Prof PONTIANO KALEEBU is the director, Uganda Virus Research Institute (UVRI), the body mandated with health research pertaining to viral infections. He is also director of the MRC/UVRI & LSHTM Uganda Research Unit, a United Kingdom funded partnership created more than 30 years ago to research on Aids. He is the first Ugandan to lead this partnership.
A researcher, academic, administrator and mentor, he has spent his entire professional career at the forefront of fighting HIV/Aids. Next month will be exactly 32 years of service at the UVRI.
He told David Lumu why he believes it is a matter of time before the cure and vaccine to HIV/Aids is found.
At the UVRI offices in Entebbe, I find Prof Kaleebu pacing about with a pile of files. He moves from one office to another and by the time he returns to the reception to welcome me, he is already exhausted.
Unlike several organizations I’ve been to, Kaleebu looked anything but the boss given how he freely mingled with the junior staff. Later, when he agrees to sit down for the interview, we found the boardroom already occupied. Those in the meeting offered to shift but he instead told them to continue with their business. We moved around until he got a free room.
Kaleebu immediately regrets the brief holdup, which, understandably, was a result of research.
“I was sharing some important information on HIV research with my team,” he says. “Of course, administration takes away a lot of my time but I’m a scientist first. Even when I retire from administration, I won’t stop being a scientist. I can do research even when I’m 80 years because this is a calling.”
That calling came shortly after graduation in 1986, but four years prior, Kaleebu was in his second year at Makerere University medical school when a mysterious disease attacked Rakai district.
It took until 1984 for it to be identified as HIV/Aids and by then, it had spread countrywide and wiped out more than 100,000 people in Uganda. It was in 1985 that Kaleebu first saw HIV/Aids patients.
“Unfortunately, one of the first people who suffered from it was a classmate who committed suicide in our fourth year as we were about to start our final year,” he recalls. “Another very good friend recognized symptoms and she passed away as we were awaiting graduation.”
After completion of his studies in 1986, Kaleebu was posted at Nsambya hospital for internship and while there he saw a lot of HIV/Aids cases.
“It was really hurting to see people you know dying and you have very little to do. That’s when I made a decision that I needed to do some work on HIV/Aids,” he says.
So, after completing his internship in 1988, Kaleebu reached out to the late Dr Sylvester Sempala, who was the director of UVRI, and he offered to avail him the opportunity of researching on HIV/Aids.
It was around this time that government with support from the World Health Organisation (WHO), the UK’s Overseas Development Agency now DFID and other donors rolled out the AIDS Control Program (ACP), and Kaleebu benefitted from ACP’s capacity building funds earmarked for the rehabilitation of UVRI.
This required Kaleebu to travel to the UK for the post-graduate diploma in immunology. While there, he won a scholarship to do his PhD. In-between the PhD studies, he returned home to marry his longtime sweetheart.
While Dr Kaleebu was doing his PhD, he discovered a new strain of the HIV virus called ‘Sub-type G not reported before in Uganda on top of other diverse strains.’
He was later able to describe for the first time that the viruses manifest themselves differently in people infected.
“The progress to AIDS is different depending on the sub-type. The D virus is more virulent. If you have the D virus, you progress faster. I went ahead to try to understand why and I discovered that the way the virus attaches to the cells is different. In Uganda, we have mainly A and D strains but things are changing. Now we have recombinants. Viruses are recombining and this can also affect one’s progression,” he says.
Besides that, Kaleebu and his team have led several international HIV vaccine trials including participating in the first adult and peadiatric vaccine trials in Africa. The other major achievement of Kaleebu’s work with his team is their breakthrough in understanding the immune responses relevant for HIV vaccine development.
“There are those who progress slowly and others faster. We had an opportunity to understand why these differences, which are the protective immune responses and then apply this in vaccine design. Then there are also those who are exposed to HIV and don’t get infected,” he says.
“Under the UVRI/MRC & LSHTM partnership we are about to start the first HIV vaccine efficacy trial in East Africa aimed to test if this vaccine can protect against HIV infection, this multi country study we are leading on will be the largest trial of its kind in East Africa.”
At the moment there is no cure, but Kaleebu says there are many drugs that are coming up. For one, he singles out the long-acting drugs that ensure that people don’t have to swallow the ARVs every day.
“You take the drug once a week; and these aren’t aimed for treatment only, but also for prevention,” he says.
“Our UVRI partnership with IAVI is doing a trial on a long-acting pre-exposure prophylaxis using a drug called Cabotegravir. The trial is looking at this injectable prevention drug. If such an injectable long acting drug can prevent infection, it will really be a game-changer in the fight against HIV”
However, Kaleebu warns that there is still need to educate the public about the injectable drugs because it could be mistaken for a vaccine.
“In fact, we are conducting a study on Prep which can be used on demand. What I mean those at high risk of getting infected taking a drug to prevent infection before they are to have the risky contact. This way, you don’t need to take Prep all the time unless you’re at a risk. But again, we need to educate that Prep is not a vaccine, it’s for a short time protection and hence you need to take it either continuously or when you are likely to be at risk,” he says.
“In HIV research there are two main scientific goals to end AIDS. One is to get a vaccine and the other is to get a cure. We can do all this treatment but those two are the eventual goals.”
On that note, it is easy for one to get excited but there is still some way to go because the vaccine has been elusive in spite of the headway.
“We are waiting for the results of a recent South African trial and other trials. The cure has always been a challenge, but new technology is coming, there is gene-editing where scientists are experimenting going into the genes to chop out the virus,” he says.
“This has been done in sickle cells recently; so, the technology is moving and I’m hopeful that we shall have a vaccine and a cure sooner. But before we reach there, even now, I’m very excited with the other new drugs that target other parts of the virus, because if we don’t expand on our drug targets due to the resistance, we narrow the drugs that we have. ”
On the other hand, Kaleebu notes that with treatment, his new worry is drug resistance; so, he emphasizes there is need to study drug resistance as well. Incidentally, Kaleebu’s research is not limited to the HIV virus, because he is also a lead researcher on Ebola, with trials taking place in Mbarara and Masaka.
Kaleebu acknowledges that when he was doing his Diploma and PhD on HIV, one of his mentors, Prof Elly Katabira, provided him with the necessary samples from Uganda. And when he returned to Uganda, he worked with his PhD supervisor Prof Jonathan Weber to win two grants from the UK’s Medical Research Council to fund his new work in Uganda
“I always tell young people to build good relationships with the people you meet, many of them can help you, stick with them,” he says.
Indeed, Kaleebu came back and started working with other colleagues here such as Dr Robert Downing, Dr Jimmy Whitworth, Dr Fred Lyagoba, Dr Jennifer Serwanga and many others. I also co-founded the UVRI-IAVI HIV vaccine Program with funding from IAVI.
“I’m very proud that we have made a contribution by expanding our work in understanding viruses and immune responses. At UVRI, Kaleebu looks back with pride,” he says. “I have been a contributor to the growth of science, bringing in money. As you know a lot of the work we do is not government funded, until recently we have been getting very little from the government. So, it is external funding that has really sustained us. To be a good scientist you need to do good research, publish and train others. I have trained seven PhDs, some Masters students and many undergraduates, I’ve published a lot.”
ON GOVERNMENT, DONOR SUPPORT
Kaleebu says that when I took over as director of UVRI, the institution was getting less than a billion shillings per year from government but now, it gets more than Shs 9 billion and it is likely to increase.
“I’m glad our funding has gone up and our activities are increasing. We are still in that transition phase where we are under UNHRO. But this coordinating body has very little funding at the moment and is not able to pay staff salaries hence our funding is direct from ministry of Finance, with a vote but under the ministry of Health overall budget,” he says.
“The advantage is the flexibility in funding. We have a lot of international partnerships and collaborations which are able to raise additional funding, this has allowed us to be a Center of Excellence in research and we are one of the few centers of this kind in Africa.”
Kaleebu further treasures the strong association with the London School of Hygiene and Tropical Medicine where he is a professor of immunovirology.
That has allowed UVRI train more people. However, he adds that UVRI is also having discussions to become an affiliate of Makerere University so that it can offer degrees in immunology and virology.
“We already have strong affiliations with Makerere and have trained a lot of its graduates doing their postgraduate studies,” he adds.
The other area UVRI and its partners are aiming is to strengthen the product development so that they can make diagnostics and vaccines.
“We are already moving in that direction. Currently, we are working on designing a Rift Valley vaccine with colleagues at Imperial College, London so that we not only test products from elsewhere but we also make our own products,” he says. “There are many viruses we are discovering that may not be of interest to the global community, it’s us to control them by making relevant products.”
However, as much as UVRI is making headway, Kaleebu admits there remain some challenges.
“I am very excited and happy that I’ve contributed in building human capacity in medical research. We have many scientists who are coming up but the challenge is jobs,he says. “We are training scientists but where are the jobs? It’s us senior and mid-level scientists to employ these people because we can’t rely on government.”
He adds that as senior scientists, they need to bring in new ideas, more grants, to train more scientists and employ them as we advocate for governments to invest more in science and research.
Funding from Government currently contributes less than 20 per cent, a lot of our funding is external. In order to survive we need a critical mass of scientists, one or two cannot sustain our activities for long but when we have many then that critical mass will move science forward.
At UVRI, there are more than 150 scientists in the different fields but Kaleebu says it is a challenge to retain those who have attained PhDs because they have higher expectations and want to be independent.
“Some of our post-doctorates have gone to other countries, others have left science but it is not bad when we train scientists and they go elsewhere but remain in science,” he says. “We are training them for the country and for the region, we don’t have the capacity to retain every person we have trained; so, we have always been open to our trainees going to other places. He admits that there are personal challenges.”