Gail Carson: Outbreak, the clinical research response
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.
This interview was recorded in September 2016