Nick White: Improving the treatment of infectious diseases

My name is Professor Nick White. I'm a professor here at the Faculty of Tropical Medicine in the Mahidol and Oxford Research Unit in Thailand, and I'm also a consultant physician in Oxford in the UK.

I work on a number of different infectious diseases, but the two more pressing recent areas of research have been on COVID-19, and how to treat and prevent it, and I have a much longer interest in malaria, I've been working on that for nearly 50 years.

So, in COVID, two things. One was we did, what turned out to be the world's largest prevention trial to find out whether chloroquine or hydroxychloroquine could prevent COVID-19, which was done in healthy volunteers. More recently here in Bangkok, but also in Brazil, in Pakistan, in Laos, and soon to be in Nepal, we've been testing the drugs. So, the question has been what drugs work in COVID and what doesn't. We've developed a methodology, which is based on how quickly the virus is cleared from the back of the throat, from the oropharynx, and we measure the quantitative virus, each day after different treatments. And that's told us, for example, that drugs like ivermectin or favipiravir don't work, but it's told us that drugs like remdesivir and molnupiravir do work, and best of all, at the moment, is the main protease inhibitor nirmatrelvir, but also ensitrelvir. So, it's given us, or given policymakers, evidence upon which to choose drugs. For COVID now, which is becoming a much less serious health problem, we still need drugs because it's still causing disease, morbidity, and mortality. So, it’s that simple question of what drugs should people take, and when should they take them.

In malaria, the major concern at the moment (in fact it's a recurring concern) is that drug resistance is going to turn back the progress that occurred in the first 15 years of this millennium. With malaria, the world's most important parasitic disease, we were winning between 2000 and 2015; numbers were coming down across the world, and now they're going up again. And this is fuelled by resistance to the anti-malarial drugs. We have developed a new approach to the treatment of malaria, which is to use three drugs, not two, to protect each other against resistance. So these triple artemisinin combination treatments, we are developing those and figuring out, are they safe, are they effective, where should they be used? That's our pressing study.

Those two examples are both very common diseases. Malaria is the most important parasitic disease of humans. So, if we can reduce the morbidity, the suffering, and the deaths from malaria, then clearly that's very important for populations living in malaria-endemic areas. For COVID, I'm hoping it's not going to come back and sting us again, but this approach to testing the drugs can be applied to other diseases. We're actually testing it in influenza, respiratory syncytial virus, and other respiratory infections. Respiratory infections are a very important cause of suffering and death as well. They're amongst the most important infectious diseases of humans. So, if we can improve the treatment of those, I think people will be pleased with that.

I would hope that funders would consider this improvement in human health, happiness, well-being, and productivity are useful things. And I think I've tried to explain that in those areas, we can do research which translates. I think it's very important in medical research that you have a reasonable prospect that it will translate into human benefit. A lot of medical research doesn't, a lot of it fails, and that's reasonable; not everything works. But I think we, particularly in our area of research, have to have a reasonable prospect that the work will translate into human benefit, and so, that's why I would hope we would be funded.

This interview was recorded in January 2024.