We are honoured to welcome Professor Sir Andrew Pollard to the Not Mini Adults Podcast this week. Sir Andrew is Professor of Paediatric Infection and Immunity at the University of Oxford, Director of the Oxford Vaccine Group, Fellow of St Cross College and Honorary Consultant Paediatrician at the Oxford Children’s Hospital, Oxford, UK.
Andrew trained in Paediatrics at Birmingham Children’s Hospital, specialising in Paediatric Infectious Diseases at St Mary’s Hospital, London, UK and at British Columbia Children’s Hospital, Vancouver, Canada.
He chairs the UK Department of Health’s Joint Committee on Vaccination and Immunisation and the European Medicines Agency scientific advisory group on vaccines, he is also a member of World Health Organisation’s SAGE.
Andrew was knighted in 2021 by Her Majesty the Queen for services to public health, particularly during the COVID-19 pandemic. Sir Andrew played a crucial role in the development of the Oxford coronavirus vaccine and led the global clinical trials that started in the spring of 2020.
There is one word to describe our conversation with Sir Andrew and that is 'IMPACT'. This was truly an inspiring conversation and we of course discuss Andrew’s work in developing a COVID-19 vaccination, but just as importantly his work in helping to develop vaccines for children all over the world.
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Theme Music - ‘Mountain’
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast editing - Right Royal Audio
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For much of what we do in science, we make discoveries that that may take decades before they actually turn into an important building block of a change. So I really like this working at the translational space, where you can see the way in which it can transform people's health. I'm just a few years down the line. You know, I look back over my career as a doctor over 30 years now, just over 30 years, and many of the diseases that I dealt with in the 1990s or as I saw as a medical student in the 1980s, we just don't see in paediatrics anymore because we've prevented them through immunisation. That's an incredibly exciting field to be in.David:
This is episode six of the third season of the Not Mini Adults podcast - Pioneers for Children's Healthcare and Wellbeing. Once again, my name is David Cole and I am joined by my wife Hannah, and together we are the co-founders of UK children's charity Thinking of Oscar on this week's podcast, we are thrilled to say that we have Professor Sir Andrew Pollard. So Andrew is Professor of Paediatric Infection and Immunity at the University of Oxford. He is Director of the Oxford Vaccine Group, Fellow of St Cross College and Honorary Consultant Paediatrician at the Oxford Children's Hospital. Andrew trained in paediatrics at Birmingham Children's Hospital specialising in paediatric infectious diseases, and at St. Mary's Hospital London, and also at British Columbia Children's Hospital Vancouver in Canada. He chairs the UK Department of Health's Joint Committee on Vaccination and Immunisation and the European Medicines Agency Scientific Advisory Group on Vaccines, and is also a member of the World Health Organization's Sage. Andrew was knighted in 2021 by Her Majesty the Queen for services to public health, particularly during the Covid-19 pandemic. He has played a crucial role in the development of the Oxford Coronavirus vaccine and led the global clinical trials that started in the Spring of 2020. There is one word to describe our conversation with Andrew and that is impact. This was truly an inspiring conversation. And we of course discuss Andrews work in developing a Covid-19 vaccination. But just as importantly, his work in helping to develop vaccines for children all over the world.Hannah:
Andrew, good morning, welcome to the Not Mini Adults podcast. Good morning. So, where we often start with our guests, is just to ask them to talk us through how they got to where they are today and the path that they have taken.Sir Andrew Pollard:
Well, I'm at this moment sitting in my office at the Vaccine Centre at the University of Oxford. And it feels like a long journey to have got to this point and particularly with the last year, which seems to have been about 10 years of my life, and very much dominates all thinking at the moment as it does for most of us. My background is as a paediatrician and my main way in which I defined myself as a children's doctor, and I spent my training specialising in infectious diseases of children. And that naturally led me into wanting to work in a research area around the prevention of those infections. And of course, because the biggest burden of infectious diseases is in the most resource poor settings around the world into global health, and so immunisation sits extremely well within that in preventing the diseases I see in the hospital, as well as trying to promote better child health in lower middle income countries around the world. And so that's really how I spent the last 30 years of my career training in infection and then working in research areas to try to improve child health through immunisation.Hannah:
Thank you. And we first became aware of the Vaccine Group when we were in the early few years of our charity. But of course, the rest of the world knows about you now as well. Could you talk specifically about the mission for the group? And then which you've already touched on briefly, but to elaborate on that a little further? And, of course, it's interesting to have your view on the last 10 years squeezed into one year, as you describe this as well.Sir Andrew Pollard:
Yeah, I mentioned that the mission of the Oxford vaccine group which I direct is to improve child health through immunisation and we have different aspects of that which we work on. One is obviously the development of new vaccines and the testing of them and evaluation here in Oxford, but also working with partners in other countries around the world, particularly in South Asia and, and in Africa, to generate data that will help support use of vaccines to protect children in those settings. So that's really our core mission, but we also know Work on public information about vaccines. We have a website, the vaccine knowledge website to provide information for the public and take a major role locally in educating general practitioners and practice nurses about immunisation to promote child health for immunisation through education. So there's there's sort of a broad remit that has at the core of it is the research and on new vaccines, but also about how to help people's understanding about vaccines, both professionally and for the public. And then those of us who are clinicians also work in the local hospital, the John Radcliffe Hospital, either as adult physicians or in my case as a paediatrician. So we have a service element of, of our role, as well. And there's about 160 people here in the paediatric department working on vaccines. So it's a very big operation. And of course, it always is in development around teams, rather than individuals. Over the last year, we've got a number of individuals have been very prominent in the media, including myself. And the behind this is a wonderful talented team of people who actually do all of the interdisciplinary activities that are required to make and test and develop vaccines. So I guess to come to your second point about the last year and a half has been a very unusual in a sense, but in many ways, it's just been business as normal, because we've been coming to work everyday doing what we do, which is testing vaccines, doing the laboratory work to see how well they work, what the immune responses look like. And so that, broadly is what I've been doing for the last 20 years here in Oxford, and so has the team. And what's been different about it is the intensity, we've been working seven days a week, and then very long hours every day. And also every time we look out the window, the the media are there, and there's so much public interest in what we're doing, that it's been a completely different experience from the normal work we do, which is largely under the radar, just getting on trying to do our business as normal. So that clearly has its challenges as well. And I think adds a new element of pressure because of the importance of the activities. But in the end, we have to do to take the same cool and calm approach because we're doing developing a biological product that's been given to now many hundreds of millions of people. So it has to be done very carefully and following the usual protocols.Hannah:
And we've been so interested to imagine how the building blocks of the work that you've been doing over the last few decades, both with the basics of developing vaccines on the one hand, and then on the other side, with a focus on childhood immunisation, how those building blocks enabled, I appreciate this answer, by the way will apply to the other teams that have also developed vaccines. Nobody was starting from scratch. But in layman's terms, could you describe to us how you were over and above the hours that you have in the extraordinary effort that has been put in, how you've been able to develop vaccines so quickly in what the accelerators were?Sir Andrew Pollard:
Well, I think that the way in which the building blocks were there are just because we have been making vaccines for a long period of time. So all of the steps that are required, right from how you design the vaccine through to the very large scale tamper trials, and the authorization processes working with in our case with AstraZeneca has been what we normally do. So they're the building blocks were there, just because it's what we do each step has already been tested before, it just hasn't been tested under the quite the same pressures as over the last year. The reason why things could move so quickly, partly was around the funding available, which normally we know do a little bit and then you wait for a year and sometimes several years before the next funding comes to do the next bit. So that's one of the reasons why it's been quicker. The other is that the many of the bureaucratic timelines have very much been shortened. So when we put in our our application for the ethical review, normally you would wait a month to even get to the committee. And in our case, it took just four days to get the committee to meet and to review all of the paperwork for the start of the trials. And similarly with with the UK regulator, the MHRA before you start any clinical trial, they do a very detailed scrutiny of the clinical trial protocol, the manufacturing quality and so on. And the regulator recognising the emergency situation puts a big team on all vaccines. So that that timeline, which again, is usually around about a month from submission, through to review, and they did their review in seven days. And so the each of those steps, whether it's the funding or the other review processes to make sure that everything is in order has been very much accelerated. I think one other critical piece here has been around manufacturing, usually the hardest bit of all, this isn't that clever stuff, designing the vaccine or, or the clinical trials to test them is actually being able to make the vaccine at scale. And because that's so difficult, and so expensive, is usually left, right until the end until you're absolutely sure you've got a product that works. And whereas here, quite rightly, the investment and the financial risk was taken very early on, to make sure that the work to upscale to make very large quantities have been done by the time that organisation came through. And that has, I think dramatically changed the timelines, usually that process would take a year or more. And because the process started, long before the authorization, it meant that essentially AstraZeneca ready to distribute a couple of days after the vaccine was authorised. So that the all those things have been quite astonishing. But there is a another bit here, which makes me quite nervous. And that is that we were dealing with a virus that we knew about. And so we knew how to make the vaccine, we knew exactly what to do. We knew that the spike protein, this protein on the surface of the virus that binds on to ourselves, was the key target for the immune response. And we actually even knew where to put it in our vaccine platform, the viral vector that we use, because we'd had previous Coronavirus vaccines that that we were working on here in Oxford. So if it had been a different virus, one that we didn't know about, we didn't understand this biology. I'm very worried that we would still be here today. puzzling about how do you actually design the vaccine in the first place. So I think we've also been very fortunate, I mean, I don't think, of course, not fortunate in having a pandemic, but fortunate that the pandemic was with a virus that we really understand.David:
And we're going to, obviously need to touch on the kind of Child Health elements of this and where we are with that. But it struck us when we were thinking about and preparing for the conversation that first of all, maybe not everyone realises that the Oxford vaccine group concentrate so much on paediatrics, so that in itself, I think is from the stories that we like to share is a wonderful story in itself, but also has that element of it has the working with children working with the physiological differences that you have in in that kind of paediatric spectrum. Has that allowed you? Or have you seen that that's allowed you to, you know, kind of make gains or be in a better position than maybe you would have done ordinarily?Sir Andrew Pollard:
Well, I think it's a really interesting point that the immune system and it definitely is a bit different in the the youngest infants, of course, most vaccines are given to very young children. And so we've had to work over many decades to understand more about the immune system in young children. But in some ways that that's been a particular challenge for understanding how we might approach the pandemic, because one of the real fears last year was that the vaccines might work very well in younger adults and in children, because we know how their immune systems work. But there's so much less research been done in the elderly. And most vaccines don't work very well in that age group. And I think we've been incredibly fortunate here. But all of the vaccines that are being deployed at the moment, do appear to work even in the oldest adults. And so one of the really interesting questions is not really about know whether we've learned from children, but the realisation that we have a lot more to do to work on why most vaccines don't work particularly well in older adults. And these ones, generally speaking, are working well. So we need to probe the immune system in older adults as well. And I think one of the things that our work on children can do is provide the approaches and the techniques that we've learned from having to evaluate the immune system in children, and to understand more about older adults. And I guess with an expanding older adult population, globally, this is going to become increasingly important in the future.David:
I think it's such a fascinating topic, because we talk so much, you know, on a day to day basis, not just on the podcast with people that potentially are thinking about investing in child health that are looking at new solutions, new drugs, new digital therapies, whatever it might be. And it always comes back to you know, the population is not big enough, the return on investment isn't necessarily there. Whereas actually, there's some there's some elements here that we're discussing, which gives them positive vibes, I guess or positive stories that, you know, maybe others we should be we should be spreading more in terms of actually starting in the paediatric community to allow us to then look at the rest of, because of the complications and then allowing us to look at the rest of the rest of society asSir Andrew Pollard:
I think that's absolutely right.Hannah:
You've also talked about, you know, how you had to operate organisationally and how you were able to work so fast. Clearly, that's not desirable to have to work at that level of intensity over a sustained period of time, but interested in what aspects of how things have changed over the last 12 to 15 months? Now? You know, what, what of that? Would you like to keep?Sir Andrew Pollard:
Well, I think the intensity would be good to dial down. And I mean, I think there is some dialling down already of that. But it still remains pretty busy. I think one of the things is that the whole team has had to learn quite a lot of resilience. And I think probably, that's a whole area where we need more focus in the workplace to help people with with resilience, because there is enormous strain on teams normally, anyway. But here, I think we've seen the pressures that that people are under having to work so hard, and feeling the responsibility to do so. So I think I'm not sure we want to keep that, for me, it does raise the issue of what can we do to support people better to continue the important work that they do. So that's one area, I think, certainly things like being able to talk with people on zoom, or on one team, which is the system we use most in the university really has improved our ability to reach around the world to add to different groups over the past year, there are definitely disadvantages of that of not being in the same room, not being able to beat a meeting where you can have the important discussion over coffee and a break, set all of those things, I think, last year, it does come into that part of supporting staff that if you're only ever seeing someone on a screen, it's very much more difficult to pick up all of the signals that you need to provide adequate support. So I think we do miss being in the same room as other people. But I think it has made us able to, to be much more efficient. And I've been I think about our clinical trials, working with colleagues in South Africa and in Kenya and, and in Brazil over the last year. And regularly talking with them really would have been much more difficult to have the type of interaction that we have, if we were doing this just by phone calls, or having to fly there and not be able to continue with day job whilst having those those meetings, I think there's been some real advantages in using the technology. But I speak at a lot of conferences, and always have done. But it's much more difficult to sit through a whole day of a conference where it's on a screen than if you're interacting with people in the real world. So I think there are various aspects which have advantages, but then they're not all how we do I'd like it to be all the time.David:
It just makes me remember actually. So member of your team, Dominic Kelly, when he was looking after Oscar in hospital, one of the things that we we talk about a lot was just, he was waiting for colleagues on the other side of the world to wake up, you know, to so that he could start to question them about whether or not they'd seen a diagnosis such as the one that Oscar had. And you know, any any thoughts on that. And, you know, we talk a lot and in my work with IBM talk a lot about the democratisation of data and being able to share data more easily, but actually just being able to have those conversations more easily as well. And I think also a benefit to what's happened over the course of the last 15 months, 18 months.Sir Andrew Pollard:
Yes, I think we've also enabled collaboration much more easily. I mean, right at the beginning of our development back in February, or March last year, one of the Chinese companies was a little bit ahead of us in development. And so we got together on on a zoom call, just to discuss our shared experiences. And I have to say, for me, that was incredibly helpful, because they had already started their clinical trials and could give some information. And right back there at the beginning, there was so much uncertainty about everything, that it really was, for me quite a boost that we had colleagues in China who work very open sharing their, their latest data, that helps. And I think that would have been almost impossible without the new ways of being able to connect to people and share a screen and look at data together.David:
I think that's such a positive statement to make because I think some of the press may have either not covered it or kind of not let it be known that there has been collaboration across boundaries across you know, organisations, whatever it might be So, so that's kind of Great. Great to hear. You've touched upon a couple of times, you know, all the other work that you've that you do. And I think we should really kind of maybe move to that in a second. Because obviously, even though COVID has hit other things didn't stop. So, you know, looking at creating vaccinations and new solutions from that point of views, I guess, not stopped. But just before we move that just as a kind of final thing from a COVID perspective, there's a few thoughts in terms of where children are in the in the balance of vaccination, not vaccination. I know you've got some, you know, strong, strong points, as you've kind of already started to address in terms of making sure that the vulnerable are prioritised. And there's still, you know, little evidence to say that the children get it in such a critical way, shall we say, as the adult population, but maybe we could just kind of cover that off? And I think we're really keen to think about some of the other stuff that you're working on as well.Sir Andrew Pollard:
Yes. I mean, I think that's absolutely right. You summarised it very well, better than I could probably. But I think for me, the issue about children is that we need to have good data about who should be vaccinated and whether children should be vaccinated. And the sorts of things that we need to take into account, there are other groups of children who are at particular risk. And so far, there are some groups where vaccine has been recommended for children here in the UK. I think that's straightforward. But actually, for most children, the risk of severe disease ending up in hospital is so incredibly low, that you wouldn't really need to be looked at carefully to see whether there is actually a benefit in vaccinating the whole childhood population, for that very low rate of disease. So I think that observations do so that needs looking at carefully. Now, the second one is obviously around long COVID. And I don't really like the term because it encompasses a whole range of different conditions might be better that we rather than lumping them all together to try and understand each one individually. But if vaccines can prevent long COVID, that might be another good reason to vaccinate. And then of course, there's this other condition called PIMS TS, which is an inflammatory condition, which occurs after COVID, particularly in younger children, we're learning more and more about that, and it may be the vaccines could prevent that condition. So there's definitely could be a really important role for vaccinating children in preventing most of these conditions. The main reason why people are asking for children be vaccinated is to protect other people not to reduce transmission and protect adults at this stage. You know, if we were looking back to six months ago, it might make a lot of sense to do that, because we know that vaccines would have a major impact on reducing transmission, we have the data from trials and from the first evidence in the UK from the alphabet read. I think the problem though going forwards is that with the virus evolving, it's evolving to transmit even in vaccinated populations. And so vaccinating children about transmission will in time over the next six months or a year become less and less viable as an option. And so it may be that we need to understand more about the role of vaccination, actually having any impact in reducing spread. And of course, at this moment with a Delta variant, we're seeing lots of spread in people who are vaccinated. And so vaccinating children isn't isn't going to stop that. So I think that definitely needs a good review of all of the data are around that. We also need to look at the potential risks. Now, are there any safety concerns from vaccinating children, and there are some emerging data around heart inflammation associated with the RNA vaccines, particularly with the second dose. And so we before launching into that we need to review that carefully and make sure that there's there's no harm. And particularly if the benefits are very minor for vaccinating children, you really want to be sure that you've weighed out those benefits and those risks carefully. So from my perspective, I, you know, I'm overall very much in favour of vaccinating children, if it can reduce disease burden for them. But it doesn't feel an urgent thing to make the decision today, when we will have a lot more data in the next few months. And so for me, it's not so much a question of not vaccinating children, which which may well be the right decision. It is just about gathering the data to make sure it's the right or a good decision. But there is another point about why timing is critical in that vaccinating just teenagers here in the UK, which is would be somewhere around six to 8 million children or teenagers. That's enough doses to vaccinate the whole of the older adult population in quite a large number of low income countries, and certainly those who are vulnerable. So those doses today would prevent 10s of 1000s of lives sorts or 10s of 1000s of deaths, if they were deployed today in countries where there are vulnerable older adults, rather than children who are very unlikely to even get a cold with the virus. So that for me is that sort of global equity question is the key driver for saying, this isn't the moment to vaccinate children, we should be protecting people who we know will die this year.Hannah:
You've brought us smoothly along to our next question, which was, our understanding of the work of your group had started with the existing immunisation programme that we have in the UK for infants and very young children and the sequence of vaccine sets administered. But you've touched just now on the work that you do in low income countries with respect to children and adults. And I'd love to understand more about the focus there, please.Sir Andrew Pollard:
Yes, I mean, just as you introduce that the one thing that strikes me about the last year, really is the children have been relatively unaffected directly by this virus. But the indirect impact by the effect it has had on their families and economies is huge. And so that's why I think actually vaccinating the adults in these low income settings is the most critical thing to do because we've got to get them their economies back to normal. But there's another bit which children have been particularly affected by this. And this is the disruption of health services, which means the childhood vaccination has really stalled in many countries and in low income countries particularly. And we're now seeing outbreaks of measles, rising again, in countries where measles was under control. measles is one of the biggest killers are very young children. And so this is an absolute tragedy that Coronavirus is not really affecting children, but vaccine preventable diseases are because of the impact it's had on health systems. So to come to our work, I mean, we've, we've particularly have worked on bacterial infections in children in low and middle income countries. And the real focus over the last 16-17 years has been on pneumonia, which is the biggest cause of death in the under fives and in low income countries and generating data, particularly in South Asia, to provide information about burden of disease and about vaccine strategies that might help to control severe disease caused by the pneumococcus one of the commonest causes of pneumonia in young children. And that work really led on for me to studying typhoid, which is spread through the water, and in circumstances where there's very poor hygiene, poor sanitation. And the real challenge with with typhoid, this this bacterial infection is that we can solve it if we can put in clean water in those many big cities in low income countries. But unfortunately, the engineering works to do that require huge investment, huge amounts of money, and political will over probably more than a decade in many different countries. So the children today need protecting from this disease. And so we've been working with an Indian vaccine developer to generate the data to support use of typhoid vaccines and that's now happening we were seeing rollout of typhoid vaccines number of countries, quite amazingly this year in February. In Pakistan, they managed to start a programme where they vaccinated a million children per day against typhoid because of an outbreak of a strain of typhoid, which was resistant to almost all antibiotics. And so the work that we've been doing on typhoid, the trials involved 100,000 children in Africa and Asia, so huge programme of work, and then has led to now rollout of that vaccine, which is protecting people from these antibiotic resistant bacteria. So that's been a real exciting 10 years of work on typhoid, particularly for children in those settings.Hannah:
Thank you and changing tack slightly, one of the trends that we've read about in the press has been the events of the past 18 months, causing more school leavers to choose to sign up for medical degree courses inspired by the work of yourselves and others across the NHS. So the question we had was around, how do you see the pipeline of new new talent coming into your field? Is it is it an area that has been difficult or easy to attract folk into and where does that come from?Sir Andrew Pollard:
Well, I think one of my hopes, really is that science and public understanding of science will be part of the legacy of the pandemic. I mean, it's it is, I think, quite astonishing to me that to talk to members of the public, who knows so much about vaccines and vaccine development and different vaccine platforms and phases of clinical trials. It's even a year ago that no one would have had much of a clue about any of it. So I think we have really had a huge increase in sort of general understanding and awareness about science. And I certainly hope that that will inspire young people to go into medicines and medicine and science degrees, and through their university education. Of course, at this moment, it takes a while for those people to come through the pipeline to become researchers and clinicians working in those areas. But we certainly have always had lots of applications from junior doctors and scientists to come and work in, in our area of science, because it's so unusual that you can work in a research area where in the course of your career, you see impact on an almost daily basis. And for me, just here for 20 years in Oxford, about half of the vaccines used in the UK, have at least had some of the data that supported their use has come from from the work here in my group. And, you know, I mentioned several of the other vaccines, typhoid and pneumonia and meningococcal, and now COVID, where we've had global policy impact by the research that we've been undertaking. And I think for people coming to work in this setting, that's incredibly inspiring to actually work on something where you see that direct impact, just in a matter of a few years from the time you're working on it. For much of what we do in science. Now we make discoveries that there may take decades before they actually turn into an important building block of a change. So I really like this working in the translational space. That way, you can see the way in which it transformed people's health. I'm just a few years down the line. And I you know, I look back over my career as a doctor over 30 years now, just over 30 years, many of the diseases that I dealt with in the 1990s, or as I saw as a medical students in the 1980s, we just don't see in paediatrics anymore, because we've prevented them through immunisation. That's incredibly exciting field to be,David:
I think the the word that I'm going to remember this conversation by is impact. And that's one of the main things that we try to do from a charitable perspective is what impact can we have on children that are in hospital, and we could talk to you for so long about and we feel like we've only just touched on the work that you do outside of COVID. And we discussed a little bit about the pneumonia, vaccines and what have you. But the there's so much else more has to do in it. But I do hope that there will be at least someone listening to this, who would feel that actually, there is an opportunity for them to move into healthcare to move into medicine and to and to have that have that impact. It's so good to hear that you get lots of applications coming to your group. And we can totally understand why. But I think for the for the wider paediatric population and people moving into Child Health space, that's still probably underserved. So absolutely no doubts, your inspiration and the impact that your group does. And all the work that you do will allow them to do that. So you know, thank you.Sir Andrew Pollard:
I mean, I think David, just picking up on that, I think that there is one issue, which is I mean, lots of people go into medicine. And fortunately, we were very well served by people wanting to do paediatrics and to care for children. But the one of the shortages though, is a paediatricians who then do an academic training. And we've actually, I mean, this is a slightly different topic. But over the last couple of decades, we've seen a reduction in the number of academic paediatricians, and that isn't just here in the UK, it's, it's in many other countries. And that is quite a worry for the future of research in child health, if those numbers and that's not just in my field, but in in a broad range of those, in fact, I suspect in my field, we won't be such a problem because of the legacy of the pandemic. But for many other areas of child health, we really need to work more to attract people into a research area to make sure that we can better support and children's health in the future with good research.David:
And we will spread your message as wide as we as we can, from from that point of view, very conscious of your time. And so you know, first of all, thank you so much for that, as we do with everyone that we have on the podcast, I kind of final question is if you could change anything within child health, what would it be?Sir Andrew Pollard:
Well, I think I touched on it before, which is clean water. It can have the biggest transformation on Child Health apart from vaccines, which we're doing. And the one other thing that is the most important public health intervention is it provision of clean water. We're fortunate here in the UK that in Victorian England, the money was made available to towns to put in sewage works and to provide clean water Dealing with cholera and typhoid, which I mentioned, which we don't see here in the UK anymore. And that was an incredible, cities were given loans to pay back over 100 years. And to put that in place, and of course, that was a time when populations were relatively small. And so getting started, meant that we are where we are now with a very healthy childhood population. But in many parts of the world, cities have 10s of millions of people with no adequate water supply or sanitation. The reengineering of municipal water and sanitation is incredibly expensive. And that is, I think one of the biggest challenges that there is in child health at this moment, is protecting young children from the consequences ofDavid:
Andrew, thank you so much for joining us today. Thank you, exposure to dirty water. especially for all the all the work that you've done. And it's just been such a privilege to talk to you. So we really, really appreciate you taking the time. Thank you for inviting me. We cannot thank you enough for joining us on today's not many heroes podcast and taking some time out from his what must be very busy schedule given where we still aren't within the global pandemic, as I'm sure you will all agree the impact that his work has had not only on the global population given COVID-19, but especially the paediatric population, given the work that he's done over many years is something to inspire us all. Over the next few weeks of the nominee Adams podcast we will be talking again about mental health and also about the importance of empathy and play. For children that are being looked after in hospital. Please do subscribe to the podcast. And if you're enjoying it, please do leave us a review as well. We hope you'll join us again next week.