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In conversation with Regius Professor of Pharmacy Ian Wong

Recently appointed the UK’s only Regius Professor of Pharmacy, Ian Wong speaks to Rod Tucker about his continent-spanning pharmacy career from community and regulation to academia and beyond. He shares insight into his varied research, his special interests in epilepsy, mental health and paediatrics, and the key learnings he’s adopted along the way.

An interest in science during secondary school was the driver for Professor Ian Wong to study pharmacy. It was, he says, a ‘very logical choice for me’. One particular hurdle he had to overcome, however, was the fact that ‘at the time we didn’t have our own pharmacy school in Hong Kong’. This meant that pursuing his career choice meant relocating overseas – an attractive proposition – and he first settled in north-east England at Sunderland University.

After finishing his degree here, he undertook his pre-registration in a busy community pharmacy in a deprived area of east London. One of the most valuable lessons he learnt from this experience was the importance of communication. ‘As an overseas student, for me, having to deal face-to-face with patients using a second language wasn’t that easy,’ he explains.

Because of this difficulty, he was also reluctant to answer the telephone, but he was grateful to his supervisor who insisted that he faced his fears and always picked up the phone. As a result, he quickly developed the necessary skills to communicate effectively with both patients and doctors – something he believes ‘benefitted me for the rest of my life’.

Public health and pharmacovigilance

Following his initial training, Professor Wong took a post at the former Medicines Control Agency (now the MHRA) to work on the Yellow Card scheme for the reporting of side effects to medicines. As a pharmacovigilance officer, his job involved looking into the safety of medicines, and the role soon made him realise that the scientific knowledge acquired from his degree was not just for patient care, it had much wider value for public health.

While working at the Medicines Control Agency, he developed a strong interest in public health, epidemiology and pharmacovigilance. During this time, drugs such as anti-epileptics and anti-depressants were headline news, particularly the high level of reports of suicidal ideation with selective serotonin reuptake inhibitors. This raised his awareness of epilepsy and mental health drugs, which were to become an increasingly important part of his later academic career.

Pondering how to make sense of data generated at the Medicines Control Agency served as the impetus for Professor Wong’s subsequent career in pharmacovigilance. But he soon realised that in order to progress his career, he would need more training in this area, and a possible route to achieve this could be through undertaking a PhD in pharmacovigilance.

Pursuance of a career in research

Given his interest in epilepsy and mental health drugs, he left the Agency after a year and was fortunate enough to commence a PhD at the Epilepsy Centre at the University of Manchester as a research pharmacist at the David-Lewis Centre for Epilepsy. His project focused on lamotrigine, which, at the time, was a newly licensed anti-epileptic drug. With reports of an association with Steven-Johnson syndrome and hepatic failure, the drug had come to the attention of regulatory authorities who were considering whether the benefits outweighed the risk. ‘The regulator had asked the manufacturer to run a post-marketing surveillance study and the company worked with my PhD supervisor,’ says Professor Wong. His subsequent PhD work led to an important observation showing that the starting dose of lamotrigine was an important factor in the development of skin rashes.

Following his PhD, Professor Wong went to work in London’s Northwick Park Hospital as a clinical pharmacist but soon realised he should follow is his real passion of academia. His first post was as a lecturer at the University of Bradford in West Yorkshire where he was involved in several projects based on pharmaceutical care, which he describes as being a hot topic at the time.

He managed to secure a million-pound grant from the Medical Research Council to undertake the RESPECT trial, which explored community pharmacy care of elderly patients. Although RESPECT did not lead to significant prescribing changes, Professor Wong felt that a key advantage of being involved in the trial was how it allowed him to widen his academic circle by collaborating with colleagues at the University of Hull.

Focusing on paediatric care

He later moved to the London School of Pharmacy – now University College London (UCL) – and established the Centre for Paediatric Pharmacy Research. Although elderly and paediatric patients are at opposite ends of the age spectrum, Professor Wong thinks that there are actually many parallels. ‘They have very similar problems. The formulations can be difficult to take, and their pharmacokinetics are usually different to normal healthy adults,’ he says.

With the need to formulate drugs differently, Professor Wong recruited a formulation scientist to enable drug delivery to paediatric patients and used his own interest in big data to look at how best to treat children. Life at UCL allowed his academic career to flourish, and he continued with a number of studies related to his main interests of epilepsy, central nervous system drugs and, in particular, the use of these drugs in children.

One important development during his time at UCL, was setting up a spin-off company in association with UCL and Great Ormond Street Hospital in 2006. The company, Therakind, developed Buccolam (oromucosal midazolam), which subsequently became a licensed product for stopping prolonged seizures in young children.

Professor Wong is, unsurprisingly, very proud of this achievement. He says it was great to be able to work on the development of a new medication that ultimately became licensed, and which is now widely used across Europe. Following on from this success, Professor Wong was approached by the University of Hong Kong. His appointment at the university in 2011 was of enormous personal interest, allowing him to return home and be reunited with his wider family and to spend time with his elderly mother.

Unravelling the adverse effects of Covid-19 vaccines

When it comes to Professor Wong’s academic career, he thinks that the last few years have been the most interesting. He has established a large team of big data researchers for pharmacovigilance research in Hong Kong. His students and colleagues call him the “father of the health-care big data research in Hong Kong” because of his pioneering big data research. As a result of his enormous experience and expertise in pharmacovigilance, the Hong Kong government quickly turned to him during the Covid-19 pandemic once vaccines against the virus had become available.

As with most countries, vaccines such as Pfizer BioNTech’s BNT162b were initially given emergency use authorisation. ‘The government of Hong Kong made it a legal requirement that the Secretary of Health needed to conduct pharmacovigilance studies to monitor the safety of the vaccine,’ Professor Wong explains. Consequently, he became the government’s representative who undertook the necessary pharmacovigilance studies to fulfil this legal requirement.

For the last few years, Professor Wong and his team have worked tirelessly on collating healthcare big data for pharmacovigilance of BNT162b and CoronaVac, which is produced by Sinovac, for the 7.4 million residents of Hong Kong.

Fortunately, these efforts paid off and have led to some important observations in relation to the development of vaccine-related adverse effects. ‘We were able to look into a lot of safety issues and were able to identify that the risk of myocarditis was higher in adolescent males from BNT162b,’ he explains.

In addition, the team also found that the risk of both myocarditis and pericarditis from BNT162b occurred mainly after the second dose. Professor Wong’s team then hypothesised that if the adverse effects occurred mainly following the second dose, was a single vaccine sufficiently effective? It turned out that receipt of a single dose of BNT162b among adolescents led to a significant decrease in the incidence of carditis. But that was not all.

The pharmacovigilance data hinted that extending the interval between vaccine doses gave rise to a better level of protection against infection with Covid-19. In fact, his team demonstrated  that if the dosing interval was extended to eight weeks, there was a 43.5% lower risk of infection with the virus compared to those being vaccinated with the regular intervals. The data demonstrated that the recommendation of an extended interval was appropriate for Hong Kong citizens.

While Professor Wong recognises that the highest level of protection is afforded by two doses of the vaccine, at the time BNT162b was introduced to Hong Kong, there were a limited number of infections, hence there wasn’t an urgent need to ensure everyone received two doses within a very short interval. He also believes that a further benefit of this work is the reassurance it gave to patients who had concerns about the risks associated with vaccination.

Weighing up the pros and cons

In other Covid-related work, his team were to connect the development of post vaccination Bell’s palsy with the CoronaVac vaccination, which led to the government paying compensation to those who had been affected. However, it was also clear that beneficial and protective effects of the CoronaVac vaccine far outweighed the risk of this usually self-limiting adverse event.

One of the most interesting observations Professor Wong finds from his work with the two Covid-19 vaccines is how adverse effects, such as myocarditis, only arose with the mRNA vaccine BNT162b. In contrast, CoronaVac, which is an inactivated vaccine produced by more traditional methods, did not seem to cause such problems. In fact, when it comes to adverse effects from this vaccine, Professor Wong says ‘we don’t see anything worrying at all except for the Bell’s palsy mentioned above’.

The downside, of course, is that the inactivated vaccine has lower efficacy and, as Professor Wong clarifies, ‘if you look at the wild-type virus, the mRNA is far more effective than the inactivated virus, which is only 51% against symptomatic SARS-CoV-2 infection, but the mRNA is around 95%’. Nevertheless, he does believe that it is necessary to have the two vaccines because it offers a choice, especially if a patient is allergic to one of the vaccines.

All of Professor Wong’s work on Covid-19 did not go unnoticed. In 2022, he received a commendation from the Chief Executive of the Hong Kong SAR Government in recognition of this work. As a born-and-bred Hong Kong citizen, he feels honoured.

Future areas of research

Having moved on from the Covid-19 vaccines, Professor Wong has returned to his roots looking into mental health drugs, and he has a particular interest in attention deficit hyperactivity disorder (ADHD) in children.

He has recently published a paper in The Lancet Psychiatry on the safety of methylphenidate for ADHD in children and adolescents when used for at least two years. He will continue to work on this important research area.  ‘I will spend the next five years looking into this,’ he says, and this includes a comparative study of ADHD treatments for treatment naïve patients with ADHD as a research recommendation  by the NICE ADHD guideline.  

In addition, over the years, he has developed a special interest in paediatric palliative care, which he sees as a very undeveloped area of research. By way of example, he quotes NICE guidance which describes how there is no evidence on how to provide safe and effective breakthrough analgesia during end-of-life paediatric care.

Professor Wong is now looking into how he might be able to help improve the care for such children, offering practical advice on both buccal and intranasal drug delivery. To this end, he has been involved in some phase 1 feasibility trials on the delivery of transmucosal palliative analgesics. He aims to influence the paediatric palliative care world-wide by providing much needed evidence.

Despite being based full-time in Hong Kong, Professor Wong continues to collaborate and co-ordinate studies with other centres across the world. For instance, in 2022, he published an analysis of opioid use in the Lancet Public Health using data from 66 countries.

Regius professorship appointment

Professor Wong was recently appointed as the Regius Professor of Pharmacy at Aston University – the only such position in the UK. He was pleased with the appointment because, while he has committed the last 14  years in Hong Kong to advance pharmacovigilance research and patient care, it creates another tie to England, where he began his intellectual quest. And, undoubtedly, it’s a huge honour as the title is usually bestowed on those deemed the best. ‘Whether I’m the best or not, I don’t know, but it’s really nice to have it,’ he laughs.

A further advantage of the position is that it does not require much, if any, administrative work, which is a part of his role as head of department that he ‘may not enjoy as much as I would like to’, he admits.

In Hong Kong, Professor Wong is responsible for a large number of staff. He oversees a research team of around 60 to 70 people, as well as another 30 to 50 teaching and administration team. But he also believes that the security of this long-term role brings complacency, which serves as an impetus for a change. ‘I’ve changed career a few times and personally found that every time I changed I learnt new things and developed new things. I’m able to do things that I wasn’t able to do because of the new environments and the new people,’ he says. He is clearly hopeful that his Regius professorship will expose him to novelties from which he can learn and continue to develop.

‘Aston is an rising university – very progressive – and I like the way they are developing themselves to become responsive and to progress,’ he explains. ‘Sometimes when the machine is too big, it’s very difficult to try to transform it, but when it’s a small enough and also focused enough institution, the opportunity to work on bigger things is much greater.’

Challenges and improvement

This desire for continual improvement first arose when he was at UCL. Following a conversation with SIr Professor Patrick Vallance, the UK’s former chief scientific adviser and who, at the time, was the medical director of University College Hospital, Professor Wong had an epiphany moment.

‘After a meeting he said to me, “Ian, you need to raise the bar of your publications and need to have a strategy for your publications in order to compete with world leading researchers.”, Professor Wong explains. ‘And of course I didn’t like it when he said it, he basically said I wasn’t good enough. But then you think carefully and actually his message is absolutely right.’

Pondering Vallance’s remarks, Professor Wong quickly realised the importance of such a competitive challenges. Things might be going well, but is it the best? This conversation led to Professor Wong pursuing his first BMJ paper and putting in place strategies to achieve this. He has continued to strive to be the best at what he does ever since.

Just as he needed support and encouragement to develop his communication skills back in those first community pharmacy days, Professor Wong now acknowledges the need for people to help him think differently and achieve his potential.

The future of the pharmacy profession

Looking at the future of the pharmacy profession, Professor Wong believes that it needs to evolve with the ever-changing developments in technology, particularly those offered by artificial intelligence (AI). This technology, he says, can offer the profession a unique position within healthcare, if it’s not embraced then there will be huge problems ahead.

By way of comparison with developments in pharmacovigilance, he cites the potential innovation brought about through AI with his work at the Medicines Control Agency. ‘Some 30 odd years ago we were looking at Yellow Card only and now we’re looking at big data, literally data from millions of subjects. The recent study in which our team analysed data came from 150 million anonymised subjects. So, we have to evolve.’

This evolution and adaptability is also at the core of Professor Wong’s take on pharmacy training. He has a simple message for those embarking on this career path: ‘The sky’s the limit, don’t limit yourself to the traditional things. Maybe you’re interested in it, maybe you enjoy it, and that’s perfectly fine, but then if you believe that this is the only thing that you can do, then you may end up thinking why I didn’t do something else?’ In short, he perceives pharmacy training as a tool to train the mind and to respond to people, but he also sees this skill set as being highly transferable and one that shouldn’t be restricted to preordained, pharmacy-only roles. His illustrious and varied career across multiple facets of pharmacy is evidence enough.

For Professor Wong, retirement is on the distant horizon, but if one thing is certain, there’s a lot more to come from him before then. His work in paediatric palliative care, which he says deserves more attention, is top of the agenda. And after that? The world’s his oyster.

Professor Ian Wong is head of the Department of Pharmacology and Pharmacy and holder of the Lo Shiu Kwan Po Ling Professorship in Pharmacy at the University of Hong Kong. He is also co-director of the Centre for Medication Optimisation Research and Education at University College London Hospital and UCL School of Pharmacy, and was recently appointed Regius Professor of Pharmacy at Aston University, UK, and will take up the position in 2024.

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