The outbreak of the coronavirus disease (Covid-19) has greatly disrupted economies, including Uganda.
At the moment, the country is pegging its hopes on the Uganda Virus Research Institute (UVRI) to successfully test and identify those infected, find cure and possibly a vaccine too.
David Lumu interviewed Prof PONTIANO KALEEBU, a distinguished virologist and director of UVRI and director of the MRC/UVRI & London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, to find out how the country is managing the pandemic.
How equipped is UVRI to handle the task at hand of testing for the coronavirus disease, its cure and possible vaccine?
Covid-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and currently, we are the only centre in Uganda testing. We use what we call real-time polymerase chain reaction (PCR) and the machines we use are ABI 7,500.
Currently, we have eight of these machines but we are only using four, if the workload increases, we can start using the other four. We also have other PCR- based tests from other manufacturers that we can use.
For now, we are not yet conducting studies on a cure and vaccine for Covid-19 but we are preparing. We will be part of the large global protocol called the Solidarity under WHO that will look at different treatment regimens. We are also preparing a vaccine acceptability protocol to first understand people’s understanding and perceptions as regards to Covid-19 vaccines. Then, later, we will plan to participate in vaccine trials.
Currently, our scientists in the MRC/UVRI & LSHTM are sequencing the virus to see how related or different it is from other SARS-COV2 viruses from other geographical regions.
How many tests do you do daily on average and why does it take 24 hours to get test results?
Currently, we test all samples sent to us and the number is increasing, some days we test about 400 samples. Our maximum capacity is between 2,000 and 3,000 samples per day.
We actually release the results the same day, it’s the other teams in the ministry [of Health] that release the results to the media, patients and those in quarantine. From sample receipt to release of results it takes about 6 hours, this includes processing the samples, testing and data entry.
Compared to other countries we are doing well. The other steps before release are with other colleagues in the ministry. Therefore, we are not yet overwhelmed but that said, we are working with the Laboratory Preparedness and Response (LPR) team to expand testing to other labs when the need arises so that we are not caught unprepared.
We have a plan of how to involve other laboratories including training. One goal in most countries is to be able to have rapid diagnostic tests (RDT) to provide results quickly, have more access and at reasonable cost. We have developed protocols to evaluate these RDTs as they are introduced. Unfortunately, most of these RDT have not performed to the expectation so far, but we continue to pursue this route.
How ready is UVRI should the pandemic escalate the way we see in Europe and the US?
We are expanding our preparedness working with partners. For example, the Medical Research Council of the United Kingdom has provided us with 10,000 kits and has approved giving us another ABI equipment this is in addition to donations from different partners and funders like USA government agencies, WHO, Africa CDC, Jack Ma’s Alibaba and so on. We also hope government will provide more funds and resources to enable us be prepared.
UVRI is one of the least-funded government agencies yet in such times of anxiety, the country is depending on your expertise. What needs to be changed?
Yes, proportionately the funding from government to our institution compared to external funding is very low. This is not unique in Africa as far as research and laboratory support is concerned.
On the positive side, government appreciates the importance of science and research and funding to the UVRI is on the upward trend. We need more advocacy, show what we do and its importance. Covid-19, I hope, has shown that investing in institutions like UVRI should be a priority.
How safe are UVRI virologists and staff as far as Personal protective equipment (PPE) is concerned?
In our laboratories, we take safety very seriously. We deal with even more deadly viruses like Ebola. We follow international and national guidelines that allows us to keep our scientists safe. That said, we need more of the PPE. It is one of the requests we are making both to government and international partners and funders.
There are two theories to the coronavirus disease. There are those worried about the situation may last for months. However, there is another school of thought that claims the threat of Covid-19 has been exaggerated, especially in Africa. How do you reconcile those two views?
There is no doubt Covid-19 is a global threat, with Uganda not spared. We are in a global village, interconnected in many ways. We can only be safe when the Covid-19 is defeated globally. There are still few cases in Africa generally, but we can’t wait for the situation to get out of control.
With the limited resources that we have, there is a need to intensify prevention as the country is doing. The challenge is when do you relax these measures if the neighbours still have cases? Or when do you lift the travel restrictions? We, therefore, need to combine the local epidemic and the global epidemic as we make decisions, a challenge!
Uganda is yet to report any death from Covid-19, something that has fueled speculation that we are used to having flu and it hardly kills anyone. So, why is this coronavirus flu receiving so much attention? Is there even need for a lockdown?
In Uganda so far we have seen few cases with mild to moderate severity. In addition, most of those infected are young. In the young, mortality is lower.
However, as we move along, we will study the clinical presentation and progression in Uganda and elsewhere in Africa, including looking at other factors like genetics, climate, co-infections, co-morbidities etc. It is possible we will have a different disease profile compared to other places.
How does this virus respond to cold or warm temperatures?
This is an important question. Indeed, flu is more in cold and rainy seasons; could Covid-19 follow the same trend? Again, this is something we will study, not only in Africa but also in Europe and America as summer sets in.
Some French doctors recently came under criticism for suggesting to do coronavirus vaccine trials in Africa because many similar trials on HIV/Aids are done on this continent. What’s your take on this?
I have listened to the clips and seen the social media. If indeed this is what they meant that Africa is where experiments should be done, then it’s a pity.
No one can accept Africans to be Guinea pigs. We have passed that and we did a lot when we planned HIV/Aids vaccine trials to raise standards and the communities understand ethics, law and human rights. So, it’s a pity, these statements take us backwards and makes Africans suspicious, yet we need a vaccine.
On the other hand, these scientists also say they were taken out of the context, they were discussing testing the vaccine in Europe and USA and the interviewer asked a provocative question of testing in Africa.
I want to give them the benefit of the doubt, that it’s the way they expressed themselves that was the problem but they have good intentions. All the same, we as African scientists will not compromise on international standards.
What can we learn from other countries like Tanzania or Tanzania that are handling this well without implementing a lockdown?
I think there are many who doubt the Tanzanian and Swedish approach and worry they have taken a wrong path. In Sweden, unlike other European countries, people are still moving freely apart from isolating the vulnerable. The argument is to leave the infection in order to develop herd immunity.
In herd immunity, if about 70 per cent of the population is infected and get immunity, then there is protection of the population, including the few with no immunity.
However, some argue there is no scientific data to show this will work. In fact, the numbers of infections are increasing. But there are also some scientists who applaud Sweden and await the results of this experiment.
Recently, the Health ministry released three individuals who had healed from Covid-19. So, is it possible to get back to normal, non-isolating life when one recovers or they remain vulnerable?
Yes, when you recover, especially if you did not get severe disease complications, you go back to normal life and no need to isolate. For people we are discharging, we check them twice that they have no virus. There are some very rare reports in Asia of people getting reinfected and having viral rebound, but this is rare and should not worry our patients who are recovering.
I’ve read projections that millions of Ugandans may get infected if the situation goes out of hand. In Germany, Chancellor Angela Merkel warned last week that 70 per cent of the population may get infected. What is your thought of that?
If no prevention measures are made, the virus can spread to the whole population, it’s very easily transmissible and over time, most people would get infected. In the longer term, we need a vaccine to protect the population.
Can a person’s immune system fight off the coronavirus without the need for treatment?
Yes, indeed, even now it’s the immune system that is working, there is no treatment for this virus as of now. Most people get infected and get either no symptoms or mild symptoms and recover. It is the immune system that does the work.
Is there anything else that you’d like to add?
I want to take this opportunity to thank my colleagues at UVRI who are working day and night to serve our country. Sometimes these young men and women in the laboratories are forgotten, yet they are also working under challenging conditions, facing risks but very dedicated.
I’m very proud of them. I also thank other medical workers who are giving care to our patients. Let me wish quick recovery to the Covid-19 patients and assure them, they will go back to normal life.