Health research opportunities, challenges

By Flavia Nassaka

The Medical Research Council (MRC), a body under the Uganda Virus Research Institute (UVRI), is this year marking 25 years of operations in Uganda. Prof. Pontiano Kaleebu, the director, spoke to Flavia Nassaka about the current state of medical / health research in the country.

Briefly, what is MRC’s background and what does it do?

When HIV/Aids was identified in the early 1980s, the disease spread very fast in different populations. Unfortunately there was political instability in the country at the time, therefore not much was done about it. But when the NRM came to power in 1986, the government became open about the epidemic and invited international institutions to come and help the population understand what was happening. That’s how the MRC came to be established in Uganda in 1989 after the MRC in UK signed a memorandum of understanding with the government of Uganda through the Ministry of Health.   Initially, our work focused exclusively on HIV but in the past four years we’ve been diversifying into other areas especially non-communicable diseases and viruses.

Why is medical research important for the health sector in particular and national development in general?

We need a healthy population to be productive and its’ the health sector’s role to ensure we have a healthy population. In order to do this we need to understand health problems in our communities and the best ways to control and manage them, and this is where research comes in. The understanding of the disease burden, how diseases arise and are spread, the development of new or better medical interventions including treatments, diagnostics, vaccines and other prevention approaches among others would not happen without health research. Different countries have different research needs.

The field of medical research is still a huge challenge for developing countries like Uganda. Why?

It’s because research especially in Uganda is largely funded by international players; funding from the government is still minimal.  A lot of medical research was done in the 1950s at Mulago Hospital on cancers and malnutrition and for a long time Uganda has recognized the importance of medical research, but this has not been matched with funding. This is partly because Uganda has a lot of other priorities to focus on including maternal health and nutrition. Research is still a bit far off though am sure the government considers it a priority because the President himself has been advocating science education.

What major challenges has MRC encountered over the years?

We want to do more than the available funding allows. Although we’ve been reasonably funded by the MRC in UK, they give us just part of the budget.

The other one is human capacity. We don’t have many trained researchers so we keep on training. We’ve not filled that gap that’s why you find in some areas we still have foreign researchers.

What steps has MRC taken in order to overcome these challenges?

We have middle level scientists in Uganda who are leading research. We are training both at Masters and PhD levels. Of recent one of our models has been to train PhDs locally because when we take our scientists abroad sometimes they may not come back but when they do it here, there’s retention. Even when we send them for studies abroad, we make sure that their research projects are done locally.

What would you consider to be the key highlights of your journey as an organization in the last 25 years?

We have been very active in describing the HIV epidemic. At the beginning no body understood how the virus was spread, what the disease processes were, how the disease progressed. Indeed, science has benefited a lot from our research since its from this that they make appropriate diagnosis.

We’ve done a lot in creating awareness. In the past people were worried about insects like mosquitoes infecting them with HIV but we proved to them that the disease is basically spread through sexual intercourse.

We have also participated in studies that eliminate HIV like HI-vaccine trials and microbicide trials but we’ve also tried to understand the viruses themselves at molecular level by identifying how they respond to treatment and how they can be ruled out.

I understand MRC has organized HIV/Aids research into five programmes. What have you achieved from these?

We are part of MRC UK, which has units and we are considered a unit.  Within units we have programmes that have a common objective. For instance the HIV prevention and epidemiology programme focuses on anti-retroviral research, vaccine research and treatment of sexually transmitted diseases.

The social science programme looks at structural drivers of the epidemic, HIV within the different life courses, and what social challenges are faced at different stages of life of a HIV positive individual.

The other programmes are HIV care that unifies research projects designed to improve the comprehensive care of people infected with HIV, Basic Science that conducts research that contributes to a better understanding of virological, immunological and genetic factors required for the development of effective therapeutic interventions against HIV, and finally the co-infection programme that focuses on interactions between infectious and non-communicable diseases.

The 2015 global target for achieving MDGs to which combating HIV is Goal Six is around the corner.  As a major stakeholder, what is your assessment of Uganda’s performance on this target?

It’s true that some countries have already hit the target. In Uganda, some people are saying the end of the epidemic is around the corner but we are saying no.  There are many things that we haven’t understood. There are key populations that we’ve neglected, there are messages that we have neglected and people are changing behaviors.

We have done studies on circumcision but only a few people are responding to the campaigns. Though condoms are available, some people still risk having live sex. As stakeholders we need to look for all ways of ruling out misconceptions about research and public messages but its unfortunate that we won’t meet the MDG target.

What’s your take on the Ebola and Marburg epidemics especially about the response of the international community?

Ebola has gone to countries that were not prepared. The people themselves didn’t believe it was Ebola and resorted to superstition, and international bodies only came in late.  We should also appreciate the fact that the strain of Ebola in West Africa is quite powerful with  high mortality.  Uganda has done well in countering such fevers through learning experiences and we’ve now come up with quick remedies. We have set up laboratories for quick diagnosis unlike a few years ago when we had to send samples elsewhere yet the fever spreads very fast. We have isolation units and the population has been taught to look at the symptoms and report any suspected cases – something that the West Africans have failed to do.

Where do you see MRC in the next few years?

HIV will continue being a major area of focus for research but this time differently. HIV has changed in the way that some people are on treatment and they are living longer.  Treatment itself has its own side effects yet living longer with HIV also has its own problems. So there’s a lot to research about as regards this as well as coming up with an HIV vaccine.

We’ll also increase efforts in tackling non-communicable diseases given the increased unhealthy practices whereby people eat too much junk food and are not physically fit.