With billions in the bank, a ‘visionary’ doctor tries to change the world

LONDON — Dr. Jeremy Farrar, the director of one of the world’s biggest and most influential medical charities, is not an easy man to track down.

Ask people who have tried and they will either cluck sympathetically or burst into gales of laughter. They have been there before.

Farrar, the director of London-based Wellcome Trust, is perpetually in motion, regularly popping up in Geneva, Washington, or wherever else his charity’s diverse interests take him. In the past six months, he’s been in India, Malawi, Nepal, Norway, Saudi Arabia, and South Africa. It is rumored his appointment calendar sometimes has four unrelated commitments crammed into one time slot.

“He must make an around-the-world circle twice a month,” said Dr. Marie-Paule Kieny, an assistant director-general at the World Health Organization. “The place where he’s not all that often is London.”

It is perhaps no wonder that Farrar (pronounced as though the final “r” is an “h”) is in high demand. As a private funder of biomedical research, the Wellcome Trust is second in size only to the Bill and Melinda Gates Foundation.

At a time when government funding for public health research is shrinking across much of the world, and epidemics wreak havoc with what seems like increasing frequency, Farrar stands to make a very big difference not only in the scientific community but, really, in the world.

He is keenly aware of the role the deep-pocketed trust can play.

“We are in the privileged position of being an independent, philanthropic organization. If we can’t act boldly and with flexibility, then who can?” Farrar said in a recent interview with STAT conducted not in his office but the atrium coffee shop of the trust’s light-filled headquarters here.

The Wellcome Trust’s mission — to improve health — is advanced through grants issued from an endowment valued at about $26.5 billion.

To that end, Farrar is backing efforts to better prepare for outbreaks like Ebola and Zika by spurring the faster development of vaccines and other drugs. He also wants the Wellcome Trust, long committed to genetic research (among other things), to play a key role in combating the massive threat of antibiotic resistance.

Farrar, a 54-year-old neurologist, has already shown he can make a difference.

During the West Africa Ebola crisis, the Wellcome Trust funded much of the work to fast-track testing of desperately needed experimental vaccines and drugs, using innovative study trial designs.

Critics said the studies were trading expediency for data that wouldn’t be reliable. But Farrar was a major proponent of the research, arguing that pursuit of the perfect should not be the enemy of the good.

“He’s a visionary, I think,” said Kieny, whose portfolio is in health systems and innovation. “He is willing to take risks.”

Farrar assumed the Wellcome Trust’s top job in October 2013, after 18 years as head of Oxford University’s Clinical Research Unit in Vietnam, based at the Hospital for Tropical Diseases in Ho Chi Minh City. With the move, he transitioned from being a trust-funded researcher to a powerful benefactor.

A medical doctor who also does research — he has co-authored nearly 500 scientific papers — he was an ideal fit for the job, people who have worked with him say.

“When you find yourself with an activist who actually has been in the field, who has been on the front lines of infectious disease issues, who also at the same time is a very big-picture thinker, putting that kind of leadership and the resources [of the trust] together is kind of like 1 plus 1 equals 3,” said infectious diseases expert Michael Osterholm, who co-chairs with Farrar a committee that critiques global efforts to develop Ebola vaccines.

Farrar’s pragmatism might be a product of his upbringing, which forced him to continuously adapt to new circumstances.

He has been on the move for most of his life, starting with a nomadic childhood. British by nationality, accent, and the sport he plays — cricket — he has lived longer outside of the country than in it.

His father, who spent six years in a prisoner of war camp in World War II, was an English teacher who moved his family often. The family lived in Yemen, Egypt, Cyprus, New Zealand, and Libya, among other countries. Farrar, the youngest of six, came along after Yemen and Egypt. He was born in Singapore.

The Farrar family didn’t sequester themselves in high-walled expat compounds. In Tripoli, they lived in an apartment above the school. When they arrived in New Zealand, the school wasn’t yet built, and they lived beside a nearby glue factory — he remembers the smell to this day. “We left after six months,” Farrar recalled.

Seven years in Libya — “stunning country, lovely people” — is the longest he lived anywhere before his father retired and the family moved to England when Farrar was approaching university age.

Later, in breaks while he was pursuing a medical degree, Farrar spent time in Papua New Guinea, Ecuador, and Peru.

All that time spent in far away places with different cultures and standards of living shaped the views he brings to discussions that bedevil the global health community at times.

“Inevitably it has a big influence, I think, on the way you see things and your approach to the world,” he said of his peripatetic childhood.

“It has some downsides. You don’t have a very strong sense of belonging somewhere.”

In England, Farrar’s intended course of study — English, history, and economics — gave way to sciences, as he decided to train to be a doctor.

A chance to do laboratory work ignited a love for research. He had not enjoyed the rote learning that makes up much of medical training, but was thrilled by the excitement “of not knowing what’s over the next page.”

An early mentor, cell biologist Cheryll Tickle, now at the University of Bath, said Farrar threw himself into the work. He “produced data of very high quality,” she said in an email.

After completing his medical degree at University College London, Farrar did a residency in neurology at the University of Edinburgh. He then completed a PhD at Oxford in neuroimmunology.

At age 34, though, his life abruptly pivoted. He was giving a talk at a neurology conference toward the end of his PhD program. Looking out at the audience, he realized this wasn’t what he wanted to do with his life.

Back at Oxford he learned the Vietnam research program was in need of a director. Off he went.

The intersection of neurology and infectious diseases is a more natural one than you might think, Farrar insisted, noting many of the infectious diseases the hospital was treating had neurological symptoms.

One of his mentors in medical school had taught him that where two specialties intersect can be a fruitful learning space. Farrar found that to be true in Vietnam.

He was there when Vietnam got its first cases of the disease that became known as SARS; a colleague, the WHO’s Dr. Carlo Urbani, alerted the world that a new disease was responsible for the wave of severe pneumonias that spread from China. Urbani lost his life to SARS.

Nine months later, several young children in Vietnam became sick and died after burying a pet chicken. Everyone thought it was the return of SARS. Instead, it was the highly virulent H5N1 bird flu, which over the next few years decimated poultry flocks and killed several hundred people in Southeast Asia.

Containment efforts focused on culling infected flocks, which taught Farrar a lesson that still resonates: Outbreaks aren’t just about the devastation a disease can do to a person, but the damage response measures can inflict.

Compensation paid to farmers who were having their chickens seized was a fraction of the value of the birds. Infected poultry was moved and sold, spreading the deadly virus.

Unintended consequences are a fixture of epidemic responses, Farrar said, arguing that focusing on the broader picture is critical.

“We risk making interventions in one sphere without considering the consequences for the other sphere,” he said. “And as a result, you’ll get it wrong.”

In his role at the head of the Wellcome Trust, Farrar wants the charity — which, under his predecessor, devoted 25 percent of its grant funding to international research — to be even more global.

He is also keen on partnerships and good at forging them.

Dr. Frederick Hayden, a virologist at the University of Virginia, has worked for a decade with Farrar, dating back to the mid-2000s when they developed a research network in Southeast Asia to study influenza.

Later, when Hayden wanted to set up something with broader reach — the International Severe Acute Respiratory and Emerging Infection Consortium — Farrar was one of the first people he approached. “He’s a natural leader,” said Hayden. “But he also has that rare ability to step back and let other people take the lead when necessary — and also take the credit.”