So could you just start by saying your name and your current position?
Yes. So I'm Naomi Campbell, and again, I have two affiliations, actually.
You could say three or four. I'm a professor at the Future of Opera, which is in Colombo in the Department of Immunology and Molecular Medicine.
I'm and because this is obviously about interview with Oxford and COVID,
I'm academic at Oxford and I've been academic at Oxford since 2008 and since last year,
last July, actually, I have also joined Drugs for Neglected Diseases Initiative and I headed the global Dengue programme.
Well, that's a lot of responsibility. That's right.
So going right back to your earliest childhood, really.
Can you tell me a little bit about how you got interested in science? Yes.
So so I am based in Sri Lanka and Sri Lankan, been living in Sri Lanka.
That and I think very interested in animals and biology.
And when I was watching BBC documentaries in all these things in Africa, I have to say that it was not in Sri Lanka.
I watched it because my early childhood, the three years I spent in the UK because my parents came over studies.
So I used to watch these documentaries by BBC about, you know, people going and discovering things.
And that's really, really wanted, you know, I wanted to be a scientist and discover things.
And that had been my aim throughout. And so, so even in Sri Lanka, you know, science in Sri Lanka is not really developed even now.
And my childhood, it was very much underdeveloped. And so there was no opportunity to science.
And anyway, for my A-levels I did biology and entered medical school and became a doctor.
And my still, my dream was to become a scientist.
And I was very much science research at the institute. And after doing my internships in shops, all that, I got the opportunity to,
I got the opportunity to do a in Oxford through a Commonwealth scholarship,
and I did my PhD dphil with him at the whim of the Weatherall Institute for Miller Weatherall Institute of Medicine, I think for him.
Yeah. So that's how I sort of entered science.
And what was the subject of your PhD or your Dphil?
Yeah, it was cutaneous immunology, a tool specifically to tell us as to why this was used to fight us clotting chickenpox.
And I was very much interested in infection and immunity and this and specifically actually to let you know, before I came to do my dphil,
I was very much interested in dengue because when I was an intern of dengue, he had come to Sri Lanka about five years before I was reminded.
But it was a very few cases. But during my internship there were lots of kids getting, you know, having dengue about three deaths.
And so I really wanted to find out why do kids get to visiting and whether people would find a treatment.
And so I started doing studies on data even before coming to Oxford.
And just tell me tell me a little bit more about dengue. What what what is what kind of illness is it?
Well, so it's a mosquito borne virus and it is currently the most fastest evolving emerging white infection in the world.
It's estimated to infect around 390 million people a year, of which one fourth are asymptomatic infections.
So we are talking about about 100 million infections per year.
And these are obvious in the endemic countries, which is near the tropics where you get mosquitoes.
So you wouldn't have dengue in countries like the UK.
And there are many people in the UK, high income countries which are not aware about the devastation I think it causes.
But because people are very much used to COVID, how the hospitals overburdened.
So people understand when you see overburdening of healthcare systems.
Now earlier they wouldn't understand what it meant. So this is what happens every time.
You know, dengue is so so we have to dengue seasons in Sri Lanka now.
So and that's when we have a ridiculous amount of patients sometimes.
And our health systems get overburdened as seen in all developed countries as well during COVID.
And so this has been getting worse every year.
And so when I was doing my internship, it was very scary because we didn't know much about this.
Now we do know and. So the mortality rates are less.
Earlier, when countries initially experienced the mortality rates for like 10%, I mean, that's a 10% mortality.
It is ridiculous.
But now, because we understanding what it is in most countries is less than 0.2% because we don't have a treatment this and no vaccine.
So I was very much intrigued about thinking about viral immunology.
And so this was an excellent opportunity to come to Greenwald's lab and to do a dphil under his supervision.
Okay, So that. So what year did that take you up to?
So you came in 2008, is that right? No, I came in 2004.
Oh, right. Yes. And I did my dphil and had my graduation in early 2008.
And since then, you know, because Graham was wanted to continue working.
And, you know, it was a very interesting area to work on.
So although I worked on chicken pox immunity to chicken pox during my difficult after I got back Sri Lanka,
dengue was a really, really important area given the importance of it.
So and Graham really wanted to work on dengue as well.
So both of us started working and collaborating on dengue.
So when Corbett came Hang on a minute, hang on a minute, we haven't got there yet.
So just tell me a little bit about a bit more about what you were able to do on dengue between all August in 2019.
Yeah, So, so 2008 to 2020. So I'm talking about 12 years, right?
So we did do quite a bit on dengue.
I mean, so basically in dengue y people, some people get severe disease is you have these blood vessels and fluid, they become very permeable.
So sweet leaks out of the blood vessels and the fluid accumulates in your crew cavities, your peritoneal cavities.
And and when fluid leaks, your blood pressure drops. So and then you get hypertension and shock.
So that's a big shock syndrome or I'll actually end the blood supply to our vital organs is diminished.
So you get liver issues and then you write us directing the liver, causing hepatitis as well, a failure, so on.
And also what you call dengue haemorrhagic fever because it causes bleeding.
So you do get this bleeding tendencies. So as I said, it's not everybody who gets this leakage.
So the number one question we wanted to answer was what causes leakage and and why do some people get it?
You know, those two, it simply seem like the most important questions to answer.
And so we we to see to understand what causes leakage.
We looked at T-cells, we were looking at antibodies and we were looking at mediators that specifically cause especially leakage.
And we found it important media to follow basic activating factors.
And for us there was this drug which was widely used even in the UK for chronic earlier added allergies called Uptodate,
which is an anti I mean it you said it has histamine obviously,
but apart from that it had platelet activating factor receptor blocking abilities so we did to treat it
so because you know it was important part of visibility and you had a receptor blocker we thought okay,
let's go ahead and try you to put it in a sophisticated trial.
So we were able to see so the bench to bedside we were able to consider, you seem to think of trials.
And so so we did the first trial in hospital which looks promising and and we got an early signal to say that if you gave it earlier,
it might be more effective. So we've been tied to the second clinical trials,
which we did outpatient so that you could get patients earlier and rather than
waiting for them to be in hospital and and the data was looking quite good,
but we had to stop the trial chart of 31 patients because of COVID.
I see. Right. So we finally arrived at COVID.
So can you I'm asking everybody this. Can you remember when you first heard about what was going on in Newcastle and and how long
it was before you realised this was going to be something that affected the whole world?
Yes. And so so it was in December because as a person working on viruses, you know, you, you keep an eye on these things and so on.
And both my husband and my son were planning to go to China.
My son had never gone and they were planning to go to China Boy's trip in March.
And and when I when I was suspended, I said, you know, I don't think you're going to China.
And they were like, I mean, this is a few cases of pneumonia.
You are overreacting. A typical, you know, like difficult case, you know, death.
And of course we are going with and I said, I don't think you very much this the.
And look good. This looks pretty bad. And this is not looking good at all.
And you see that? That's how it was end of December when things were not looking good.
And, you know, as a part of our collaboration, me and Graham, I visit Oxford once a year, sometimes twice a year.
Graham also comes to Sri Lanka once a year because, you know, apart from the virtual meetings we have, it's always important to meet.
But when you meet, you know, face to face, it's always you can communicate that.
I think. I think, you know, I think we accept that even after COVID,
after we all the success of the virtual world, face to face communication is so much better.
So. So we do we we were meeting twice a year and gram usually comes in January you see
so Graham did come come end of January to Sri Lanka for his annual collaborator
visit and that's when you know UK had reported that he landed UK was reporting the first cases and and the Sri Lanka reported the first COVID patient.
And and you know he's obviously very excited about science and AI.
And so we sort of I remember this we were planning actually not in the lab,
but both of us were like sitting very relaxed casually and thinking, okay, this doesn't sound look good, obviously.
And by end of January, people knew that it was, you know, a bad thing to happen.
And and what should we be looking at? And we were designing all we were deciding on all the things we should be doing.
What should we be looking at? Antibodies, T cells, other things, you know.
But but because, you know, ethics applications can be troublesome.
So we wanted to, you know, to apply from time to time asking for things that hold you back.
Right. So so what do we report, What samples do we need and all that we were planning end of January and yeah,
so that's how how things basically evolved and yeah so it was, it was good that we could have a face to face discussion about COVID in January itself.
And just I think just initial background.
Can you just give me a quick sort of thumbnail of how the COVID epidemic evolved in Sri Lanka itself?
Yes. So just to let you know, so when I look back about how people with affected Sri Lanka,
I mean, obviously COVID affected every all countries and in a bad way,
but I think especially specifically low and middle income countries and low income countries, they were also good sites to meet of of COVID.
And that's might be surprising when I say that's right, but I'll expand myself.
What I mean by that. So when we actually came to Sri Lanka, there were only apart from the private labs which were doing their thing.
So we had like two private labs which would do real time.
PCR There was only one Ministry of Health lab and our university lab which could do realtime PCR cooking.
And so we are talking about this, that sort of facilities and, and we and you know,
the funding, we are very closely working with the clinicians who manage it.
So we have the National Institute of Infectious Diseases in Sri Lanka, which was the Incident Management Centre.
So all that, that is the place we have patients within Yemen.
So all our clinical trials were conducted in this hospital. All our other studies are conducted in these hospitals and we had, you know,
working with this hospital very closely for like ten years, actually more than ten years.
And with the key physicians of the hospital for a very, very long time, even putting on books,
actually even for my Ph.D. And but then when COVID came, that hospital was the first one to be converted to a COVID hospital.
You see, because this and actually it's huge of infectious diseases with previous people, idiot.
And you know, Sri Lanka was under the British rule for a while.
And so and earlier there were several pandemics, you know, like, dude, I'm talking about in the 18th century, 19th century.
So this hospital was built as a quarantine hospital.
So it's not in the heart of Colombo residential area, but it's sort of, you know, in in in an isolated area.
But now, of course, you can notice it in actual area of that.
I know so and because we had this connection and then it became the COVID hospital, people naturally, then, you know, handling their samples,
it's talking from, you know, for diagnostics, basically, you know, they were patients coming in and you needed to do you have to find them, right?
I mean, diagnose. So you were getting all the PCR samples.
We and, and because we got a fix very soon we were getting all the blood samples to look at biomarkers, antibodies and all the T-cells and, and Yeah.
So and with that we were able to our lab you way engage in training many other labs setting setup that we just couldn't be two labs.
That's crazy right.
And so we were involved in a lot of training but at the same time as the, you know, like the Pioneer Lab, we had to be involved in doing lots of PCR.
And we our lab ended up doing a 24 seven service for so many months during the pandemic.
So, I mean, how many samples a day would that represent?
So, so when we started with, we didn't have automated RNA extractors automated, so it was all manual, you see.
And when the when the virus initially. So this is just to be, you know, biosafety level lab to lab.
And so initially people in my life, my students were a little bit scared to handle, you know, I mean, by your working in the hood.
But if the electricity goes, which sometimes happens in Sri Lanka, okay, then then the safety cabinet is not safe anymore using.
So so I was actually inactivating all the samples for the first one and a half months.
So every single sample that came into our lab, I was inactivating it.
But after that, all, all the research, my students, postdocs, assistants,
everybody took over their duties themselves, realising, you know, that's fine.
So, so we were doing this 24/7 service and apart from that, you know, we then we just got the sequence.
So just for you to understand how, how things were in Sri Lanka, we, we had never sequenced white us in Sri Lanka, we had never sequenced.
That's interesting. And now it was coffee was here and you know,
you could be sending samples overseas for sequencing because there were no flights working, you see, So so then off to speak.
And so after pulling a lot of strings in the sense, you know, it was a time that everybody came together and,
you know, you could do things that you that we possible earlier.
So so the Sri Lankan ambassador to Singapore intervened put stuff in the in the flight and sent us sequencing reagents and and all that.
So we managed to actually sequence Sri Lanka the Sri Lankan way.
This is just just for in the beginning in April 2020.
And I think that was a huge achievement given that we had never sequenced the virus in Sri Lanka.
So we did a whole genomic sequencing of SARS-CoV-2 just focussed in in April 2020.
And from that time onwards we did a lot of troubleshooting,
lot of learning because initially a lot of samples we sequenced didn't work actually done, would understand when you're starting a new thing.
But but then they did and you know, the W.H.O. wants 1% of samples sequenced at least so we did manage to.
But by last year, mid-last year we would be like point 5% positivity like the samples sequence.
So and all that sequence in our lab.
So that was quite, quite nice to have the sequencing thing going on as well.
And so and. During this time.
You know, of course, Oxford made vaccines and did all these things.
So I'll come to the work that we did with Oxford.
But people were developing a lot of vaccines and everybody was trying to get hold of vaccines, including Sri Lanka.
And so we did give a huge order to serum institute India for the Oxford vaccine.
It is the same, you know, tetanus vaccine.
But then they were they wanted it for India because of the situation.
So they couldn't give us enough and they want to give us the pain, in other words.
So then Sri Lanka was entertaining Chinese vaccines, the Sinopharm, the Sputnik, trying to get some Pfizer Moderna.
So in the end, Sri Lanka used all of these vaccines with Sinopharm being the predominant vaccine.
And by that time, you know, there was very little even although Sinopharm and Sputnik, we started using this on W.H.O., given EU way by the WTO.
I mean, eventually Sinopharm was going to be the best view of satellite and our data sort of we were working on t cell responses to sinopharm,
the antibody responses that was not published by the manufacturers on the developers themselves and all this work we actually did with also.
So if I actually describe the work from the beginning to the end until now,
the work we did with Oxford, you won't believe the amount of work which we did.
Try me. Try me. Okay, Start at the beginning.
So initially, you know, after Graham left and he managed to leave before the borders closed in the UK.
Lucky for him, he he left with February.
And so we what we initially started looking at antibodies and how,
how these work and if I'm from Oxford we were also having some collaborations with Duke and with Singapore so and the surrogate utilising the test.
They were developing this they sent us and so we were looking at because we do not have B category three or BSL three facilities.
So to do INITIALISING antibody test still we don't have in Sri Lanka, we can't isolate the SARS-CoV-2 because we don't have recently.
That said, but anyway, we were working on antibodies and doing different tests and you know,
because we had been working on things for a long time and people who get to building immune mediated disease,
I mean you react strongly to the virus and you end up getting the cytokine storm, which you get to building.
So and when you look at looked at Kobe in light of April, sort of.
Colby, although we didn't know a lot about what we did look like the same I did.
I mean, you get the virus, but by the time you get all this pneumonia, it was because we were doing repeated.
It looks like when you're sort of getting like when the white e-mail is being cleared,
or at least the values were increasing, you get these complications.
So the initial work we did was comparing the site of files with COVID.
And the reason we did it was to see because apart from the quality,
we had identified several other drug targets for the target and we wanted to look with any of those could work on COVID to understand the differences.
Corbett And then so that was our initial work. And yes, there were certain similarities and differences.
And so we initially published that because these are important things to note.
And then we went on to look at antibodies, how the antibody levels courses, the duration of antibody levels,
the decay, the differences in antibodies in people who have severe cold with mild COVID.
And one important thing in Sri Lanka, because Sri Lanka and usually when pharmaceutical with policy you see so I think you
could never when pharmaceutical and policy activity kind point if I'm not mistaken,
I think we left it too late for that. So it was never going to be possible.
Once they never closed the airports or checked anybody, it was just it got away from us.
So. So Sri Lanka from the beginning had a theoretical I mean, it had a suitable policy for some time and it didn't work.
We realised it did work. By end of 2020. But so we did have no virus, speed it for like three months in the middle of 2020.
But anyway, so there was a lot of community testing and also for people to be discharged from hospital,
you need a tour, two PCR, two days apart, a 24 hours apart.
And also we were getting PCR test from the same patient in 50 days or something to see if this is a real patient, could this person go home?
So we had all these if you know how the virus behaves and everything, you know, and today they will be positive.
Tomorrow they have high viral loads again. So they will go home to some people in hospital for two months.
You see, they're completely fine and they were getting depressed.
Also imagine, I mean, you're stuck in hospital and because of feel countries have to hold a policy back in 2020 of those times,
whether you had an infection like that, you do this or not, if you didn't feel positive, you were in hospital.
So so some people clear the virus very early, but some people were asymptomatic, but they had, you know, persistence, waiting for like.
Two months. Like the picture was positive and then it found that actually the antibody responses were different in these individuals.
And this was interesting. King's interesting developments how?
Because I think other countries, all the high income countries, they had given up on these things, but very early this year.
I mean, so we had this opportunity to look at these things.
And because I was closely working with Grimm and, you know, Oxford had everybody was working with everybody else.
And tell Tell Don West was working.
Yes. So the tail down was very closely working with Grimm to look at T cells.
And she's she's an immunologist as well. Yes. And I had no power because she was she's in the Withdrawal Institute of Molecular Medicine.
And, you know, since my days, I had known her.
So she was working closely with Grimm on T cells, and they were publishing all the data on T cells.
And so Oxford had this source then also joined our collaboration to look at T cells, which we were looking.
So we did that.
So just for the benefit of people who don't have the background, why was it particularly important to look at T cells as opposed to antibodies?
And so because antibodies sort of prevent infection or are I mean,
one of the roles of antibodies is to prevent infection and also they would reduce the severity to some extent.
But as we know now, specifically now with all the variants coming up, the antibodies are not preventing infection very well.
But still, people don't get severe disease if they've especially been vaccinated and had fought with both like hybrid immunity.
Because although the white has changed because you have lots of lots of T-cells targeting various areas of the virus,
the T cells are doing their work and and the antibody can target a virus if it is outside a cell.
But once a virus is inside a cell, the antibodies can sort of access it.
You see it because antibodies outside.
But the T cells actually they are very good at recognising infected cells and and basically deliver signals so that the the cells commit suicide.
So, so, so this is why t cells are very, very important and of course know T cells.
I mean you have different populations like, like in the UK and Sri Lanka if technique wise.
And one of the questions that we wanted to ask at a moment with UK was having quite a bad time with COVID.
But in our studies, at least with the variant that was spreading around, we didn't seem to be getting a lot of severe disease at that point.
But, but it could be transmission differences in transmission as well.
But I'll come across your surveillance studies, which re the transmission I mean, the seropositivity was,
but it could be the weather because it's hot and hot and humid and, you know, ventilation because because it's hot and humid.
We always have our doors and windows open in all the buildings which which we now know that Kuwait is airborne and all.
So I think those things made a huge difference, which people on transmission,
disease, severity and all that, which we didn't realise during the early outbreak.
But anyway, there was all this help.
The British government was doing a lot of things to try and do something about COVID.
And so the British High Commission in Sri Lanka actually approved.
I mean, they contacted me and said, you know, do you have any contacts with the UK and what it is?
And I said, Yeah, I mean, you're working with Oxford, We've been working with a long time.
So then the British High Commission, the Foreign and Commonwealth Office gave us a research grant for, for to, you know, to for collaborative work.
And, and you know, at the beginning of the outbreak for the Foreign and Commonwealth Office to actually help us in back there by it was
because in Sri Lanka we didn't have funds and you see the government was spending its its funds on the control programmes.
Obviously the government of Sri Lanka did not have any funds at all to give for research.
And you know, the threat of the situation that we are using.
So there was absolutely no funds for research and so we were just using some funds which we had here and there,
which was very limited funds and basically we didn't have funds to do this with.
So the Foreign and Commonwealth Office that the Grant research grant we got from the Commonwealth Office in 2020,
like in June 2020 actually was really, really important.
Excuse me. Yeah.
So. But in the meantime, apart from working with Tower.
Then Prosser and Townsend's group presented Townsend himself to his group.
Developed this amazing antibody test. And so.
Which I'm sure you are aware of. Yes, I've interviewed Alan. So he he told me about the test and I very much like to hear it,
and he told me about you using it in Sri Lanka, but I'd like to hear about it from your perspective.
So I saw this antibody test, which you don't need any equipment.
You just need a. Want to get your blood and you can do it.
And it was very, very easy to do and very easy to interpret.
So and so Graham put us in touch with Professor Townsend.
And so evolvement of brain confidence.
I mean, they sent us the first reagents for the Wuhan variant, which we used to do a field survey in, in, in Colombo.
So the community based service was about to get a survey.
So it was the Colombo Security Council, which had the highest number of COVID cases.
We didn't actually have cases in the rural areas by the end of 2020, not much,
not much of cases in rural areas because of travel restrictions between districts, you know, suitable with policy and all that.
But when we did a pseudo survey in 2020 in the Colombo Montagu difficulty, we found that 25% had been exposed to COVID, you see.
And so and we compared these the neutralising how to get neutralising antibody tests developed by you can use with with the Townsend's.
I see. And it worked. I mean, it was, you know, sort of the same.
And the similarities and plus, the town obviously is like very cheap to use and, you know, but easy to do and ideal for countries like ours.
It was a life saver and and and research wise.
So then they developed other. Apart from looking at the antibodies to the initial, you know, variant,
of course then we got alpha, beta, delta gamma, you know, you know, I mean all that.
So they managed to develop reagents to look at antibodies specifically for these different variants.
And so after. And so by end of 2020, December 2020, you know that.
And the Pfizer vaccine was already registered. AstraZeneca was immediately registered.
And so this was a still people were not very sure because there was apart from the trials data and trials done very fast,
even in the scientific community and in the medical community, people were like, okay, do we have enough data?
How how if this and we didn't have real world data and there were a lot of questions like,
okay, and in Sri Lanka, we we didn't get the AstraZeneca vaccine initially.
We was the Serum Institute vaccine, which is the same of course.
But again, people were like, okay, there is no data of the vaccine developed in tiramisu.
After all, it's a different vaccine manufacturer that was selected.
How is the immunogenicity, all that? So then we we were very much involved in doing the initial immunogenicity studies for the the COVAXIN,
which is the Serum Institute vaccine in human trials is not a trial.
It is actually real world deployment.
Yes. Right. Yes. Yes.
So so as all these vaccines were approved by the national regulator and and in the national regulator to assess these vaccines, I mean,
because they had they had to be people who knew about vaccines because these were not like W.H.O., who are, you know, like not approved as such.
So you had to sort of countries have to assess the data themselves. So I was also in the vaccine regulator.
So I was in the committee that approved COVID vaccines.
So I actually received all the dossiers, confidential dossiers of all these.
So not just the published data, but the actual vaccine, you know, like huge five dossiers.
And so by that time I realised, you know, we have to do these studies ourselves to look at the immunogenicity.
And as in all countries, the vaccines were initially given to healthcare workers.
So we looked at this Serum Institute's head of vaccine in Healthcare Workers.
So we initially started giving the vaccine on 29th of January 2021 in Sri Lanka.
So from that day, so we immediately got a large cohort of healthcare workers, actually 2200, and did immunogenicity study.
So the first study was published in Nature Communications.
So how long after the vaccination did you look at it?
One month after three months, after then six months and so on.
So we did. So we did that for just mutagenesis studies.
The initial one was one month after because that data,
what people wanted that data and also in that paper we looked at data for the T cell responses and so on.
And in Sri Lanka. So we did get this vaccine from Serum Institute.
And so the healthcare workers were given and then subsequently other people were given.
And so there was an issue with the second dose.
Now, there were not enough vaccines for the second dose, you see, and there was no other vaccine for the second dose.
I know I know that you can mix and match,
but for us to even mix and match with all the all the doses that you want to know, there were no second doses.
And and initially, you see it was the time death was supposed to be four weeks, then it was eight weeks to a week.
Then ultimately and and here we were at the time of fighting and no vaccines and there was no data for like if you give the vaccine at 16 weeks worth,
as this time did, the immunogenicity change like so?
And how did the immunogenicity immune responses to different variants.
When you prolong the time gap between the vaccines, I mean, from from the Oxford vaccine data, what they showed was the gap was increased.
Yes, the immune responses were better.
But but for the Wuhan, the initial variant at that time, like might be coming up to May 2021, we had all these things alpha, beta, gamma and delta.
Right? So, so and the council, it had developed all these variants.
It was available to us. We were then looking at antibodies for all these different variants in AstraZeneca, 12 weeks worth for 16 weeks.
And so and that was important data.
And, and in the meantime, we were also had the sinopharm brought over and again,
there was no data for any variants, very limited T data on t cell functionality of,
you know, like just like the frequency or the magnitude, but apart Formula T cells produced in these do they do all these other functions.
So and along with the tell tale and tell us even while in all the cases studies which we did for vaccines and even for Sputnik,
there was very limited data published. So we also looked for these t cell data for the functionality of T cell responses.
Again, antibodies of the question a lot of people wanted, the general public wanted was that antibody responses for different variants because by mid,
you know, like June, July 2021, that's after what was happening in India with the Delta and Delta heading into treatment.
That that was one of the questions people really wanted to know.
So and so we were covering all the T cells, antibodies for all these different vaccines.
And then subsequently, you know, different countries were using different vaccines.
And in Sri Lanka specifically, you know, things were getting I mean, there was a lot of political piece to these things.
And, you know, and a lot of people were like, look, if majority of Sri Lankans are given sinopharm, why can't we get Pfizer?
Why can't we get you know, the healthcare workers were given AstraZeneca.
Everybody else is giving inferior with Chinese people.
You can you could and you could understand how how how it would have gone, how it went right and and how the media also.
So so you needed a head to head comparison.
I mean, each each of the vaccine studies would be reporting look at the efficacy data with this much this much.
But you can't compare like that between like the immune responses of between different studies done in different countries.
So we had this golden opportunity. I mean, it is the same population of Sri Lankan population of it's heterogeneous but
still is the Sri Lankan population and it is one lab doing all these essays.
And so so we did a time series of four weeks, three months, six months.
Of all these vaccines at the same time point.
And we did a head to head comparison and and yeah, so that data is, I believe,
useful for everybody because it's there's very much consistency between assays
because it's the same lab so and yeah so so it was it was comparing Moderna,
AstraZeneca, Sputnik, the Sinopharm and also the Sputnik.
Again, we got first doses, but we didn't get second doses. And then Russia said that actually you don't need a second dose.
They are actually using one in one dose and the one dose vaccine is marketed as looking great.
So then we looked at people immune responses, time series of people who had received two doses of the specific vaccine with us.
One because they said it's enough, but they didn't have any data to show was to say okay is the same number seen at all you know suffice I you Yeah.
So what what were the what were the results of your comparisons.
I mean the one dose of Sputnik induce fileless antibody responses and t cell responses like longitudinally and at different time points.
Then the two doses of the Sputnik vaccine, which I don't think Jesus Christ.
And what about the other comparisons between the other. Yeah.
So the others are the comparisons are actually the Moderna gave the highest antibody responses,
Sputnik and AstraZeneca and the two Adenoviral vector vaccines in people who had received
two doses had equally followed by Sputnik one dose followed by two doses of sinopharm.
Yeah. So I saw it look like the Sinopharm was not inducing adequate antibody responses.
But what was interesting is, you know, then they'll be protected, right?
Sorry, I didn't hear what you said. Yes, yes, yes.
And it was causing havoc in all these countries.
And everybody was very scared, I mean, because it was so transmissible and, you know, again, increasing hospitalisations either.
So we got the big one just for a tiny bit because we then got a two and we got to empty them.
But strangely, our hospitalisations were not that high.
And our mortgage rates because duty does really crazy and our hospitalisations and deaths were not I mean,
it was not bad in the sense of during the outbreak we had around in the height of the the Delta outbreak, we had like 200, 220 deaths per day.
But that to me, chronic was like a ten, which is, you know, so much less.
And so and people expected more people to like that not to be the case especially given that the Chinese vaccine but was,
you know, possibly not more immunogenic.
But what what sort of cover it excuse me what sort of coverage of the population had you managed to achieve by then?
So it's like this. So the vulnerable population had been vaccinated.
So we did we do have a anti-vax movement, but it is not at all as strong as what you're seeing in the West.
So so because of that, all the vulnerable people were immunised except a few people.
And in January 2022 we got the booster doses rolled out as well.
So we did have like 18% of the population boosted by much, but it was the people who needed it.
And and also of sinopharm.
You know, as soon as people got sinopharm, they also got a Delta infection.
So, so sinopharm worked in that way in the sense although it might have what we see in China right now, fine.
So I mean, they had sinopharm, but they're getting infection long after they were they were vaccinated.
So then the immunity would have been and they're having issues.
But in Sri Lanka, you know, one month after getting fully vaccinated, you got infection and,
you know, one month after you are fully vaccinated, that vaccine would hold,
you see, and then you get very strong immunity because actually you get two doses of the vaccine and a third dose, the infection at a third dose.
So so I think that that contributed a lot to how how then when we came back, we didn't have a huge issue in Sri Lanka.
And yeah, so as of now we are having a.
Almost all the weddings here in Sri Lanka.
But we are not doing a lot of testing because I'm sure you are aware that we are having an economic crisis.
So we don't have a lot of discussion about that. But at the same time, we do not have patients.
You know, our hospitals filled with lots of patients with with COVID, the patients who do have pneumonia and going to hospital.
The the vast majority have influenza.
And in 2022 we had about three times more hospitalisations funding you than quoted.
So just coming back to the big story and that has been so many when you speak to other countries on the equator,
wow, you have a hot, humid climate throughout and that leads to a lack of ventilation because,
I mean,
you can be putting air conditioning all the time in a lot of places don't have air conditioning because you open your doors and windows you find.
Right. So and you have the fans going on that.
So I think that actually really helps in reducing transmission because our schools are designed like that.
They don't have windows, actually. That also is where most of the schools are like that.
All hospitals are like that. You see all the windows and everything are open all the time.
Which I think in in those environments and most of the offices are like that.
So I think. And but but of course the problem of dengue is death in a big way.
And so that's why I said as far as Sri Lanka is concerned, for 2022, we had four,
three times more hospital admissions, at least a dinghy that then floated.
Okay. So your experience with COVID, what kind of impact has that had on your dengue work, if at all?
Oh, yes. So.
So it is slightly so, of course, in 2020 and 2021, because of the scale of work we were doing, apart from doing the research that I described before,
looking at sequencing, looking at different variants, immunogenicity of these vaccines going out and getting the samples and all that.
I mean, that's a that's a lot of time that we were also running a diagnostic lab for PCR.
Right. You had me and we were offering antigen tests. We were offering. So, so we were doing all that.
And we don't it's not like we have a huge staff. So there was no opportunity to do much dengue research in 2020 and 2021.
However, luckily for us and rest of the didn't countries, we didn't have much dengue at all in both years.
Now you will ask me why not? I mean, it's a mosquito borne infection.
And did the mosquitoes disappear and. No, they did not.
So this this was surprising because we have collaborations ongoing with our heads who has a large both in Nicaragua and also in Latin America.
And when we were speaking to our colleagues in other Asian countries, I mean,
they think he had disappeared and people weren't in the sense it was a really low number of cases.
They were they were basically and it's not the patients were not coming to hospital because if they didn't,
we would have more than 10% mortality, you see. So and we saw that people were coming.
So we were really confused and maybe what we did was so I told you, you know, we had three months of COVID free period in 2020.
So then we opened our schools. Then we got dengue again.
We school, then we got Kobe closed our schools. Dengue event.
So it looks like these social distancing restrictions had a greater effect on daily than COVID.
Which is very surprising. But I think you see, if you get a school environment,
the kids are sitting close together and you have one mosquito biting a kid and there are lots of legs very close by.
The mosquito bite, the mosquito doesn't have to travel, you know, like 100, 200 metres and and bite another one.
And then, you know, so it's easy to jump for the mosquito.
So social distancing made it difficult for the mosquito.
And so we didn't have a patient.
So this is this is why we because our work is very much dependent on getting patient samples,
because we've always been working on four samples because we have enough and more patients with dengue.
And so there were not many dengue patients in both.
So, you know, we're here so we could be concentrated on COVID.
And it's only in 2022 that we started working on dengue again.
So we did basically do much with funding in the two years.
Hmm. Now, I'm just wondering whether the level of international collaboration, different sources of funding,
what you learnt about how the immune response works, whether any of that will feed into research that you do in the future on dengue?
There's no doubt about it, absolutely. So because there are a lot of similarities and differences between didn't concur with us and just to, you know,
because I've been working on both know to get to clear my head, you know, you have to clear your head first to generate research ideas and to think.
So me and Graham, I wrote this review article on compare the comparison of dengue in COVID because a lot of similarities in the T cell responses,
even pathogenesis and so on between dengue in Hawaii.
But but actually, when I wrote that review article, one thing I realised we had been there for two years for a ridiculous amount of years,
about 30 or 40, 50 years, that there were so much less work done on dengue then forward.
And that was that was, I think, shocking.
You see, I mean, and the differences because of lack of funding for dengue, not because dengue costs less disease severity,
but just because there is less funding for dengue and and presumably because COVID affected people in high income countries.
High income countries. Because because right now I told you in in many countries, the case fatality rates are less than 0.2%.
But in India, I mean, something like 2.6% at best, large mortality rate.
And in some Asian countries, it's like 15.5%.
And if you look at the current COVID mortality rates, it's less than point 1%, you see.
So it's very much less than point 1% we are talking about.
And so and we have so many different COVID vaccines.
So we do have drugs for it. But still, there's a lot of drug development happening for four weeks.
And but but when you speak to somebody about the non-availability of drugs for dengue, people would be like,
but what about what about the Wolbachia project that's going to control the Wolbachia mosquito project, which is targeting vectors?
Oh, yes, yes, yes, yes. So don't we have that? I mean, I mean, that's like having social distancing for [INAUDIBLE].
That's one measure, but that can't be the only missions. And of course, Takeda has developed a dengue vaccine which applies to face trials.
Sorry, what was the name of the company again? EDA. Takeda?
Takeda. Yeah, yeah, yeah. Have you seen It has been approved in Indonesia and it has been given approval
by the European Medical Association and it's looking at approval in Asia.
And again, if people would be like, but don't you, like, have a promising dengue vaccine?
Why would you want to have drugs for dengue?
And that's like asking, you know, you have so many different vaccines for COVID, why would you want to have drugs for it?
And if you are somebody that like despite you do, bye, you will do need drugs for coolie.
People don't think you're mad. I mean, why are you even asking that question right now?
For dengue, you have just one vaccine which has the same efficacy as a cold vaccine, mind you.
Okay. So the theory that any vaccine is good.
But if it doesn't prevent infection, it's not like a measles vaccine and it reduces hospitalisation in about 80%.
Okay. So basically the same. Because he will be backseats.
And so which means people are still going to get dinghy and all of that and and we don't know
the duration of immunity that is going to hold because it's and we have to provide assistance.
So but still, people would ask why would you want a dinghy now?
And you have all these things and that just shows you don't know how hospitals are overloaded.
Healthcare systems are burdened with dengue and and how dengue affects kidnapped mothers.
And just to let you know, in 2017, when when Sri Lanka had the largest outbreak, similar to Colgate,
if if dengue affects pregnant women, they're very much more likely to get sick and die off.
Then you see. And in 2017, the number one cause of maternal mortality girl was dengue.
And that that's that's scary.
And and there was this large study done in Brazil which showed that if you compare a non-pregnant female versus a pregnant female,
the chances of dying when you get dengue haemorrhagic fever was 450 times more if you're pregnant.
Okay. So so so and and people with pregnant women get thank you all the time because we
have increasing each year the number of dengue is increasing with climate change.
You see with global warming, the vector densities increase and all of that.
So so that's really impacting pregnancy we have.
And also people with co-morbidities, people who have diabetes,
obesity for get are likely to have severe COVID, but they're also more likely to get severe.
So so the risk factors are sort of similar.
And we know that in most parts of the world, even in low middle income countries,
you have a double burden of disease, the infectious diseases and all these diabetes obesity issues.
And Sri Lanka and many endemic countries have this the same situation.
So the dengue thing has got worse because now you have the population of developing severe diseases is more because of this obesity diabetes thing.
So. So there's a lot of angles to look at.
Thank you. And so I'm really happy also to be working at Drug for Neglected Diseases Initiative.
So realising all these issues with dengue and that dengue affects the neglected population,
it's not just a neglected diseases effects a neglected population, which is the Olympics.
They have to the thing in the portfolio in 2021 and they recruited me as the head of dengue in July.
And so the idea is to actually learning from experience, from COVID,
where the initial thing was to repurpose drugs, etc., so that you can move faster.
But at the same time learning from quoted, you have to do a lot of pre-clinical testing so that you don't waste drugs in clinical trials.
So to proper treating for testing before you move on the trials, learning from all that the India is moving ahead with this lab,
the dengue strategy of discovering a treatment solution for the needs and how it's done is by forming this alliance,
which is in a lot of research institutions of lower middle income countries coming together to develop treatment for something that facing themselves,
which is dengue. So that.
So this alliance is formed by partners from in Malaysia Mahidol University Thailand STI which is the translation have is Duke
from New Delhi Fiocruz and you have them from Brazil which which are the endemic countries and also part of this alliance.
So we have a pre-clinical working group which works on the pre-clinical clock
of it being log antibiotic testing and drugs that affect the immune system.
And we have also initiated the clinical working group.
There are people with the know we are looking at clinical trial design and all that with the clinicians,
dengue experts from from these countries so that we find what sort of endpoints are we looking at, how should we design our trials?
So we are talking with drug repurposing because it's fostered by the same time we
are very much open to people like industry who might be because some industry
partners already do have some antivirals that they would like to collaborate and
actually work with the Olympics and with the alliance to take the drugs forward.
So. So do you think that the extra collaboration that went on internationally?
During COVID has helped to give some impetus to the development of this new institute and encouraged us to stay together.
The reason why I think maybe we are alive today because this I think it's difficult to find people who haven't got COVID by now.
It is. Well, it seems when I got with, I had two doses of AstraZeneca and one dose of Pfizer got into me.
So when I got cold, it was pretty mild. But it wouldn't have been the case if if probably if I hadn't been vaccinated.
And the reason why we have all these vaccines and drugs is because of these international collaborations, people actually coming together,
putting their differences aside and working for a cause, which is, you know, let's all of us get out of this alive, the sort of thing.
I think that that was what brought people together. I mean, let's get out of this alive.
Either we get all of us get out alive.
I mean, it's not going to be one or two people for any infectious disease if is going to be one or two people who are going to just you know,
you can't close borders and stop infectious diseases.
So. So and, you know, it worked for people were sharing their data, people working together and, you know, ironing out a lot of differences.
And it was so beautiful to see how how everybody was just working together and the ability that actually,
you know, the world is not a bad face after all.
But what we make it to be, people are actually nice people and people like to work together and work for a good cause.
So I think that actually is very inspiring and this is a very inspiring for the alliance that is there for find the freedom,
the solution for doing it.
And I think when a lot of people come together, something is likely to be more successful than individuals working in isolation.
So so I'm quite hopeful that I mean, obviously that's going to be failures because we know that science is very high, risky.
I mean, most of the time that are failures then things going right.
I mean, 90% of failures and I mean more than 90%.
So I would say 95% of failures and 5% success in any science project.
And so. So I think but given those risks, which I think everybody who works in science accepts,
it is very promising that when people come together, you achieve much, much more and much faster than working in isolation.
Mm hmm. So let me just ask you a couple of questions about how working through the pandemic impacted on you,
and particularly as Sri Lanka had this zero-covid policy, how did the restrictions impact on what you were able to do or how you were able to work?
Yes. So the Sri Lanka had a policy in 2020 and 2021.
They gave up that idea. Yes, yes, yes. It became obvious that, you know, it's not going to happen.
So it didn't impact my work because, you see, we were the the PCR lab, the doing the things for the Multiplicity Council and all that.
And we were doing the sequencing and all this so.
So we were doing a 24/7 service which meant that we will open like seven days, 24 hours.
So, so you were, you were excluded. I mean, you didn't have to observe these.
No, no, no. Because actually, I went to work on seven days, which sounds a little bit sad.
And what kind of how many hours in the day were you doing yourself?
Yes. So. So it was like I was on the site, at least, you know, 12 hours a day, but remotely even longer.
And and also, apart from the research work I was doing, I was as I said,
I was in the National Medical Regulatory Expert group with vaccines, evaluating all these vaccines.
Then I was in all these Ministry of Health committees, which were looking at all these diagnostics of,
you know, guideline committees, you know, then then put to put out rules.
You know, they they there were a lot of, you know, all these. So I was I was in all that.
And apart from that. I had something I didn't enjoy with the media presence.
So I was also put in the frontline of media, which which was actually done by the Ministry of Health,
because me coming from a university background, I think I had the ability to explain things.
Maybe you do.
And also because I was not in the Ministry of Health and I was sort of outsider and a researcher up there was people maybe tend to believe me more,
but I see. I don't know. But but, you know, when you get into media, there are good size and bad sides.
And you would have known that a lot of scientists who were in media, but it was both so and so.
I was on media a lot and I was doing a lot of webinars and a lot of, you know,
a lot of updates for doctors about various, you know, why are we doing it this way?
And I mean, in 2021, September to November, I was doing like three webinars per week.
And so so we are talking about a huge amount of webinars, student talks, public talks.
So it was a huge amount of work.
And when I look back at and just wondering what I would not want to repeat now, but how did you feel about it at the time?
I mean, I've asked other people this and some people say that the excitement and adrenaline just carried them through
and other people found it awful and terribly stressful and needed to find ways to support their wellbeing.
Where would you say you fell on? I mean, the excitement, the excitement of the research,
because the research was very exciting and and more than more than just the research being exciting,
you know, you knew that you were doing something which was very important to Sri Lanka, you see.
I mean, if you didn't step in, then, you know, you had to step in.
I mean, you felt like you were doing something.
You were a very bad person. If you didn't do that, like, I would like like, like now, if I didn't do that in 20,
20, 2021, how I would be feeling about myself, that I was a really bad person.
And it matters to me that I feel that I'm not a bad person, you see,
because the impression you have about yourself is the most important question, I would say.
So I would not could not live with myself if I didn't do all that, that I could have helped.
But I didn't start off feeling so and so because everybody needed help.
I thought I had to help. And if I didn't, I was being a really, really bad person.
So. So the fact that I was doing good and because then that that really this despite I was talking about the media,
despite, you know, sometimes backlash over that and, you know, social media and so on still,
because I was doing something good and I was helping and I would not be able to live with myself if I didn't, it was okay.
Yeah. And were you able to take any time to do anything for yourself?
I mean, just go for walks or do some yoga or so that was the good part of it.
Again, I mean, when the restrictions were lifted, I did go running and stuff and yeah,
and so but when the restrictions of from time to time when restrictions were lifted, I did all that.
But I did gain weight, I would say which, which I have managed to finally get off now.
Yeah. Yeah. Right.
I think, I think we've covered everything. It's been wonderful. Thank you.
So. Yeah.
So this is the final question. Has the experience of working through the pandemic changed your attitude or your approach to your work?
And is there anything you'd like to see change in the future? Yeah I think it very much I would say, because as I told you in Sri Lanka,
we had never sequenced a virus before a whole genome sequencing and just started doing that and doing it.
And that's clear. That gave the confidence that I mean,
if you want to use you could you see and and all all the other work that we did and the need for able to generate a lot of funding,
the things that we got after the British High Commission gave us funding and we
started off work and we've actually very visible and actually delivering results.
Then the W.H.O. gave us funds, the Sri Lankan office,
and they continue to support us in a big with the WTO, Sri Lanka and then the World Bank gave us funds.
So. So and then you understand that actually if you can work, you do get funding in the end.
And and if you want to do something and if you put your mind to it, actually you can I mean, you give it you give a lot of confidence.
Yeah. I decided to do it and I think I'm going to do that.
And then. Yeah. That's great.
Thanks so much. I'm going to.