kirsty le doare

Kirsty LeDoare is a Reader in Paediatric Infection and Immunity at St George’s. She was recently awarded a UKRI Future Leaders Fellowship for a project she is setting up in Uganda and the UK.

Can you describe your main research project?

I am working to set up a mother and baby study in Uganda, with the aim of understanding what it is that makes babies sick. Then I want to understand whether there are things in the mothers’ immune systems that can be transferred, whether via blood or breast milk, that might stop babies getting those infections.

The idea is to investigate whether developing and using vaccines for women when they are pregnant, against Group B streptococcus and pertussis (whooping cough), could boost that natural immunity and result in babies that aren’t infected with these diseases any more.

Group B Streptococcus is the major cause of death and illness in babies under the age of 3 months and is usually passed from mother to baby at birth. Vaccinating the mother could prevent the disease as the mother would pass antibodies via the placenta to her infant.

In Africa they have a lot of pneumonia which is one of the things you get with whooping cough and there’s not currently very much in the way of vaccinations against pneumonias before a baby gets their first vaccinations.

How did you decide on locating the project in Uganda?

It was partly by chance. Three years ago I went to review the Mulago National Referral Hospital in Kampala with a colleague from Cambridge. It’s the largest hospital in the country and has a unique cohort of women and children as it has three maternity wards – about 80-100 babies are born there every day. It also has the largest rate of mother and baby deaths from infection in Africa.

I was very impressed by what they do there with very few resources and it seemed like a good opportunity to set something up which might have direct benefits for patients coming through the door and in the wider community, as well as adding a research site in Africa to compliment that we were hoping to establish in the UK.

I then spent a very long time developing the project together with my collaborators. We received money from the Gates Foundation to set up a pilot and we’ve now received further funding from the European & Developing Countries Clinical Trials Partnership (EDCTP) to do part of the study, along with the more recent support I have received from a UK Research and Innovation (UKRI) Fellowship.

What will the UKRI funding be used for?

The UKRI Fellowship is being used directly for my project. The money will be split between St George’s and the Uganda site because the needs of pregnant women from Group B streptococcus, which is what the Fellowship is for, are different in Uganda and to the UK. So we have two parallel arms running which I’m overseeing.

So we are aiming to set up a large lab here in the UK which will be looking at how the immune system works and trying to replicate a baby’s immune system in the lab; and then we will have the field site in Uganda that will directly feed into that through providing samples from patients with Group B streptococcus to develop tests to look at different parts of the immune system. The ultimate aim is that we have this ‘cross-talk’ between the labs so that we can have an exchange of ideas and people, transferring ideas from the UK back to Uganda.

We are carrying out a series of studies in Uganda. Firstly, a sero-epidemiological cohort study will look at antibodies and other immune factors relating to Group B streptococcus and that then will lead directly into two group B strep vaccine studies, from different manufacturers looking at different targets to boost the immune system.

The funding will be life-changing. As it’s a 7 year fellowship I will be able to recruit and develop staff to support the project for the long-term, which will enable me to spend time on the research itself and developing new ideas. It’s got a huge capacity-building element so we’ll be able to do more in Uganda, transferring skills across sites and retaining our people there. Lastly, it involves a secondment to the World Health Organisation (WHO) in the third year, as well as an Executive MBA in year 4, helping provide context of where our project will fit in in the wider global health space.

What are the conditions like in Mulago hospital?

It’s very basic. There are 35,000 births a year so about 100 women a day come in to deliver babies; but 25 of those babies will die in the first day of life. Often the hospital will have 100 babies needing care in its special care baby unit, yet they have just 20 cots available. So the babies that need oxygen, for example, will be in just two cot beds, in a little ring around the oxygen because there is only one oxygen concentrator, so they all have to share.

The WHO have had a push for the last 10 years to bring women into hospital for safer childbirth. But that doesn’t mean the facilities have kept pace with that. While 80% of women in Kampala now deliver in hospital, in underfunded, understaffed government hospitals, it can be more dangerous. You sometimes see that the most junior staff with very minimal supervision end up delivering quite complex cases. Private practice is paid better so the more senior doctors may end up going that route.

In general though the culture is changing. The WHO used to aim for 4 antenatal clinic visits for each woman before delivery in hospital; now it’s 8 attendances before birth. They’ve realised that pre-eclampsia and gestational diabetes need to be picked up earlier. While no extra funding for that has been available, at least there’s recognition that this level of care is needed.

What is the contrast between working in Kampala and coming back to work in the UK?

In the patient populations at St George’s you do see children with HIV and TB which makes them similar to their counterparts in Africa; though it’s often quite difficult seeing that stark difference when parents bring their children to hospital when they get sick. The availability of simple things like medicine is better in the UK because the budgets in Uganda are so stretched.

What was your route into this area of research?

I did a European economics degree, spending time in Germany, the UK, Spain and France. When I graduated I became a management consultant at McKinsey Consulting in their charitable division and started to work with Oxfam. I enjoyed it so much that I moved over to work at Oxfam as a logistician economist. But I’d always in the back of my mind kept thinking about medicine. When St George’s announced its 4-year programme for graduate medicine, I was selected to join the second intake and started training in medicine.

When I graduated I wanted to carry on with the global health side of things – they had just advertised academic training from house officer level. I did that at St Georges then went to the Institute of Child Health at UCL for paediatric academic training. Next I applied for a Wellcome Trust Clinical Research Training fellowship at Imperial College, which funded a 3-year period of clinical research based in The Gambia. I moved back to St George’s last year.

I often joke that I keep trying to leave St George’s but always end up coming back! I’ve never felt as supported anywhere else as I do here. It’s so rare in academia. One of the benefits of a small institution is having access to senior leaders and research directors and freedom to explore my interests wherever they take me. Throughout my career I have had – and still have – fantastic mentors who encouraged me and have built my confidence, especially to apply for the Fellowship.