his profile on the London School of Hygiene and Tropical Medicine website, on, and the Centre for Global Mental Health website. You can also watch his TED talk “Mental health for all by involving all“.

Image of the Week: New Chair Eliza Manningham-Buller

2 Oct, 2015

Eliza Manningham-BullerOur image of the week this week is a rather special one since it marks the end of an era – and the beginning of a new one – at the Trust.

On one hand, we wish a fond farewell to Sir Bill Castell, Wellcome Trust Chair for the past 10 years, who has now officially retired from the Trust, and on the other, we extend a welcome to Baroness Manningham-Buller, who takes over as the new Chair of the Board of Governors.

During Bill’s decade at the Trust, his positive influence, humour, and challenge for us to be braver, was widely felt. He championed the view that all research outputs should be made freely available to all, and played a key role in ensuring that the Trust became the first research funder in the world to introduce a mandatory open access policy.

Bill was particularly engaged with the Trust’s efforts to improve science education, and this did not just improve our thinking, but brought tangible benefits, as Hilary Leevers, Head of Education and Learning explains. “Bill’s commitment to enabling teachers and technicians to participate in funded professional development at the National Science Learning Centre led him to forge a unique partnership across government, industry and the Trust”. The result of this – Project ENTHUSE – continues to embrace new organisations, and almost £50 million has been committed to it. “This investment has had a measurable impact on the educators themselves, and, most importantly, upon their students” she says.

The image above captures something of the spirit of Bill’s leaving party at Trust HQ. Bill shared memories of his time at the Trust and was presented with a special Wellcome medal in thanks for his work. With Eliza in attendance at the party, the metaphorical baton was passed.

Joining us, she said: “I am delighted to be starting as Chair of the Wellcome Trust. After a happy and fulfilling career in MI5, I did not expect to have such an interesting job again”.

“I feel immensely lucky to have joined the Board of Governors in 2008, and now to become Chair. The Trust’s power to do so much good in the world makes it a rewarding place to work. And I am really looking forward to making our ambitious plans succeed which I am sure, with your help, they will.”

We hope you will join us in thanking Bill, welcoming Eliza to her new post, and taking the Wellcome Trust to new levels.

A Brief History of Childbirth: Exploring the National Childbirth Trust Archives

28 Sep, 2015
Erna Wright (founder member and author), teaching NCT antenatal class. The National Childbirth Trust. Image credit: Wellcome Library, London.

Erna Wright (founder member and author), teaching NCT antenatal class. The National Childbirth Trust. Image credit: Wellcome Library, London.

The Wellcome Library is a treasure trove of books and archives than span a wealth of biomedical and health related subjects. The newly-catalogued National Childbirth Trust (NCT) archive, containing over 270 boxes of rich archive material, brings to life the history of childbirth and maternity care from the post-war period to the present day. Elena Carter, Project Archivist at Wellcome Library shares what she has discovered in the NCT’s rich archive…

In 1956, a woman gave birth and lost her baby. As she was discharged from the hospital, a sister flippantly commented “that’s the last we’ll hear of you”. Bereaved, and angered at how she’d been treated, this woman – Prunella Briance – decided to take matters into her own hands. In her words, she “wanted to do something positive to prevent such tragedies happening to other mothers”.

So she put an advert in The Times newspaper – a call to arms to form a Natural Childbirth Association, run by mothers, for mothers.

L0079482: The Natural Childbirth Association of GB advertisement in the Times, 4 May 1956. Wellcome Library reference: SA/NCT/A/1/1/1.

L0079482: The Natural Childbirth Association of GB advertisement in the Times, 4 May 1956. Wellcome Library reference: SA/NCT/A/1/1/1.

Letters began to flood through the door from women sharing unhappy stories of childbirth. Some wrote of being left alone in stirrups to labour for hours by themselves; others of how they had gas and air forced on them against their will; of fathers not allowed on maternity wards; and of babies taken away from their mothers as soon as they were born.

Galvanised by this shared outrage, the women set about founding an organisation to promote natural childbirth based on the teachings of Grantly Dick-Read. Their aims were to teach women how to prepare themselves for birth through antenatal classes and education, so that they were able to approach labour free from fear and ignorance.

Erna Wright (founder member and author), teaching NCT antenatal class. The National Childbirth Trust. Image credit: Wellcome Library, London.

The archive available at the Wellcome Library charts the story of this organisation – the Natural Childbirth Association (later National Childbirth Trust, NCT) – from its grassroots beginnings in the 1950s to the present day. Through letters, birth reports, and heated meeting papers, the archive lays bare the challenges facing the organisation as they tried to rail against the ‘doctor knows best’ attitude of the 1950s.

It wasn’t an easy battle and the early papers in the archive show just how fraught the organisation’s relationship with the medical profession often was. These early documents show the group struggled to work out the best way to press for change in the provision of maternity care – with debates raging over whether to fight the medical profession head on, or try to win them over through tact and cooperation.

NCT local publicity flyer

NCT local publicity flyer

There was a fair bit of suspicion facing the organisation in its formative years, so it didn’t take long before the organisation was called to appear before the Ethical Committee of the British Medical Association (BMA). The BMA had received alarmed approaches from doctors concerned that the NCT was “challenging existing hospital rules and teaching midwifery”.

The NCT argued that they were offering something different – by having mothers teaching mothers, they hoped to develop a network of peer support and information unlike that found in the health service; their antenatal classes were offered in support of, and not instead of, medical care. Once the Committee were convinced that the women were not trying to overthrow the medical establishment, they offered the NCT a nod of approval to continue their work – but, interestingly – instructed them to do so quietly.

Havering Branch, 1968: photograph of woman practising using hexham air bolster. The National Childbirth Trust. Wellcome Library reference: SA/NCT/B/1/2/1/3/5.

“Quietly” could be an apt way to describe how the NCT tried to go about their work in these early years. Certainly the language in documents from the 1950s and 1960s in the archive seems to suggest the organisation’s attempts to appease the medical profession – in the words of one member, to work “towards advocacy rather than head-on collision”.

Early documents talk about using “dignity”, “charm”’ and “tenacity” to work alongside doctors, to persuade and influence. In order “to establish cordial and harmonious relations”, it was up to the NCT member to use her feminine charm and middle class connections to speak to doctors on their level.

To avoid treading on any toes, the NCT also asked doctors for permission for women to attend its classes. A few of these permission slips survive in the archive. And in another self-conscious attempt to placate the medical profession, the organisation changed its name from the Natural Childbirth Association to the National Childbirth Trust, dropping the word ‘natural’ to appear more respectable to doctors.

NCT 40th Anniversary postcard: “A Normal Birth?” Wellcome Library reference: SA/NCT/H/3/2. Credit: Wellcome Library, London. Wellcome Images

NCT 40th Anniversary postcard: “A Normal Birth?” Wellcome Library reference: SA/NCT/H/3/2. Credit: Wellcome Library, London. Wellcome Images

However as time went on, and in the context of the rising consumer and women’s rights movements of the 1960s and 1970s, the organisation was able to grow in strength. A growing dissatisfaction with the ‘do-as-you’re-told-and-don’t-make-a-fuss’ attitude of the 1950s gave way to a developing lexicon around notions of choice, control and individual rights. In this context, it became easier for the NCT to fight its battles more openly and politically.

Through the 1970s and 1980s – a time of the rise of the machines – the NCT became more vocal, raising concerns over the rising rate of inductions, caesarean rates, and use of episiotomies. In 1974, word reached NCT that women due to give birth over Christmas were being told they would have their births induced to avoid the festive period. In anger, then-President Philippa Micklethwait wrote to the papers, voicing her indignation that there was ‘no room at the inn’. NCT was not alone in its outrage, and a larger public backlash against inductions developed, alongside a wider feminist, anti-doctor critique.

Throughout its history, NCT has aimed to bridge the gap between lay-person and medical establishment. Its successes, failures and compromises are all charted in this rich archive collection, which demonstrates how attitudes of doctors towards expectant mothers have changed, as well as how expectations of parents have shifted.

The archive not only tells the institutional history of the National Childbirth Trust, but also contains letters and labour reports from mothers, reflecting the experiences of parents over the years.

This post has been adapted from a post that originally appeared on the Wellcome Library blog. You can find out more about the NCT archive, and other archives that we hold, on the Wellcome Library website.


Wellcome Trust Research Round-Up: 28.09.15

28 Sep, 2015

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

A shot in the dark

Caffeine crystals Credit: Annie Cavanagh and David McCarthy. Wellcome Images

Caffeine crystals. Credit: Annie Cavanagh and David McCarthy. Wellcome Images

Drinking a double espresso three hours before going to bed can rewind our body clock by an hour, according to a study published in Science Translational Medicine.

Wellcome Trust-funded scientists have shown that caffeine delays sleepiness by slowing down the normal rise in levels of the main sleep hormone, melatonin.

US-based researchers studied five people in a laboratory over 49 days, exposing them to only artificial light in a clock-free environment. Before sleeping, the subjects were given either caffeine and exposed to dim light or a placebo and exposed to bright light.

Melatonin levels in the first group rose 40 minutes later than those in the second.

Researchers in the UK wanted to understand what caused this so they added caffeine to human cells which delayed the cells’ internal body clock, known as the circadian rhythm. By switching genes on and off in each cell throughout the day, the circadian rhythm allows us to adapt to the external cycle of night and day.

Disrupting the circadian rhythm can increase risk of diseases like cancer, heart disease, type 2 diabetes and neurodegenerative disorders.

Dr John O’Neill, joint lead researcher at the MRC Laboratory of Molecular Biology, said: “The effect of caffeine on sleep and wakefulness has been long established, but its impact on the underlying body clock has remained unknown. These findings could have important implications for people with circadian sleep disorders, where their normal 24 hour body clock doesn’t work properly, or even help with getting over jet lag.”

New treatment for liver failure

B0007363 Mouse liver with blood cells Credit: Jackie Lewin. Wellcome Images The internal structure and specialist regions of liver tissue from an adult mouse. The sinusoids (vascular channels lined with endothelial cells) can be seen as pink structures running through the tissue. These contain red blood cells (erythrocyte) and Kupffer cells (specialist macrophages of the liver). Hepatocytes, shown in brown, are arranged in plates surrounding the sinusoids. Bile is secreted into the canaliculi, shown as green channels. These are dilated intercellular spaces between adjacent hepatocytes and bile flows through them en route to the small intestine. Wellcome Image Award winner 2009 Scanning electron micrograph Published: - Copyrighted work available under Creative Commons by-nc-nd 4.0, see

Mouse liver with blood cells
Credit: Jackie Lewin. Wellcome Images

A treatment that boosts patients’ immune systems and tackles infections could help with liver failure, new research suggests.

The Wellcome Trust-funded study published in Gastroenterology shows that natural defence mechanisms in the liver can be triggered by an immune-boosting molecule called CSF-1.

Scientists analysed patients’ blood samples and recorded levels of the CSF-1 molecule. They observed that patients with high levels of CSF-1 in their blood had a better chance of survival than those with lower levels.

When researchers gave CSF-1 to mice with liver damage, they found that the treatment enabled the immune system to manage infections.

If the therapy is also successful in patients with liver failure, it could treat those who are not suitable for a liver transplant.

Professor Stuart Forbes, of the MRC Centre for Regenerative Medicine at the University of Edinburgh, said “Severe infections are common in patients with liver failure and are often fatal. Our next step is to test whether the treatment is safe and effective in people, before it can be made available for patients with liver failure.”

Detecting recurrent breast cancers

B0006421 Breast cancer cells Credit: Annie Cavanagh. Wellcome Images A cluster of breast cancer cells showing visual evidence of programmed cell death (apoptosis). Scanning electron micrograph 2006 Published: - Copyrighted work available under Creative Commons by-nc-nd 4.0, see

Breast cancer cells
Credit: Annie Cavanagh. Wellcome Images

There has been a step forward in our understanding of why some breast cancers return while others do not, according to a study published in the European Society for Medical Oncology.

Scientists have identified genetic factors that only occur in relapsing cancers, which could help doctors identify at-risk patients and provide personalised treatment.

A team from the Wellcome Trust Sanger Institute analysed data from sequencing 1000 tumours from breast cancer patients. They found genetic differences between cancers sampled at first diagnosis (primary tumours) and recurring cancers. The large number of relapsed breast cancer samples studies means that this is the most comprehensive study on this subject to date.

Approximately one in five breast cancers come back after treatment, either to the same part of the body or spreading to new areas, known as metastasis.

Presenting the results to the 2015 European Cancer Congress last Saturday, Dr Lucy Yates, a Wellcome Trust Clinical Research Fellow, said, ““We have found that some of the genetic mutations that drive breast cancers that relapse are relatively uncommon amongst cancers that do not relapse at the point of primary diagnosis. We believe that the differences we have seen reflect genetic differences that can predispose a cancer to return, combined with mutations acquired throughout the period from first diagnosis to the subsequent relapse. Some of these genetic alterations are potentially targetable with drugs”.

In other news…

Congratulations to Professor Simon Hay, Wellcome Trust Senior Research Fellow who was awarded the Chalmers Medal at the Royal Society of Tropical Medicine and Hygiene (RSTMH), and our Director, Dr Jeremy Farrar, who was awarded an honorary fellowship at the same meeting.

The use of Selective Serotonin Reuptake Inhibitors (SSRIs) – an antidepressant medication – is modestly associated with violent crime, according to Trust-funded research published in PLOS Medicine. Scientists found an association between SSRIs and violence in young adults aged 15-24.

Euro report

The World Health Organisation’s Regional Office for Europe has published the European Health Report 2015. The report, a partnership between the Wellcome Trust and WHO Europe, takes a multidisciplinary approach to measuring health and wellbeing.

The first Frontiers meeting on ‘One Science – Life at the interface’ took place on 22nd-23rd September at the Wellcome Trust. The meeting convened a diverse range of people to spark new thinking and help us better understand how the Trust and others can best support collaboration across disciplines.

Researchers at the Wellcome Trust Sanger Institute involved in the UK10K population genome sequencing effort have published their latest findings. The study involves nearly 10,000 individuals, and has helped health and disease, according to a new study published in Nature.

New types of evidence for measuring health in the 21st century

23 Sep, 2015

Euro report
Covering 53 member states and a population of 900 million people, the European Health Report 2015 is a landmark publication of the World Health Organisation’s Regional Office for Europe (WHO Europe). The report details the progress the European region has made towards the goals laid out in Health 2020, the European-wide health policy framework. Wellcome Trust Head of Humanities and Social Sciences, Dan O’Connor, welcomes the report’s multidisciplinary approach to measuring health and wellbeing…

Did you know that 30% of Europeans still smoke, even though it’s one of the three leading causes of mortality? Or that despite life expectancy going up across the continent, the gap between the countries with the highest life expectancy and those with the lowest is over ten years?

These are just an example of the facts you can find in the report, but in amongst all the usual interesting health and policy measures there is also a very welcome commitment to thinking about health more broadly, and to exploring the influence of culture on health and wellbeing.

Credit: WHO Europe

Credit: WHO Europe

The European Health Report 2015 represents not only a widespread acceptance that cultural factors (such as gender norms, faith traditions, and racial prejudice) impact health, but also an understanding that to measure and analyse such factors requires a multidimensional and interdisciplinary approach that includes the humanities and social science.

The Wellcome Trust has a long track record of thinking about health in the broadest possible contexts, from curious exhibitions at Wellcome Collection, through innovative work in public engagement, to our growing investment in humanities and social science research.

The report commits WHO Europe to engaging in further work on the cultural influences on health and wellbeing. The aim is to begin measuring health and wellbeing not just with numbers and bar charts, but with the subjective and narrative tools of the humanities and social sciences too. This will build upon work already supported by the Wellcome Trust in partnership with WHO Europe – connecting our humanities and social science researchers with policy makers at the national and international level.

The European Health Report 2015 reflects the partnership between the Trust and WHO Europe, which we hope will be the beginning of an on-going and broader collaboration with other major health organisations committed to making significant changes in the way we measure and improve health.

You can read the complete “European Health Report 2015 – Targets and beyond – reaching new frontiers in evidence” on the WHO Europe website. The highlights of the report are also available in English, French, Dutch and Russian, and WHO Europe have also created a smartphone app for Android and iOS, which allows you to search the data from the report.

Researcher Spotlight: Professor Thumbi Ndung’u

21 Sep, 2015

Prof Thumbi Ndung'uProfessor Thumbi Ndung’u is the Victor Daitz Chair in HIV/TB Research at the University of KwaZulu-Natal in South Africa. He works in the KwaZulu-Natal Research Institute for Tuberculosis and HIV and is the Programme Director of Sub-Saharan African Network for TB/HIV research Excellence (SANTHE) network, funded with a DELTAS Africa Award. The aim of the network is to strengthen partnerships in HIV and TB research across 12 African research sites, and to train the next-generation leaders of African science and create enabling environments for excellence in research and collaboration in Africa. With so much interesting work to talk about, we couldn’t wait to read his answers to our Researcher Spotlight questions…

What are you working on?

Our research goals are to understand how the immune system fights off HIV and TB and how these pathogens in turn evade or adapt to continuous immune pressure.  Ultimately, we hope to use this knowledge for rational vaccine, immunotherapeutic or cure strategies against these two major killer diseases.

What does your average day involve?

I have this odd habit of first checking baseball scores when I get to the office – to see how the Red Sox did! Blame that on the time I spent in Boston as a graduate student. I then embark on a lot of meetings! I may start the day with a lab meeting or a meeting with one of my students or postdoctoral fellows. I will then sit to work on a grant application, draft manuscript, student thesis or sit to discuss experiments. I will then be interrupted by a student or other colleague – which is the best part of my work! Next might be dashing to a meeting, then on to a conference/Skype call, attend a lecture and then I’m off for an evening jog before heading home to catch up with my family…

Professor Thumbi Ndung’u and K-RITH Post-Doctoral Fellow Jenn Maroa prepare blood samples for cell separation and analysis

Professor Thumbi Ndung’u and K-RITH Post-Doctoral Fellow Jenn Maroa prepare blood samples for cell separation and analysis

Why is your work important?

Vaccines are the most effective public health tool available for the control of infectious diseases.  It is a great honour to contribute to the effort to develop effective vaccines against the two major infectious killers in the world.

In addition, I am contributing to knowledge generation and capacity development in the region of the world with the least collective scientific capacity and yet which has the greatest burden of infectious disease in the world.  There is no greater calling.

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

Reduction in human suffering, and better scientific capacity to combat major diseases and socio-economic development for Africa.

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

I have been blessed with a supportive family and friends and great mentors who believed in me.  I have incredibly gifted colleagues who make me look forward to fun at work every day!

They have collectively guided, encouraged, cajoled and intimidated me into the field of HIV/TB research and ensured that I stayed the course.  Along the way, they have taught me to take my work seriously, but never take myself too seriously.

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

This is a turning point for my career. Not only is it an opportunity to undertake cutting-edge research and train scientists focused on African problems, but we also want to build attractive research environments and engage communities in which we work.  It is an opportunity to do transformative science that solves problems, builds for the future, and is good for society in a holistic way.

Thumbi and Research Associate in my lab, Dr Emily Wong on a recent visit to the coffee farm where I grew up in Gathugu village, Kenya

Thumbi and Research Associate in his lab, Dr Emily Wong on a recent visit to the coffee farm where he grew up in Gathugu village, Kenya

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

“When will we get an HIV vaccine?”

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

“When will we get an HIV vaccine?”

I dread this because my answer remains as it was ten years ago: “I don’t know!” – and yet I am optimistic that there will be one.

Tell us something about you that might surprise us…

I grew up on a coffee farm in rural Kenya, I hand-milked cows as a young man on the farm and I did a newspaper delivery job as a postgraduate student at Harvard University. I still get a chill down my spine thinking of my newspaper delivery route during the Boston winters!

k-rith tower building night 2

The K-RITH Tower Building, which is based on the UKZN Nelson R Mandela School of Medicine campus in Durban

What keeps you awake at night?

Experiments that are not working…

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

There are so many gems over the years, but I grew up in a Christian home that valued time and hard work, so Psalm 90:12: “So teach us to number our days that we may get a heart of wisdom” easily comes to mind.

The chain-reaction question, set by our previous spotlit researcher, Naomi Penfold, is this: “If you were transitioning from school to university now, what undergraduate degree course would you take and why?”

I love inquiry and discovery, so it would have to be medicine or medical sciences.  Medicine, law and journalism all best epitomize the human instinct to know, which appeals to me a lot.

Medicine or medical sciences take the prize because of their ability to change the human condition in a personal, visible and ultimately universal way.

You can find out more about Prof Thumbi Ndung’u’s DELTAS Africa Award and the work that he is involved in on his profile page on the K-RITH website. Our DELTAS Africa press release and recent blog post have more information about DELTAS Africa and the awards made under this scheme.

Image of the Week: Ebola Medals

18 Sep, 2015
Credit: Greg Smolonski ABIPP

Credit: Greg Smolonski ABIPP

It’s a far cry from an Ebola treatment unit in West Africa, but over 50 researchers came together in the Rector’s Garden at Exeter College on a fine late-summer evening this week, to be awarded medals for their contribution to tackling the Ebola epidemic. Principal Investigator Professor Peter Horby, from the University of Oxford tells us more…

The Epidemic Diseases Research Group in Oxford, with colleagues in Liberia and Sierra Leone, Médecins Sans Frontières and GOAL Global, and volunteers from 12 other countries set up two clinical trials of experimental treatments for Ebola. The team worked under incredible time pressures and extremely challenging conditions to set up the trials in record time.

The work was funded by the Wellcome Trust, and almost a year to the day after the grant was awarded the investigators were honoured at a ceremony hosted by the Vice Chancellor of the University of Oxford, Professor Andrew Hamilton, and the Head of the Nuffield Department of Medicine, Professor Sir Peter Ratcliffe.

30 team members received the Ebola Medal for Service in West Africa, announced by the Prime Minister on 11th June, and 39 received a medal specially commissioned by the University to recognise their unique contribution.

Ebola medal Chris Smith

Credit: Chris Smith, Director, Oxford Media Factory

Project Manager Dr Catrin Moore came up with the idea of the Oxford medals, “Peter Horby and I were discussing how wonderful the Ebola medals are, but that they are only available to Brits who have spent over 21 days in one of the affected West African countries” she says.

“We thought that it would be wonderful to thank all of the West African, non-British and Oxford staff who dedicated so much of their time and effort to our project. We were unable to find a medal anywhere which expressed this so I suggested that we design a University of Oxford Ebola medal.”

The medals were awarded in a ceremony that followed a full day workshop on ‘Fast-tracking clinical research in an epidemic’ which sought to capture the collective experiences of the team and the research partners over the past year. The workshop findings will be published as a Rapid Research Response Framework that will outline the key steps for a successful and fast research response to infectious disease outbreaks.

The key elements of good data sharing practice

16 Sep, 2015

Data sharing KAG3
The Wellcome Trust is a leading partner in the
Public Health Research Data Forum, which brings together research funders who are committed to increasing the sharing of health research data in ways that are equitable, ethical and efficient and will accelerate improvements in public health. On behalf of the Forum, the Trust funded a major international study of stakeholders’ views about best practices for sharing public health research data from low and middle income settings, which recently published its results. Dr Susan Bull and Prof Michael Parker, from The Ethox Centre, University of Oxford, discuss the key issues and findings of the study.

Data-sharing is increasingly seen as an important component of effective and efficient biomedical research – both by researchers, and research funders. At the same time, it is recognised that efforts to increase access to individual-level data raise important ethical and governance challenges, some of which may vary depending on the context in which the research takes place.

The primary argument in favour of more routine sharing of de-identified research data is its potential to generate more – and higher quality – science. This could in turn lead to improved health outcomes, and promoting the public good.

Maximising the use of data is also seen as an efficient use of resources, and a key element of demonstrating respect for research participants – by increasing the impact of their contribution to research.

While previous studies have examined the perspectives of research stakeholders in high-income settings on sharing research data, there is a dearth of evidence about the perceptions and expectations of stakeholders in low- and middle-income countries. To help address this, our study examined the views of researchers, research managers and community members about best practices in data sharing. We conducted the research in Thailand, India, Vietnam, South Africa and Kenya in order to begin to establish an evidence base for models of good data sharing practice.

Original maps courtesy of:

Original maps courtesy of:

The findings of the study suggested four key factors as being important considerations in judging whether any particular data sharing initiative is likely to be viewed as an example of good data sharing practice, and thus likely to command support in the development of models of data sharing practice.

These are:

  • assessing the value and benefits of data sharing
  • minimising risks of harm and safeguarding the privacy and confidentiality of research participants,
  • promoting fairness and reciprocity,
  • instilling trust and trustworthiness among participants, communities, researchers and the wider public .

In the majority of the settings we looked at, routine sharing of data from clinical and public health research was a relatively new concept, even among researchers. The majority of sharing that had taken place was with known researchers and in collaborative relationships.

Researchers noted the value of sharing within existing or novel collaborations as this helped them to minimise the potential risks of sharing data, and appropriately promote participants’ interests. Sharing data within collaborations was seen to support trust building and capacity development. In addition, collaboration could improve the quality of research by ensuring that the research context was understood and any errors addressed early. It also helped to ensure appropriate recognition of the initial researchers’ contributions to the secondary research.

Participants in the study emphasised the importance of transparent, accountable, efficient, fair, and proportionate governance processes in instances where data sets are shared with researchers where there is no ongoing collaborative relationship during secondary data analysis.

Given the relative novelty of sharing data from clinical and public health research, some participants discussed the value of reviewing different approaches to governing data sharing that are currently in place in a range of settings. They also mentioned that guidelines for the constitution of governance procedures might be useful.

Our research, together with existing evidence, suggests that whilst greater data sharing is desirable, high ethical standards of practice are going to be an essential component of sustainable, successful data driven science.

It is likely that some approaches to data sharing are more likely to promote effective and efficient research (while also maintaining public trust) than others. It is also possible that the most effective and sustainable approach may vary between settings and different forms of data or research.

As a key output of our project, we have established a website that focuses on ethics and research data sharing, with useful links to reports, articles, guidance and platforms for sharing data.

We invite you to join the discussion group and let us know about your experiences with sharing individual-level data, and look forward to your input.

Find out more about the study results and related resources in this special issue and accompanying paper, website and free online course. Please visit the Public Health Research Data Forum website to discover more about the Forum’s work.

Accelerating Excellence in Science in Africa

15 Sep, 2015

AESA press conf

Last week the Wellcome Trust and the Department for International Development (DFID) announced funding for seven new research and training programmes under our Delivering Excellence in Leadership, Training and Science (DELTAS) Africa scheme. The focus of the programmes ranges from biostatistics, to malaria genetics, to mental health. This news formed part of a larger announcement of the launch of the Alliance for Accelerating Excellence in Science in Africa (AESA) – a new initiative that shifts the centre of gravity for research funding decisions to Africa. Supported by the Wellcome Trust, the Bill and Melinda Gates Foundation and DFID, AESA will drive the African Union’s science, technology and innovation strategy in the area of health. Sophie Mathewson, International Operations Adviser at the Wellcome Trust, explains why this is an evolution of our funding strategy and a step forward for science on the continent…

Abdoulaye Djimdé

Abdoulaye Djimdé, one of the first DELTAS Africa awardees. Credit: AAS

DELTAS Africa is a new scheme that aims to establish environments that will promote the production of world-class research at African universities, and create training opportunities for the next generation of African researchers. The first seven DELTAS awardees, funded for the next five years, were announced last week at a press briefing in Nairobi.

The awardees are spread across six countries in sub-Saharan Africa – Ghana, Kenya, Mali, South Africa, Uganda and Zimbabwe – and, together with their co-awardees, they will help to create a network of research excellence across the continent.

Most people with an interest in global health are familiar with the need for research in HIV, TB and emerging infectious diseases in sub-Saharan Africa. They also recognise the leading role of African researchers in developing the treatments and interventions that have increased life expectancy in countries with the greatest burden of diseases such as HIV or malaria. Some of the new DELTAS Africa programmes will continue to respond to these needs, and will build on the longstanding collaborations between leading institutions within and outside of Africa.

However, while the high burden of HIV in sub-Saharan Africa is common knowledge, less attention is paid to the common mental disorders, such as depression and anxiety, which are associated with major chronic illnesses, including HIV. The DELTAS Africa programmes include awards to address diverse topics such as mental health, biostatistics and host-pathogen genetics.

These programmes have been funded for their excellent science, and because they bring together leading health researchers in these fields, working in institutions across the continent. They are also all examples of subjects that have been underrepresented in sub-Saharan research but which are no less important to researchers and the communities they serve.

By funding research training in these areas, we hope to advance scientific knowledge, so that we know more about the disease burden and effective interventions, but also to develop career opportunities for researchers in these fields so that they can begin to collaborate and advance the research agenda.

deltas imagesOn the surface, DELTAS Africa may sound like many of the activities that the Wellcome Trust has long supported in sub-Saharan Africa, including the African Institutions Initiative, our long-term funding of three Major Overseas Programmes in Africa, and the Public Health and Tropical Medicine Fellowships, of which we are rightly proud. The DELTAS scheme draws on this history, and continues a commitment to funding research in places where research will play a critical role in addressing major health and social challenges.

However, DELTAS Africa represents a clear evolution in the way in which the Wellcome Trust provides support to African researchers and our role as a funder on the continent.  Usually when the Wellcome Trust launches a call, most activities happen in London with the support of an international network of scientists as reviewers and committee members.

With this scheme, the Wellcome Trust has been working in partnership with a new organisation, the Alliance for Accelerating Excellence in Science in Africa (AESA), which is hosted by the African Academy of Sciences (an organisation based in Nairobi, Kenya but with a pan-African network) in partnership with NEPAD. AESA is funded by the Wellcome Trust, the Gates Foundation and DFID, with the common aim of supporting African science, both financially and in terms of policy and advocacy work from within the continent. We are working closely with our colleagues in Nairobi with the intention that eventually they will lead on managing the DELTAS initiative, and as they develop, future funding schemes.

AESABy working closely with the DELTAS Africa programmes, AESA will begin to address many of the issues that make the life of a scientist in Africa particularly challenging, such as under-developed research administration, reliance on funding from multiple donors and lack of clear pathways for research careers.

AESA will also be able to act as advocates to increase national governments’ funding for research, and for the greater use of research to inform policy.  In part, this reflects recognition that while the Wellcome Trust can exert influence and address issues that affect researchers in the UK, it may not be the most appropriate agent to foster change in research institutions across sub-Saharan Africa or to engage with African governments.

Much of what we have done over the last year has been daunting and required the ability to experiment, improvise and be ready to adapt. But this process has also been rewarding.  Over the last year, together with other colleagues at the Trust, I have seen the emergence of fully-fledged programmes from very early ideas. During last week’s inception meeting in Nairobi, we saw the initial encounters of researchers that we hope will form the basis of lasting relationships between the DELTAS Africa programme teams.

We are proud of the programmes that we are funding and look forward to their successes. Yet we also recognise that, five years from now, our own measure of success, will be that our colleagues in Nairobi are leading on, and advancing, the cause of research across the continent.

You can read more about the projects funded by the DELTAS Africa awards on our news pages, where you can also find out more about the launch of AESA.

Wellcome Trust Research Round-Up: 14.09.15

14 Sep, 2015

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

ADHD from adolescence to adulthood

4 views of the human brain Credit: Heidi Cartwright. Wellcome Images - CC-BY-NC-ND

4 views of the human brain Credit: Heidi Cartwright. Wellcome Images – CC-BY-NC-ND

Wellcome Trust- supported researchers have found differences in brain structure and memory in young adults with attention deficit/hyperactivity disorder (ADHD), which suggests that teenagers may not ‘grow out of’ ADHD.

ADHD is a disorder characterised by short attention span, restlessness and impulsiveness. Doctors usually, diagnose ADHD in childhood or adolescence, but until now, most research into the maturing of adolescents with ADHD has focused on interview-based assessments. This approach leaves questions of brain structure and function unanswered.

In a new study, Published in the journal European Child and Adolescent Psychiatry, researchers compared the brain structure and memory function of a control group with those of a cohort of young adults who had been previously diagnosed with ADHD as teenagers. Results showed that the latter had both reduced brain volume and poorer memory function, regardless of whether or not they met diagnostic checklist criteria for ADHD. Furthermore, in the part of the brain that is key for storing and processing memory, known as the caudate nucleus, there was reduced grey matter in adolescents with ADHD.

Graham Murray from the Department of Psychiatry, University of Cambridge, who led the study, said: “in the controls, when the tests got harder, the caudate nucleus went up a gear in its activity, and this is likely to have helped solve the memory problems. But in the group with adolescent ADHD, this region of the brain is smaller and doesn’t seem to be able to respond to increasing memory demands, with the result that memory performance suffers.”

Can bacteria help protect our environment? 

Bacteria that can oxidise methane, one of the greenhouse gasses, could be used in biotech applications to protect our environment, according to a new Wellcome Trust-funded study.

Published in Nature, the study explains how these bacteria, called methanotrophs, can use large quantities of copper for methane oxidation. The researchers identified a new family of copper storage proteins called Csp, which store metal in a way never seen before.

To oxidise methane, methanotrophs use methane monooxygenase, an enzyme requiring copper or sometimes iron to exploit this otherwise toxic recourse for the carbon and energy they need Understanding how methanotrophs use copper could point the way to other potential applications of these organisms, such as helping reduce the amount of methane being released into the atmosphere.

Lead author Chris Dennison, Professor of Biological Chemistry at Newcastle University explained: “Methane is such a useful and plentiful commodity but we need more cost effective methods to unlock its potential. Using bacteria could be the best option so a better knowledge of how these bacteria operate is required.

“As copper is so important for the oxidation of methane, all potential applications based on this reactivity requires knowing how methanotrophs acquire and store copper. The discovery of the Csps adds a new dimension to our understanding of this complex process.”

HIV self-testing success

HIV-self testing (HIVST) in Malawi is safe, accurate and acceptable, and could be widely used in urban sub-Saharan Africa, according to research published in PLOS Medicine.

Illustration of HIV Credit: Medical Art Service, Munich/ Wellcome Images CC-BY-NC-ND

Illustration of HIV
Credit: Medical Art Service, Munich/ Wellcome Images CC-BY-NC-ND

Researchers from the London School of Tropical Medicine and the Malawi-Liverpool Wellcome Trust Clinical Research Programme studied HIV self-testing in Blantyre, Malawi. Trialling this method as an alternative to home-based HIV testing and counselling, HIVST requires much less intensive training, instead focusing on individuals learning to test and interpret their results.

The study sampled 16,600 adults in 14 neighbourhoods across two years. Overall, 75% of residents in the study took a self-test. The majority of these were women and adolescents, but uptake in men was also higher than expected.

HIVST received positive feedback from participants, with 94.6% reporting they were ‘”highly satisfied”.

While the authors acknowledge some limitations in the study design, the findings suggest that HIV self-testing could be scaled up to complement existing approaches to control the HIV/AIDS epidemic.

Senior author Professor Liz Corbett, Wellcome Trust Senior Fellow and Clinical Epidemiologist at the London School of Hygiene & Tropical Medicine, said: “Continued high uptake in the second year suggests that scaling up HIV self-testing could have a sustained impact on the coverage of HIV testing and care in Africa, especially for men and adolescents.”

In other news…

A new study published in Immunity has found that a type of white blood cell known as cytotoxic T cells can destroy tumour cells and virally-infected cells. The researchers, funded by the Wellcome Trust, used advanced imaging techniques to record the process on film.

Wellcome Trust-funded researchers from the University of Oxford have developed a new powerful statistical tool that enables accurate prediction of ‘missing’ genetic data. The tool, called IMPUTE, has changed the field of human genetics.

deltas imagesThe Wellcome Trust and the Department for International Development (DFID) have recently funded seven leading African researchers to establish cutting-edge research and training programmes across the African continent.

CSR Banner 1 Tw

Along with almost 200 organisations from across the life sciences, the Wellcome Trust has signed a letter published in the Financial Times to urge the Government to protect the UK science budget.

The Wellcome Trust has outlined its initial position on genome editing, in a joint statement with other medical research funders in the UK. We believe continued research is important to learn more about the technique’s potential for clinical application in the future. You can find out more about genome editing in our Q&A. 

What is genome editing and how does it work?

10 Sep, 2015
Credit: Peter Artymiuk. Wellcome Images. CC- BY-NC-ND 4.0

Credit: Peter Artymiuk. Wellcome Images. CC- BY-NC-ND 4.0

New scientific techniques are constantly being developed, and some of them have the potential to make a large impact on future research and have possible applications for health. One technique showing great promise is CRISPR-Cas9 – which can be used as a genome-editing tool. As with any scientific advance, it is important that society has sufficient understanding of the potential of these techniques in order to make informed decisions about how and when they should (and in some cases, should not) be used. Hannah Isom and Kate Arkless Gray have collected answers to some common questions about CRISPR-Cas9 and genome editing…

What is CRISPR-Cas9?

CRISPR-Cas9 is a new technique that allows scientists to edit the genome, by removing, replacing, or adding to parts of the DNA sequence. It’s not the first tool to allow us to do this, but it is by far the most efficient, inexpensive and easiest to use, enabling precise genetic manipulation in practically any living cell, even those inside the body.

If you think of the genome as a book filled with millions of letters of genetic code, CRISPR-Cas9 can be used to insert or delete new words (genes) or even make a change to a single letter.

So how does it work?

Credit: Kate Whitley. Wellcome Images. CC-BY-ND 4.0

Credit: Kate Whitley. Wellcome Images. CC-BY-ND 4.0

We’ve actually borrowed the technique – or at least the principle – from nature. Some bacteria use a similar in-built gene editing mechanism to protect themselves from harmful viruses – a sort of rudimentary immune system.

It uses a pair of ‘molecular scissors’ that cut the two strands of DNA at a precise location, so that bits can be added or removed. These molecular scissors are actually an enzyme called Cas9, which is attached to a small piece of RNA (a close cousin of DNA) that helps guide the scissors to the desired location.

When the cut is made the DNA starts to repair itself, but because this natural repair method is error-prone it can cause bits of DNA to be added or deleted. When this happens it can change the way the gene at that location works. In some circumstances it is even possible to insert a desired DNA sequence to replace what was originally there, though this requires a slightly more complicated process.

Is this the first time we’ve been able to edit the genome?

No. Scientists have been able to make changes to the DNA in cells for a while and have used these techniques widely in research. But, CRISPR-Cas9 is widely acknowledged to be a game-changer because of the speed, simplicity and specificity with which edits can be carried out. It even allows researchers to make more than one edit at a time.

Due to its relative simplicity, the potential applications of CRISPR-Cas9 have become a hot topic of discussion, particularly the idea that it may one day be used to make edits to human reproductive cells or embryos (known as the germ line), that could then be passed to future generations.

Why would you want to edit genetic code in the first place?

Engineering DNA Credit: Spooky Pooka. Wellcome Images. CC-BY-NC-ND 4.0

Engineering DNA
Credit: Spooky Pooka. Wellcome Images. CC-BY-NC-ND 4.0

There are lots of reasons scientists are interested in this idea, for starters it can be used as a powerful research tool. By making changes to genes using CRISPR-Cas9 and studying the effects, we can learn more about what these genes do in the body and how they might be involved in causing disease.  It is particularly useful for studying diseases that involve more than one gene, as it can be used to edit the genome in several places at once.

This type of pre-clinical research may involve studying cells or tissues in a petri dish – which may include very early human embryos, under very strict conditions (it is illegal to implant these to create a pregnancy).  It’s also possible to use CRISPR-Cas9 to introduce or remove genes in research animals (such as fruit flies, mice, zebrafish) so we can study the effects in living organisms.

Understanding more about diseases processes in this way can help in the development of new treatments.

So, it’s useful for research. What about treatments?

CRISPR-Cas9 has shown a lot of promise as a potential treatment in human somatic (non-reproductive) cells. Several teams around the world are already using CRISPR-Cas9 and other genome editing techniques to develop therapies for a range of conditions.

One such approach is a type of gene therapy – where cells are taken from the body and their DNA rewritten to correct a fault, or add a new function, before being put back into the patient. There is already work underway to apply this principle to bone marrow cells as a potential treatment for sickle cell disease and another blood disorder called thalasaemia.

Another interesting avenue of research is in CAR-T cell therapy for cancer.  Here researchers are looking at using CRISPR-Cas9 to make changes to immune cells so that they can recognise and target tumours.

However, it is likely to be many years before any of these techniques are being used routinely in patients.

Can we edit human embryos?

Credit: Wellcome Library, London. Wellcome Images. CC-BY-NC-ND 4.0

Credit: Wellcome Library, London. Wellcome Images. CC-BY-NC-ND 4.0

CRISPR-Cas9 and other genome editing techniques have sparked a lot of interest, and some people believe that we should also explore the possibility of using them to prevent children being born with serious inherited diseases. One question is whether this could be done by editing the genome of embryos during the IVF process.

In reality, we currently know far too little about the technique to be able to use it in this way and even if our technical understanding had reached this stage, it is illegal in the UK and many other countries to edit the genome of an embryo and implant it into a woman to create a pregnancy. In fact, any research that involves human embryos is governed by strict legal, ethical and scientific regulations.

Even so, we believe it is important to start an open conversation about potential applications now, so that the ethical, safety, and legal issues can be widely debated. We need to consider a wide range of voices and opinions (not just those of scientists) to inform any future decisions.

Is this a slippery slope towards designer babies?

Credit: Nanette Hoogslag. Wellcome Images, CC-BY-NC-ND. 4.0

Credit: Nanette Hoogslag. Wellcome Images, CC-BY-NC-ND. 4.0

When discussing genetic research and how it may be used to improve health in future, we often hear the phrase “slippery slope”, which can cause alarm. The law currently forbids any use of this technique in human reproduction.

Some people are concerned that in future CRISPR-Cas9 could be used to engineer ‘desirable’ traits into babies, such as appearance, physical prowess or intelligence.  These are complex traits, affected by both nature and nurture. We are a long way from being able to engineer these things and society may choose never to allow this. Editing any traits that can be inherited – even for health reasons – is a big step for humanity and so there needs to be a wide ranging discussion before we consider whether to allow this.

We wholeheartedly support the UK’s robust regulatory framework, which ensures that science progresses at a rate that society is comfortable with, and potential uses of technology such as genome editing undergo a high degree of scrutiny before being permitted.

Changes to the law should only ever be considered after extensive public consultation, ethical and scientific review. We must consider all concerns and ethical implications of being able to manipulate the genome before we consider making any changes to current rules and regulations.

In every case so far, this has meant that procedures have only ever been approved when they have shown compelling medical reasons to justify their use (as in the case of IVF and mitochondrial donation).

How is Wellcome involved?

Credit: Adrian Cousins. Wellcome Images. CC-BY-NC-ND. 4.0

Credit: Adrian Cousins. Wellcome Images. CC-BY-NC-ND. 4.0

The Wellcome Trust has funded a number of scientists who use CRISPR-Cas9 in their research. These include a collaboration between AstraZeneca and the Sanger Institute, who are working to use genome-editing technologies to identify and validate new drug targets for cancer, heart disease and diabetes.

Last week, we published an initial joint policy position with several other research bodies, reinforcing our support for further research in this area, which we believe holds a great deal of promise.

We are not currently funding any genome editing research that involves human embryos, but would be open to doing so in the context of thorough ethical scrutiny and approval, high-quality science, and in accordance with all legal and regulatory requirements.

If the clinical applications are years away, why are we talking about this now?

We think it’s important to have an open and inclusive debate sooner rather than later so that scientists, ethicists, doctors, regulators, funders and policy makers can exchange knowledge and ideas on the issues and also to encourage the public, including patients and their families, to feed into those discussions.

There are lots of activities already in progress, including a project by the Nuffield Council on Bioethics looking at the impact of genome editing, a meeting of international experts called the Hinxton Group and an initiative led by the US National Academy of Sciences and National Academy of Medicine.

You can read our initial joint statement on genome editing on our website.


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