It is not easy to pigeon-hole Noni MacDonald, Professor of Pediatrics at Dalhousie University in Halifax, NS, Canada. Paediatrician, infectious disease specialist, vaccinologist, founder of a paediatrics journal, the first woman in Canada to become Dean of Medicine, and passionate global health advocate, her career has been long and diverse. “My professional life has all been about confronting health problems. In my view, if you don't do something to solve the problem, you end up being part of the problem”, she says.
Although she stopped clinical work 4 years ago, MacDonald remains involved in teaching, research, and policy work, notably on vaccines. “Everyone in and outside the vaccine arena thinks they have the answers to what is preventing vaccine uptake, known as vaccine hesitancy. I see my role as helping to manage expectations around vaccination programme implementation”, she says. Through her work for WHO's Strategic Advisory Group of Experts (SAGE) on Immunization, she has contributed to Immunization Agenda 2030, a strategy presented and approved by the World Health Assembly on Aug 7, 2020. More recently, her SAGE work has focused on the importance of catch-up and sustaining immunisation recommendations in the COVID-19 pandemic.
Another current priority concerns the ongoing stewardship of MicroResearch, a non-profit organisation she helped establish in 2008 to build research capacity in sub-Saharan Africa. “While working in Uganda, the gap was clear; there were no local opportunities for health workers and communities to gain relevant community focused research training, and no money or mentoring to support small local research projects. This is where MicroResearch comes in”, she explains. It has trained more than 1000 local health researchers across seven African countries. “One MicroResearch trained team in Uganda, concerned about neonatal deaths, identified which traditional practices, such as putting herbs on the umbilical cord, were risky while a second team determined that cord-related sepsis was a major cause of death. Presenting their published findings together to the Ugandan Department of Health resulted in the development of chlorhexidine gel for umbilical application, and later its acceptance into cultural practice”, she says.
Her passion for finding solutions to tough problems partly stems from the values of her parents during her childhood in Montreal. MacDonald graduated from medical school at the University of Ottawa in 1975, followed by a residency in paediatrics and paediatric infectious disease fellowships at McGill University in Montreal and at the University of Rochester, New York, USA, before she returned to the University of Ottawa in 1981, her professional home for two decades. There, she became the first paediatrician to be certified in paediatric infectious diseases in Canada, an emerging specialty at that time. “This was at the start of the HIV epidemic, so infectious disease (ID) work was tough and ID specialists were rare. Fortunately, by the time I left Ottawa in 1999, there were 14 ID specialists, and antiretrovirals had changed HIV care”, she says. As a paediatrician at the Children's Hospital of Eastern Ontario, she also worked with cystic fibrosis (CF) patients. “In the early days, a child would die as often as we made a new diagnosis; when I left Ottawa there had been no paediatric deaths from CF for a decade, all because we had used continuous quality improvements to adjust our care programme”, she says. During her time in Ottawa, MacDonald became the founding editor for Paediatrics & Child Health, a position she held for 20 years.
She left Ottawa in 1999 to become Dean of Medicine at Dalhousie University. “Early on, I proposed ideas for what I called the ‘social accountability’ of a faculty of medicine; ensuring our young doctors were suitably equipped to work in the diverse environments across Canada and emphasising the importance of research. While at the time the other medical deans chuckled at this idea, it is now an accreditation standard for medical schools across Canada”, she says. Despite enjoying the benefits of managing a strong team of clinicians and researchers, she found the heavy administrative role and conservative nature of Canadian academia frustrating. After her term as Dean, she continued as Professor of Pediatrics, while also stepping in to help a leaderless Canadian Medical Association Journal, taking on editorship for 9 months in 2006, “one of the hardest jobs I've ever done, having to juggle it with my clinical, teaching, and research work”, she says.
Philippe Duclos, a former Senior Health Adviser in the Department of Immunization, Vaccines and Biologicals at WHO, worked with MacDonald for over 30 years, and has seen her impact in Canada and on the global stage. “Beyond her scientific contribution, the legacy of Noni's career has been how she has energised, inspired, and motivated thousands of physicians, scientists, and vaccinologists, and to have helped build local and national capacity to enable countries and local health-care workers find long-term local solutions for maternal and child health problems”, he says. In 2019, MacDonald received three notable awards, from the medical faculty at the University of Dalhousie for her leadership in global health, and the Orders of Nova Scotia and of Canada. “I am a proud Canadian, not only because of what we have achieved in health and medicine domestically, but in our nation's wider commitment to global health. As a Canadian physician, the values of doing what you can to have impact and help others, both locally and internationally, are what drives so many of us”, she says.