Sunday, July 14, 2013

Working from home (as published in The Kathmandu Post, 9th July 2013)

(KTM Post link for this article is here:

Experts working in different fields interpret the phrase ‘public health research’ in different ways. Whatever the interpretation, ultimately, everyone would agree that research is ideally carried out to generate data that can then be used as evidence to answer various queries or hypotheses set out prior to initiating the research activities. In Nepal, there is a positive trend towards public health research activities. This is evident in terms of the various sectors’ involvement, publications, workshops and discussion forums in this area around the country. The nongovernmental sector appears to be the strongest in non-laboratory based research (such as formative, implementation, social, intervention) while private and public organisations have a stronger base in clinical, biomedical (lab-based), case-study and similar researches. There is an increasing trend of clinicians who want to pursue research as part of their development and embark on an otherwise traditionally ignored (at least in Nepal) area of biomedical research. Since hospitals have access to human samples, it allows those working in such settings to carry out biomedical research while trying to answer various questions pertinent to microbial pathogenesis (the ways in which a bacteria, virus, parasite or other pathogen interact with the human body to cause disease).

Biomedical research is the modern approach to public health research. The reason being, personal (non-communicable) and pathogen genetics interact in all infectious (communicable) disease settings. As a result, controlling disease in the modern perspective is not just about medication that controls the symptoms and destroys the pathogen. It is also about enhancing the human immune system and destroying the ability of the pathogen to harm humans. In the case of non-communicable diseases such as cancer, biomedical research is about improving human genetics so that genes that are detrimental to health are either destroyed or rendered harmless while those that are required for health are allowed to perform at optimal levels. This is only possible if we understand human immunity (our body’s ability to fight off disease) and molecular epidemiology (DNA/RNA level understanding) of all human-pathogen interactions—the approach for both is lab based/ biomedical research using the tools of microbiology, immunology, molecular biology, and if we wish to combine all the fields, biotechnology.

In Nepal, there are organisations that are gradually carrying out basic biomedical research in the public health arena. Interestingly, the government, private and nongovernmental sectors are all realising its importance. As a result, we are now more knowledgeable about HIV, TB, hepatitis, typhoid, malaria and Japanese encephalitis in the communicable disease arena while inroads are being made into cancer, cardiac and diabetes research. While this is a reason for the general public to be excited, there is a darker side to recent advances in this area.

Traditionally, in the absence of proper laboratory facilities in the country, samples used to be sent to India and Thailand for basic diagnostic tests. This practice is still in effect today, in spite of advanced facilities available in the country. The problem has now been further compounded by bio-piracy, where individuals involved in public health research send samples to labs in developed countries on the pretext of research.
The process of bio-piracy is simple. Researchers/research organisations (usually from developed countries) with an active interest in accessing genetic material from humans in developing countries contact public health professionals with access to such samples in Nepal. They are then offered free testing for the samples in overseas labs, along with offers of any publication arising from the work. Furthermore, in many instances, they are also offered basic funds for field activities leading to the acquisition of samples and sometimes, even travel to foreign countries for conferences and training. For a typical researcher in Nepal, this is a big incentive. However, what they either don’t realise or care about is that the sample they send overseas can be used for lab research that can lead to, but is not limited to, vaccine development worth billions of dollars. Neither they nor the country benefits from this.
A clear example of this was in the recent case of cholera samples from Nepal sent to the International Vaccine Institute (IVI) in South Korea for apparent genetic tests, only to be used as further evidence to implicate Nepali UN soldiers stationed in Haiti during the 2011 Haiti cholera outbreak. All this was carried out in a secret manner, without control mechanisms in place and without consulting health research professionals about the consequences of such actions. If those samples are now used for vaccine development against cholera, will the country be informed?
The transport of samples to overseas facilities is understandable if, and only if, facilities are either not available in the country or if samples are being sent only for validation purposes. However, there can be no justification for samples from the Nepali population being sent overseas for diagnostic or research purposes if such labs are present in the country. There needs to be a stringent requirement for all diagnostic and research personnel to prioritise intra-country collaboration.

The Nepal Health Research Council under the Ministry of Health and Population should take the lead in controlling such bio-piracy resulting from future disease diagnostics and biomedical research. Let us first empower the internal capacity of the country by way of collaboration and sharing of internal resources at the front end of any research. This will make us more self-reliant and capable of higher level research in the country, similar to measures adopted by India, Vietnam and Indonesia. Only then should we consider sharing our samples as part of an active collaboration with our international friends for the back end research. If they are truly our well-wishers, they will, and should, understand this and support the Nepali research fraternity. Nepal should not be a supplier of samples, rather it should be a supplier of research findings resulting from research within
the country.

Dixit is a biomedical public health research scientist and country director for the Center for Molecular Dynamics Nepal, Kathmandu
Posted on: 2013-07-09 09:34