Provocative research

Breaking boundaries in South African healthcare

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Scientific research is revolutionising healthcare in South Africa and across the globe. The CEO and President of the South African Medical Research Council (SAMRC), Professor Glenda Gray, has just been re-appointed for an unprecedented second term.

She elaborates on how they are using science to change the world. Prof. Gray spent much of her career as a Paediatrician, Clinician, Researcher and activist based at Chris Hani Baragwanath Hospital, in Soweto, where she co-founded the Perinatal HIV Research Unit (PHRU).

Prof. Gray is the Protocol Chair of two large HIV vaccine trials conducted in Sub-Saharan Africa with the HIV Vaccine Trials Network, HVTN 702 and HVTN 705. PHRU is one of the trial sites enrolling for HVTN 705.

“I am an accidental Scientist. When I started my career in medicine, I just wanted to be a Doctor,” she explains.

Fate, however, had other ideas. Her career led her to the forefront of fighting for the right HIV treatment for babies as a Paediatrician and, today, to the President of the SAMRC. Her moral imperative and groundbreaking efforts in health in the country culminated in her receiving South Africa’s highest honour, The Order of Mapungubwe, and her research in the prevention of mother-to-child transmission (PMTCT) that has improved the outcomes of infants born to infected mothers.

Please could you provide us with a brief background of yourself?

I started off as a Doctor, as a Paediatrician. I had no intention of ever becoming a Scientist. I wanted to train doctors and paediatricians. Then HIV happened, during medical school and during my training as a specialist—I was working in progressive health structures.

During my training, HIV became evident in our hospitals, though it was still rare at the time. Gradually, it grew from being an exotic disease to being in every third child and, soon, we had all these babies that were infected. They were dying and we could not do anything about it. My first research project was based on stopping mother-to-child transmission. We knew that a third of the transmission was through breastfeeding. My scientific research was quite provocative because, at that stage, we had no drugs, and women could choose to breastfeed (ultimately, transmitting the disease if infected). If they bottle-fed their babies, there was a big possibility that they could still die of diarrhoea.

I conducted a study in Soweto between 1992 and 1993, when the HIV epidemic was starting to take off. We explained to the women what was going to happen, telling them that they had to make a decision to either breastfeed or bottle feed. We would monitor babies that were not being breastfed in order to understand what caused their death; whether it was diarrhoea or due to HIV for those who were breastfed. The study was controversial at the time because at that stage, the World Health Organization (WHO) was saying that women in poor countries who were infected with HIV needed to breastfeed their babies.

My issue at the time was that these women were essentially not being given a choice in the matter. I believed in making informed decisions as opposed to dictating without context. Once antiretroviral drugs came along we could use them to prevent mother-to-child transmission. My work in science was based on a moral and ethical imperative, rather than “I want to be a scientist”.
I saw just how powerful science was. It enabled us to challenge policymakers at the Constitutional Court through articles, publications and tangible empirical evidence. This is why I love science so much—it is the evidence we need to change the world. That’s how I became addicted to science.

How did your role at the SAMRC materialise?

The SAMRC requires a medical doctor, who is proficient in science, to lead the division of science in South Africa. There comes a time in your life when you have to put your own individual science interests aside to pursue the science interests of the country.
There is a time in your life when you have to give back—it is my time to do so, which is why I joined the SAMRC. By 2010, the SAMRC was in a state of decline, that had started in the mid-2000s, and it had become a bloated organisation with mediocre scientific output. Baseline government funding was insufficient and the future of the SAMRC at that time was bleak, some even calling for it to be shut down. But the Minister of Health at the time knew that the SAMRC could be a powerful instrument, in improving the health of South Africans. To this end, a process of revitalisation occurred led by an interim President,Prof. Salim Abdool Karim. After the process of revitalisation, it was time to appoint a new President, which eventually led to a headhunting process, where my name was put forward, so they approached me. I became the first female President of the SAMRC. I came in five years ago, this is my second term. I am the first President, since democracy, to be offered a second term.
I’ve got the best job in the country because I have the opportunity to help determine a vision of medical science for South Africa. We take the 10 most prominent causes of death in South Africa and then design a programme of science formulating solutions. I cannot find a job that is as profound as this which, simultaneously, has such a strong impact on orchestrating how medical science is conducted in South Africa.

How has your job as a Paediatrician helped you manage your role as the President?

Looking back, being a Paediatrician enabled me to develop a lot of empathy and compassion. Being involved in medicine in South Africa, I saw the differences between the diseases of the poor and the elite first-hand, and dealt with that injustice within the system.
Being a woman, a mother and a Paediatrician, I saw diseases, which should have been eradicated in 100 years, causing deaths in the country. It made me angry about the state of health in South Africa. Working with HIV-infected women and their children, watching the mother or one of my child patients die was devastating.
The positive stories also left an indelible mark on me. Seeing some patients survive from a young age to living fulfilling lives filled me with immense happiness.

Under your guidance, what are your values and aims within the organisation?

There are four co-aims. Our mission is to fund and conduct research that changes the lives of South Africans. We do this by using our money wisely, firstly, by ensuring that our team is very lean and by giving money to scientists. The money is disbursed in such a way that the bulk goes to science and very little goes to administration.

Anything we fund has to impact South Africans, from drug discovery to policy. The work should be aimed at changing the burden of disease. We are also interested in funding innovation, finding vaccines, diagnostics and finding easy ways to diagnose people in the community. Building the pipeline of scientists is another major objective. Doing so will replenish and create capacity within the organisation. When I came to the SAMRC, one of the things I wanted to focus on was building a pipeline that is diverse—looking at gender parity— that funded African scientists and that looked at all areas, rural and urban.

I wanted to create a pipeline of scientists who are geographically diverse. When I started at the SAMRC, the bulk of our funding was going to institutions like UCT and Stellenbosch, to predominantly white men. We started changing our strategy and, now, most of the people we fund are women and the majority are black African scientists.

Can you please elaborate on some of the breakthroughs you’ve had?

The first is the Beijing Genomics Institute (BGI). We have a collaboration with BGI to establish a whole-genome sequencing facility in South Africa. The SAMRC Genomics Centre will be the first of its kind. The lab has been built and we are about to launch it—that’s a great achievement because it is going to leapfrog our ability to understand the genetic response to drugs, why certain drugs work and others don’t for various populations.

When I joined the SAMRC, I was worried that the institute was not doing enough research in terms of maternal and child health and I was looking for an innovation that could help us prevent stillbirths. We came up with Doppler technology—UmbiFlow. UmbiFlow is a sophisticated portable continuous wave Doppler used to measure blood flow in the umbilical cord. You can pick up whether babies are at risk of death or not.

We invested R4 million in the development and delivery of new and affordable antibiotic treatments for drug-resistant neonatal sepsis and sexually transmitted infections (STIs). Conducted by the Global Antibiotic Research and Development Partnership (GARDP), the clinical research studies aim to have a treatment for drug-resistant gonorrhoea registered in a number of countries, including South Africa, and to develop two new treatments for neonatal sepsis.
We also funded Iyeza Health through our Grants, Innovation and Product Development (GIPD) Unit. The innovator behind Iyeza created a network to dispense medicine in various locations. This has helped numerous individuals and is a key part of health product dispensation. The SAMRC supported Iyeza Health to build a mobile app system.

Since you have just started serving your second term, what is your vision for the next five years?

When you invest in medical research, you invest in the longevity of a person. This will increase the GDP or wealth of the nation. We are underfunded and this makes running the organisation difficult. We have increased our baseline. Last year, we brought in over a billion rand, but that’s not enough. For the kind of science we want to do, it’s minimal, given that it is amazing what we achieve. My focus is on capacity development and transformation in science. At the end of my five years, I want medical scientists in this country who are internationally recognised and who also represent the diversity within our country, because we don’t have that at the moment.

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