KEYWORDS:
1. Firstly, could you briefly summarize your background in the field, and what led to you working within microbiology & infectious diseases?
I graduated with an undergraduate degree in Biological Sciences specializing in microbiology and biochemistry. It was a four year ‘sandwich’ degree, and my year out was in forensic science, and I worked at the Metropolitan Police Lab and a Home Office lab – I had planned to continue this after graduation. However, when I graduated, my mentor within the service advised me to do a PhD and then come back into the service. So, I started a basic Biochemistry PhD, but after nine months I really didn’t enjoy it. By that point, the recruitment had opened for the forensic science service, so I applied for that job, but decided I should have a backup. My back up was to do a PhD while working at a hospital in Birmingham with Professor Richard Wise, who was one of the leading experts on antibiotics (which I later found out, I didn’t know this at the time). The PhD was working on the target of penicillin, which had only been described as a few years before for E. coli and S. aureus; my PhD was in a bacterium where nothing was really known. Then serendipity played a role; the interview for the job at the hospital came up a week before the Forensic Science Service interview, and I got offered the job at the hospital. Richard was very assertive and told me I had 24 hours to decide. I took it and never went back to forensic science.
I started my PhD in 1982 and finished it in 1985. I had a wonderful experience with Richard, he plunged people into the ‘deep end,’ but that meant he offered a huge number of opportunities. Already very early on in my career, I was doing work on antimicrobial resistance that was outside my own PhD project. I stayed with Richard another two years post-doctorate as a senior scientist in the hospital and then left to go to the University of Birmingham Medical School to set up my own research team. I’ve been working on antibiotics my entire career. The University provided a great platform for me to do additional activities beyond teaching and research. The university allows one to be on external bodies and seconded to other organizations, for example, I was an expert adviser to the WHO on antibiotic resistance and I have been a member of various boards, such as the MRC Infections and Immunity Board, and the UK Food Standards Agency Advisory Committee for the Microbiological Safety of Food. This allowed me not only to do my research and teaching, but also build up my portfolio of external activities. This led into a lot of policy work while I was President of the British Society for Antimicrobial Chemotherapy (BSAC) and to be involved at an international level, rather than just nationally.
Richard used to say, and I’ve really borne it in my mind for my entire career, ‘don’t focus on the top right-hand corner of someone’s chromosome.’ Whilst there is indeed a role for very detailed and focused basic research, I always felt the gap that I filled with mine was addressing clinical microbiology and infectious disease issues such as AMR.
2. Your career has primarily focused on antimicrobials and antibiotic resistance. How has the field evolved since you first began working in this area, and why is this work particularly important?
In terms of antibiotic resistance, we were very much on a steep learning curve. Back when I did my PhD there were no genomics, no whole genome sequencing, no PCR. The technologies that we think of now as common and routine, just didn’t exist. They were either under development or hadn’t even been described. So, the technology has vastly improved, but has the environment improved?
Well, the answer depends in terms of antibiotics and new antibiotics. When I was doing my PhD, Richard’s team really excelled at investigating new antibiotics in partnership with the big pharmaceutical companies that were active at the time. From investigating antibiotic activity, pre-clinical research, and first in human studies (phase 1 trials). The lab was always doing projects on new antibiotics. My interest was whether we could get drug resistance to those new antibiotics and if so what was the mechanism, and so from 1985 onwards that was a main focus of my research.
In the late 90s the field started to change, and suddenly there were fewer antibiotics being researched and developed; many of the big companies started merging. An example being Glaxo, Smith & Kline, and Beechams; three large companies that ended up becoming one (GSK). There were not only fewer companies, because many of them had merged, but many of the companies divested themselves of antibiotic R&D. As a result, there are now few new antibiotics, and fewer opportunities for people to get the type of experience that I had.
Research on antibiotics is also very different to what it was in the 80s and 90s, and even in the early 2000s. In 2011, everyone was saying that there’s no money in this field, that therefore the companies are leaving. There has been activity in the last decade and things are somewhat better but that’s not to say this situation has been resolved. Funding for this field, whilst improved with some push funding (from national funders and organizations such as CARB-X), and some pull funding (e.g. UK ‘Netflix’ model), the level of funding for this therapeutic area is dwarfed by that for other areas such as R&D for new cardiovascular or cancer treatments and is far from sufficient to resolve the global crisis of AMR. Nonetheless, funding has inspired novelty and innovation, and there are new treatment modalities in the pipeline. For example, there is exploration of vaccines to tackle specific drug-resistant infections. It’s a very different landscape to the 1980s where we were very ‘wedded’ to new antibiotics, and if resistance or a toxicology problem developed, there were more agents under development. We’re in a very different place now.
3. You are currently the scientific director for the global antibiotic research and development partnership (GARDP). Could you explain a little bit more about who GARDP are and what they do?
GARDP was created by the World Health Organization (WHO) and the Drugs for Neglected Diseases Initiative (DNDi). I joined GARDP on secondment in January 2018 and became a staff member in January 2021. GARDP arose from the question ‘What needs to be done to help fulfil the global action plan to address AMR?,’ and the challenges of R&D of new antibiotics. Like DNDi and the Medicines for Malaria Venture (MMV), GARDP brings together different entities in partnership to work together, to get new treatments, in this case antibiotics, to those that need them. As part of its Sexually Transmitted Infectious diseases R&D programme, GARDP is the sponsor of a phase three clinical trial for a gonorrhea drug, zoliflodacin. GARDP has a particular focus on antibiotics for children and for neonates, and a Serious Bacterial Infections programme. We also have a Discovery and Exploratory Research program that I lead. This aims to fill gaps in the global pre-clinical pipeline that no other actor is doing and to build partnerships to identify new chemical entities that could form the basis of new drugs. GARDP also has an education and outreach program that I lead. This program aims to prevent depletion of expertise and wisdom due to those exiting the field and help ensure that the antimicrobial R&D community can access the technical knowledge needed to develop new treatments. This is delivered under the brand REVIVE and includes various activities such as webinars, the annual virtual Antimicrobial Chemotherapy Conference, and Antimicrobial Encyclopedia. Everything is free and accessible to anyone, anywhere. GARDP also has a collaboration with the pharmaceutical company Shionogi and the Clinton Health Access Initiative (CHAI) to provide access to one of the newest approved antibiotics, cefiderocol in different regions of the world.
GARDP is not an end-to-end virtual pharmaceutical company, or a funding organization. Most of GARDP’s R&D is late-stage clinical development. Access is an important area of activity for GARDP as there’s no point in getting a drug approved for use in people if no one can get hold of it. We aim not to compete with other organizations such as CARB-X who fund projects. GARDP work with others who help to deliver our strategy, and we will fund different projects with different organizations, such as the zoliflodacin clinical trial. Depending on the project or programme, the different organizations that partner with GARDP include academic groups, research institutes, healthcare professionals, contract research organizations, and small and large pharma.
Partnership examples include for zoliflodacin, a drug that was developed first by AstraZeneca, and then by their spinoff Entasis, and now in partnership with GARDP. Several Japanese pharmaceutical companies have partnered with GARDP and shared their proprietary chemical libraries that GARDP has done a high throughput screen with drug-resistant pathogens that are on the WHO critical priority list, that is a little bit different to more traditional approaches
4. During your career, is there anything you have worked on that stands out as a particular highlight?
There have been so many highlights. I have been very fortunate, but also my ‘guiding light’ has been that when presented with an opportunity, if I think I will look back and regret not taking it, then I say yes. Whenever I’m given an opportunity, I always think about this. That was true even for GARDP, I had not planned to leave the University of Birmingham, I enjoyed being there, but when the opportunity arose, I thought ‘I’ll regret this if I don’t do it.’
Something that stuck with me was from a conference in 2011. I’d been doing a lot of advocacy work and outreach about the need for new antibiotics and need for funding the whole way through the pipeline (from basic research, upon which discoveries based, right the way through to access). Someone in the audience said to me ‘What are you doing then?.’ I came off the podium and realized that all I was doing was talking about it. My research was understanding different drug resistance mechanisms, but the other side of that is ‘what do we know about drug resistance that we could base a discovery programme on?’ And that’s what I was doing with my academic research in the years before I joined GARDP. It’s important to challenge these things, and that was a major turning point for me.
The first time I went to the Houses of Parliament in 2011 was a highlight, the advocacy work suddenly became real when you’re privileged to go ‘behind the scenes’ and engage with politicians. Another unexpected moment was when I was asked to chair a meeting at the United Nations Conference on Trade and Development. I remember walking to the building, looking at all the flags, thinking that never in my wildest dreams did I think I would end up at the UN. There have been many interesting people from different walks of life at various speaking events or advising on important reports such as the World Economic Forum in 2013, and the ‘Jim O’Neill’ AMR Review in 2016. So many wonderful moments; I hope I’ve have many more!
5. Do you feel that opportunities within infectious diseases have improved for women during your career, and have you come across any unique challenges in being a woman in the field?
So firstly, are there more opportunities in infectious diseases as a whole? There are more PhD students and positions in academia. But, not in industry where the antibiotic R&D field is a hugely depleted scientific area. Nonetheless, my perception is that the number of people working in microbiology and infectious diseases is similar or greater than the 1980s, they just do not work on AMR.
Is it a challenge for women in the field? I don’t think the challenge for women in infectious diseases or microbiology is any different to the challenges of women in the workplace in general. It is difficult when you’re starting out, and that is not just gender specific. An additional problem is if you are not part of a particular educational background and haven’t been to a particular establishment as an undergraduate, you are immediately disadvantaged. As people often say about women or other minority groups, you must work twice, or five or ten times harder to get to the same place. I still think that’s the case as I continue to see very talented individuals overlooked for some who are mediocre but became part of a particular cohort early in their career. So, who you know remains fundamental and this translates to receipt of prestigious funding and ultimately career opportunities.
Once one has their foot on the ladder, as it were, I think the challenges then come with work life balance. The challenges that women find, and increasingly for men too, are managing caring responsibilities. Not just with children, but with elderly parents. I’ve observed that in academia and at GARDP; work life balance is a problem everywhere. However, I still think this is a particular problem for women, and I talk about this from a personal point of view. I have two children, now adults, but when they were younger, I was part of the problem. I really struggled with wanting to be 100% at work and with my baby daughter. It was really hard to leave her – that biological pull is hard to override. That’s not to say men don’t feel the same, it’s just that our society has evolved such that woman are more susceptible to this.
I am lucky to have a husband who has and remains incredibly supportive and was absolutely equal, not only with childcare, but in the way we live our lives; this is a key reason I have been able to take advantage of so many opportunities. I have seen some people, mostly women, whose partner is less supportive. That’s not to say they are unsupportive, it’s just that somehow their career is seen as more important. What you find is that somehow there has been this tacit agreement within that relationship that the woman will not pursue her career in the same way. Timing of job opportunities is also a factor for a couple having to choose the first career opportunity, and I understand. This isn’t a criticism; it’s just that career opportunities tend to be exploited more often by a man than a woman. Also, I’ve heard lots of discussions, about there not being equal opportunities and this remains true in various sectors, but in academia at senior level there can be few or no women applicants – when I’ve asked individuals why they didn’t apply, alongside feeling that they cannot commit the time for such a position, imposter syndrome also plays a part.
You asked me right at beginning what has changed. I can tell you, attitudes to women are nothing like they were in the 1980s and 90s. However, I am very sad when I hear young women (by young I mean under the age of 35) still having the same discussions that I was having at that time, still encountering the same problems with sexism. It makes me sad, but I do think things are changing. I doubt that anyone is going to be asked to pour the tea at their first departmental meeting as a lecturer/associate professor, which is what I was asked to do. I would hope that doesn’t happen anymore. In fairness, I don’t think his sexism even registered with the person who asked me, because when I said that I would pour the tea if he did the milk, he did. These are unconscious actions, but I do think and hope that they are being overcome, but this remains very much region dependent and I am horrified at the attitudes and actions taking place in certain parts of the world to restrict women.
6. Finally, do you have any advice to inspire the next generation of female infectious disease scientists to make their mark in the field?
That is a really difficult question because I don’t consider myself inspirational. I just look back and think, how did I get here? The advice is what I said before, never, ever turn down an opportunity if you think you’re going to regret it. There is always a way of working things out. If you don’t like it, you can always change your mind and stop doing it. If you end up on too many committees, you can leave. If you end up doing a job you don’t like, find another one. I know it sounds very easy, but I think people put barriers in their way for saying no or for not making change when really that is what they should be doing. So that’s my advice. But then I think that’s the same for any person, not just women. I know some people might say, that’s all right for you to say, you’re confident in everything. But I’m confident because of where I am. I was not like this in my 20s or early 30s. People see me as I am now, not as I was then. A lot of people have a fear of failure, being embarrassed or looking stupid. At times, I still do but cover it better! It is worth thinking, what is really stopping you from taking up that opportunity, is it just an excuse rather than a reality. I still cringe at some things I said or did a long time ago, but I may be the only one who remembers! So, in the long run, did it matter? Probably not. So, my advice is to grasp opportunities and have no regrets.
Disclaimer
The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Taylor & Francis. This interview was not peer reviewed.
Declaration of interest
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.