By Aliya Ahmad Nabil
On 10 August 2020, Professor Sir Alimuddin Zumla was informed via an official video call that he had won the 2020 Mahathir Science Award. Aliya, our programme executive had the pleasure of sitting in on that video call and listened to his passion for empowerment of the younger generation (view an excerpt of the call here).
Professor Zumla’s words during that call left an impression on Aliya, a young person herself. To follow up on some of his brief thoughts during the initial call, she caught up with Professor Zumla to know more about his message for the youth, his work on infectious diseases, and of course, COVID-19.
Young people are at a period of transition in their lives where they have to make important decisions that may shape the direction of their future. I was reading about your background and was rather surprised with your decision in your youth to turn down a prestigious Rhodes Scholarship to study medicine at Oxford to study medicine locally at the University of Zambia. What was your thought process behind that decision?
It was an agonizing decision to make. I was 18 years old at that time and having a Rhodes Scholarship was every student’s dream. However, I have always believed that one does not need a Rolls Royce to make a journey in life – it is the careful, committed driver with experience who is more important to achieve milestones and reach our goals.
I gave the issue much thought. Having seen the devastation and misery caused by poverty related diseases in my own home country, Zambia, after much thought – my parents were neutral on the subject and left the decision entirely to me – I decided that it was more important for me to continue to train in medicine at my local medical school and hospital in Lusaka, Zambia so I could gain first-hand experience of locally prevalent health problems such as infectious diseases. Looking back over the past 48 years, it was the right decision to make.
Following on from that, you have chosen to specialise in infectious diseases with some particularly outstanding work in TB. Why did you decide to specialise in this area (of infectious diseases and TB in particular) and why should other budding scientists or clinicians do the same?
All medical students face difficult choices as to what specialty to choose after they qualify. For me, all medical and surgical specialties appeared important as we progressed through medical school, since they all help improve human health in one way or another. Thus, it does not really matter what one chooses to specialize in.
I wanted to choose a specialty where I could make a big difference in saving lives of many people. I chose to specialise in the area of infectious diseases for several reasons:
Firstly, infectious diseases are the top causes of death worldwide. Secondly, it is very rewarding to see patients with infectious diseases recover after appropriate antibiotic treatment. Thirdly, even with availability of antibiotics and vaccines, the poorer sections of the community especially in developing countries do not have access to them and they continued to die unnecessarily of treatable and preventable infections. Thus, raising political and funder visibility for infectious diseases is important, and this can be done through high quality research and providing an evidence base for management and policy recommendations.
Last but not least, I have always found the world of micro-organisms fascinating – their biology, function in nature and evolutionary co-relationships with humans. As the current COVID-19 outbreak has illustrated, humankind’s existence is dependent on microbes.
You and your team explore different methods of tackling infectious diseases, from using mesenchymal stromal cells to autopsy studies. I read that at some point you were developing a cheap solar-powered diagnostic for TB, that sounds like it would be of great use in tropical countries. Could you tell us a bit more about that?
In 1993, two infectious diseases were declared global emergencies by the WHO – HIV and TB. At that time 6 million people died of TB and TB/HIV each year. There were no rapid diagnostics tests to diagnose TB or distinguish it from other causes of respiratory tract infections. The important thing for the village health clinic or the global doctor, is the identification of the organism that causes the respiratory tract infection because antibiotic treatment must be specific for that organism.
Most diagnostic tests required sophisticated equipment which were only available in tertiary care facilities or centralized labs. My teams at UCL, and our collaborative teams in Africa pioneered the concept of developing affordable, easy to operate, point of care rapid diagnostic test platforms for use in developing countries. It was one of our main aims that our diagnostic run on solar power in order to make them available for use in peripheral rural areas where electricity supplies may be erratic.
There are several point of care diagnostic platforms becoming available such as those that use a sputum sample, identify whether it’s a bacteria or virus causing the illness, and read out the antibiotic susceptibility pattern if it’s a bacteria, to render targeted antimicrobial therapy. This also helps towards antimicrobial stewardship and reducing the growing burden of antimicrobial resistance.
I think antimicrobial resistance is even more important than COVID-19 at the moment. It’s going to kill many more people and a lot of focus should be given back to antimicrobial resistance and other killer infectious diseases.
As we are in the middle of a global pandemic, it is inevitable that I bring up COVID-19 to an infectious disease expert. COVID-19 is obviously impacting the world globally, but the fight against other existing infectious diseases persists. What does the COVID-19 outbreak mean for efforts to eradicate existing infectious diseases like malaria and TB?
COVID-19 has spread globally and presented a huge additional burden to existing health services worldwide, which for developing countries, were already stretched. With the influx of cases, COVID-19 is adding another layer to the already stretched health services at every level, from staffing, diagnostic services to in-patient facilities.
This has had a major negative impact on preventive and curative strategies that were already in place for other killer infectious diseases such as malaria, TB, HIV and others. It is critical that political attention is not diverted from other major killer infectious diseases. Increased resources must be made available and all existing health services should be aligned to incorporate COVID-19 within those services rather than have specific silos developed for COVID-19.
Considering that COVID-19 and other infectious diseases are often so widespread and affect more than one area, what kind of collaboration needs to happen to tackle these diseases?
That’s a million-dollar question, because we’ve had repeated outbreaks for emerging and re-emerging diseases like Ebola, MERS and influenza epidemics.
Many of these pandemics arise from zoonotic diseases, which are diseases that jump the species barrier- moving from animals to humans. Philosophically speaking, all zoonotic diseases are of our own making, due to humans interfering with the animal world in one way or another.
It is vital that human and animal health sectors work together for proactive surveillance, prevention and control of zoonotic infections with full engagement of local communities. This now developing as a specialty through the ‘one-human-environmental-animal-health’ concept which is gaining traction. We have our own large one-health consortium across Africa-Europe (PANDORA-ID-NET) which is now incorporating the Middle East. We hope to expand it to include the One Health networks across all continents and regions, including Southeast Asia.
Furthermore, empowering the younger generation human health and veterinary health professionals to take leadership of the one-health agenda is critical to building and sustaining an upward trajectory of activities and deliverables. That is the future of having control over zoonotic infections.
Collaboration is not just limited to working together, it also includes sharing data and information. Do you know of any platform where this is happening in your field of work?
Absolutely. In all the One Health networks that I am involved in, including PANDORA-ID-NET, we have open data sharing, effective communication and transparency. I think you may have seen this happening with COVID-19 between the WHO, the CDC and Public Health England. An example of this is the Africa CDC getting involved in Africa over COVID-19 in terms of increased global cooperation in an open and transparent way.
Currently, different countries are developing different vaccines for COVID-19. It’s good that we seemingly have many different options, but no one really knows which vaccine will succeed and whether that vaccine can then be effective in a large population. Are there any vaccines currently in development that you see as a frontrunner, or likely to be most effective?
If you look at the history of the development of vaccines for RNA viruses, there has been no effective vaccine developed so far, rolled out for universal human use. That’s quite a pessimistic picture to paint here but this outbreak is different. There have been massive investments in vaccine development. There are over 150 candidate vaccines now, of which about 16 are already in Phase 3 of development. You may have seen these in the media – the Oxford vaccine, the Russian vaccine, the Brazilian vaccine, a Chinese vaccine and an Italian vaccine. I am optimistic that at least one of them will be effective. Hopefully, by the time the vaccine is rolled out, the epidemic will be over.
The main issue here is that one cannot determine how pandemics behave. The SARS virus in 2003 which again originated from China, rapidly spread worldwide, especially to Canada which caused a huge problem. It then disappeared totally, as in eight months, there were no cases recorded. COVID-19 is behaving a bit differently.
The number of deaths worldwide are now decreasing. There have been very few deaths in Africa compared to Europe and the USA. This all suggests that there is a problem with the virus in that it is not happy in the human host. It lives happily within animals and has reached an equilibrium there. Now that it’s entered the human host and the human immune system targets it, it wants to escape. That’s why there’s transmissibility as it tries to find the right host. Hopefully, it will get ‘tired’ and realise that “these [humans] are not the right hosts for me”.
Knowing the erratic and unpredictable behaviour of new virus outbreaks, and the virus not being in its natural animal host, I expect it’s a matter of time before COVID-19 burns out or becomes seasonal with small outbreaks. Whilst the virus is becoming more infectious, it will become less virulent, I hope.
Is there a way to expedite that process and make the virus “die out” faster?
Viruses are very unpredictable. I think at the moment, the best hope for controlling it is the vaccine. But there’s no magical formula. There’s no effective cure, there are no vaccines at the moment, the best shot at bringing the pandemic to an end is to ensure that the standard public health measures and interventions including social distancing, hand washing, use of face masks, testing, contact tracing and isolation, are implemented worldwide. All the communities should be involved too. That is the only way we can keep this pandemic under control.
What must be done now to prevent future pandemics and ensure that nations are ready to face another outbreak?
I think the One Health concept of getting the veterinary health and human health sides together to form large consortia with effective funding and cooperation is the only way forward. I also think that Western dominance of the emerging and re-emerging diseases agenda should now move towards a more equitable partnership with developing countries by making sure that whatever research and development training being done is aligned to capacity development. We need developing countries to take leadership of issues that affect them most.
I totally agree. That’s part of the reason why our Foundation was set up – a tropical country aiming to champion tropical sciences for the betterment of this region and the entire world.
What I’ve seen from PANDORA-ID-NET is that the younger generation scientists and doctors are so excited, enthusiastic and passionate about it and I feel confident that the future will be secure. It’s only a matter of time.
Touching on your point on young people, we would like to use our platform to inspire young people who are the future as you said, to do something for their own nations. What is your message to the young people out there in tropical countries who want to make a difference for their region?
I am sure young people across the world have reflected on several life issues during the COVID-19 lockdown period. The young scientists and doctors will have found it incredible to believe that a small virus, invisible to the eye, has been able to cause a devastating global pandemic.
It has also made everyone realise that life is not infinite, and it is too short to waste. I have several bits of advice for the youth. I do a lot of counselling for the younger generation.
I think for the youth who want to make a difference for themselves and their community or region:
You should take pride in your work and develop a passion for asking the right questions and then finding the answers. Be open-minded, communicate effectively with each other and your seniors, and be polite and respectful to everyone around you. Work hard and focus on excellence, whatever profession you are in. The world of science and medicine is your oyster.
The critical step in defining your career is to focus on something that fascinates you and captures your imagination. When life becomes stressful and difficult, never give up hope or lose courage. Seek help and wait for opportunities to come your way. They will come.
If you have free time, get involved in activities that directly or indirectly help the poor and disadvantaged in your community, and work with like-minded people who share your humanitarian values. That will make your career worthwhile.