Rosanna Peeling

Rosanna Peeling has spearheaded ground-breaking global efforts in diagnostics of infectious diseases including malaria, sexually transmitted infections (STIs), visceral leishmaniasis and dengue, and introduced rapid testing in many countries around the world.

Rosanna Peeling traces her decision to become a scientist back to sailing races with her father during weekends in Hong Kong where she grew up. “He would replot the entire course of a race and analyse what we should have done to win it when as a child all I wanted to do was go out and sail,” she laughs. “Everything he did, he was always very scientific in his approach. That impressed me very much. I am still not as good as he is. He’s in his 90s now but he was always so meticulous in what he did.”

Rosanna Peeling Provided by R. Peeling

The race against sexually transmitted infections: baseline mapping

Plotting the course of a race and particularly what went wrong is in many ways what she has devoted her career to doing. First in Canada, then with TDR, and now at the London School of Hygiene and Tropical Medicine, she has collaborated with countries to map the baseline disease burden of devastating STIs such as syphilis, chlamydia and gonorrhoea and establish alternative ways to screen target populations.

“There were a lot of issues with countries not knowing how serious their disease burden is,” she explains. “It is very difficult and expensive to do screening on a population basis, so for STIs we typically target prenatal women because of all the serious consequences of STIs in pregnancy. They have contact with the health care system and you don’t have to try and find them. Health care providers can educate women about the risk of STIs in pregnancy and ask for their consent to test them. They can serve as a sentinel population as to the extent of the disease burden.”

From Hong Kong to international research

From Peeling’s high school science in Hong Kong, she went on for a BSc in Physiology and Biochemistry at the University of Toronto in Canada and a Masters in Medical Microbiology at the University of Manitoba.

The head of the department asked her to stay on and work on rapid diagnosis of viral infections when there was a lot of excitement about the discovery of interferon in the 1970s: “Until that time there was no treatment for viral infections. Diagnosis was completely retrospective with antibody titer tests that measure antibody levels in the blood. Studies showed a four-fold rise between the acute and convalescent stage of the disease. With the promise of interferon as a potential treatment for viral infections, there was a real push towards rapid diagnosis using electronic microscopy and fluorescent antibodies.”

Peeling seems always to have been requested to join departments, committees and international bodies and, despite a career break to bring up her children, she has excelled in a field where women are still in the minority. She “did no science” for 1 years, leaving Canada for the UK when her husband was offered a post-doctorate at Durham University, and stayed home to look after their children until they were in school.

But she soon returned to diagnostics when her former department head who had become Dean of Medicine at Manitoba encouraged her to do a PhD in her late thirties, proving that there is no one specific career path and people can succeed outside the norm. Subsequently, the Canadian government approached her to set up a national reference lab for chlamydia, recognized as a new pathogen for STIs when very few people knew how to diagnose it. She worked with the government for 10 years, becoming Chief of the Canadian National Laboratory for Sexually Transmitted Diseases (a term often used interchangeably with sexually transmitted infections).

Sexually transmitted infections diagnosis on a global scale

Canada’s excellence in medical microbiology gave Peeling her strong foundations and experience in diagnostics, but TDR offered her a global platform and unique relationship with industry.

In 2001 she was asked to go to Geneva and manage the STD Diagnostics Initiative (SDI). Originally intending to stay a year, she stayed more than eight years, managing diagnostic research for all neglected tropical diseases, STDs, TB and malaria.

She points to TDR’s convening power: “I arrived on the 3rd of January and by the 31st of January we had 55 experts in Geneva for a consultation,” she says. “This was really important to be able to get all the world’s experts to drop what they were doing and come to Geneva in less than 30 days.” Those 55 experts prioritized needs, reviewed technologies and issued a call for applications for laboratory and field sites to evaluate these technologies to determine whether they were fit for purpose – a formula that was then used in TDR for all diagnostic evaluations.

Rapid and affordable prenatal syphilis screening leads to saving lives

Congenital syphilis is Peeling’s real success story. “WHO already had some statistics on syphilis in pregnancy but they were incomplete and what I wanted to know was, were there rapid tests that we could use in the field because we knew that the reason a lot of countries have a high burden of STIs is because they don’t have access to diagnostic laboratories.”

She showed that screening for syphilis, using a drop of blood from a simple finger prick with results available in just 15 minutes, and giving a shot of penicillin to infected women before the end of the second trimester, can prevent a baby from getting infected and dying either as a stillbirth or infant.

On that basis, WHO launched the Global Elimination of Congenital Syphilis Initiative in 2007, later extending it to the dual elimination of Mother-to-Child Transmission of HIV and Syphilis. Peeling and her team worked with seven countries to develop strategies and tools for implementation of rapid testing worldwide, ensuring tests were available through WHO at affordable prices.

The tests have been shown to work in settings ranging from urban China and Peru to remote East African villages and even more remote indigenous populations deep in the Amazon Rainforest.

Delivery of tools in fragile settings

In 2009 Peeling was offered the Chair of Diagnostics Research at the London School of Hygiene and Tropical Medicine (LSHTM) and took early retirement from TDR. She became founder and Director of the International Diagnostics Centre (IDC) at LSHTM where she facilitates the development and evaluation of point-of-care tests for the detection of multiple infectious diseases.

“The priority is not only to facilitate technological innovation by saying what kind of tools we need but also to establish what kind of system we need for the delivery of those tools in fragile health care settings.”

Her colleagues point to her outstanding achievement, her extraordinary energy, international reputation and great esteem in which she is held by national programme managers, CEOs of companies and major international organizations and the health care teams she engages with in the field.

It is her tenacity that Peter Piot, Director of LSHTM and former director of UNAIDS admires: “She uniquely combines a deep knowledge of technical and scientific issues around new and old diagnostics, with a pragmatic understanding of the challenges in the real world. She does not easily give up, and is totally committed to improving the health of the poorest in the world.”

Peeling has retained ties to TDR – she is a member of the Scientific and Technical Advisory Committee (STAC), Chair of the Scientific Working Group for the Intervention and Implementation Research group and is on a number of WHO guidelines committees.

John Nkengasong, Associate Director for Laboratory Science and Chief of the International Laboratory Branch at the Division of HIV & TB at the Center for Global Health for the US Centers for Disease Control and Prevention (CDC) describes Peeling’s contribution to diagnostics as “remarkable”.

“Perhaps there isn't anyone I have met in my over 25 years’ career in diagnostics who has such a detailed understanding of the breadth and depth of diagnostics on a broad range of diseases. More importantly, she is a champion of capacity development for laboratory medicine in the developing world, and she is such an innovative thinker.”

Professor David Mabey at LSHTM says, thanks to her commitment, “Regulatory harmonization for diagnostics is in sight, which could reduce the time from the development of a new test to its being available in low- and middle-income countries from more than the current, over 10 years, to less than three years.”

Peeling may not have won those early sailing races, but she appears to be well on course in the race against some of the world’s most pernicious diseases.