"No matter where you live, our health and the world's health depend on its most fragile link"
The 2019 Jimmy and Rosalynn Carter Humanitarian Award has been presented to our Director Jeremy Farrar in recognition of his work to improve global public health. Ahead of the award ceremony on 9 May, he spoke to the National Foundation for Infectious Diseases (NFID) about his career and the people who have influenced him.
Who or what has had a profound impact on you to this day?
The heroism and tragic death of Carlo Urbani had a profound impact on me. Working for the World Health Organization in Vietnam, he realized something was wrong – a series of patients with very severe respiratory infections were coming into the hospital in Hanoi, many were dying, along with many of the staff treating them. He unselfishly closed the hospital and in doing so saved a country, alerted the world, but tragically contracted and died of SARS.
In my very early career as a young doctor at the start of the AIDS epidemic, I witnessed the fear and prejudice before we knew what caused AIDS and before there was any hope of treatment. We watched helplessly as mostly young people died, with public health and clinical medicine impotent to intervene. It was devastating. But then over 10-15 years, through science, research, and leadership from the HIV community, we slowly worked out the cause and could provide public health advice and the start of the era of treatment. This turned an inevitable death sentence into a long-term manageable condition. It showed me the power and impact that can happen when you combine community leadership with great science and innovation and put that to the service of society.
We were far too slow to appreciate the impact on low-income countries, particularly in Africa and Asia, and far too slow to make sure public health interventions and treatment were available independent of the ability to pay. A lesson which we must heed today, science and innovation can and does change humanity, but we have to ensure that all the benefits are shared equitably and that such advances benefit the maximum number of people, independent of their ability to pay.
Who has had the greatest impact on your professional career development?
So many people have influenced me. Cheryll Tickle, a fundamental developmental biologist, taught me that medical science was not about rote learning a long list of facts; it was about ideas, the unknown, the edge of knowledge, the joy in uncertainty and the comfort that you – you of all people – could help change that knowledge.
Charles Warlow taught me that the most exciting areas of science and medicine were at the interface of disciplines that did not usually work together, an ever more important lesson in an increasingly fragmented world. Nick White showed just how important listening to and looking after patients was to a fulfilling career and the best way to really change clinical science.
My mother and sister taught me how to laugh, enjoy, see a way through, and always remember that tomorrow will bring a brighter day.
Those whom I admire most are people who seek to make a difference and do so with ambition, humility and a sense of fun.
What are the greatest threats and opportunities for the infectious disease profession?
The greatest threat we face is to return to an insular, inward-looking, more nationalistic world, where we care only about ourselves and those who are like us. None of the greatest challenges of our time belong to one group, none can be solved by one group or country alone, and certainly none can be solved by isolationism.
For infectious diseases, the greatest threats are that we are complacent: by forgetting that drug resistance is inevitable; that not everyone is persuaded by vaccination; that inequality and poverty drive so many of our greatest challenges; and that conflict, inequality, migration, urbanisation, ecological and climate change will spread infections around the world. No matter where we live, and secure we may feel, our health and the world’s health depend on its most fragile link. Without sharing that risk and vulnerability, without sharing the benefits of science and research, we will not overcome the permanent threat of infections or address the great challenges of our time.
For young professionals from all backgrounds thinking about what career to pursue, there has never been a better time to choose clinical science and global health in particular, from basic discovery science, through public health, to clinical medicine, policy and practice. But we have to inspire people to become interested; rework the incentives that facilitate a career in global health; make sure that people have the right opportunities to explore their ideas and dreams and provide a career path that supports this critical next generation.
What are the greatest changes you have seen in the profession since you began your career?
Today there is a lack of flexibility, over-specialisation too early, an unforgiving career path, and an under-appreciation of the value of breadth, an open mind, and diversity of perspective. We must retain that breadth in knowledge and appreciation of the critical role of the clinician scientist and people who appreciate public health, clinical medicine, basic science, innovation and policy. There has never been a better time or greater opportunities to make a difference – we have to bring that optimism and sense of fun back into global health.
What is your greatest professional accomplishment?
I am most proud of helping to build a world-class clinical and public health research centre in government hospitals in Vietnam, Nepal, China, and Indonesia; supporting the next generation of clinical scientists; continuing my own clinical work; and contributing in a small way to local as well as global health.
I am glad I never lost the sense of wonder, the love of what I do, and a sense that we can all contribute to improving the world in which we all live.
What is the greatest challenge you have faced in your career?
Cynicism or a pessimistic attitude that we cannot make the world better and less inequitable.
"What President Carter has contributed to those less fortunate than himself is an inspiration to all of us – because of that legacy, this is the proudest moment of my career."
Knowing what you know now, what, if anything, would you do differently?
I would have embraced personal coaching, management and leadership training earlier, and spent more time with family.
What most keeps you up at night?
The political and increasingly nationalistic world we live in.
What advice do you have to offer to the next generation of infectious disease professionals?
Go for it! Embrace and enjoy uncertainty, be as broad-minded as possible for as long as possible, and never stop believing you can make the world a better place – you can.
Is there anything else you would like to share?
It is an absolute honour to receive the 2019 NFID Jimmy and Rosalynn Carter Humanitarian Award – what President Carter has contributed with such dedication, ambition, grace, humility and real impact to those less fortunate than himself is an inspiration to all of us – because of that legacy, this is the proudest moment of my career.