Menno is a medical microbiologist. After completing medical school, a PhD on HIV treatment and a specialisation in medical microbiology at the AMC, he briefly worked as a medical microbiologist at the AMC and LUMC. Then, Menno and his wife Constance Schultsz (also a medical microbiologist and active in NCOH) made the adventurous decision to move to Vietnam, where they worked at the Oxford University Clinical Research Unit and Hospital for Tropical Diseases in Ho Chi Minh City. There, Menno set up a new virology lab, because there was no lab for that purpose yet. His wife directed the bacteriology lab that already existed. Menno calls his move to Vietnam a turning point for the rest of his career:
“Right after arriving in Vietnam, bird flu caused by a highly pathogenic H5N1 virus emerged in China and the north of Vietnam. That was a very intense time because suddenly, there was this new zoonotic infectious disease that killed not only chickens but also humans. Worldwide, people were really afraid the H5N1 outbreaks in Asia would evolve into a new pandemic of the same severity as the one from 1918 when millions of people died. It was also a challenging test for the still-developing lab because reliable diagnostic tests to detect the virus had to be set up quickly. In addition, study protocols were developed right away so that we could learn important insights from the first patients who were suspected of being infected with H5N1. What are the clinical manifestations, what are people dying from, how can we best treat them? A few weeks later, the first patients were actually admitted to the hospital and since we were so well prepared, we could immediately include them in observational studies, while the whole world was breathing down our necks to get much-needed information!”
What was it like to arrive in Vietnam and immediately be confronted with H5N1?
“It was a rather stressful but also exciting period. As parents, we wondered what we had gotten our family into. We were probably the first family to have a personal stockpile of Tamiflu in order to protect our kids and ourselves if needed. It was a very hectic period, but one in which we learned a great deal in a short time.” It was there that Menno’s interest in and passion for emerging infections started and, by seeing what can be done and how much can be learned in a short time, the value of preparedness and collaboration. “Since the virus originated from animals, we also started to closely collaborate with the veterinary sector in southern Vietnam back then so we were truly working according to the One Health concept for H5N1. I realised the strength of having the proper laboratory and clinical capacities and being able to work in a multidisciplinary manner.”
Can you elaborate on this concept of working from a multidisciplinary perspective in conjunction with a scientific capacity?
“The research unit contained both expats and Vietnamese scientists with an aim to build sustainable scientific capacity in Vietnam. The expats came from different disciplines: immunologists, clinicians, geneticists, microbiologists who had all coincidentally come together, which allowed us to work in a very multidisciplinary way. This was not only extremely stimulating professionally but also needed to truly address important scientific and clinical questions related to H5N1 and a range of other infectious disease relevant to Vietnam. Not unimportantly, the success of the unit attracted funding as well.”
How do you see this NCOH?
“If there is a question or problem related to One Health, then people should know that the NCOH is the best place to address these. During H5N1, the whole world was concerned and a lot of money was made available to us to tackle the threat. For example, funds were made available to develop a network of hospitals in Thailand, Indonesia, and Vietnam in order to conduct clinical studies on influenza and other emerging infectious diseases. This resulted in the establishment of a strong and still existing clinical network and also allowed us to open sister units in northern Vietnam and Indonesia. Thus, strength and success lead to future opportunities. This could apply for the NCOH too: if we show our true strengths, people (and funders) will know on which door to knock when a One Health infectious disease problem needs solving”
Why is this One Health approach so important?
“It is important because infectious diseases are becoming more complex — more and more infectious disease threats to human health emerge around the world which can subsequently spread globally due to increasing globalisation. As most of these threats originate from animals, a One Health approach for addressing these is essential. For rapidly emerging infectious diseases, you need a clinical and scientific infrastructure that is ready to go. This approach allowed us to conducting clinical research in a timely fashion in Vietnam. I have been working on this since my return to the Netherlands in 2008.”
Menno returned to the AMC as a professor of Clinical Virology and Medical Microbiology. How was it when you returned?
“The first years were hectic with managing and further developing my new department, setting up my research here, and maintaining my still ongoing research in Asia.
What I learned in Vietnam was how important it is to build capacity for science in regions where new infectious disease threats likely emerge. Ultimately, the best defence against global spread is to nip an emerging pathogen in the bud where it emerges. For this, enhancing clinical, laboratory and public health capacity is essential. For example, adequate local diagnostic capacity would likely have substantially limited the extent of the recent Ebola outbreak in West Africa by not misdiagnosing the initial cases as cholera.”
Upon his return, Menno focused part of his efforts on the importance of doing clinical research when a new epidemic appears.
“During an emerging outbreak characterization of a novel pathogen can be done very quickly nowadays and public health measures can also be taken rapidly. However, clinical research which is needed to understand how people transmit the disease, how they get ill and how they are best treated, is usually initiated much too late during outbreaks. There are many reasons why clinical research responses are generally much delayed, including several logistical, administrative and ethical barriers, the fact that health care workers are usually overwhelmed with work during outbreaks, the absence of operational clinical networks and the absence of platforms to share clinical and diagnostic data. There are increasing efforts worldwide to tackle these issues, such as the EU-funded PREPARE and COMPARE projects in which several NCOH PI’s, including myself, are involved.”
How do you see the future for the NCOH?
“In the Netherlands, we have so much knowledge and expertise in the fields of AMR, SHF, HWE, and EID. In the absence of an initiative such as NCOH, people of course also can and do find each other, but collaborations are usually fairly ad hoc, focused on single projects or topics and not making use of all existing talents, technology and training opportunities in the Netherlands to address pressing questions. NCOH can be a breeding ground to use existing knowledge and expertise to its full potential. NCOH must work very hard to demonstrate this potential by showing sustained synergies between groups and institutions and integrated research efforts within and between the NCOH cornerstones of AMR,EID, HWE and SHF. The biggest risk I see is that, despite all good intentions and great enthusiasm, individual groups and researchers tend to return to business as usual – life and work is busy enough – and people do not put enough energy into exploring and enabling cross connections to be formed. Therefore, these connections and collaborations likely need to be forced to a certain extent in the coming years to truly establish NCOH as a powerhouse. The NCOH PhD cohorts are excellent opportunities for this, but only if multidisciplinary inter-institutional collaborations are mandated for these projects. As I implied earlier, we really need to show our strength and success in the coming years, not only to others but also to ourselves. Only then NCOH will sustain and be regarded as an indispensable centre of excellence in the decades to come.”