At the Festival of Genomics and Biodata, we are lucky enough to be joined by some of the biggest names in the business. In January, we sat down with a few of our esteemed speakers to chat about their backgrounds, roles and the work of their organisations. In this interview, we speak with Andrew Roddam (CEO, Our Future Health) about preventative medicine, the use of genomic data in healthcare and the importance of diversity.
Please note the transcript has been edited for brevity and clarity.
Interview originally conducted by Miyako Rogers.
FLG: Thank you so much for coming to speak at the Festival of Genomics and Biodata. To start the interview off, please can you tell us a little about yourself and how you became interested in epidemiology and genomics?
I suppose it started when I did my PhD in statistics many, many years ago now. And it was really the drive towards how you use data to get insights from people or the populations that you’re trying to study. So from finishing a PhD, I moved into an academic career for about 10-12 years, mostly focused on epidemiology, working in large datasets, and also in a lot of different disease areas. So infectious diseases, cancer, public health.
I worked on probably one of the largest ever studies that the UK has done, the Million Women Study, where we had 1.3 million women who’ve been followed for 20+ years now. And it was the insights that came from that that really excite you about whether you can use the data in the right way. The impact that you can have on the health of an individual or the country, or the world, is just huge, and the potential is great. It’s then just been a steady stream of roles, which kind of take those learnings and apply them.
FLG: Brilliant. So you’re the CEO of Our Future Health. Could you discuss how your experience is being used in this role, and also the objectives of the organization?
So Our Future Health came about quite a few years ago as an idea and a concept around, ‘how do we tackle this burgeoning health care system’ and thinking about really moving the conversation away from treatment of the sick people to ‘how do you prevent illness in the first place.’ But clearly, to prevent diseases, you need to understand individuals and then their transition into becoming unwell. And that’s quite a difficult thing to do. Because you end up having to study lots and lots of people who are otherwise healthy for a long time to see what it is that might trigger them to be unwell.
Our Future Health is really trying to focus on how you understand those transition points across a whole range of different population groups, trying to be broadly reflective of the UK population. So all ages, ethnicities, socioeconomic regions of the country, and measure things about them, which will hopefully infer and help us understand who has high risks of certain things happening, who’s at low risk, and then helping academics, clinicians, the NHS, and ultimately companies and industries, think about what’s the intervention that’s going to make a difference. So it’s that move towards using the data in a better way, finding the people at highest risk, deploying the right technique, intervention treatment to the right person at the right time, hopefully leading to people living healthier lives for longer.
FLG: Brilliant, thank you. Can you speak a little about the current state of healthcare, the current state of preventive medicine, and how Our Future Health aims to address these issues?
Well, I think you can’t go a week without reading about the challenges the NHS is facing. And it’s arguably not that unique to the UK, across the world whatever healthcare system you happen to live in is facing huge challenge from the burgeoning pressures of people living longer, treatment being slightly more effective when you get ill, but you’re living in a sort of unhealthy life state for a longer period of time. And that just creates an enormous pressure on the health system to manage, look after, treat and follow those people over time. So what we’re trying to do is think about how do you turn that towards prevention. Prevention is a really hard thing to achieve.
I think, at the moment, there’s lots of good advice out there about healthy eating through diet and exercise, maintaining a good body weight, but mostly they’re broad population statements. And I think the view of the world is if we can get to a place where we start to be more targeted to individuals and saying ‘because you’ve got a high risk, you would benefit from this’ or ‘because you’ve got a medium risk, you would benefit from this intervention,’ or ‘because you are the type of person who will follow an exercise programme, you should do an exercise programme.’
That’s going to be the world that we move to, taking the healthcare system away from treating sick people towards preventing diseases, or at least slowing their onset in the first place. That’s really what we’re trying to do and Our Future Health I think will provide the platform on which companies, academics, clinicians, and others can come along and test out novel interventions, test out different ways of addressing the population to think about how this scaling could be deployed in the future.
FLG: People speak about bespoke treatment, but that’s bespoke preventive medicine!
Yeah, if you look at classic treatments for well-known conditions – people who take antihypertensives, certain numbers of them drop off after a little bit of time. People who take bisphosphonates for osteoporosis, again, you get a massive drop off because people don’t comply with therapies where they’re slightly preventive of the disease progressing. And it’s just a characteristic of us all – some of us are very compliant, some of us aren’t very compliant. And there’s every other where in between those two boundaries. If we can better understand the individual and better understand their characteristics, you can maybe get a better targeted therapy. In exactly the same way as in oncology today, we better understand the genetics of the tumour and the person to better target the therapy to that particular tumour type to get the best possible responses, just extrapolating that further out into the preventative world.
FLG: That’s great. Could you tell us how Our Future Health uses genomic data and genomic medicine, and how it aims to improve detection and prevention using genomics?
So what Our Future Health is doing is trying to recruit these 5 million people over the course of the next few years. And really, to do that quite simply, so to ask people, obviously, to consent and get information about taking part and what that involves. To answer a questionnaire, so some basic lifestyle factors about themselves, you get a little picture of those individuals. And then to give a blood sample, and that blood sample serves two purposes. One, we’re going to do the DNA extraction, so that we can run a genetic array on every individual, but also then plasma will be banked for future use, so that when novel tests and biomarkers or interventions come up, you can go back to those stored samples and look at how well they perform.
The genetic part, it’s going to be an array, so it’s not yet going to be whole genome sequences on 5 million people. But the array allows us to measure the common genetic variants for common chronic diseases, so to calculate things like polygenic risk scores, but also to have a range of variants of interest that could be relevant for research in the future. And if you’ve got polygenic risk scores, there’s a lot of interest into if they have a use in health care. Should they be added to existing risk scores? Are they different to existing risk scores? Do you use them in different population groups? And again, that allows us to create the evidence base, or at least to create the cohort base so that other researchers can then come along and test out a lot of those really interesting ideas so that you can say, ‘Well, what about if you had a polygenic risk for this particular condition that isolated the really high risk people? What would you do to intervene on those people?’ And that’ll help form the basis of, should polygenic risk scores ever be used in the health service? How should they be used either in treatment, or prevention or in diagnosis, to really create that research platform for the future.
FLG: Can you speak about the importance of diversity in genomic data collected by Our Future Health and by the NHS, and in general, the importance of diversity?
Yeah, I think diversity is key to everything that we think about when it comes to genetics. 85+% of the genetic information we have on the health of the world is based on white European ancestry individuals. So clearly, there’s a gap that we don’t understand whether disease processes are the same, we know incidence of diseases are very different across the world. That could be partly ethnicity, it could be partly due to other factors as well. But if we don’t start to really put a focus on that, we’re not going to be able to produce evidence and produce treatments and interventions that benefit everyone. And so, you know, I think just simply looking at COVID, we saw huge differences in both severity and outcomes based on ethnic differences, but also based on socioeconomic differences as well. The outcomes that we see for health are very, very stark when you look at the highest socioeconomic to the lowest socioeconomic class. And that’s where we’ve really got to focus on how we become a cohort that truly reflects everyone who lives in society and in the communities, so that the evidence that people can generate actually benefit everybody.
FLG: Can you also discuss any major challenges or obstacles you faced in your career so far, and the work of Our Future Health so far and how you manage to overcome them? And do you have some advice for people who are interested in pursuing and powering their research or powering public health and policy using genomics?
So recruiting 5 million people from the UK in a short space of time, it’s probably one of the biggest challenges I’ve ever had! But I think, if I look through my career, there’s lots of things where I enjoy having challenging problems and things to work on. So whether that’s with the Million Women study early in my career and how you use huge amounts of data repeated over time to understand transition patterns of individuals. To now, how do you recruit 5 million people and collect blood from 5 million people, and do so in a really short space of time, from a baseline of nothing, against a backdrop of COVID starting just as we were starting to deliver the programme.
I think the way that you always have to tackle issues, there’s two things, I think it’s trying to be really, really focused on what you’re trying to solve now. And then pick the problem off step by step. So have a plan of how you think you’re going to walk through it. Try not to solve every single problem at once. ‘I’m going to recruit 5 million people,’ – don’t worry about what happens after you get to 4 million people, worry about how you get going, how you get the scale to work, how you then optimise all of the bits and pieces you’ve had to put together to enable that to happen. And being really, really focused on those things and not being distracted by the myriad of other really interesting and exciting problems that might come around you really helps you to kind of hone in on tackling really big challenges.
FLG: Thank you. So just a few more questions. One more about Our Future Health – can you discuss the collaborations and partnerships Our Future Health has with other organisations and how they contribute to a successful programme?
So I think, obviously, it would be nothing if it was trying to do everything by itself. And really, it’s only through partnership and collaboration that you see that true power of what we’re trying to do. And so whether that’s working with the NHS at the basic level of how we invite people, partnering with the NHS to use their ability to connect to the population, working with NHS Blood and Transplant on how we could recruit blood donors, it’s an obvious way of getting people who are already being altruistic in their motives in life.
Whether it’s working with the partners in the government and medical research charities, those core funders of the research powerhouse of the UK in our medical and life sciences research. Whether it’s working with the academic community on how we make sure that this really serves the purposes and needs and builds in the latest scientific thinking about what the utility of the programme could be in the future. And working with industries and again, through things like COVID, we’re seeing the power of partnering between academia and industry, like very rapid development of a vaccine, which was unprecedented. But no intervention, no treatment, no diagnostic, no test is ever going to be delivered by one group trying to think they can solve the problem alone, the problem is too big. So you need to bring all these companies, partners, individuals, the NHS, together.
And also then there’s a whole bunch of other commercial partnerships we have to have on how we deliver the programme. So whether that’s clinics – we set up in car parks, to take them to the community. Whether it’s the ability to actually run the genetics in the lab, whether it’s the storage of 5 million samples in big freezers, at the biocentre in Milton Keynes. We can accelerate, because we can build those relationships and work with the best in the UK and across the world in how we are trying to deliver this programme.
FLG: Thank you so much. How do you see the role of genomics and big data evolving in the field of public health? And also, pathogen surveillance and genomics surveillance, how do you see that evolving in the next 10 – 20 years?
I would hope we realise some of the transformative potential in the public health space that we currently see in rare disease, cancer, and other well identified genetic spaces. When I started my career 20-ish years ago, in the 1990s, enthusiasm for SNP analyses and gene-environment interactions was huge. It took a long time to go from that to ‘actually they didn’t quite work’, then we had to do genome wide association. And then you learn a little more, and then we did whole genome sequencing, and now we’ve learned a huge amount more. And you see what UK Biobank have now done with massively important insights into disease process. The work of Genomics England – so how you can start to think about genomic sequencing, translating that into everyday healthcare. And I think now’s the opportunity to think about how we use genetics and other data elements that exist about us all that really help us and power us to take better control of our own health and lifestyle, and better use ongoing evidence to think about what’s working for me. What is going to be the thing that is most important so that ultimately healthcare becomes a way of thinking about prevention as the norm and treatment is the exception, as opposed to today, where treatment is a norm and prevention is almost the exception.
FLG: We’re here at the Festival of Genomics and Biodata. You just mentioned collaborating with industry and academia and there are often very few opportunities for these people to actually get together in one space. So what about the Festival are you most looking forward to?
I think there’s a few things, I’ve noticed in the past few months, since in-person things have started happening again, that there’s a very, very different connectivity between people when you do it in-person, versus when you try to do it on Zoom, which is a hugely beneficial platform. And actually, we probably are way more efficient generally by having technology and using technology in the right way. But nothing actually beats the ability to meet with people in person, to have the conversations that just don’t happen naturally in a virtual world. And that’s really great. And I think coming along to these, you can sort of dip in and out of really interesting talks about what’s happening in the field, go and see people who you’ve kind of had a curiosity about.
Clearly, there’s a whole bunch of people here, where we’ll talk, but I know exactly what they’re going to say, because I hear them all the time and we work closely with them! But it’s the real opportunity to be exposed to some of the new and interesting science and think about, you know, for a project like Our Future Health, trying to think about what happens in five years, or in 10 years or in 15 years, really dipping into some of this really exciting development, thinking about what the potential could be in a few years time. What should we be designing into the programme now so that a researcher in five or 10 years time will come along and go, ‘that was really brilliant you did it that way, because now we can apply this new technique we never thought about.’ That sort of stuff, the real power and benefit of these things, which just, as I said, just can’t ever be achieved in exactly the same way when you do it as a virtual event.
FLG: Thank you so much. It was a pleasure to meet you.