NZ Researchers Win Medals For Game-changing Studies Into Cervical Cancer And Rheumatic Fever

The Health Research Council of New Zealand (HRC) has awarded its prestigious medals for excellence in health research at the Royal Society Te Apārangi Research Honours Aotearoa event at Government House in Wellington this evening. And in a first for the HRC, two of its three medals have gone to researchers from the same team who are working with iwi and whānau to prevent cervical cancer and improve maternity and infant outcomes.

Professor Beverley (Bev) Lawton, ONZM (Ngāti Porou), founder and director of Te Tātai Hauora o Hine, the National Centre for Women’s Health Research Aotearoa at Victoria University of Wellington, has received the HRC’s Beaven Medal for excellence in translational health research.

Alongside Beverley, the team1 that she leads with deputy director Francesca Storey at Te Tātai Hauora o Hine has taken out the HRC’s Te Tohu Rapuora Medal for outstanding leadership, excellence and contribution to Māori health.

A clinician, researcher and staunch advocate for women’s health, Professor Lawton has worked tirelessly over the past 20 years to ensure that her and her team’s work is translated into clinical practice, particularly in the areas of cervical cancer prevention and maternal health outcomes for wāhine Māori. Much of this research has been undertaken in partnership with iwi, guided by a Kāhui Kaumātua.

Research published by Te Tātai Hauora o Hine showed that enabling women to self-test for human papillomavirus (HPV) rather than undergo a traditional cervical smear could significantly reduce the number of under-screened or never-screened Māori women, resulting in a decrease of deaths from cervical cancer in Aotearoa New Zealand.

The team’s trials showed there were multiple benefits to self-testing for HPV, including that it was less invasive and easy for women to do themselves, and highly acceptable for wāhine Māori, with under-screened or never-screened wāhine Māori over three times more likely to do a self-test rather than a smear.

The work of Te Tātai Hauora o Hine has led to the acceptability and introduction of HPV self-testing for the prevention of cervical cancer, and the team have championed a more equitable referral pathway and provision of longer appointments for those under-screened at colposcopy.

Forging strong relationships with iwi and whānau, Te Tātai Hauora o Hine have also created expanded maternity wraparound care programmes and informed the establishment of this country’s severe maternal morbidity monitoring programme. A long-standing relationship and partnership with Ngāti Pāhauwera Development Trust has led to more investment in community-based research, including in Wairoa, Tairāwhiti and Porirua. Guided by the iwi partnerships, including with Ngāti Porou Oranga and, more recently, Ngāti Toa Rangatira, their impactful work highlights strong, community voices.

HRC chief executive Professor Sunny Collings says Professor Lawton and Te Tātai Hauora o Hine have been champions for making changes to the national cervical screening programme to ensure it is safe and equitable for wāhine Māori.

“I think a large part of the success of Bev and Te Tātai Hauora o Hine can be put down to their unwavering commitment to engaging with communities to help build trust and facilitate the dissemination of important information about women’s health, and their ability to build collaborative long-term partnerships with iwi,” says Professor Collings.

Professor Lawton says that while the road to making meaningful and lasting change is not easy, she and her team remain as committed as ever to making a difference to mama, pēpi and whānau through their research and advocacy work, guided and supported by kaumātua who are steeped in Te Ao Māori.

“The health system defends itself at all costs and resists change. Therefore, your evidence must be strong, you must have persistence and be willing to sometimes put your head above the parapet when others won’t, and you must treasure your community champions who are so vital to successfully translating research into real world settings,” says Professor Lawton.

The HRC’s Liley Medal for an outstanding contribution to health and medical services was awarded to epidemiologist Professor Michael Baker from the University of Otago, Wellington, and his team2 who published two companion papers in the Lancet3,4 that represent a breakthrough in our understanding of the causes of acute rheumatic fever and the role of group A streptococcal infections.

These studies found the strongest evidence yet that household overcrowding and poor access to primary healthcare are major modifiable risk factors for acute rheumatic fever and streptococcal (strep) infections of the skin.

They also identified strep skin infections as a key pathway driving the risk of rheumatic fever.

“Finding a strong association between skin infections and rheumatic fever adds to other research that our group has done about the importance of strep skin in triggering this disease, which disproportionately affects Māori and Pacific children,” says Professor Baker.

“We think children in crowded conditions are getting repeated skin infections with strep. This repeated exposure may be priming their immune systems to become sensitised to strep so that when they encounter it again, they develop a pathological immune response that results in rheumatic fever or rheumatic heart disease.”

The team’s results suggest that treating skin infections in young children could prevent them from developing rheumatic fever, providing an effective intervention in the short term while promising long-term interventions like vaccines for strep are still being developed.

In an unexpected finding, the team also found that drinking sugar-sweetened drinks was twice as common among the children in their study with rheumatic fever, even after adjusting for all the other risk factors. Follow-up animal studies suggest that sugar may alter the behaviour of strep in the top part of the throat, although Professor Baker says research in this area is still ongoing.

Professor Sunny Collings says there is an urgent need to stamp out rheumatic fever – a disease that showed a remarkable decline in high income countries from the 1950s onwards, but which persists today in communities living in deprivation in Aotearoa New Zealand and Australia and in low- and middle-income countries.

“These studies, which involved a long list of talented and internationally recognised scientists, are among the most rigorous to identify risk factors for rheumatic fever. They provide a very strong base to help guide the goal of eliminating this devastating disease as a global health problem,” says Professor Collings.

1 The research team of Te Tātai Hauora o Hine includes a Kāhui Kaumātua consisting of Matua Matthew Bennett (Ngāti Pāhauwera); Matua Charles Lambert (Ngāti Pāhauwera, Ngāti Kahungunu, Ngāti Ruapani); Dame Areta Koopu (Te Aitanga a Hauiti, Ngāti Kahu); Whaea Wendy Dallas-Katoa (Kāti Mamoe, Waitaha); and Matua Warihi Campbell (Ngāti Porou). Current research team members include Professor Beverley Lawton (director, Ngāti Porou); Francesca Storey (deputy director); Dr Kendall Stevenson (Ngāti Awa, Ngāti Kurī, Ngāpuhi); Anna Adcock (Ngāti Mutunga); Dr E Jane MacDonald; Dr Tania Slater (Ngāpuhi, Ngati Kahu); Dr Melanie Gibson; Sidney Ropitini (Te Whakatōhea Ngāti Rakaipaaka, Ngāti Kahungunu); Ngaire Sparkes (Ngāi Tūhoe); Associate Professor Jo-Ann Stanton; Hayley Laursen (Ngāti Tūwharetoa; Te Āti Haunui-a-Pāpārangi); Kia Paasi; and Maxine Schmidt.

2 The rheumatic fever and group A strep research team includes Professor Michael Baker; Dr Julie Bennett; Associate Professor Nicole Moreland; Professor Deborah Williamson; Associate Professor Jason Gurney (Ngāpuhi); Associate Professor Dianne Sika-Paotonu; Associate Professor Dame Teuila Percival; Associate Professor Matire Harwood (Ngāpuhi); Associate Professor Nigel Wilson; Dr Florina Chan Mow; Dr Jane Oliver; Professor Nevil Pierse; Professor Tony Merriman; Dr Catherine Jackson; Professor Richard Edwards; Professor Murray Thomson; Professor Julian Crane; Ms Jane Zhang; Professor Jonathan Carapetis; Professor Diana Lennon (deceased).

3 M G Baker, J Gurney, N J Moreland, J Bennett, J Oliver, D A. Williamson, N Pierse, N Wilson, T R Merriman, T Percival, C Jackson, R Edwards, F Chan Mow, W M Thomson, J Zhang, D Lennon. Risk factors for acute rheumatic fever: A case-control study. The Lancet Regional Health – Western Pacific 2022.

4 J Bennett, N J Moreland, J Zhang, J Crane, D Sika-Paotonu, J Carapetis, D A Williamson, M G Baker. Risk factors for group A streptococcal pharyngitis and skin infections: A case control study. The Lancet Regional Health – Western Pacific 2022.

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