Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

A quick and efficient response to an outbreak requires strong central communication and coordination. Information needs to be shared quickly and then fed into patient care and policy. A wider approach, cutting across disciplines and specialities, helps limit the number of infected people and the impact on the economy.

Q: When is a disease considered an outbreak?

Gail Carson: It is considered an outbreak when there is an increase in cases of that disease above what you would normally expect in a population or a place. If we think about, for example Zika, the increase that occurred in microcephaly, the babies who were being born with small heads, raised an alarm in Brazil that there was something wrong, because they were seeing more cases than they would normally see.

Q: Why is responding quickly to an outbreak important?

GC: Quotes aren't easy to do when you are speaking, but I'd like to use one from a Roman poet from a very long time ago called Ovid who said "To act, before disease becomes persistent through long delays". That still stands true today: if we act quickly we are more likely to limit the number of people who are infected, limit the impact on the economy and so on. To help us act quickly we have to be better prepared.

Q: What are the most important responses to an outbreak?

GC: Strong central communication and coordination has to be in place without a doubt. Within that you have to think about how the main players all work together: the doctors, the nurses, the public, the laboratories and the public health agencies. Within that infrastructure you want to embed a clinical research response so that we can try and respond as quickly as possible. For all of the above to work we want to try and make sure there is the capability to share information quickly, to share data that then feeds into patient care, policy and so on.

Q: What are the most important lines of research that have developed over the last 5-10 years?

GC: I think the recognition and agreement that data sharing is imperative. It sounds very simple. It is something that has been discussed for a while, but I think mainly because of more recent outbreaks such as Ebola in West Africa and then Zika, all of the stakeholders are now recognising that we need not only to speak about it, we need to make it happen. That good comprehensive clinical data collection, it is nothing sexy but often it isn't done well. With Zika, however, under the leadership of the World Health Organisation, ISARIC and partners like Institut Pasteur, we have been working well together to try and make sure that we harmonise various study protocols, to try an ensure that data can be compared across the studies in the future. By doing so, by working together more efficiently, we can try and answer the key questions quickly.

Q: Why does your research matter and why should be put money into it?

GC: There was a clear need for ISARIC to be formed after the 2009 flu pandemic, when the heads of international research organisations basically said 'where is all the clinical research?' and charged people like Jeremy Farrar and Fred Hayden to form a network like ISARIC, and for us to seek funding because we try to put the infrastructure in place to make sure that we can launch a quicker clinical research response.

Q: How does your research fit into translation medicine within the department?

GC: ISARIC is multidisciplinary. We are network of networks, predominantly clinical research networks but also we have members who are geneticists, virologists, microbiologists, pharmacologists, clinicians (obviously), and work very closely with the public health agencies. We are very aware of the need to cut across disciplines and specialities, and to have a wider approach. For example we speak of one health; so not just to think in a silo about humans but think more broadly than that, and with the type of diseases we deal with that is crucial.

Gail Carson

ISARIC

Dr Gail Carson is Head of ISARIC Coordinating Centre (International Severe Acute Respiratory and Emerging Infection Consortium), a network of networks established in 2011 to ensure a rapid research response to outbreaks of pandemic potential. ISARIC's 50 network members share a multidisciplinary and global approach to encourage preparedness and collaboration locally, regionally, and internationally.

More podcasts related to Global Health

Mike English: Health services that deliver for newborns

Basic hospital care may be key to saving newborn lives. Professor Mike English outlines a multidisciplinary project engaging policy-makers and practitioners in Kenya. This project demonstrated poor coverage of Nairobi’s 4.25 million population if a sick newborn baby needs quality hospital care. Using novel research approaches the team also identified how severe shortages of nurses contribute to poor quality of care for patients and negatively affect nurses themselves.

Tran Hien: Infectious diseases in the tropics

Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.

Ronald Geskus: Sophisticated biostatistics for complex clinical research

The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.

Rogier Van Doorn: Research at OUCRU Hanoi

Antibiotics are widely used in Vietnam, leading to widespread antimicrobial resistance. Monitoring antibiotic use helps inform the government to change treatment guidelines and implement antibiotic stewardship programmes. This may also prevent the transmission of resistant bacteria outside the country.

Heiman Wertheim: Clinical research in low and middle-income countries

Drug resistant infections are a global crisis and we cannot focus on our own country only. Clinical trials in low and middle income countries where the burden is highest, as well as work with local communities and engagement with policy makers help influence public health policies.

Guy Thwaites: Tuberculosis meningitis

Tuberculosis meningitis affects a fractions of TB patients but causes high levels of mortality and morbidity. A recent trial at OUCRU showed that aspirin can greatly improve outcomes. Such trial is typical of the work done in our Vietnam units, where all the research is focussed on improving the outcome for patients directly.

Motiur Rahman: OUCRU laboratory management

OUCRU laboratories provide support to the unit’s extensive clinical research programme, from level 2 laboratory to SAPO 4 laboratory for high-risk pathogens responsible for zoonotic infections. Early diagnosis and detection of antimicrobial resistance helps prescribe the right medicine in time, contributing to better patient management.

Raph Hamers: Developing collaborative clinical trials in Indonesia

Indonesia is a very populous country with a huge burden of infectious diseases such as TB, malaria, HIV and CNS infections. Running clinical trials requires high levels of expertise, currently developed and strengthened by institutions such as IOCRL (Universities of Indonesia and Oxford Clinical Research laboratory). Better collaborations will also help great ideas make a bigger impact.

Jeremy Day: Central nervous system and HIV infections in Vietnam

Brain infections such as meningitis and encephalitis are highly debilitating diseases, and an accurate diagnostic is essential to give patients the best treatment available. For cryptococcal meningitis, clinical trials focus on prevention, for an early diagnosis, and novel ways to use existing treatments or repurpose old drugs.

Abhilasha Karkey: Connecting research with communities in Nepal

Antimicrobial resistance is a huge burden in Nepal, particularly in hospitals where many nosocomial infections are caused by resistant pathogens. With limited resources, little infection controls and proper guidelines in place, finding out the main risk factors helps reduce infection rates within a hospital and better target vaccination campaigns.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.