Introduction

A recent case study candidate asked us whether he should enter vaccine research. As part of our research for that study, we contacted the Jenner Institute, an international centre based in Oxford that develops vaccines for infectious diseases . Our aim was to interview one of the scientists to better understand how careers in this sector tend to go, and to get their thoughts on a variety of important questions (especially those concerning vaccines) for our case study candidate to cross-check against other interviews we have done with medical researchers.

Katie Ewer, a cellular immunologist based at the Institute, agreed to talk to us. We sent her a list of questions by email (see the appendix), and discussed them on Skype. Below, we present a summary of her responses and key quotes from the Skype call.

Key updates for us

• Katie was less keen on starting your career by studying medicine than our previous interview, because she didn’t think the benefits are worth the lost time, which made us less certain about this question.

• We updated slightly in favor of the idea that most of the benefits of doing vaccine research on a specific disease are flow through effects i.e. advances in one vaccine have many benefits for other vaccines, reducing pandemic risk, and medical research more generally. This suggests that ability at research is relatively more important than the priority of the research question than we previously thought.

• Katie suggested without prompting that research into neglected tropical diseases might be particularly neglected, which fits with previous research done by Giving What We Can into the Sabin Vaccine Institute.

• Katie, as with everyone else we’ve spoken to, said that strong motivation by the subject is very important, because the work is tough and the pay is low.

• Katie thought that the vast majority of people would be better off supporting research through earning to give than by becoming researchers, though talented people should do research, which fits with our view.

• A useful way to test out a medical research career is to take a research assistant job over the summer.

• We found that careers in medical research might be more flexible than we had first thought.

Highlights of the interview

Her story

Katie’s undergraduate degree was in biomedical science and included a year of microbiology training. After graduating, she worked as a research assistant and then decided to complete a PhD focused on the immunology of tuberculosis. Around that time, there was a major TB outbreak at a secondary school in Leicester. She spent four years researching the immune responses of children there who had been exposed to TB. That research ultimately led to the development of a better tool for diagnosing TB that is now commercially available. She continued researching TB and eventually decided to move back to academia. She has worked at the Jenner Institute for 5 ½ years and now researches malaria vaccines.

“How interactions with microorganisms shape the immune system is my big interest. In my current position at the Jenner Institute, I research how the human immune response interacts with the malaria parasite and how the vaccines induce immune responses that can protect people against malaria. We develop vaccines against a variety of infectious diseases: HIV, tuberculosis, malaria, flu, and some veterinary diseases.”

“For malaria, we are in the unique position of being able to vaccinate people and then infect them under controlled conditions with malaria to see if the vaccine works. As an immunologist, that’s a fascinating thing to be able to do, and it’s a massive appeal of this job. That process accelerates vaccine development very rapidly compared to say TB, flu, or HIV. We can then take vaccines to Africa, where we run efficacy trials. The advantage and interest for me is taking something from quite a novel development stage to something you can test in babies in Africa over a relatively short time span.”

With the TB diagnostic tool you helped develop, how did you turn your research into an actual tool that could be used on the ground?

“The TB outbreak in Leicester allowed the research team to run a natural experiment that compared the prevailing tool for diagnosing TB at the time, the skin test, to a new technology involving t-cell responses. Opportunities for those types of experiments do not come along very often. Without that experiment, it would have been much more difficult to convince the field that the new technology was a good tool for diagnosing TB. Following that experiment, the University’s technology transfer department, Isis Innovation, took the product forward and created a spinoff company. That company holds the license for the intellectual property of the original discoveries that were made. The company markets and distributes the diagnostic test.”

Getting involved in vaccine research

How useful is doing a medical degree. Do you think your career would have benefited from studying medicine?

“I don’t think a medical degree is a recommended way of accelerating a scientific research career. If you have a medical degree and then do some research and decide to do a D.Phil, it’s much easier to do a PhD if you are already an MD. Certainly once you have a D.Phil, there are lots more funding opportunities for people who are clinically qualified. But I don’t think I would necessarily recommend that a person go to medical school as a way of accelerating an academic science career because apart from anything it’s hideously expensive and takes six years. If you are really good and good enough to get into medical school, then those six years are probably best spent in the lab writing papers and getting grants, in my opinion.”

The most important areas of research

Do the insights gained from the development of one vaccine tend to benefit the vaccine field as a whole, or is a lot of the innovation relevant to just one disease?

“Broadly, big developments in vaccine research are applicable across the entire field.”

Do you think the bulk of the benefits of vaccine research come from these more broadly applicable results (versus disease specific advances)?

“If you can make a really good viral vector that will induce a strong t-cell immune response, then that advance will benefit people making TB, malaria, HIV, and flu vaccines, so they are very translatable. That happens a lot in the field, where people make some change or come up with some molecule that’s able to increase the immune response and then try to apply it to lots of settings.”

Do you think the kind of vaccine research that goes on at places like the Jenner Institute contributes much to reducing the risk of pandemics?

“If you could make a vaccine that is effective against all of the strains of flu, then that problem goes away and you effectively mitigate the risk of a flu pandemic. That is something we are doing at Jenner—trying to make a flu vaccine that is effective against all strains of flu.”

Neglected tropical diseases

If Katie had a significant amount of money that she could devote to making a difference, she would spend it on neglected tropical diseases (NTD’s).

“If you overlay the incidence of HIV, TB, and malaria with the incidence of worm infections in Africa, for example, they overlay almost perfectly. Yet, we have no idea what the effect of widespread infections with helminths are on immune responses to malaria, HIV, and TB. We know broadly that worms dampen one’s immune system and that malaria alters how your immune system responds in childhood. But there’s a real lack of big scale research into NTD’s, which have a huge burden of morbidity on the population in Africa. If you really want to help the continent become more economically active by reducing the burden of disease, instead of worrying about things that might or might not happen, you could give out anthelmintics.”

“In terms of public health, you can be sure of having an impact if you treat people for NTD’s.”

What’s your impression of the reasons why research into NTD’s receives less funding than other diseases?

Katie explained that research into NTD’s has increased but still lags behind other diseases.

“It is possible to get research into NTD’s funded, but for whatever reason there are just a lot more people interested in making HIV vaccines and looking at the natural history of HIV vaccines than there are in looking at NTD’s. I guess more people have the potential to die from HIV, but many people live with chronic NTD infections that are debilitating in the long-term. The more I understand NTD’s, the more interested I become. Hopefully momentum will build as more people start to do that research and high profile publications come out. Hopefully more people will think it’s an interesting area to study.”

Research constraints: Funding vs. people

With NTD’s, is funding or the availability of strong researchers a bigger limiting factor?

Funding constraints seem to be greater for NTD’s than HIV, TB, and malaria. Funding is available, but it is probably not as high priority for some funders.

“I think the funding is there if you can write a good proposal, and there are lots of good researchers already in Africa. Maybe it’s not as easy to convince funders of the relevance for NTD’s as it is for HIV, TB, and malaria.”

Is your impression is that it’s harder to find good researchers or additional funding?

“In order for research to progress, you need lots of different types of people within an organization. You need people who are very methodical in what they do and are capable of doing large volumes of high through-put work, and then you need a few people at the top with the creativity to pull ideas out of the sky that nobody else would ever think of and convince Bill Gates to give you £1 million. I guess if you have somebody like that in your institution who is that creative and has that amazing ability and insight, then you can probably convince people to give you £1 million. But funding is always limited. We could proceed our field more quickly if we had as much funding as the HIV field.”

“If you are uniquely gifted in scientific research, then you should probably be a scientific researcher. But for the other 99.9% of the population, they’re probably best going and earning £1 million elsewhere and funding research.”

Qualities of a strong researcher

What qualities can one look for in deciding whether he or she has strong potential in the vaccine research field?

“To pursue any scientific career, you must have an insatiable curiosity for your subject because what we do is hard, and most of the time things don’t work and it can be quite frustrating. Every now and again you have a day where something amazing happens and you get a really fascinating result that makes the other 364 days of the year feel worthwhile. Unless you have an absolute obsession with your subject, it’s very hard to persevere and not become demoralized. I personally am really obsessed with how the immune system interacts with the malaria parasite and how t-cells evolve after vaccination. I’m lucky enough to travel to Africa now and again and see the magnitude of the problem that we’re trying to address. If you’re not motivated in that way and don’t really think you can make a difference with what you’re doing, then it’s probably not the career for you.”

“It is a tough career, and nobody goes into medical research for the money. You get into it because you believe you can make a difference and it’s scientifically and academically challenging and stimulating. I would strongly advise people to find a branch of medicine or science in which they can find a new question to answer and be motivated enough to go and answer when their last 10 experiments haven’t worked and they don’t know why.”

Deciding on graduate study

What suggestions do you have for people considering a career in medical or vaccine research who are not yet sure whether they are passionate enough?

“We get a lot of people who think they might want to do a PhD and they’re coming to the lab to see a) what it’s like to work in a research group and b) what vaccine research is like. I think that’s a good idea before you commit yourself to a PhD program or even a master’s program. Getting a job as a research assistant is often a good way in, but those posts are often quite competitive. I have hired about eight research assistants in my time at the Jenner. Half of those will go onto do a PhD within the Jenner, some of them will stay as research assistants, and others will decide to do something else.”

“It takes about six months to fit into any new job. If you’re excitement or interest hasn’t been piqued within six months of starting to work in an area, that’s probably a sign the research field isn’t for you.”

Keeping one’s options open

What options are open to people who do a PhD and maybe work in the field for a few years, but then decide to work elsewhere?

Katie listed the following options: public health and policy, scientific writing and publishing (e.g., working for a scientific journal), and teaching. She also knows several women who have left the field to become full time mothers.

To what extent do researchers need to start focusing on a specific research area?

In Katie’s experience, people often do a D.Phil in one area, and their natural interests develop over time. If they are lucky, they can create enough momentum to turn their side project into the main focus of their research. Katy challenges the assumption that increasing research specialization limits one’s flexibility.

“Discipline hopping and translational medicine mean that many people do immunology, molecular biology, and parasitology almost interchangeably. I think it is possible to do your PhD in genetics and then do something completely different. It’s easier now than it’s ever been.”

“At the PhD level, people tend to do immunology or molecular biology. If you can develop a really good, broad skill set in either of those areas at the DPhil stage will be really useful going forward. Acquiring lab skills and techniques is always a bonus on your CV because it maximizes your options for post-doctoral positions.”

Appendix – list of questions sent by email

1. How useful is doing a medicine degree first?
2. How much is progress in this field achieved by large contributions from few people vs. small contributions by many?
3. What are the options for someone who tries to make it in vaccine research and fails? Do most people stay in the field?
4. What would a ‘good person’ look like and how competitive is the field?
5. Do lead researchers seem to find it more of a struggle to find good people or get funding?
6. How much funding would you exchange in order to get a ‘good person’ rather than an average person?
7. Are there other roadblocks to progress?
8. Within medical research, what are the most important questions to work on over the next couple of decades?
9. Which of these areas seem the least ‘crowded’ with researchers? i.e. where it would easiest for a good person to get a lot of funding.
10. Which of these areas seem the most underfunded?
11. How easy is it to change your research focus over time?
12. Who else would be good to talk to and what else would be good to look into?