Global Health Matters
A podcast on innovative & inspiring actions to achieve health for all
Global Health Matters
50 years of developing global health leaders
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We kick off season 4 of the Global Health Matters podcast with an episode that highlights the remarkable career journeys of two research leaders and the role of capacity development in their formation. Host Garry Aslanyan speaks with Wilfried Mutombo, the Head of Clinical Operations at the Drugs for Neglected Diseases initiative (DNDi) in the Democratic Republic of the Congo, as well as Yasmine Belkaid, President of the Institut Pasteur in France. As this episode is produced in celebration of the 50th anniversary of TDR, the Special Programme for Research and Training in Tropical Diseases, TDR Director John Reeder also joins this episode to reflect on the challenges and future frontiers of capacity development.
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Hello and welcome to season 4 of the Global Health Matters podcast. I'm your host, Gary Aslanion. In this season, we will be bringing you more thought-provoking and inspirational discussions on a variety of global health topics. We kick off this season with an episode that highlights the remarkable career journeys of two research leaders and we discuss the role of capacity development that played in their formation. In this episode, you'll hear from Wilfred Butombo, the head of clinical operations and DNDI in the Democratic Republic of Congo, as well as from Professor Yasmin Belcaid, president of Institut Pasteur in France. This episode is produced in celebration of the 50th anniversary of TDR, the special program for research and training in tropical diseases. Research capacity development has been a central pillar of TDR's work over the years, and to mark this occasion, I'm joined by the director of TDR, Dr. John Reeder, to start a discussion and reflect on challenges and future frontiers of capacity development. Hi, John. How are you today? Hi, Gary. Very well, thank you. Great. So welcome to Global Health Matters. You are not a stranger to Global Health Matters because I remember I actually emailed you first with this idea, and um you were very uh enthusiastic about it.
SPEAKER_04Great to be here, and I still am very enthusiastic about it, Gary. It's been a fantastic success.
SPEAKER_02John, let's get started. You have had an extensive career in research, working in many different settings and institutions. Where did your passion for science and research come from?
SPEAKER_04Science, basically my first day of high school, I walked into a biology class and loved it and realized I'd found my topic. And while I was quite good at other topics and other sciences, I've had the love of biology since that day. It really drives it. But I guess turning that into research. The science itself drove me into my first job, which was as a laboratory technician in a hospital laboratory. And while studying there and studying for my fellowship, we had to do a research project. Uh and it was to take on one of the problems we were having within the laboratory, which happened to be uh young children who got sticky eyes in the maternity ward. So I spent some time looking at that and I was fortunate to win the prize for the best project that particular year in the fellowship, which meant I could present my work at the at a national meeting and also publish the work as my very first scientific paper. And from that moment I was hooked, both on the research, but also on the fact it was part of what I was doing. It was part of my science, it was part of my job to be doing that kind of research.
SPEAKER_02And of course, after that you worked in many different uh research institutions, settings and countries. But since 2012, uh you've been the director of TDR. Why were you interested in transitioning from actually doing yourself the science and research to focusing on efforts on strengthening in-country research systems from a global level?
SPEAKER_04Like all things, these things happen in stages. Now I'd love my time as a research scientist, and I did have the opportunity to work with the malaria research team at the Hall Institute in Australia on some very basic discovery research. But really in the back of my mind was putting this research into action. So the step before coming to TDR was actually when I stepped out of that laboratory and became the director of the Papua New Guinea Institute of Medical Research and running the National Institute of Medical Research gave me much more of a feel for how you could put science into action and really address health problems in countries. And of course, there is an element of giving up your own hands-on elements of this, but I've learned to really take the pleasure in the achievements of the people around me and the science aro around me. I often um compare it to the fact that you may be, you know, an excellent pianist, but if you pick up a baton and you start directing an orchestra, you can pull much more out than you can in your own individual instrument. And I think I've made that transition first in Papua New Guinea, but then I was very excited to take that up to a more global level with TDR when I had the opportunity.
SPEAKER_02And that was where your passion for that came into fruition by running the program that really strengthens capacity in low and middle-income countries. Exactly.
SPEAKER_04It it put all to g all these parts of my career together. You know, this uh experience of working in country and realizing the problem, this love of science and research. And even in my own career, which was not a straightforward go to university career, I did all my study part-time while working and built a rather hotchpotch career through that, which was based on getting opportunities or meeting good mentors and taking this career forward. So a real passion for making sure that we give an opportunity to everybody with potential, and hopefully this is really still at the center of TDR's activity.
SPEAKER_02I spoke to two former TDR grantees, Dr. Wilfred Mutombo and Dr. Yasmin Bel Kaid. Both Wilfred and Yasmin had a very remarkable research career. Wilfred started as a medical doctor working in a small village in the Democratic Republic of Congo and was confronted by multiple challenges in treating patients affected by sleeping sickness. In particular, there was a drug that was very high in toxicity and uh that was used at the time. And then he received a clinical research fellowship from TDR to be further trained in clinical trial management, and then that enabled him to lead to the first clinical trial in DRC to test vaccinidazone. This is a drug that is an oral drug and is for sleeping sickness. And then currently, Wilfred is the head of the clinical operations in DRC for DNDI, the uh drugs for neglected diseases initiative. Let's hear from Wilfred.
SPEAKER_00So, just after my medical school, so I started working in the small village called Casanza, and I was the only one, medical doctor for the entire village, and the village was uh a small village, but uh with about uh 11 uh000 people. So I was the only one dealing with uh any cases of uh of uh disease. And this village was endemic to uh sleeping sickness, and so uh I was uh managing those cases of sleeping sickness, and uh and uh at that time the only drug we had was melastopor. So I was treating my patient with uh that drug, and uh I could cure some patients, but some others was were relapsing and come again and uh with uh some very bad and painful experience, you know, because the drug was toxic and uh it happened that uh I I lost some of my patients, and that was uh very you know, very bad experience. After my two years spend in this uh small village, so uh DNDI launched his uh clinical trial called Next. And so I was very interested because I was facing, you know, those uh uh challenge with uh with this toxic treatment. So I was very interested and I applied. So I was selected, and so uh that was my very first experience in a clinical trial. So I heard it through one of our elders that there were this program of TDR, and I applied to this program of fellowship of TDR with uh I had support of uh recommendation letter of TNDI. So I applied and I was selected. So I spent uh uh six months at uh Sanofi uh Paris and six months at uh DNDI. And that was very, very interesting experience because I could walk, share with people doing clinical trial at different levels and different aspects. So this was uh, you know, a kind of learning by doing, but in the very best way.
SPEAKER_02John, just before I ask for your reflections, let's also listen from Yasmin. Yasmin is a career scientist, and her career started in Algeria. And in 1996, she received her PhD from Institute Pasteur in France. This was followed by an illustrious uh range of research projects during her time at the National Institutes of Health in the USA. And actually, as of January, Yasmin has returned to France and has a new role as the president of the Anstitut Pasteur, and this is what she had to say.
SPEAKER_01So it's really a full circle because my first experience and research was in Pasteur Institute in Algiers, in Algeria. And this is after that, and I was lucky enough to receive uh a fellowship from DDR, which I'm very grateful, which allowed me to do my PhD in Paris. So this is really a full circle, not only in terms of coming back, but also in terms of this conversation I'm having with you. Uh so this is really uh coming back to Ambassador is extremely important to me. Ambassador is one of the only institutes in the world that is known across the planet, and for the reasons Ambassador exists in 32 countries. So it is for someone like me, as many others, that is absolutely passionate about what we need to do for global health, an extraordinary opportunity to contribute to questions of high importance to humanity.
SPEAKER_02John, clearly both Wilfred and Yasmin really benefited from the support they received and and having um worked and continuing working in countries and affecting the health of people. In your view, uh, how important are these early capacity investments for the long-term trajectory of researchers and addressing the country-level research priorities?
SPEAKER_04So important. And first let me say you picked two great examples in Wilfred and Yasmin or people I know and really admire the work that Wilfred did in DRC on Texanidazole in really difficult situation. And Yasmin building that career, working at NIH at the very forefront of microbiome research coming out of this. And there are a couple of reflections from this. One is when you're supporting capacity development, you are not inventing people. These fantastic people were there, and they are in every country. And you know, we can expect similar numbers of people in every country. But the problem is in some countries, those people do not get the opportunity to fulfill their potential. They do not get that break to get the education, to get the research funding and be able to move that forward. And this is what TDR has done really well over the years, is provide an opportunity, not to everybody, it's a small drop in the ocean, of course, for any one organization. But you can see when you give the opportunity to people like Wilfred and Yasmin, they seize it, they make the most of that opportunity, and it allows them to fulfill what is already in them, which is obviously brilliant scientific careers from this. I often say, you know, when you're looking at science and laboratory science, particularly, people get fixated on the expensive equipment and the fancy technology that surrounds this. But the most important investment in a laboratory is the scientist who is in that laboratory. Because all other things aside, the ability to see the problem, think of innovative solutions, to test them critically, and to have the open mind to be able to see the discovery coming through that, you invest in that and you've got great science.
SPEAKER_02That's so interesting because this issue of how sometimes the actual capacity or actual researcher is an afterthought in some of these projects. It's the buildings, it's the equipment. Uh, this is so spot on. John, I'd like to ask you next um about the capacity support still required in countries. But let's listen to Wilfred who shared about the challenges he and his team faced when setting up that first clinical trial in DRC, and also what needs are still there and are remaining.
SPEAKER_00The first challenge is to reach those areas because to perform a clinical trial, you need to go there in those areas, on those remote areas. And as you may know, we have bad roads and this is not very safe. The second challenge is when you are in those areas, you can imagine in what state those health facilities are. So the health facilities are in very bad state. But if you want to perform a clinical trial, a high-quality clinical trial, you must do it in the acceptable standard. So we had to improve uh the these health facilities, you know, to build improved laboratory, patient war, the office of investigators, to provide water, to provide electricity by generator or solar system and internet connection that is important in any research project. So we had to set up all this. And another challenge is um you know, the health facility, the worker, health worker. You know, those health workers, yes, they are there, but they are not aware of uh what is clinical trial. And uh so if you need this high-quality clinical trial, so they will need to train them and have a very, very close supervision of their activity. So we organize all this, we have to train them first on good clinical practice and after on study protocol, on all those aspects, on SOPs and all this, and after had a very close follow-up. I can say I'm a little bit proud of uh uh what a strong network we had of uh those health workers that can they can be involved in a clinical trial, they they they know uh things about uh trials and so on, and how they are able to be involved in any trials about any disease. But we we need to to support them. And first, let me say, you know, the program like this TDR program, this is this is one of the very interesting programs that need to be continued because I am the fruit of this. And uh as you can see, what I'm doing now. So we need to keep this and to continue, but we need to connect all those uh clinical sites in uh just to keep them, because you know, after a project is finished, we are fearing that a site can fall down. So to keep all this, we need, for instance, to connect them with uh research institutions locally like university uh and so on, so that as they have this basic knowledge of uh what is research, they can continue working in this environment. So we need uh uh our government to create uh those connections and to give more support and more money to maintain uh those facilities. This is very important for government because the first step and very important step has been done, but now we need to maintain them at that level. So all this is important and uh to maintain this network, to connect them with uh research institutions, local research institutions, national, international research institutions, because they need to remain in that environment.
SPEAKER_02John, clearly establishing this uh trial infrastructure in DRC was not an easy thing, yeah?
SPEAKER_04Incredibly difficult in for a number of different circumstances. But Wilfrid hits some really great points there about so often big trials in those sort of circumstances are driven from the north for the purpose of getting the results and leave little behind in terms of the the structure in them. I hope we're changing, and certainly I know DNDI, who Wilfred works with, has got a very different model of this. But that that issue of sustainability and creating capacity that's useful to the country are really critical aspects.
SPEAKER_02I know after COVID and some of the role that WHO is trying to have at the global level, and of course TDR is also involved in uh continuing this capacity strengthening. What do you think is the role of international organizations, WHO and TDR and others, to really contribute to this sustained capacity in countries?
SPEAKER_04Look, it's got to be on the top of the agenda of anybody who's driving research now in countries. I can only speak for TDR. I don't want to speak for others, but I think firstly, I'd like to hope that TGR has always been a model for centering on the scientists of the low and middle-income countries. It's its foundation, our board and our governance is based on voices from the South coming into that. But of course, our model has not always reflected that. You know, if we went back 20 years, we would have the model of trying to find people to develop capacity, but pulling them out of their own country, sending them into the north, doing very good degrees, and some of them have done extremely well from that, but leaving very little behind in the countries for continuity in this way. So I think one of the main strategic shifts we've had in recent times is that all of our training now happens in the South, and we invest in building the institution as well as training the individual, because then you have sustainability beyond your immediate fellows in that time. But it's also really important to uh look at where the research agenda is uh set and how we respond to that. And obviously it should be set in the countries, looking at the topics that they have prioritized in this way. So simply flipping to this mindset, not thinking of what we think is for the greater good of the global health, but actually asking countries what they need and trying to respond to that is a second really important point and a really important shift of the way that we fund our research. And part of that is moving a little bit away from the pure specialism that we might have had in the past. Because while, of course, we want a cadre of specialist academic researchers, where many countries are missing research is the power of applying it on the ground and training people who are also practitioners into this space. Again, I think one of the big shifts we've seen over the last few years in TGR is what we've been talking about as democratizing the science. So thinking about the science not just as an academic pursuit, but also as a tool that could really help push forward the agendas of the countries and help them to solve the health issues on the ground themselves. So that means extending beyond universities and academics, working with practitioners and implementers of programs, and one of the more recent successful uh programs has been working with social innovators at a grassroots level, but giving them tools to be able to see whether their innovations are scalable. So getting it out there, making sure we have not only the connection into the south, but the power and the ability to train, to set the priorities, and also to use the research must sit with the countries that need to attack their own health problems.
SPEAKER_02And of course, in the last 50 years, capacities have improved globally when it comes to research and TDR has its role, but the needs also change, hence um these adaptations and kind of engaging other stakeholders who need to be engaged in this enterprise are really critically important, huh? For what I hear from you.
SPEAKER_04Absolutely. And you know, we've really got to understand that we as researchers are only one small piece of the puzzle within countries. And also that if we are as health researchers, we need to look much broader into multisectionality and multisectorality and realize that what we do is part at one level on a one-health basis, but even that is too narrow, it's part of the entire ecosystem within the countries. And I think you hit the nail on the head of this transference because ultimately the ambition, of course, is that the countries themselves drive the capacity development and build the ecosystem within the countries themselves. At the moment, many are not in a position to do that, and so we continue to assist in those ways, but the ultimate goal has got to be for country driven, country built, strong research systems that serve the needs of the countries.
SPEAKER_02So in my conversation with Yasmin, I also asked her about factors. That enabled her journey as a researcher, and also what vision she holds in her now role as the president of Institute Pasteur for the future of capacity building. Let's hear from her.
SPEAKER_01My support was extraordinary beliefs for my family from the get-go. And I think this gave me an energy that I'm still carrying with me, which is this belief in me as a young girl, woman in science, and the belief of my family was incredibly empowering. But I think what we need to do to make sure that we allow talented people, people with passion to grow is to create infrastructures and mentoring support that allow people to overcome certain difficulties that will exist in the context of carriers, especially if you come from uh low to middle income countries. And making sure that you actually maintain this mentorship for a long time, protect people, allow them to actually express their passion, find opportunity for them, allow them to build resilience when needed, give them opportunities. I think it's extremely important to identify talents across the planet and put all our energy to make sure that they reach their full potential. I'm myself a product of TDR vision, about investing in humans, investing in leadership. I truly believe that actually everything will be about investing in human capital and to make sure that we build the leader of tomorrow internationally. No research should be done anywhere on the planet without this in mind, that we need to make sure that we empower local leadership and we actually empower infrastructures locally to develop truly sustainable collaborative research. So my vision is this one, which is the fact that everything needs to be done in a highly respectful way, but also always, always coupled with empowerment of local leadership. Um I think if there is anything I can do over the next few years is hopefully to help in any way again to grow, nurture the leaders of tomorrow internationally. The way we are we will position ourselves is to become truly collaborative. So Bassetur Institute is part of a network of those two institutes. The way we see moving forward is to develop a truly collaborative project where the Bassetors Institute in Paris is one of the collaborators of federating projects. This is really how I see moving forward is the dimension of Basset to me and its strength is the fact that it belongs to this network. It's its identity. We need to actually develop a truly collaborative and federating project where we become all part of one collaborative network. This is really how I've envisioned the future. Um and no longer in a way that is, as it has often been very I'm not sure I should use the word, but neocolonialistic approaches, which is really no, we are part of a network and we will develop mutually uh element that allows us to grow as a community and as a collaborative network. So no project will ever be done unless it is part of a growth that happened as a network. And we are one of them.
SPEAKER_02John, reflecting on some of the thoughts uh from Yasmin and earlier from Wilfred, how do you envision the future with the changes in global health and how we approach various organizations? And going forward, how can we work towards a new vision for capacities in researching countries?
SPEAKER_04Firstly, I very much agree with Yasmin's perspective, and I it's really exciting for the pasteur to be now under leadership and her being able to bring that high-quality science and that experience of countries and networking and very much in in this way. I think the important point she's making there though is for us to let go of our ego and be respecting the needs of the countries we are working with and really pushing hard to make sure that we are building something sustainable and building something that will be with them and owned by them and taken on by them. And in the foreseeable future, we know the world isn't the perfect place we would wish it is, that uh some people are gonna need a real hand with that, but we've got to do this in this respectful manner. We don't have the answers, but we perhaps have some more of the resources. So, really, if we can help answer the questions they're asking, then I'm really optimistic about we push forward. But back again to you've heard it off Wilfred, you've heard it off Yasmin, is it's about the individuals. In the end, we can talk about systems, we can talk about institutions, but building leadership, building vision, and that vision to be from country and really understanding the needs of that country is absolutely critical. I think you know, one of the things that really struck me in in listening to Yasmin and her own story is that you know, sometimes when we're running schemes for for supporting this, we have numbers. And one of the things we like to say within the team at TDR is step back off of the numbers and realize every single number is somebody whose life has been changed by this investment and somebody who has the potential for leadership and real impact in the world of tomorrow. And I find that fantastically exciting. That gets me out of bed in the morning, uh, you know, motivates our team here. And particularly when we have those examples from the past that we can see in front of us. Wilford, Yasmin, many, many other scientists who've come through in this way. We know we're on the right path because we see them. We just need more of them, and we need to be listening very hard to the countries to make sure we're delivering the kind of scientists that they can really use to help them take forward the health agenda.
SPEAKER_02Thanks, John, for those reflections. And it was really great conversation. I learned so much from Wilfred and Yasmin, and I feel that the future is quite hopeful in a way we plan for these kinds of capacity strengthening programs. So really thank you for joining me today. Thanks, Gary. Pleasure to be here. Capacity development is not inventing people, but harnessing their potential, as John reminded us. Low and middle-income countries are filled with talented people who, if given the opportunity, can become impactful leaders. Wilfrid and Yasmin are both remarkable examples of local and global health leadership. Wilfrid highlights the importance of maintaining and sustaining the capacity created through local investment and commitment. Yasmin's vision for the future of research capacity development is one that nurtures true collaboration by respecting the needs and contributions of all involved. Let's hear from another one of our listeners.
SPEAKER_03I have followed Global Health Matters podcast since its launch, and back then I was looking for something to fill a gap. Podcasts are a big part of my day in the global health space. I was really struggling to find something that engaged and enlightened and inspired. And then through Twitter, I came across Global Health Masters, and I felt confident that given the calibre of the post, it potentially was going to be interesting, and I haven't been disappointed. The podcast has quality topics, it's got quality guests, and it really spans a wide range of issues that are on trend and relevant. And I also learned something. And at the end of the day, that's what I want from the podcast to feel that I've really got something out of it, that it's added value to my working day. And I've particularly enjoyed the new dialogue series, and I'm looking forward to what's in store in 2024.
SPEAKER_02Julie, thank you for being such a loyal listener since 2021. Our team is excited to season 4 and the conversations to come. To learn more about the topic discussed in this episode, visit the episode's webpage where you will find additional readings, show notes, and translations. Don't forget to get in touch with us via social media, email, or by sharing a voice message. And be sure to subscribe or follow us wherever you get your podcasts. Global Health Matters is produced by TDR, a United Nations co sponsored research program based at the World Health Organization. Thank you for listening.
