Authors: Martha Powell, Future Science Group
In this interview, we discuss public health and music playlists with Natasha Crowcroft, Chief of Applied Immunization Research and Evaluation at Public Health Ontario and Professor in Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health at the University of Toronto (both Canada).
Natasha, who has 25 years’ professional experience in public health, speaks about her idealistic outlook and the importance of collaborative research, in addition to discussing her interests in maximizing the health benefits of immunization.
What global challenges are currently facing access to vaccinations? And does public health require an interdisciplinary outlook? Find out more in our interview below.
To begin, could you please provide a brief summary of your career to date?
I started out with a very clear plan to become a parasitologist but on the way to executing my plan discovered I was more interested in epidemiology and public health and switched career paths. I have never regretted it – I absolutely love working in public health because it is so diverse and multi-disciplinary. [/userpro_private]
“I absolutely love working in public health because it is so diverse and multi-disciplinary.”
What prompted you to move from focusing on medical microbiology to focusing on public health?
It is hard to say what made public health seem so interesting to me. Something about applying scientific approaches to really practical problems that make a difference to people’s lives. I also really love analyzing data and thinking conceptually. I am a bit of a nerd really, and hopelessly idealistic. What public health training brings to the mix is a good sense of how many of the solutions to health problems are not technical but societal. The best vaccine in the world is of no use if no one wants to have it. We also have to think globally. For example, we can’t protect Canadians, or anyone, fully from measles if we can’t control measles in every country in the world, because we are all so globally connected.
“The best vaccine in the world is of no use if no one wants to have it.”
Could you outline some of your current research interests?
I am currently really interested in how vaccines work in the field and am in the middle of a study of pertussis vaccine effectiveness in Canada. I am also involved in projects evaluating the impact of immunization programs on population immunity, on how we best eliminate diseases such as measles, and some projects on vaccine hesitancy.
All of these research projects have a wide range of partners involved in the research and are stronger because of the diverse views. It is like being at a really good party where you are hearing new music that you haven’t heard before but want to add to your collection as soon as you get a chance.
You’re involved in Canadian Immunization Research Network (CIRN) – could you describe the aims of this network, and why do you feel there is a need for this?
Canada is a complex political environment with multiple levels of government. Immunization research and evaluation can be a hard sell to traditional basic-science funding agencies because it is so applied, which leads to a gap in funding this kind of work. Yet a systematic and stable funding source is essential to ensure we have good data on which to base decisions about immunization. CIRN was established in order to fill this gap.
“CIRNS’s goal is to conduct an evaluation of vaccine safety, immunogenicity and effectiveness.”
CIRNS’s goal is to conduct an evaluation of vaccine safety, immunogenicity and effectiveness. The Public Health Agency of Canada (PHAC) is enlightened in supporting CIRN to ensure ongoing relevant and high quality research in Canada. CIRN is also a network of fantastic people, with very different but complementary approaches to the problems of vaccines.
You’re interested in the interface between disciplines; do you feel communication and collaboration are important in helping the field of immunization progress?
It is often said that the most exciting advances in science occur at the interfaces between different disciplines. I also think it is the most fun to work alongside people with diverse perspectives on the world. For example, I love working with microbiologists because they are so smart and so detail-oriented. I learnt from my time in the UK that some of the best work in my field happens when the public health epidemiologists and microbiologists are open to working together, respect and value what each different perspective brings to the table. Throughout my career my favourite jobs were those involving multi-disciplinary teams. It is just so interesting when people have different views, as long as it happens in a safe environment in which people feel comfortable disagreeing and being open with each other, which requires good communication and a will to collaborate.
People who work in health want to have an impact and make a difference. By connecting the front line with academics, and different disciplines together, we see things in different ways and ask (and answer) different and better questions, which lead to different interventions and more impact. I have tried to draw an analogy with sharing playlists. If you want to convert someone to liking Jazz you don’t start them with Ornette Coleman, you start with someone really accessible like Ella Fitzgerald. But if you really want to understand where they are coming from then you need to listen to their music too. And in the end, you may up dancing together to a shared playlist that is better than anything you would have put together on your own. I think multi-disciplinary research is the same.
“… in the end, you may up dancing together to a shared playlist that is better than anything you would have put together on your own. I think multi-disciplinary research is the same.”
How important do you think advocacy and outreach are as aspects of the immunization field, and science in general?
Advocacy is a really interesting and topical issue right now. The word is a bit ambiguous in usage – having negative connotations. The Naylor Report on Science in Canada has led to a lot of discussion about whether and how scientists should be advocating more for increased funding for science. Populist politicians and a general move of our post-modernist society towards an anti-expert and individualistic approach to the world is leaving science high and dry. In a world where every issue has a lobbyist fighting its corner, is it any wonder that science is not taken seriously? Our voice is drowned out by everything else. We need to get smarter about making the importance of science clearer and real to ordinary people. And avoid coming across as too entitled or elitist. Science is for everyone. We should be celebrating that, getting over our innate scepticism and inviting people in to see what we do. Part of the issue is the culture of science, to be humble and spend our time trying to prove ourselves wrong; it goes somewhat against the culture to be self-promoting.
“We need to get smarter about making the importance of science clearer and real to ordinary people.”
Having said all of this, there is a specific issue with respect to advocacy for vaccines. It can be viewed as too heavy handed or preachy. Scientists definitely need to seek the right balance in our communication.
The pertussis vaccine has formed the basis of a lot of your research – what are the issues around the current vaccine and vaccination regimens?
Pertussis is fascinating and a great topic for me because there is so much disagreement about what is happening and so many different perspectives. The current vaccine is working really well to prevent deaths in infants and maternal immunization has been a huge step forward in that regard. However, we do not know how to make a vaccine that generates protection that last as long as we would like, which is causing all sorts of problems including outbreaks. We don’t know how to interrupt transmission of pertussis and we can’t just keep adding more and more boosters to the schedule. In addition, whilst the vaccine works well at protecting new-borns when given to their mothers during pregnancy, we still have work to do in many countries to convince mothers that it is ok to have a vaccine while pregnant.
“We don’t know how to interrupt transmission of pertussis and we can’t just keep adding more and more boosters to the schedule.”
Pertussis is a good example of a problem requiring an inter-disciplinary research. Every three years there is a Bordetella meeting that brings together all sorts of researchers. At one of these meetings in Hinxton in 2004 I asked about the problem of interrupting transmission of pertussis. Afterwards an epidemiologist who’d been in the audience contacted me to say that no one in the audience had understood why I was asking the question or how important it was. Nearly a decade and a half later and everyone is asking about transmission and there is even a Baboon model of transmission. We got there eventually, but it does take time for ideas from one discipline to get taken up by other areas. Yet, this is so important for finding new solutions to complex problems, and why I am interested in how we can motivate people to be interested in listening to and hearing different perspectives.
Finally, what do you think are the greatest challenges currently facing global access to, and uptake of, vaccination?
Broadly, we need universal equitable access to publicly funded health care, high quality surveillance and monitoring, and political and public trust and support for public health and science. Without good government and good governance, the public doesn’t trust in the institutions that are needed to deliver safe effective vaccination programs. Good governments place the health of their communities as their most important responsibility and support immunization as one of the most effective tools we have for achieving healthy communities.
Oh, and we need world peace and an end to poverty too. Did I mention that I am idealistic?
Thank you to the many inspirational colleagues with whom I have had the privilege to work.
Dr. Natasha Crowcroft is Chief of Applied Immunization Research and Evaluation at Public Health Ontario, and Professor in Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health at the University of Toronto. She trained in medicine and public health at the Universities of Cambridge and London, UK, and in field epidemiology in the European Programme for Intervention Epidemiology Training (EPIET) in Belgium. She has 25 years’ professional experience in public health including a decade at the UK Public Health Laboratory Service/Health Protection Agency (now Public Health England) and nearly a decade at Public Health Ontario, Canada. Her research aims to maximize the health benefits of immunization, leading to over 200 scientific papers so far, and she provides expertise to the World Health Organization.