In cases like the Ebola outbreak, disciplines must learn to work togetherGlobal Panorama

Global health, and in particular emerging infectious diseases, is a theme of extensive research within Cambridge. I spoke to Professor James Wood, leader of the Cambridge Infectious Diseases group and head of the Department of Veterinary Medicine, to find out about what is being done in Cambridge and elsewhere to improve health and tackle infectious disease globally.

The ethos behind global health is based on both democracy and context: all global citizens deserve equal access to the healthcare they require, depending on the associated diseases of different locations and socio-economic backgrounds that determine an individual’s health. Much of the research of Wood’s group is based in West Africa. “If you want to understand the processes of disease emergence, you have to work in areas where these diseases most emerge and if you look at all of the work that’s been done in evaluating this, the tropics are hotspots.”

Wood’s research has a particularly interesting focus, looking at the crossover between human and animal diseases – in his words, “trying to understand the process of spillover and the human responses to the spillover”. This, of course, is all in an effort “to try and mitigate the risks of people suffering from these diseases”. Following the Ebola epidemic, the group have recently expanded their research to the Kenema Hospital in Sierra Leone, one of the major treatment facilities. The key idea is to focus on both the medical science and the socio-personal effects of this deadly infection, alongside the Institute of Development Studies in Brighton.

This longer-term work is coupled with more short-term efforts by other Cambridge departments. “I think the work that Ian Goodfellow, in the virology division of the Pathology department, has done on Ebola diagnosis, setting up a lab and a sequencing facility in Sierra Leone with Wellcome Trust funding, is really exciting. It’s a great example of how response to a really big problem can actually be turned into longer-term advantage for the local community.”

Yet global health need not, and indeed must not, be limited to simply the exchange of empirical research and technological innovations. Wood suggests that efforts to overcome obstacles that inhibit health-care workers and systems’ ability to carry out necessary research and provide effective treatment are equally fundamental in shaping the future landscape of global health. Africa Day, which took place last Tuesday at Emmanuel College, exemplified some of the efforts of the Cambridge-Africa programme. The project was founded by parasitologist Professor David Dunne of the Department of Pathology in 2008, supported by Wood, and has since brought in well over £10 million.

The aim of the project is capacity-building, Wood tells me: “to help them do research on African problems in Africa rather than thinking that we’ve got a solution to all of their woes. The solutions need to come from Africa but we can help by helping them to develop their sites and in bringing funding into what they do.” Top-down approaches to policy are rarely effective, as people on the ground tend not to trust those implementing the policy. Seeding a bottom-up approach puts power in the hands of the people and countries affected, reducing reliance on foreign aid in the long run.

The idea of One Health – a movement to improve cooperation between medical and scientific experts across the world – has sprung up recently in the world of policy as a method of cross-linking human health, ecosystem health and animal health, thinking about these three as a single entity. One Health, suggests Wood, puts pressure on science to deliver “things for local communities that are useful for the people living in them. [It’s] absolutely essential and is particularly important for neglected diseases, which often don’t spread rapidly but have a high burden of disease.”

He also points out that the concept of disease burden – the total impact of a disease, financially and socially – must not be limited to human suffering. Often these diseases are caused by zoonotic spillover events: “if you think just of the burden of the disease in one species, that’s only half of the story. I think it’s an essential approach for us to take.”

Yet it seems, at the moment, One Health remains a useful and potentially influential idea but without any real-world application. “People are talking about One Health but not many people are doing it. That’s something where here in Cambridge Vet School, we are trying to take a real leadership role in promoting this approach to the infectious diseases that many of us study.” It seems a movement towards a One Health approach to policy and action would help facilitate the true integration of the different kinds of knowledge – social, biological, mathematical – needed for curative and preventative measures. The work of Wood and others in pushing this agenda forwards will hopefully encourage this transition.

The Ebola epidemic scared the world, with its horrifying symptoms and the chance of a worldwide pandemic. With changing social environments and increasing population sizes, scares like this will likely become increasingly regular. So learning what went right in controlling this epidemic, suggests Wood, is integral to the response efforts of the future. “What distinguishes an effective response from one that’s ineffective actually relates to how people ‘work’.” Key, he adds, is “ensuring the systems we set up to try and respond to these outbreaks are resilient enough to deal with all sorts of different outbreaks, rather than thinking: ‘Do we have a drug or a vaccine? If we don’t have a drug or a vaccine we can’t do anything.’”

But there’s more to it than science: “it’s not just a technical solution that we need to produce. It’s a locally informed solution that relates to resourcing and human behaviour,” he tells me. “I think that the longer-term solutions to infectious disease problems will come from multidisciplinary teams working holistically together.”

This cross-fertilisation of knowledge between disciplines, which showed considerable efficacy during the Ebola outbreak, is also crucial behind the scenes in prediction. Wood suggests it is “important for biologists to work with a really solid quantitative framework, working with mathematicians in making mathematical models” providing a more rounded framework for how infectious diseases are studied.

It is also necessary to understand the daily lives of those affected by disease. “For all infectious diseases in the tropics, probably the greatest risk factor is poverty, so anything that can be done to reduce poverty probably has the greatest impact on infectious disease.”

Diseases don’t transmit in a vacuum: they propagate via people. Hence, in many ways, coping with global health challenges relies as much on the human sciences as the natural sciences. Improving living conditions and sanitation, stabilising health-care facilities and promoting education will be central in curbing the effects of infectious diseases in the future