When she was starting her career as a paediatrician in the United Kingdom, Amanda Kvalsvig never would have guessed she’d end up assisting a pandemic response in New Zealand.
The University of Otago epidemiologist is the lesser-known third member of a trio of Otago public health experts who have studied and advocated for policy changes over the course of the pandemic. The other two are Michael Baker and Nick Wilson.
Although Kvalsvig’s name has appeared as a co-author and lead author on more than a dozen academic papers about the pandemic, alongside Baker and Wilson, she has had a far lower media profile. In part, this is due to inclusivity issues in media. As Kvalsvig is profoundly deaf, phone and radio interviews aren’t accessible to her.
But she has still played a fundamental role in New Zealand’s response, with her byline one of five on a landmark paper published on April 3, 2020, outlining how New Zealand could eliminate the coronavirus. She has also been the lead author on articles arguing for widespread mask use in New Zealand – which has since been partially but progressively adopted – and sketching out a framework for New Zealand’s response to the next pandemic.
The best career advice
Epidemiology, however, was not Kvalsvig’s first choice.
Born in South Africa, she always wanted to be a paediatrician. After her undergraduate degree, she studied clinical paediatrics at the Royal College of Paediatrics and Child Health in London.
Even as she neared her goal, Kvalsvig came to realise she might never accomplish it.
“All the way through my 20s, my hearing was getting worse. Eventually I became completely deaf, so profoundly deaf,” she says.
“I was running the model, putting in the parameters and looking to see what came out. The result came out and it was just a terrible, terrible, terrible scenario.”
– Amanda Kvalsvig, University of Otago
“At the point where I took my paediatrics exams, I realised that I wasn’t going to be able to carry on in paediatrics because my hearing was getting too bad and I was starting to worry that if it got worse, I would miss important information.”
In Bristol at the time, Kvalsvig asked her mentors for advice. “I got some really, really terrible career advice,” she says.
But she also got the best advice of her life, from renowned British epidemiologist George Davey Smith. He suggested she do the Masters in Epidemiology at the London School of Hygiene and Tropical Medicine. So she did.
Pandemic: ‘The worst kind of video game’
Kvalsvig still remembers the sense of fear that accompanied the early stages of the pandemic response. Like Baker, she quickly became convinced New Zealand was sleepwalking into viral disaster.
“It was a very strange, surreal time because we were doing these reports but nobody else seemed to be talking about this pandemic.”
One evening, she was sitting at her dining table running numbers through the CovidSIM model – a simplistic, web-based simulation that informed responses around the world in the early months of the pandemic. Although New Zealand now relies on specialised stochastic models devised by Te Pūnaha Matatini, CovidSIM offered researchers the opportunity to get rough numbers quickly.
“That was the moment that I realised we were in huge, huge trouble. We had been saying that all along, but there comes a moment when it becomes an internal, absolutely visceral feeling.”
“I was running the model, putting in the parameters and looking to see what came out. The result came out and it was just a terrible, terrible, terrible scenario. I thought: ‘Maybe the parameters are a little too strict.’ I made them a bit easier, ran it again. Still terrible,” she says.
“Made it a bit easier, a bit more optimistic. Still terrible. I remember thinking, ‘This is the worst kind of video game. It’s a game you can’t win.’
“If you’ve got a highly transmissible viral infection and a completely susceptible population, it will always run through the population unless you stop it. It will not stop by itself. That was the moment that I realised we were in huge, huge trouble. We had been saying that all along, but there comes a moment when it becomes an internal, absolutely visceral feeling.”
Responding to the pandemic
Now a Senior Research Fellow in the Department of Public Health at Otago’s Wellington campus, Kvalsvig has been in New Zealand for 15 years. While her research has spanned a broad array of topics, her role as a soft money researcher has kept her in pursuit of whatever might provide a source of funding.
Unlike Baker and Wilson, who are paid out of Otago’s core funding, Kvalsvig effectively works on a contract basis.
“My ongoing employment at the University is dependent on my being able to generate my own salary so employment is always precarious,” she says matter-of-factly. “A lot of my time is spent just making sure I’m still employed, instead of doing the real work, if you like.”
Covid-19, of course, has provided plenty of opportunities for funding. But securing that funding is no easy feat.
On March 23, 2020, the day Jacinda Ardern announced New Zealand would move immediately to Level 3 and then to Level 4 in 48 hours’ time, Kvalsvig hardly had time to notice the momentous decision.
“I barely noticed the meeting because I was writing a grant proposal that was due that same day. There was all sorts of noise going on in the department, bustling about, drama, and I was just sitting there frantically typing this proposal, which was a grant application for funding to do Covid research,” she says.
“That was my memory of that day, getting that grant proposal. That’s typical of our problems – we’ve had so much difficulty getting funded for the research we were doing. We were writing a 10-page proposal, plus budgeting, plus organising all the collaboration, at the same time as the pandemic was happening and at the same time as we were informing the response. March was just a blur to me.”
‘A year of many hats’
Even in the course of the pandemic, Kvalsvig has written on numerous different subjects.
“It’s been a year of having many hats,” she says.
“Some of the work has been, at a higher speed than I’ve ever done it before, setting up a series of projects and coordinating an enormous number of people.”
The proposal she was writing on March 23 was for funding to set up Co-Search, a Covid-19 research collaborative on which she serves as lead researcher.
“We’ll never go back to the before times. We’ll always be ‘after the pandemic’.”
“We had to, from zero, set up a research programme and then run it. A lot of that was actually just administrative because we didn’t have any administrative support for it,” she says.
“We had the busy work of getting research done, the actual research – so data, analysis and so on – and, at the same time, working outside that research programme in terms of responding to what was happening in the pandemic. Sometimes it was responding to requests for advice from the ministry, sometimes it was generating that advice when we saw something happening that we didn’t agree with.
“It’s been very messy. I wouldn’t know how to describe my job description. I don’t have a job description. It’s been about, every day, doing what’s immediately in front of me and what needed to be done.”
The critical lesson: Move faster
Alongside the rush to submit the grant proposal and a sense of relief that the Government was finally taking the virus seriously, Kvalsvig recalls she greeted lockdown with a sense of foreboding.
“Lockdown felt almost like the end of the world. I remember that feeling, that the world was ending,” she says. “And I think it was. We’ll never go back to the before times. We’ll always be ‘after the pandemic’.”
She hopes to bring lessons from the pandemic to the work she was doing before Covid-19 surfaced.
“It should change what we do next. I think that is a very satisfying way to work. We know that we mustn’t snap back to the old normal, we have the new normal and start to think of what that new normal looks like. This is what’s going to occupy me, I’m certain, for the next couple of years.”
One lesson is a systemic one for academia and research funding: Move faster.
The Health Research Council, for example, gives her group most of their funding. But if they apply this year in June or July, they’ll only be able to start the work a year or more later. “Which means that if you can see a problem today, you’ve got maybe 18 months before you can even really start it, properly. And another three years before that research starts to make a difference.”
Syndemics and wellbeing
And there are plenty of problems Kvalsvig can see.
One particular topic of interest for her is syndemics: the links between infectious diseases, long-term conditions and the structural determinants of health. As lead researcher for the Symbiotic Programme, which investigates the role of poverty in worsening outcomes from infectious diseases and long-term conditions like cancer and diabetes, Kvalsvig already has a history in this space.
“The term syndemics originally rose with HIV and TB, two conditions that occur together. The third factor is disadvantage,” she says.
“Conditions and health problems and health issues aren’t distributed evenly across populations, they cluster. So you have populations where people have everything go wrong for them. That’s the syndemic thinking.
“What it means is looking at conditions one-by-one is never going to work. You’re always going to be behind because you have to think about the factors that are accelerating those cycles.”
That dovetails with Kvalsvig’s interest in wellbeing and Matāuranga Māori as a framework for population health.
“How effective Māori models of health and wellbeing are. How effective those responses are. How Māori-led responses are the way forward,” she says. “Māori were excluded from a lot of [pandemic] decision-making early on and we all have to do better.”
Third, and still related, is Kvalsvig’s research on health inequities.
“How do we think about resources and who has resources and drawing on resources? That’s where resilience is going to come from in the future. In terms of protecting the population going forward, how do we make sure that people have the resources they need?” she asks.
“When the next disaster hits, that’s going to make an enormous difference to how well we can respond.”
