Podcast

The Global Physician

Intro: The narrative in global health is still a lot about doing good. People who are giving out grants are often thinking about global health funding as humanitarian aid. It is not humanitarian aid, but it is a reciprocal process. And we do need to really also acknowledge the skills, and also experience that is there in African countries. For example, if we talk about Africa or talk about Asia as well, where there are centers of excellence and that needs to be brought more to people's conscience. We cannot think of global health as children playing in mud. AskDifferent the podcast by the Einstein Foundation with Nancy Fischer

Nancy Fischer: The most known challenge for global health during the last decades was a disease we all heard of again and again. It's COVID-19. It turned our lives upside down, no matter where in the world you were isolated or infected. The pandemic is, I assume, the example if we speak about global disease and global health. But there is way more to speak about. Global health and health equity is a massive challenge. And this year, the Berlin Charité Center for Global Health was established to accept the challenge. The newly appointed Einstein Professor Beate Kampmann took over this center as a scientific director. She's sharing this job with virologist Professor Christian Drosten, and she's also the Director of the Institute of International Health. She is a global expert, and her main areas of research are pediatric tuberculosis, HIV co-infection and vaccinology. I'm very happy that we now have almost 30 minutes to not speak about COVID-19 too much, but many other topics and aspects of Professor Kampmann's life. So welcome to our Einstein podcast AskDifferent, Beate Kampmann.

Beate Kampmann: Hello. Good morning, Nancy. Delighted to be here. 

Fischer: Maybe let's start with your recent job here at the Global Health Center where we are today, that you started only five months ago. Is it hard for someone with your career after so many years to begin a new job with new colleagues in a new city?

Kampmann: Absolutely. And you put your finger right on it. I think if it hadn't been for this unique opportunity within Berlin, I probably would not have left my life, my job in London and in the UK and also in Africa where I've lived and worked for over 30 years of my life. But this was just a brilliant opportunity to try and pull together some of the diverse, but really exciting opportunities within Berlin and with colleagues who have already been working in global health for a long time, but maybe a little bit in isolation, and I think there could be more visibility of the subject. So I'm hoping to enable that to happen. 

Fischer: And so we are, just to mention that, on Charité campus. So sometimes we're gonna hear an ambulance in the background, just to explain that. And why are we speaking in English? Also an interesting point because you were telling me like of course we want to reach out to an international audience, but also you have lived for 30 years in Great Britain and other countries abroad. So this is more natural for you today, which is also interesting. 

Kampmann: Yeah, at the moment, you know, obviously I can talk in German as well by now, but if we're talking about global health, it is really an international subject and I feel for better or worse English remains the international language of communication there and my scientific background and knowledge is better conveyed in English still than it is in German at the moment. 

Fischer: The Center is committed, it's very new, it's founded new, it's committed to improve health worldwide, to link researchers to contribute to global solutions. What does that mean in daily work life for you? What are you doing today, for example?

Kampmann: So you know, global health is a network activity. No institution by themselves can ever say they really do global health, and this is a kind of strange concept because we can't do global health for people. We can only improve global health with people and with their input. So today is an interesting day because I'm starting off with this podcast here. Then I'm going to spend a little bit of time with my excellent team here at the Institute for International Health. And then in fact, I'm traveling to the WHO for a meeting to think about what we need to put in place for maternal and baby health to make the time around birth a bit safer, and what roadmap points we need to create to come together as a global community. And it's so important to have, you know, stakeholders from all countries involved in that because as I said, solutions that fit our country or the vision that we might have for another country might not be what that country or the people really want or need. 

Fischer: Which I assume is a very big challenge to make giving birth safer for so many people now.

Kampmann: Oh, absolutely. I mean, the mortality for women in, let's say in The Gambia where I've worked for a long time is at least 10 times as high as it is in Germany. And 44% of children who die under the age of five die in the neonatal period. So, it's a really fractious moment in life. 

Fischer: Maybe we can take this as an example or another example you have in mind, but how would you explain the challenges of global health to a child?

Kampmann: Oh, that's a great question. I think people often understand things better if they start finding a personal connection. And if you say there's millions and millions of people dying all over the world from potentially preventable diseases, which is the case, it often doesn't resonate because big numbers don't mean an awful lot to people. So, the idea is to bring it to people's own experience. And if you speak to people in Africa and even children, they're likely to have seen brothers and sisters die, which is not an experience that we share in our countries. And that causes incredible grief for families. And if you then explain to them that there are ways to, let's say, they've lost someone from meningitis, right? Which is a common disease still in Africa, or pneumonia or tuberculosis. But there are ways to improve the health of people affected by those diseases. And there are ways of improving the fact that they don't get the disease in the first place. So you can take children through, for example, why they had their own vaccines. Because that's an experience of childhood as well. Or you could take them - we do that with school children quite a lot - you could take them to the research center at the Medical Research Council in The Gambia where I've worked, we have an open day for school children all the time. And you can show them how the science that you do in the lab or in clinical trials or even in, you know, big data crunching for surveillance that is happening in their communities actually results in some change in what happens on their ground. And, and that's, I think is the aim. 

Fischer: I have another question coming up way later in my preparation, but I'm going to ask you now because it's just the topic. Speaking of the Global South, because you just mentioned also the African continent: How easy is it to work on global health from Germany, from a country, which in my opinion is very safe concerning healthcare? 

Kampmann: I think it's absolutely essential that people spend time with the communities in which they think change is needed. Because ultimately that change needs to come from that community and needs to be supported by that community. It's not for us to sit here in Germany saying, oh, well you should be building an intensive care unit when they basically have hardly any drinkable water. So, it's very important to actually have an understanding of the societal circumstances. I'm very privileged that I've had 12 years of spending every second month of my life in Africa. And I have that connection, but you know, even me, I'm not exactly part of that community, but I need to listen to what that community really needs. And I think this sort of, you know, I call it safari science, where people go out and think they have an intervention, maybe collect samples, bring them back, I don't think that's an acceptable way of creating equitable partnerships in global health. 

Fischer: So, you mean you have to go longer? 

Kampmann: You have to go longer. You also have to bring investment that's not just a little project. So, one of the beauties of the experience I've had in my career is that I've worked in institutions that had sustained funding. And although we had to generate a lot of grants and make sure that we did projects which had sustainability as well, we had some basic requirements which were set, like transport facilities, a clinic, medical supplies. And that's essential. So, these small intervention projects are very difficult to really create momentum. And we probably need to, you know, really critically think about who's driving the agenda. Because there's a big discussion in global health at the moment that the people who most benefit from global health are northern researchers. And that's a terrible narrative. 

Fischer: That's probably one of your tasks you would like to change, working here in the Center for Global Health. So, you have any idea how to…

Kampmann: We have very interesting clinical partnerships with a variety of settings here, which is also through the Institute of International Health here at Charité and there are other partners at Charité who have similar projects. So, what we're doing at the moment is a bit of a mapping exercise to see who's working where, on what topic, and that we hopefully can create some synergies and that people who might have set up an enormous clinic for non-communicable diseases in, let's say Uganda can also accommodate for projects that might be more related to mental health issues or vaccine studies or antimicrobial resistance. So, it's important to put things together in a way that they make a bit more sense longer term. 

Fischer: I was talking in my introduction about what comes to my mind when speaking about global health which is of course COVID-19, and also here your co-leader at the Charité Center for Global Health is Professor Christian Drosten, who was the voice in Germany informing about the pandemic. But you were just mentioning some other aspects. What should we know about Global Health besides the pandemic, besides COVID-19, what big other challenges are there? 

Kampmann: Oh, completely. There are, apart from infectious diseases, which remain probably a third of the challenges that we face, antimicrobial resistance which is a huge topic because the way hospitals are run and the antibiotics that are at people's distribution could do with some improvements here and there. There is an enormous epidemic of non-communicable diseases going on. The similar tendencies that we see in our countries that with socioeconomic levels rising people's diseases change from infection to non-communicable diseases such as heart disease, high blood pressure, diabetes, et cetera, and often societies in Africa now also, emerging societies fall almost into two groups: very impoverished people who are still primarily affected by infectious diseases and people who are quite wealthy who often suffer from the sort of spectrum of cardiovascular diseases that we see in our countries. And we need to address both of those challenges. And the healthcare systems are poorly equipped to do so, and they don't necessarily have the breadth of therapeutic interventions that we can offer in a high-resource setting like Germany. 

Fischer: I guess that sounds like a task that is never finished, right? 

Kampmann: Yeah, you're right. I mean, health is never finished, right? What is the saying? Health is not everything, but without health, everything is nothing. And it's also a very personal experience. You know when your child's sick or if, if a relative of yours is sick, everything comes to a standstill. And, you know, beyond the individual care, which is limited for people in resource-poor settings, there's a public health agenda there as well, because ultimately, the emphasis needs to be on prevention, and it's really through setting up preventive services that to some degree rely on new diagnostics as well, that we need to try and help countries to shift to more sustainable healthcare systems. And we've seen the challenges for healthcare systems through the pandemic everywhere in the world. It's not just a question of low resource settings. 

Fischer: Is that motivating you that there are so many challenges or is it sometimes also demotivating you because now people say, ah, everything is worse. 

Kampmann: No, I know, I know that people say, you know, where do you have the energy to get up and look at these things? I think it's because, you know, nobody can shoulder these challenges on their own backs. This is all, you know, it's everybody's business just as much like planetary health is everybody's business. And, for me, it's like a question of where do I see myself best placed to make a contribution? And I'm a clinician, a clinician scientist in pediatric infectious diseases. So, to work on prevention of infection comes very natural to me. And through the time, I've also acquired some knowledge around public health and the interactions with infectious diseases. But I'm in no way well equipped to make great recommendations about non-communicable diseases. But that's why we have teams and that's why we have, you know, the opportunity to contribute with other people, and that's where the Center of Global Health is a great challenge and a great opportunity. 

Fischer: While you are working here, you're the co-leader of this Center, so I guess it's also a little administrative work or also like networking work, but you also continue your own research projects, even though I think timewise it's a tough schedule, but why is this important to you? 

Kampmann: I think the credibility of people working in global health comes from the experience that they bring to the table. There's a lot of talk and we need to show that we are also embedded in the question. And my career has really begun as a pediatrician, as a person who observed internationally, that, you know, in a different setting, different children are getting different things for different reasons. And asking the question, why are there these differences? And so that drove me being a researcher. And I've come to it from childhood tuberculosis originally, and then more and more through vaccines, which are a wonderful tool to actually prevent some of the infectious diseases that we're all worried about. And I think my track record in also clinical trials shows that really the evidence base needs to be created really solidly. And then we can also move into policy. And this is an opportunity where I think I'm best placed as an advocate for children, as an advocate for evidence-based medicine, especially generated through clinical trials, and as an enabler and networker with an amazing amount of freedom to operate. And that's not the case for everybody. 

Fischer: What a good thing to know that you are in the place you feel best, right? Or you can do best. 

Kampmann: I think I'm described as a person with a lot of energy. And I'm also described as a person who is pretty collaborative. And also, I think I'm quite good at spotting talent and I've brought through the last 12, 15 years up a generation of scientists, clinicians, pediatricians, other public health experts who are taking on some of the work that we started 15, 20 years ago. Just as much as I've benefited from mentors who have shown me their way of operating. And yeah, through that you build networks and networks are absolutely important for any success not just in global health, but in general in science. 

Fischer: That's a beautiful bridge to the next topic I would like to talk about with you. Do you remember when you had in mind the first time the idea of ‘I would like to become a scientist, that's something I'm interested in’? 

Kampmann: So even at school, when I did my A-levels, one of my subjects was biology. And it really fascinated me. It was just at the time when also there was lots of advances in genomics and molecular biology and, you know, it was not clear. I always wanted to be a medic. Let's put that clear. I never started my career thinking I'm going to be a scientist as such, and I would describe myself as a translational scientist, which means that I bring developments that are already a little bit away from the bench to patients. And then see how we can create change that way. I've not done basic science. I've not worked on Crispr Cass, I've not worked on animal models, for example. I truly appreciate my colleagues who do that, but I do need the application of the science that I do to direct patient care or to the greater public health agenda, which is I think, why I found my niche in vaccines.

Fischer: And now that you know that and that you scouted your way, your career in medicine first of all, how important were mentors to you or people that support you? 

Kampmann: You know, this is really something that especially the younger generation of clinician scientists are struggling with, and I do see it here in Germany as well. And it's maybe one of the reasons why I didn't return until now, that the support for the translational aspects of science in the global sense is still fairly limited and therefore it is absolutely important that you find people who kind of tick in a similar way and that you have a peer group of people that you can moan together, but you can also create a bit of momentum together and that you don't feel you are the single person who wants to do something that nobody else is doing. Plenty of people are on that path. You just need to find the network and then the mentors, and you need chaperons in your own department. If you are faced with a department where everybody is just only focused on whether the rotor is clearly staffed and you get seen as the person who goes on a groovy holiday when you travel to a really challenging site in Tanzania or something, then that is difficult. And there you need mentors. You need people who've done it before, and you need to put yourself in a place where you're closer to those people.

Fischer: How do you do that? Take part in networking meetings?

Kampmann: Sure, conferences are an important part and research meetings. I've just come back from the German Tropical Pediatric Society meeting in Bonn, which was lovely. It's not a huge group, but it's a very committed group where the majority people have worked abroad, and we had a little sort of what was called ‘Kaminfeuer discussion’ and, you know, I asked people to write down what was in their mind about why they wanted to come and talk. And literally all of them were mid-career scientists or clinicians rather, who wanted to know how they could nurture their career in global health against almost the institutional boundaries. And it needs a lot of solidarity with colleagues. And I think sometimes you need that little bit of critical mass in an institution to move the goalpost forward. And I would hope that through having a center of global health, we can also influence that debate a little bit and we can have clinician scientists’ fellowships that are earmarked for people who want to work in global health. So that would be one of my goals. 

Fischer: Being back here in Germany after so many years abroad in the UK and other countries, what do you think, what could the Center for Global Health, which has started new, what could they learn from other countries from the way they deal with global health?

Kampmann: The thing that strikes me coming back to Germany is, that the narrative in global health is still a lot about doing good. And it's about the separation between the science that is required to solve global health problems, which are, you know, we mustn't take ourselves out of that circle. It's almost like, I don't like talking about the Global South, for example. Global is global. Global means it's just as much the Ukrainian refugees who have ended up in our doorstep, as it might be some teenage pregnant mother in the US as it is some person struggling with malnutrition in Africa. So, first of all, to change the perspective of what is actually global. It's not a North-South relationship. Global means global. 

The second thing is that people who are giving out grants are often thinking about global health funding as humanitarian aid. It is not humanitarian aid. Humanitarian help or aid can be a part. And hopefully through our trials and interventions we deliver some form of aid. But it is a reciprocal process, and we do need to really also acknowledge the skills and also experience that is there in African countries. For example, if you talk about Africa, or we could talk about Asia as well, where there are centers of excellence. And that needs to be brought more to people's conscience. We cannot think of global health as children playing in mud. And the media play an important role about that as well, I think because it's always about humanitarian this and that and, you know, the money is getting put into some place you never see it and there's corruption, et cetera. I think the media can make a much better point about showing examples of excellence and the talent that there is in Africa. And I can primarily talk about Africa, but I also know that it's similar in Asia, in Latin America. 

Fischer: So maybe from your experience in Gambia, just give us one example of what should people here that listen to this podcast know about what you learned there, what you took over from there? 

Kampmann: I took over from there that people are quite aware of the problems that they're facing, and that because of the relatively limited means they're not always aware of what they could do to improve the situation, but that they embrace an opportunity for learning and for developing with a little bit of improved infrastructure. And that means that they have opportunities for career development just as much as we like to have here in our settings, and that they embrace mentorship and that they will work extremely well together when there is a task at hand. Communication is often much better in Africa. 

Fischer: So, we spoke about mentorship, about international work and like advice to younger researchers. How important was failure in your career? 

Kampmann: I think failure is an absolutely essential part of life, not just in career, but to, you know, to not get a grant, for example, for a project you really, really wanted to do can be very disheartening. And you just have to speak to other people who've also gone through a similar experience and you realize, okay, well, failure happens, you know, the success in grants is maybe one in three, one in five. So you just have to write another four. And you need to improve, and you need to think. And I think for me, the most frustrating thing is not to understand why something failed. It's not so much that something didn't quite come off. But if there is something that you can fix that that doesn't happen either to you again or to someone else, then you can draw some lessons from that failure. 

And you have to be quite resilient in global health, I guess in clinical science in general because there are times when stuff doesn't work out. And what's happened to me often was maybe the main project or the main research question that I asked might not have been the one to which I found a definitive answer, but the platform of doing the science gave me the opportunity to look at a couple of other things. I give you an example. I had set up a project on trying to understand why in the same household, some children get TB and others don't, although they all live together. And I was thinking this is primarily due to the fact that the immune systems are functioning in a different way. I still haven't been able to prove that hypothesis, but on the back of that, I found that, for example, the vaccine that we give against tuberculosis, which is called BCG, has a certain protective effect against TB infection. And that's really driven the field trying to think about the next generation of TB vaccines. 

So, you know, I'm a very glass half-full person. There's always a silver lining. You just have to spot it, and you have to also deal with failure as a lesson of how things might have to be done better.

Fischer: Glass half full is a good point. You also told us you have a lot of energy. I also wanted to know if I would speak about free time or holidays, is that something you need, you want to have as a scientist? 

Kampmann: No, I mean, you're right, and you know, medics are sort of probably notorious for not having a great work-life balance. And to me, that paradigm doesn't really apply because if my work wasn't also my life, I probably wouldn't do the job I'm doing. However, I also know that I do need breaks. We need to recharge. And I try and reserve time because like, you know, when you have small children, there isn't really a break, but you have an opportunity to spend time not doing work because there's just no option. Right? You have to take them to football. You're doing this, you're doing that. And I experienced that when my son had grown up that I was doing more and more work on weekends because there was just more time. And eventually I decided that that wasn't the right thing to do. And now I try and reserve at least one of the two days of the weekend where I'm doing something different. 

Fischer: If I read your CV, there's so many positions, projects, roles, we can't mention all of them, there are too many things you did in your life so far, prizes and honorings. What are you striving for today if you think about the next couple of years working?

Kampmann: I'm not a spring chicken now and I feel, science is a never-ending question and it's not something where you say, okay, that's it, I've done it, I can retire. I think now the challenge is to keep my own research portfolio going, to set up the Center as primarily an enabler. To bring people together who might not have worked together previously, and to really look at the opportunities we give for more junior scientists. So, I don't need to be the last on every paper anymore. I don't need to be the group leader. I don't need to run every single meeting. I am now in a privileged position where I've got people who have gone through, you know, maybe my mentorship who can take on certain aspects of that work and do that quite well, and I can, it's not exactly, I'm not exactly sitting back. But I watch that with great pleasure, and I don't need to have, you know, the top dog job on a daily basis. It's more important to me that there's sustainability and to create that sustainability and give an impulse for the directions of science that I think are important. And one of them being equitable partnerships in global health, and another one being safety of vaccines and vaccine communication to appreciate the value of vaccines for societies because there's a lot of, you know, false and fake news going on at the moment. Those would be two ambitions in which I'm still very, very committed. 

Fischer: Good luck for that, most success, most possible success to Professor Beate Kampmann I was speaking to, Einstein Professor, thank you for your time today.

Kampmann: Thank you. It has been a pleasure.

Fischer: I'm very glad we could spend some time speaking about the research, the career, the points of view on all that, because you've heard it, Professor Kampmann’s career in science is remarkable and there's yet more to come. So, we wish you all the best for your work as the leader of the Charité Center for Global Health. 

This was AskDifferent, the Einstein Foundation's podcast about science and even more the people who do the science. My name is Nancy Fischer and I thank you for listening. 

AskDifferent the podcast by the Einstein Foundation.