Climate conference, COVID and pregnancy, and inspiring careers

Gareth Mitchell:

Hello everyone. I'm Gareth Mitchell. Welcome back. In this edition, climate change. Three important studies from Imperial as COP approaches. And meteorological winter is just days away, so we'd better talk about Covid. Being vaccinated is good, being boosted if you qualify is even better when it comes to winter protection.

Dr Vicky Male:

Getting vaccinated gets you most of the way there, but it's still beneficial to get boosted because you're adding that extra protection up from 79% to 94%.

Gareth Mitchell:

And we have another pick of the pods, this time a podcast all about inspiring stories to help you make the best and wisest career choices.

All right then folks. So it's always good to be here with you talking about Imperial College related matters. Hayley, COP is approaching, isn't it, at the end of the month into December. And wouldn't you just note, those Imperial College studies related to climate change, they're flying off the shelves, aren't they? So just bring us up to date with some of the latest research coming out of the college as we approach COP.

Hayley Dunning:

Yes, our researchers are always very busy this time of year checking out what the status of the world is and what we need to know going into COP28 and how we might maybe try and get ourselves out of this climate pickle. The first study I have to tell you about is not that cheerful. It sort of suggests that the window for us reaching 1.5 degrees, which is the more ambitious goal of the Paris Agreement, which suggests that we could avoid the worst impacts of climate change, that is very unlikely to happen now.

So it says that the carbon budget, which is how much carbon we can release before the world is committed to reaching that 1.5, is only about six years’ worth at current levels. That doesn't mean that there's only six years left to save the world, very cautious about that message, but it's suggesting that we need very deep emissions cuts sooner rather than later. And that even if 1.5 can't be reached, we should still do everything we can because every 0.1 of a degree makes a difference.

Gareth Mitchell:

Okay. Now then, what happens if or when we reach net zero then? Is that the end of the whole worry or maybe not? What do other studies say about this?

Hayley Dunning:

It's a complex picture because like I said, then we've got six years until we're committed to reaching 1.5. So that doesn't mean we'll be at 1.5 degrees of warming in 2029 or 2030. It just means that the effects in the atmosphere are locked in. So that 1.5 will happen. But even longer term than that, say if we do reach, if the globe reaches net zero in 2050, which is where the emissions, carbon emission we put out out are matched by what we can take out of the air again, then there will still be some effects. And these are just parts of the environment system that we don't completely understand, but we know that will still have some changes going on at that time, such as the fact that there will be less ice, so there'll be less reflectance. And so that there will probably be some effects of warming still going on after that and what the ocean will do.

And so one of the latest studies also looked at a lot of these factors and tried to look at how these might affect beyond net zero, and it suggests that there will still be significant warming. So again, the message is, we've got to cut those emissions fast and now.

Gareth Mitchell:

Which brings us to another study just out from Imperial, which looks at CO2 removal, that side of the equation. So not the stuff that's going into the atmosphere, but the CO2 that is being removed by geoengineering and other means. And a kind of cautionary note on over-reliance on CO2 removal, certainly as an industrialized CO2 removal perhaps to put it more correctly.

Hayley Dunning:

So a lot of governments around the world, their net zero plans, while many of them have emissions cuts built into them, for one, those don't seem to be happening. But also where they do have emissions cuts, most of them also have a portion that relies on carbon dioxide removal. So it sort of allows a bit of an overshoot and then we remove some of the carbon dioxide to get to net zero. The problem with that is that a lot of those carbon dioxide removal technologies are immature and they are probably not going to be deployable on such a large scale. And the longer we emit more fossil fuels, the harder we would have to rely on these technologies which are uncertain to be useful.

And what this new study suggests from Imperial and Oxford researchers is that nations that are relying too heavily on these technologies might actually be breaching international law. And so we've seen around the world lately more kind of climate court cases, for example, where young people have taken their governments to court over plans for net zero. And this could be another area where we might see growth, where governments are taken to court over their plans.

Gareth Mitchell:

Right. So that's going to be a lot of stuff for all these experts and scientists and policy makers to chew on over there at COP28. It's taking place in the United Arab Emirates, isn't it? So what's the Imperial involvement there? I assume that a delegation will at some point head in that general direction.

Hayley Dunning:

Yes. So we've got about 15 researchers going. Some of them are hosting side events there, some of them will be observing, some of them will be commenting on various parts of it. Obviously, reducing fossil fuel emissions is number one. That's the thing the world needs to do. But there's often discussions about other things around the climate such as loss and damage and adaptation. So funds from countries that have historically emitted more to countries that have emitted less but are feeling the effects more. That's a huge discussion that's going on, but also expanding what we understand to be the effects of climate change. So this COP has its first health day focus for example, and also things about agriculture and the way we make food, and even the mental health challenges of dealing with climate change are all going to be looked at this COP too.

Gareth Mitchell:

All right, Hayley. Thank you very much indeed for that. So given the season, vaccines, viruses and precautions are back on the agenda. And reminders that Covid hasn’t gone away, however much we'd all like to assign it to history. There'll be plenty of advice for us as the nights continue to lengthen and the days really now begin to chill. But in this edition, we're thinking specifically about pregnant women and Covid. Time for a chat then with one of our top Imperial experts, Dr Vicky Male, a senior lecturer in reproductive immunology.

Dr Vicky Male:

Well, I think it's important to start by saying that most people who catch SARS-CoV-2, or we might more informally say Covid, when they're pregnant will be just fine and so will their babies. So I don't want people to panic. But it is important to know that being pregnant puts you at increased risk of severe disease. So if you're unvaccinated, it's two times more likely that you'll need to go to intensive care if you're pregnant compared to if you weren't pregnant. And catching Covid increases the risk of preterm birth by about 1.5 times, and increases the risk that your baby will be stillborn by about 2.5 times.

Now of course, these days most people have been vaccinated in the past, so those risks are lower. But we do have some information about the risks as they are now or as they were last autumn, which will probably be quite similar to now. And it's still worth having a booster if you're offered one, which you will be. Because even now, we still see an increased risk of preterm birth when you catch Covid if you're pregnant by about 1.12 times, and an increased risk of your baby having neonatal disease by about 1.2 or 1.3 times.

Gareth Mitchell:

What do we know about how this risk comes about? Is it to do with the immune system?

Dr Vicky Male:

It's probably to do with two things. First of all, we do know that being pregnant changes the way that your immune system responds, particularly to viruses. We quite often say, oh, being pregnant makes your immune system weaker. That's not really true. It actually makes it stronger against some things, particularly against worms, but it makes it weaker against viruses which is relevant here. And then we also have to remember that particularly in late pregnancy, you have a really big increased strain on the heart and lungs because you are supplying oxygen and blood supply for this whole other person that you're carrying inside you. And so particularly for things that involve pneumonia, which Covid can, this is another reason that you are at increased risk.

Gareth Mitchell:

What about immunity passing from the mother to the baby during pregnancy? And I'm thinking in two categories here. If the immunity comes from vaccines or if the mother previously before the pregnancy had Covid and has built up some immunity that way. Is there a transfer of immunity to the baby? And that might be quite reassuring, if so.

Dr Vicky Male:

Yes, there is. Even though components of the vaccines, there's no evidence that they cross the placenta, we know that the antibodies as a result of you getting vaccinated can cross the placenta. And similarly, actually, the antibodies that your body will make if you get infected can cross the placenta. But we've looked more at vaccination. And there have been, or I'm trying to remember now, I think about six studies that haven't just looked to see if the antibodies crossing the placenta. There are easily 20 that show that, but that's not a surprise, but have actually said, okay, if you got vaccinated when you're pregnant, how much is your baby protected against Covid in the first six months of their life?

And the answer to that is there is actually a reasonably significant protection for your baby against Covid in the first six months of their life if you get vaccinated during pregnancy. So we're really encouraging people to get vaccinated to protect themselves and their babies at that very vulnerable time when they are pregnant. But I think it's a lovely bonus, kind of like a two for one, that also your baby will get some protection when they're very little and vulnerable from Covid if you get vaccinated or boosted while you're pregnant.

Gareth Mitchell:

How beneficial is a Covid booster? There was a study in The Lancet, wasn't there?

Dr Vicky Male:

So the first thing to say is that this study in The Lancet found that if you are vaccinated but not boosted, compared to not being vaccinated at all, you are 79% protected against severe disease. And that was basically anything that puts you into hospital, intensive care, all the way up to some people in the study who weren't vaccinated died. And on top of that, if you then as well as getting vaccinated got boosted, that moved your protection up to 95%. And I think that the lesson from this is that getting vaccinated gets you most of the way there, but it's still beneficial to get boosted because adding that extra protection up from 79% to 94%.

Gareth Mitchell:

What does this mean for women? So there may be pregnant women listening to this as the autumn and winter set in. What should they make of all this?

Dr Vicky Male:

I think it's important for everyone to know that they are at increased risk, but also to know that because they're at increased risk, the JCVI, which is our committee that decides who should be offered free vaccines on the NHS has recognized that if you're pregnant, it is a priority to get you boosted. So for example, let's say you are 32, if you're not pregnant, you are not going to be offered a booster because it's considered that you are young and you are at low risk if you've got no other health conditions. But if you're 32 and you're pregnant, just being pregnant puts you at higher risk. And so you will be offered a booster. We would really encourage anyone who gets offered a booster because they're pregnant to come forward and take it up to help protect themselves and their babies.

Gareth Mitchell:

Some pregnant women may be worried about the effect of any kind of vaccine or let's say a Covid booster, the effect of that on the baby. Is there any risk that we're aware of?

Dr Vicky Male:

So of course, it's really important to be sure about the safety of anything that we're going to recommend during pregnancy. And so a lot of work has been done on this. We do have some limited clinical trial data, which shows no safety concerns for getting vaccinated during pregnancy. There are 38 studies that have been done across 10 countries, and they include more than 360,000 people who have either been vaccinated for the first time or have been given a booster while they're pregnant. And in all of these studies, we find no increased risk of any pregnancy problems, no increased risk of health problems for the babies when they're born or up until six months old in the studies that have continued to follow the babies.

And actually in the observational studies, we see a decreased risk of stillbirth in the people who choose to get Covid vaccine while they're pregnant. That's probably at least partially because the studies that were done at the height of the pandemic when you were really likely to catch Covid. And if you're unvaccinated, I've mentioned it's more likely that Covid will cause a stillbirth. At the height of the pandemic, I'm sure it helped a lot with that, and that's probably why we see a decreased risk of stillbirth among these studies. But I think the really important thing is that's no increased risk of any bad things, and potentially a decreased risk of Covid related stillbirth.

Gareth Mitchell:

Should pregnant women be considering other vaccines? We've talked about obviously the Covid booster here, but what about other vaccines? I'm thinking flu for instance.

Dr Vicky Male:

Yeah, absolutely. So in the UK at the moment, we offer three vaccines as part of your routine antenatal care. The Covid vaccine or booster, as we've just discussed, is one of them. But we'll also offer you a flu vaccine or a flu booster. And for really similar reasons, being pregnant puts you at increased risk of needing intensive care if you get flu. But we'll also offer you the whooping cough vaccine. And this is kind of different from the other two because the aim there is to protect your baby from whooping cough in the eight weeks after they're born, but before they're old enough to get their own whooping cough vaccine. So those are the three that you'll be offered and that you'll really be encouraged to take up to protect yourself during pregnancy. And in the case of whooping cough vaccine, to protect your baby when they're really tiny and vulnerable before they can get vaccinated themselves.

Gareth Mitchell:

Words of wisdom there from Dr Vicky Male. Well, now for the pick of the pods where I select a title from our Imperial College Podcast directory and I get to play you a little taster. This month we have TL; DL. The presenter is Senda Ben Abdallah, and she's an alumnus of the MSc in strategic marketing in the Business School. Before Imperial, Senda was at UCL. And these days, Senda works at a tech startup in London. Well, here she is to introduce our little excerpt of her podcast.

Senda Ben Abdallah:

Hey there, I'm Senda, the host of TL; DL, or Too Long; Don't Listen, a podcast of inspiring stories. I started this podcast to help you as a student or a young professional to figure out your career decisions and choices. The podcast features a wide range of profiles from first time founders to artists and writers with the aim of giving you the tools to navigate career decisions. To date, TL; DL has 31 episodes. The most recent one features Paulina, the co-founder of Dama Health, who's also an Imperial graduate. Dama Health is a reproductive health startup. Its mission is to empower women and providers to make personalized reproductive health decisions. In this episode, Paulina and I discuss her journey as a woman entrepreneur. She also shares her experience as a first time founder and the challenges she's met along the way. You can follow Too Long; Don't Listen on Instagram for more updates, and I hope you'll enjoy this episode.

Gareth Mitchell:

We will. And the story of Dama Health goes back to Paulina's days on placement as a medical student.

Paulina Cecula:

We were literally in the clinic with my friend actually doing the placement, and we were watching so many different consultations. And some of them were contraception consultations. And I think you just relate as a young med student, you relate to the patient, but you also relate to the doctor. And you know you're going to be that person soon in the same position, really struggling to deliver good quality care to the patient. And it just felt very personal. And you can see the struggle on both sides. So doctors have 10 minutes, it's usually quite rushed. And you don't have the clinical evidence very often on how to deal with the complex situation. For example, side effects, or management of PCOS or endometriosis. We don't have that much evidence and guidance yet of how actually to do it well. And then on the patient side of things as well, obviously it's such a personal thing.

And it's not about birth control, there's so many other aspects around contraception that you need to take into account. Like is it for acne as well? Is it also for managing your difficult periods? And it's all very difficult to talk about. And sometimes patients don't even know the different options and actually that you can take that step back and think what is important to me? And there's just not enough time to do it in a short consultation. But that's generally a problem of medicine where everything's very rushed. And I was passionate about that holistic, personalised approach, and how can we make this better? And actually, this applies to so many different areas of medicine as well and different areas of women's health. So there's some evidence that's showing us that specific genes and genetic variants are related to how you respond to contraception. And that just blew my mind because this is the first step to the future of personalised medicine for women because genetics is the first aspect of really understanding how your body reacts to things, to medications and treatments.

And there's so many other environmental, hormonal factors. But for me, the first step is really understanding my own body and my metabolism. And that starts with that fundamental level of your genetics. But then once we understand how you respond to certain things, you can apply it to so many other aspects as well. So we are doing contraception now because that's when the evidence is... But we are hoping to do it for fertility treatments and menopause treatments as well in the future. So to me, it was just like this is really aligned with my vision for medicine and healthcare for the future. So this personalized preventative approach, not just fighting disease, not just firefighting, actually taking that proactive approach to health. So it wasn't really that I'm super committed to solving this particular solution, it was more that the idea and the vision was really in line with my vision for healthcare, and that's why I decided that this is the right thing for me to work on.

Senda Ben Abdallah:

Wow, that's a very powerful story because you've experienced the pain of the future clinician that you would become, and then you understand the patient's point of view. And then there's research that's telling you this is an opportunity to start something in this area. The science is kind of backing up your business in a way. So I'm very curious to hear more about the product that you guys are building. Because if I'm not mistaken, it's not launched yet, right? Tell us what Dama Health is all about. We understand the vision, so what's the product?

Paulina Cecula:

Of course. So taking a step back, Dama Health is all about bringing a vision of personalized medicine to women's health. And we are starting by tackling this trial and error of contraception prescribing. So as I mentioned already, the problem is that there's loads of different methods of contraception and different treatments. We have around 200 different brands in 15 different categories. And on average, woman try to switch the method at least two or three times to find the right one. And it's really very important not only just for your birth control, but actually especially for management of other symptoms like, as I mentioned, PCOS, acne, endometriosis as well. And just the future of medicine, it's going to be very, very personalized as well. So might as well just start as well looking into things. So what we are doing is, we are developing screening tests that will help how we deal with the prescription process.

So we are developing a digital tool that looks into all the other factors that you need to take into account as well. So your medical history, drug history, your symptoms. We have around a hundred different factors that we developed with clinicians and with evidence and guidelines to make sure that every important data points about you is reflected into that decision. And this R&D project as well that we are working on is the genomics test, which will be looking at the genetic variance that are related to contraception prescribing. And the genetic variants will relate to three main areas. So one is the predisposition to side effects, are you at higher risk of specific side effects? The other one is the adverse reaction, very important as well. So do you have any genetic predispositions to things like blood clots? And it's super important in terms of contraception because a lot of people are really scared about blood clots. And if you do have genetic predisposition, that can be quite devastating as well.

And then the final one is effectiveness. So for some women, you take contraception just as you should, but actually you still become pregnant. And that can be because you metabolise things differently. And that can be also very devastating. You've been taking your contraception, you get pregnant. And then in some, obviously areas with stigma, and in the US now, it's really hard with the abortion situation as well. So it's also super important. So that's what we're looking at. But this is more still in the pipeline. The digital product is something that we already have as the first solution, but we're actually positioning it for the clinicians so they can use it when they prescribe contraception.

Gareth Mitchell:

Well then Senda and Paulina went on to talk more about the Dama Health business model. So do check out the full episode if you get the chance, and indeed the whole TL; DL catalogue. You can search for it or just come along to our Imperial College Podcast directory or find it via the Be Inspired pages. And not only that, but you'll be treated to lots of other titles on health and medicine, science and technology, climate and the environment, business and careers, and much more.

Well, that'll do for today. Although I suppose while I am plugging podcasts, let's plug this one. And just remind you, there's a massive back catalogue on this one. So if you just want to go back down memory lane slightly, then of course you can. And we're on the Be Inspired pages, and that's where you'll find our quite extensive back catalog. Well, that's it. I'm Gareth. Thank you very much for listening, and I'll see you next time. Bye-Bye.