Spotlight 07/05/18 | TB and AMR seminar post World-TB day

By Vinesh Patel

I came in to the Rose Room one April lunchtime at LSHTM, alongside a handful of other students, to sacrifice a rare sighting of the sun in London for an insight in to AMR research. Though slightly sleep deprived from assignments, I was nonetheless upbeat to hear from leading researchers. The event organisers Chathika (Researcher, TB modelling group) and Titus (PhD fellow, interest in TB diagnostics) cheerily introduced the event – aimed at telling the personal journeys of TB/AMR researchers after world TB day.

Speaker Helen Fletcher (previous Director and Deputy Director of LSHTM TB Centre) began by describing current roles including co-editor of Tropical Medicine and International Health and Challenge Leader in Global health at the Global Challenges Research Fund Interestingly, she then quoted herself as a 17 year old school leaver (I’m paraphrasing) “I’d like to do a PhD in medical research, ideally having a career heading an international research team specialising in epidemic diseases.” Nostradamus! She was the first person in her family to go to university and she highlighted this background to say that despite challenges, people from all walks can make it in TB research.

Discussing stepping stones in her career, after a microbiology BSc in Leeds she did a PhD researching molecular diagnosis of fungal infections. From there she did a post-doctoral research fellowship checking for TB in mummies in a Church in Hungary, leading to TB VACSEL vaccine selection research and on to the African Tuberculosis Vaccine Research Trial in Senegal and the Gambia, before further trial work in South Africa. Factors in her success included an impressive record of continuous publications, though this was punctuated by decreases when she had children. Take home points: 1) know what you want – if you have a focussed concept of direction, you will ride out challenges and get there with effort and time and 2) the world is unfortunately unfair -childbirth and falling ill are not generally reasons for CV leeway in the research world.

Yet this inspired Dr. Fletcher to challenge these issues – she is involved in F1000, an open research publishing group, and the VALIDATE network, which helps fund post-doc research fellows.

Gwen Knight (who incidentally supervises a project I am working on) began by explaining what modelling is, and how she became involved in it. She studied mathematics at Oxford and while she greatly enjoying her time there, had some sense of juxtaposition given she was from a small town near Cardiff. Later she moved on to applied mathematics investigating rather varying topics, from why elephants have big feet, traffic jams occur, and coral reefs are changing. Her PhD at UCL was on the spread of antibiotic resistance in MRSA, and a well cited and received publication resulted (though publishing was hard work given the nature of the modelling). Of the post-docs she applied for she took the one at LSHTM because it was more applied, looking at drug resistance and TB vaccines. In her opinion the early post-doc period requires a lot of work and can be very stressful, but her take home was that one big paper is worth more than a few low impact ones.

In this period, like many researchers, her job security, mortgages and a stressful three years’ post-doc were major aspects of her experience; these were factors as she moved on to Imperial College to be a lecturer on AMR at the NIHR Health Protection Research Unit on Healthcare Acquired Infection and AMR. After one year at Imperial, she became pregnant, took nine months maternity leave, and returned to work full time. She felt that it took 18 months after giving birth to fully get her head back in to research. Her partner was very supportive: he took three months paternity leave but she spoke of the additional challenges to her career and the personal adjustments she needed to make. There was some help, such as Imperial College and now, possibly, LSHTM paying for childcare for researchers when they attend a conference.

She experienced setbacks; observing some patterns of carbapenem resistance Enterobacteriaceae (CRE) – in the northwest of England and London – she submitted fellowship researching this but did not get it as there were not enough details in her methods section. She did however, get a small grant to do TB modelling. She later submitted a fellowship application to the MRC again, making a few changes and this time the outcome changed! Taking up this fellowship though, being alone at Hammersmith was not as good as having a mathematical modelling community, so she reapplied to LSHTM with funding behind her.

A really important point she mentioned in her journey was that if you sit and talk with people openly for 20 minutes, you can figure out if you are on the same research page.

The lessons she has learned during her career include: a) check the publication records from a research unit: it allows you to see if there are regular low and middle impact factor publications from small PhD projects as well as a few big publications every few years – the right balance of nurture and challenge a PhD student needs. b) read, listen and talk widely: go for it! You don’t ask, you don’t get. She described an opportunity to go out to Harvard for three months of funded research because she took the initiative to ask. Use technology well – twitter is a great way to stay up to date and find papers. Find an inspiring environment by looking for the right people and the right subscriptions. c) Prepare to fail multiple times – keep submitting for publication, keep your eyes open for grants, prepare to get one out of three fellowships only, and plan – there is often a lag between effort and results! Fellowships are somewhat like applying to the X Factor. d) Plan your research – there may be days you do nothing but read. Ask yourself what you really want to be when you ‘grow up’. Try and have research publications within each stage of your research pathway. e) there are growth opportunities in AMR (data analysis – it’s coming slowly). e) Challenge yourself f) Be fascinated.

She identified growth opportunities in a number of areas. Within AMR, data analysis is coming to indicate how to analyse individual patient data, how to deal with missing data (an often underrated issue). TB is seeing new tools emerge – vaccines and regimens, and MDR-TB has issues of fitness/burden/control.

All in all, this was a really great opportunity to get in to the hard facts of personal experiences and career journeys of two leading researchers at LSHTM. It was quite memorable as I think of how to fit in research in to my future career. There should be more of these events for upcoming researchers as AMR generates more attention in society in coming years.

“If I have seen further it is by standing on the shoulders of giants.” Isaac Newton