Collaboration and friendship

A medical school elective to a Kathmandu hospital became the launching pad for Professor David Murdoch's significant contributions to the global fight against infectious disease.

Professor David Murdoch has been involved in some of the world's biggest and most influential infectious disease projects, yet each has a deeply personal aspect for the Christchurch clinical microbiologist.

Among the most notable of these projects are the largest-ever study of pneumonia in children and a 15-year research programme in Nepal on the same, too-often deadly, disease that has culminated in a national vaccination programme for Nepali children.

But all have been defined by the principles of partnership and facilitation, with many of his international collaborators becoming long-time friends. Indeed, in addition to his substantial skills as a scientist, Murdoch is also a luthier – or maker of stringed instruments – and has been known to cement friendships with collaborators with a personally hand-made instrument.

An overview of the University of Otago, Christchurch professor's stellar global research career necessarily begins in Nepal.

His first international travel experience was on his medical school elective to a hospital in Kathmandu. He subsequently travelled the country and fell in love with the place and its people. Then, as a newly trained doctor, he worked at a high-altitude aid post in the Mount Everest region, then at nearby Kunde Hospital for two years with Sir Edmund Hillary's Himalayan Trust.

His time in Nepal gave Murdoch invaluable and long-lasting connections with health professionals there, and an understanding of the medical problems facing the country. The experience also led to him specialising in the field of infectious diseases – part of his specialist study was undertaken at North Carolina's Duke University.

“When I was a fellow at Duke University my boss at the time was interested in international work. He knew of my relationship with Nepal and encouraged me to explore some research opportunities there. He said if I came up with a worthwhile project, he would sort the funding,'' Murdoch recounts.

The idea was a simple but much-needed one: to work with staff at Kathmandu's Patan Hospital to identify which infections were hospitalising patients.

“I started by talking to a physician friend working at Patan Hospital. At the time it was well recognised there was a huge burden of infectious diseases in Nepal, but there was not a lot of information about exactly which infections were causing the worst trouble.

“We set up a study in adult patients in 2000. Years later it is still referred to as a milestone in collaborative research because, from such a simple study, we were able to answer some pretty fundamental questions. It had far-reaching impacts on patient management.”

The success of that study led to requests for the same sort of information about children. Murdoch turned to another friend, Andy Pollard, now Professor of Paediatrics at the University of Oxford. The pair had already worked together co-writing The High Altitude Medicine Handbook that is still considered one of the best clinical reference books of its kind.

So began Murdoch's involvement in what would become a series of highly-influential and practical research studies on infections in children around the globe. The first project was to catalogue the serious infections affecting Nepali children, particularly vaccine-preventable ones.

“We initially focused on getting data that showed pneumococcal disease [the most common cause of pneumonia and an important cause of meningitis] was a problem and identified the strains of disease in Nepal. We then did studies of the various vaccine options to show which schedule would work best for the country.''

The team spent years building relationships with the Ministry of Health in Nepal, the World Health Organization's local office and Global Alliance of Vaccine and Immunisation (GAVI), which provide a mechanism for the funding of vaccines in poor countries.

Last year, the government in Nepal introduced a national pneumococcal vaccine programme for children, influenced directly by the 10-year research programme based at Patan Hospital.

Murdoch says one important reason for the project's success was that it was a genuine partnership among all relevant stakeholders.

“I learnt long ago that the most successful projects were those that were initiated and led locally.”

"When I lived in the Everest region of Nepal I witnessed the response of the local Sherpa population to foreign efforts to clean up rubbish discarded by tourists. Though well-intentioned, the locals were frustrated by the invasive, paternalistic, uninvited and often ineffectual activities to clean up their back yards. In the end it was a locally-run pollution control project that finally made a difference.

“Unfortunately, I still think a lot of research activities done in developing countries benefit more the expatriate researchers – who are often in the most senior roles – than local staff or the countries themselves.”

Murdoch says he sees his role as that of a “facilitator”. “Andy [Professor Pollard of the University of Oxford] and I see our main roles as helping to secure funding, which would otherwise be quite difficult to obtain, and to mentor young Nepali investigators. It is a true collaborative partnership with our Nepali colleagues and we are guests in their country. That has always been our style.”

The success of the Nepali research led to Murdoch's invitation to play key roles in the landmark Pneumonia Etiology Research for Child Health (PERCH) project.
This Bill & Melinda Gates Foundation-funded project is the largest-ever study of the causes of severe pneumonia in children.

It systematically looks at current and likely future causes of childhood pneumonia in some of the world's hardest-hit populations. The research is expected to inform global efforts against pneumonia – the world's biggest killer of young children – for many years.

A key part of the PERCH project was the establishment of laboratory capacity in seven study sites in Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand and Zambia. Murdoch was the laboratory lead for the project and was on the overall leadership team.

He says the last major effort to study the causes of childhood pneumonia across many countries was conducted in the 1980s, before the HIV epidemic and the introduction of several vaccines, so new information was sorely needed.

“PERCH will have a far-reaching impact in terms of developing vaccines and other preventive measures, management plans and risk factors globally.”

Significant publications from the study in top journals are pending.

In a relatively new project, Murdoch is working with Professor John Crump from the University of Otago's Centre for International Health on building infectious disease research capacity in Myanmar.

“This is a poor country with a very proud history of excellent tertiary education, but which has had limited opportunities for engagement outside their country in the recent past. This situation is changing and we have partnered with one of their major medical schools in Yangon to help facilitate research activities.”

Closer to home, Murdoch, with Professor Nigel French from Massey University, is co-leader of the One Health Aotearoa initiative – a local arm of a global movement espousing a more holistic approach to the fight against infectious diseases.

Murdoch says the One Health concept – at a basic level – recognises that the health of humans, animals and the viability of ecosystems are inextricably linked in relation to infectious diseases.

“The importance of this holistic approach is underscored by the fact that 60 per cent of known human infectious diseases have their source in domestic or wild animals, as do 75 per cent of emerging human infectious diseases and 80 per cent of the infectious micro-organisms that are potential agents of bioterrorism.''

The One Health initiative is now supported by many of the world's key human public health organisations and is increasingly used to support public policy.

Whatever the project and whatever the country, Murdoch's collaborative style seems to produce results – and enduring friendships.