INFECTIOUS DISEASE
for five years in The Gambia – first as a researcher with the Wellcome Trust and then as Head of the Viral Disease Research Programme at MRC Laboratories. “Our son loved growing up in The Gambia, near the beach,” he says. Professor McConkey’s research has focused on therapeutic vaccines against Hepatitis B, a chronic viral liver condition that affects almost two billion people worldwide, and against malaria. “I showed very definitively that a particular strategy for vaccination against Hepatitis B did not work,” he says. “Sometimes science is not just about showing what does work, but also what is not effective.” That research has steeped him in the language and processes of vaccine development, a hot topic for COVID-19. “We are seeing a lot of hype about vaccines against the SARS-CoV-2 virus that causes COVID-19,” he says. “But you can get a lot of false starts with vaccines and the initial vaccines that are developed may be not be very effective. It can be like having a first draft, then the vaccine gets refined and improved over time.”
Inequalities
As well as medicine and maths, the interplay between disease and society has long intrigued Professor McConkey. He has witnessed how a virus can exacerbate inequalities in societies. “Something I probably didn’t anticipate when I started medicine is the importance of listening to the stories of people,” he says. “We carried out a lot of qualitative research in The Gambia on what helped or hindered people through their journey with HIV. We could see unfortunately that women with HIV and their children suffered horrendous discrimination and that the people who were rejected by society often didn’t have enough food to eat – this was one of their biggest constraints to having better health.” Today, he can hear echoes of this imbalance playing out in the COVID-19 pandemic as it exposes some parts of society more acutely to disease and insecurity more than others. “We need to pay attention to how the COVID-19 pandemic is affecting people and sections of society differently,” he says. “And we must not underestimate the influence of social factors on disease outcome.”
“MODELS OF DISEASE HAVE THEIR LIMITATIONS, BUT I SEE THEM AS A TOOL LIKE A HAMMER OR A SHOVEL, AND WHEN YOU USE THEM PROPERLY THEY CAN REALLY HELP YOU BREAK DOWN A PROBLEM.” Vaccines by numbers
Following his medical degree at Trinity College Dublin, Professor McConkey did his Fellowship in Infectious Disease at Washington University School of Medicine in St Louis, Missouri, while doing a Masters in Statistics on the side. “I was always very good at maths and science in school, and during my medical training I had thought of going down the route of mathematical modelling. Models of disease have their limitations, but I see them as a tool like a hammer or a shovel, and when you use them properly they can really help you break down a problem. Over the last few months I have often been up at 6am on a Sunday morning, plugging the COVID-19 numbers into models so I can discuss them with colleagues.” With statistics in the toolkit, Professor McConkey was comfortable designing experiments and analysing data when he worked in Oxford University and then
Speaking out
Another experience that left a lasting impression was when, in the early 1990s, Professor McConkey and his wife, Mary Dowling, worked as APSO (Agency for Personal Service Overseas) volunteers during the civil war in Sierra Leone. In his role as medical superintendent in a mission hospital run by Irish nuns from the Holy Rosary Sisters, he led the hospital through escalating contingency planning up to a complete shut down. He carried out surgery and obstetrics and, with some help from Professor Martin Corbally, presented and published a case series of 180 acute abdomens in World Journal of Surgery, the largest in Africa at that time. “Those experiences of leadership and planning for a crisis have flashed into my mind during the last three months many times, and certainly helped me,” says Professor McConkey. “The message that emerges for me from that experience is to speak out clearly and loudly what you understand to be the truth, even if others consider you odd, or forceful.” As the situation came into sharp focus in China in late January, he wrote to the Department of Defence, he encouraged senior management at RCSI to set up a contingency planning team and he bent the ear of media, writing for national newspapers and commentating on news and current affairs programmes. “I had done media in Ireland during the Ebola outbreak in West Africa, so they knew I could talk sense,” he says, adding his gratitude that RCSI communications
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