Georgina Humphreys: Optimising malaria treatment
WWARN is a network of research that analyses pooled data of numerous clinical trials. The sheer size of those data sets allows study groups to answer questions that couldn't be asked of a normal size clinical trial, such as the efficacy of an anti-malarial drug on malnourished or severely anaemic children. This research helps design policies to maintain the efficacy of current anti-malaria drugs, currently threatened by growing resistance.
This is a podcast from the Nuffield Department of Medicine. Today we speak with Dr Georgina Humphreys about her role as a malaria scientific coordinator.
Q: Can you tell us about your role as a Malaria Scientific Coordinator for WWARN?
Georgina Humphreys: My role is to drive the scientific output that we generate from pooled analyses of collected data. The data is from a whole network of collaborators from across the world, collected from clinical trials on anti-malarial drugs. The primary purpose is to analyse the efficacy of those drugs currently available. We do that by analysing the pooled data that is shared with all these collaborators on specific scientific questions.
Q: What are the current issues when working on Malaria?
GH: At the moment, WWARN is focusing on pooled analyses on particular areas of interest, which we are able to ask of the large data sets that we have, that couldn’t be asked of a smaller clinical trial normal sized data set. For instance, some of our areas of research are on sub-populations of patients that receive anti-malarials that might be quite a small number of people in a normal size clinical trial, but when you pool together tens of thousands of patients’ data you can start to tease out some of the drug efficacy questions within those minor sub-populations. For instance at the moment we are looking at particular sub-populations of children that are malnourished, or sub-populations of children with severe anaemia, and seeing how within those populations the drug is working, whether it is effective or not.
Q: Can you tell us about your research?
GH: My research is not primarily driven by me, but the whole point of WWARN is that it is a network of research. What is exciting about my role is the connection to researchers all over the world who pool together to collaborate through what we call study groups, where we ask a question, sometimes that question is generated internally but sometimes externally, that is of great relevance to the field. Last year I was lucky enough to work on the gametocytes study group. Gametocytes are a form of the parasite which are important for onward transmission from the human to the mosquito, and we pooled together over a 150 studies involving hundreds of different researchers from all over the world who had data sets where they had measured these gametocytes in the patients given an antimalarial drug. We finally published that paper which demonstrated that some of the drugs do have a different effect on gametocyte carriage in the patients, which is obviously important in terms of then onward transmission of malaria in those endemic countries.
Q: What are the most important lines of research that have developed over the last 5-10 years?
GH: For malaria the biggest challenge is about growing resistance, resistance to drugs and of course resistance to insecticides. Those are the two big challenges and the current treatment regimens that are available to those in endemic countries are the ACTs (Artemisinin Combination Therapies) and we have already seen very worrying signs of resistance to both the artemisinin and to its partner drug, in South East Asia in the greater Mekong region. At WWARN we are concentrating on trying to support researchers in the field to answer questions like "where is the best place to sample next?", "where should we be looking for the boundaries of the resistant parasite population that might be spreading?" or "is it occurring independently in different locations?", keeping monitoring up to a high enough level so that we can keep an eye on resistance and try to contain it, if possible.
Q: Why does your research matter and why should we put money in to it?
GH: The research questions that WWARN asks are extremely important and possible through these large data sets from the pooled network. It is of critical importance to maintain the last few drugs that are efficacious currently. To do that we need to have a good picture on where the drugs are working, or where it is starting to look like it is failing. That is of critical importance to the patients on the ground because that is all they have left at the moment. As you will know, the rate of new drug production is slow and there are not many in the pipeline coming along. We need to try and preserve the drugs we have got, keep them as effective as possible and try and protect those populations that are still very vulnerable to the disease.
Q: How does your research fit in to translational medicine within the department?
GH: Our research has direct impacts on policy. We have had a good example on a study group where the output of the study group led directly to a rewriting of the drug treatment guidelines because we demonstrated that the dosing regimen wasn’t quite correct for the youngest children. I think also what is brilliant about the WWARN network is supporting young researchers out in the field trying to run trials, connecting with them and saying "how can we support you?", "what can we develop that you can use?". We are looking at developing tools and resources, helping to guide standardisation in data collection in new trials and helping people to progress through their careers too.
This interview was recorded in September 2016