Faith Osier: Make malaria history through vaccination
Malaria is a big problem in Africa, but individuals who get repeatedly infected become resistant. As technology improves, we can measure more parameters and better understand how people become immune to malaria. A protein microarray can help us understand the immune response to malaria, paving the way for a vaccine.
My name is Faith Osier, I’m Kenyan, I work on malaria. I have two labs, one in Kenya at the KEMRI Wellcome Trust Research Programme, and one in Germany at Heidelberg University Hospital. We try to understand how we can make better malaria vaccine, because it is still a big problem for Africa, but the exciting thing is that, if you get infected by malaria repeatedly, you eventually become resistant to it. You can have the infection, but it doesn’t make you ill. In Africa, it plays out that little kids, little children, they get really sick and they can die from malaria, but the adults are resistant. They get the infection and it doesn’t bother their bodies. We try to understand how this happens so that we can make vaccines that will then protect the little kids. That’s mostly true for falciparum malaria, and to a lesser extent for the other malarias. Falciparum is the highest and the most common type that we have in Africa and that what all my work focuses on.
As a junior doctor, I got interested in malaria when I went to work as an intern. I ended up at the coast of Kenya – lovely! I came from the capital city, Nairobi, it seemed so romantic to go and work at the coast. I thought at the end of a busy day, I would be strolling on the beach, but it did not quite work that way. Once I finishes there, then you are posted to a district hospital, so you are going away further in land, away from the city, and I ended up in Kilifi County Hospital, and that’s where I found people who were doing research on malaria. I was working on the ward, and there were lots of patients with malaria. I could admit five children a night with severe, life threatening malaria. It was surprising to me that this is a treatable disease, we are still seeing lots of patients with the disease. Then there were people researching the disease who seemed really clever. I couldn’t figure out, if you are so clever, why can’t you just fix it? And that’s how I got drawn into studying it myself.
Malaria is difficult to solve because it is a complex parasite. It’s big, it exists in your body in multiple forms, and it goes into different parts of your body. The question that I found the researchers asking was how people become immune to malaria. I couldn’t understand why they seemed to ask the same question over and over again. But as I got into the research, I began to understand. When you are trying to measure what makes you and I immune, in the lab you can measure one thing, two things. As time has grown, you can measure hundreds of things, even thousands of things. From the time that we started, the few things that we could measure, they fitted a puzzle, a corner of puzzle. Then the more things you can measure, as technology gets better, you add more pieces to your puzzle. And that’s what I think is happening with us understanding immunity. The parasite is complex, we are complex, and we are trying to fit that puzzle together. We are some way to completing the full puzzle, and that’s why we don’t have a vaccine yet.
Two things drew me into moving from a doctor to becoming a vaccinologist, and I didn’t realise them at the same time. But the first one is when you are a doctor, you can see you are really limited by your physical body, the number of patients you can see in a day. Even if you think you are a superhero, within a day you are going to see the number of patients you can see and you are going to drop down, exhausted. As a doctor, your impact is defined really by your physical limits. But as I’ve done research, it’s been so much more exciting because now you lead teams of people, it’s like multiplying yourself. What I could do in one day, now I do thirty times that in one day, because I’ve got all those people working on different aspects. If you think about it in the sense that if I treat you for malaria today, good for you, you go home, but there are hundreds where you came from that would also need the treatment and need the doctors. If I could make a vaccine, well, that would get rid of the problem, save the doctor’s time for something else and save people’s lives. That’s why I’m keen on vaccines.
In my line of research, I think it’s become really interesting in the last decade. That’s because of increased development in technology. When I started to do this work just over ten years ago, we knew so little about the parasite at the molecular level. How many proteins are there in this parasite? What do they look like, how do they change over time? We didn’t know that. But in the course of doing my research, technology has advanced, so that now we know that in detail not for one parasite but for many malaria parasites. That’s been fascinating because you can understand how big your puzzle is in a better way than you could, when you only knew a few things. I think that’s been fantastic. And then also on the immunology side, understanding how our bodies work, technology has advanced so much. I used to measure your antibodies, how you respond to the parasite, one protein at the time. Now I do 400 proteins in a single experiment. And then, now I have a new challenge: how do I analyse that data quickly enough to see which are the important responses that I am making. It’s a really exciting time and I feel very optimistic that we are making a progress in the right direction.
I am optimistic that we can have a vaccine in 5, 10 or 15 years. I think that as a community of scientists, we’ve not understood the magic that would give us a vaccine. But a lot of science happens by serendipity. I am a strong believer that even though we can’t see the direction exactly, we must keep working. And that moment of ‘Aha’, we will find it on the bench, doing what we do.
We have already developed a tool, it’s a chip, we call it KILchip. It’s a protein microarray that’s got parasite proteins stuck on it. If I have a blood sample from you, I can run it on my chip, and I can tell you what your response to malaria was. That is becoming an incredibly useful tool for us to try and understand the immune response, and work out what might be good for a vaccine and what might not be good for a vaccine. To me, that’s already translational: we’re using it in studies where we have volunteers who are infected with malaria, and we are studying their immune response using that chip, for falciparum, and we are making one for Plasmodium vivax now. The ultimate translation would be bringing a vaccine to the clinic, and that’s where we really want to go.
I think that the world should put a lot more money into malaria research, because it has a huge impact on millions of people. When you do the maths, and this was done some years ago, it was estimated that if you add up all the costs of people going to clinic, laying at home, slow at school, all the problems that result because of malaria, this costs Africa 12.5 billion US dollars every year. Africa needs all the money it can get for all sorts of other things, let alone malaria. If we could get rid of malaria, I think we could move Africa towards the sustainable development goal of good health, well-being and economic prosperity.
This interview was recorded in September 2019