By Jessica Sinclair
Research Writer
“I do two things. All the people who know me from my vaccine work think that’s all I do, and then all the people who know me from my MicroResearch global health work think that’s all I do. And I do both,” says Dr. Noni MacDonald.
She is also two things to the Faculty of Medicine: a magna cum laude alumna from the class of ’75 and a former Faculty member for 18 years, who founded the Division of Infectious Diseases in 1981 and led CHEO’s Pediatric Infectious Diseases service. Dr. MacDonald is one of those people for whom it is impossible to fit every award, honour and achievement—even the big ones—into a short profile. As a sample, she is an Officer of the Order of Canada, was the first female dean of a Canadian medical school and has served as editor-in-chief of CMAJ.
As a vaccine expert, she sits on national and international bodies guiding the rollout of COVID-19 immunizations (see sidebar).
Since co-founding MicroResearch International in 2008, Dr. MacDonald has been applying proven microfinance principals to health research in Africa and Asia. The organization has trained more than 1,100 local people on research methods in order to support culturallyrelevant health research, and more than 100 projects are now up and running.
“Some of them have totally changed practice and policy in a country, because these people actually know what the problems are in a way that you and I would never be able to understand because we don’t live there,” says Dr. MacDonald.
The far-flung teams that take MicroResearch workshops and receive coaching also benefit from networking amongst themselves. In at least one case, this led to a startling discovery and solution in the area of neonatal survival. It involved the confluence of two MicroResearch-supported research streams conducted by Ugandan citizens.
The first research team looked at traditional cultural practices around pregnancy, delivery and neonatal care among the Acholi tribes of Southwest Uganda. Around 60% of babies in Uganda are born in villages, rather than in hospitals, but existing research has largely focused on hospital-born babies, so this project aimed to address that research gap and compare local practices with the World Health Organization’s (WHO) recommendations.
After interviewing birth attendants, mothers, grandmothers and other Elders, the researchers set aside traditions like avoiding graveyards during pregnancy and focused on more health-relevant practices. Whereas the WHO recommends the umbilical cord be left to dry and fall off, Acholi births involved rituals where herbs and other materials were spread onto the cord. The team published two peer-reviewed studies on their findings.
Meanwhile, a team in Luwero District, in the central part of Uganda, was looking into the causes of neonatal death among babies born outside of hospital. It was a particularly challenging topic to investigate as births were not registered until after the child was six months old, and taboos discouraged people from discussing babies that had passed away.
“After the baby has been dead for three days and buried, it’s as if they had never existed,” says Dr. MacDonald. “So nobody would have even talked to us, except that the MicroResearch team members who came from Luwero district knew the language and culture and were able to gain trust in the community.”
People in the villages discretely introduced the researchers to 72 women who had lost their babies within the previous year in the first month of life. They conducted a verbal autopsy that asked about the circumstances of those deaths and took the results for independent review by three pediatricians. Almost half of the babies were found to have died from umbilical cord-related sepsis.
The two unrelated research teams heard each other’s results at one of the MicroResearch fora and connected the dots. Something in the herb mixture being rubbed onto babies’ umbilical cords was causing sepsis. They got together and determined that it would be critically important to work with the birth ritual, rather than against it, if these babies were to be saved. Then, the researchers returned to Luwero District to ask the mothers and Elders whether they would accept something else to be mixed with the herbs. The answer was ‘Yes.’
With published science in hand, the team approached the Ugandan Ministry of Health. The Ministry, along with the Aga Khan Foundation, formed a not-for-profit drug company to make antiseptic chlorhexidine gel.
“They branded it Umbi-gel and started including it in the mama packs that mothers buy in preparation for their baby to be born. Now it’s being exported to Kenya and Tanzania,” says Dr. MacDonald. “Literally, it’s saving thousands of babies.”
Each of the projects cost $2,000.
Dr. Noni MacDonald wrote the 2014 report on vaccine hesitancy for the World Health Organization (WHO), and the topic has only become more vital as demoralizing numbers emerge about how many people don’t plan to accept a COVID jab. She currently sits on the WHO’s 15-member strategic advisory group on immunization and chairs the Canadian expert advisory committee on vaccine confidence for COVID.
As a pediatric infectious disease specialist, Dr. MacDonald is particularly concerned with a hidden effect of the pandemic: the toll it takes on routine immunizations for other serious diseases. In low-income countries where measles has a high mortality rate, the fact that measles immunizations have fallen behind is very worrying. Even in Canada, vaccination programs missed out children in March, April and May, and there is not yet evidence that we have caught back up.
“We really need to have people understand that you are not safe unless your family is safe. Unless your community is safe. Unless your region is safe. Unless your province is safe. Unless your country is safe. And unless all countries are safe. That’s what people haven’t understood,” says Dr. MacDonald.
