For the readers that don’t know you, can you tell us a bit about what you do?
I’m a research scientist at NIMR Tanga Centre in Tanzania. I joined NIMR in 2003 to establish a molecular biology laboratory in Tanga. Since then, I’ve been working primarily on malaria. Around the time that I finished my PhD in 2011, I started getting more involved in building local capacity, particularly in two areas: first to develop the sites for conducting clinical trials on antimalarial drugs and, second, to run the laboratory to be able to monitor resistance to antimalarials. These are some of the things that I’ve been doing and that I’m still pursuing.
Through this work, you’ve played a pretty key role in bringing genetic monitoring of malaria to the communities where you work. What has that entailed and why focus on the molecular aspects of malaria?
When I joined MalariaGEN back in 2006, we were working on human samples. When I started my PhD in 2007, I’d become interested in studying malaria parasites. In particular, I wanted to look at antimalarial drug resistance using molecular techniques. Genetic studies have the potential to get us ahead of time in monitoring the evolution of drug resistance, potentially detecting resistance against artemisinin once it emerges in Africa.
Around the same time, we formed the Tanzanian Genomic Network (TGN) to develop the capacity for trials where we could collect samples from different sites in Tanzania and other African countries, and build the capacity of young researchers in Africa to do genomic studies. Together with colleagues in five other African countries, we applied for funding to continue this work but were ultimately unsuccessful. The reviewers felt that we didn’t have the experience in genomics, in particular. So from there, I have been addressing that gap – and I can tell you, we have gone so far.
With just some small funding we have implemented three trials since 2012, and we have collected samples and submitted them for sequencing under the MalariaGEN Community Project. Now, in the area of one thousand genomes will be available by the end of this year. And, we have published papers in parasite resistance, molecular markers, that kind of thing.
A couple of those papers were looking at molecular markers of resistance to sulfadoxine-pyrimethamine (SP), which was abandoned as frontline treatment in Tanzania several years ago but is still used during pregnancy. Is this type of information seen as useful by local policy makers – do they know what’s happening?
They do know. I’m keen to make sure that we’re not out of touch with the malaria control programmes. At the moment, I’m the National Coordinator of the Antimalarial Resistance Monitoring Network in Tanzania, and we work with the National Malaria Control Programme (NMCP). I also sit on their committee on surveillance, monitoring and evaluation where we report everything we do. So they are really aware, and we are pushing to ensure that molecular surveillance is also given a high priority in their activities.
One of the challenges, I would say, is that in many cases people have failed to synthesise research findings to avoid burdening policy makers with lots of scientific jargon. Policy makers are busy people and we need to present them with key, salient information which is very useful to policy implementation.
You also talked about connecting with colleagues in other African countries. How important is collaboration in growing the capacity for genetic research in Africa?
Incredible. For several years, many of my colleagues and I have felt strongly that we need to lead a group in Africa where we can collaborate with each other to do the science that we want to do — science that makes sense to malaria control programmes, science that makes sense to our communities. We are not doing something wishful. We really mean it from our heart so that we can pursue it no matter what the obstacles we might be facing.
This was the genesis of the Plasmodium Diversity Network Africa (PDNA), which started to take off in 2012 following our initial meeting in Oxford. From there, more of our African colleagues have joined; we now have 15 sites in 13 countries. We are a strong team that can have a voice in the next five, ten years. With such a level of diversity, we are in a good position to respond to key challenges in Africa.
Can you give an example?
A current example is the surveillance of HRP2 deletions, which can impact on the performance of certain rapid diagnostic tests (RDTs). The RDTs are an important diagnostic tool — they can be used anywhere, by anyone, with minimal training and no special equipment.
However, some Plasmodium parasites have a deletion in the HRP2 gene and therefore cannot be detected by RDTs targeting this gene. Initially, it was thought to be a problem in South America but we are seeing that it is emerging in Africa, and we might reach a point where these RDTs are not helpful to the people in the field.
That would be a pity because the drugs we are using are very expensive. And, particularly in areas where malaria transmission has gone down, not everyone has malaria. If you cannot confirm who actually has malaria and who doesn’t, then we’ll be making a lot of mistakes and that can have serious implications for drug resistance.
This is at the top of the WHO agenda at the moment, and we’re talking to the US CDC about it. As an established network with teams in place at sites across Africa, the PDNA are best positioned to support the global community in Africa to monitor how the RDTs are working particularly in areas where the HRP2 deletion might be coming in.
It sounds like there is some momentum now. How well-developed is the capacity for genetic research in Africa and how can we keep this moving forward?
The PDNA is at the position where we can do so many things, and also contribute to policies at different levels – locally, regionally and internationally. But, we still have major challenges.
We need more people trained in big data management, genomics, bioinformatics, and even cell biology to confirm some of the things which will be revealed by the findings from our genomic studies. This process is two-fold: as upcoming researchers, we need to continue to develop our own understanding about genomics and data analysis so that we can support the young scientists who are now being trained. Because these guys are amazing; the moment they take off, they will be on top of us. That’s where I think Developing Excellence in Leadership and Genetic Training for Malaria Elimination in Sub-Saharan Africa (DELGEME) comes in. Through DELGME and many more initiatives to come, we should train a critical mass of African researchers and ensure that they stay and work in Africa.
And, there are other challenges that need to be addressed at the same time. One is infrastructure – making sure people have the internet, machines that can handle the data, servers – and the other is retention. It doesn’t make sense to train people and fail to retain them at the sites because we’ll not be able to move beyond the point that we are. If we train but don’t retain them, I can tell you we’ll keep training forever.
Capacity building is clearly a recurring theme throughout your career. If you were speaking directly, with one of the next generation of African scientists, what advice would you give them?
What I would tell them is that as an African researcher, you have more opportunity when you work in Africa than working elsewhere. There is also a cost on that. You need to be very strong and very understanding. And, you have to be prepared to work under serious hardship: limited funding, limited infrastructure, and complicated political systems. But the moment that you start moving forward, the speed is really steady and very promising.
When I came back after my PhD, I didn’t even have a penny to do a post-doc or continue with the work in our laboratory but I’m still doing research for five years now – and I look forward to doing more. By the time I retire, I want to leave an environment where my colleagues can feel like the environment is much better for them than it was for me. I can’t do that if I don’t stay in Africa.
In this spirit, we are inviting young scientists to stay in Africa and think of solving problems which face their mothers, fathers, young brothers and sisters – irrespective of the challenges. Because when we work in Africa, we are working on problems which face our people and we are doing it ourselves, not looking to someone from elsewhere to do it. That kind of pride is what I would want to see my young brothers and sisters take up.
DELGEME has an open call for PhD students and post-docs. The deadline is 30 October 2016. For more information, visit their website: www.delgeme.org.
Baraka, Ishengoma et al. High-level Plasmodium falciparum sulfadoxine-pyrimethamine resistance with the concomitant occurrence of septuple haplotype in Tanzania. Malar J. 2015 Nov 5;14:439. doi: 10.1186/s12936-015-0977-8.
Kavishe, Kaaye et al. Molecular monitoring of Plasmodium falciparum super-resistance to sulfadoxine-pyrimethamine in Tanzania. Malar J. 2016 Jun 23;15:335. doi: 10.1186/s12936-016-1387-2.
Golassa, Kamugisha et al. Identification of large variation in pfcrt, pfmdr-1 and pfubp-1 markers in Plasmodium falciparum isolates from Ethiopia and Tanzania. Malar J 2015, 14: 264.
Shayo, Buza, Ishengoma. Monitoring of efficacy and safety of artemisinin-based anti-malarials for treatment of uncomplicated malaria: a review of evidence of implementation of anti-malarial therapeutic efficacy trials in Tanzania. Malar J 2015, 14: 135.