Philip Bejon: KEMRI Wellcome Trust Research Programme

The KEMRI Wellcome Trust Research Programme has been in existence since 1989. It is a partnership between KEMRI, Wellcome and Oxford University. Our work is focused on healthcare and medical research. We are based in Kilifi on the Kenyan coast, in Nairobi and in Mbale which is in eastern Uganda. Our work covers a range of different areas of science; I can talk about 5 main scientific themes.

Vaccination is one of our main themes. It’s an incredibly important area for human health, probably second only to clean water and sanitation. We work on vaccines from the very early stages of development, where we do studies designed to identify the immune responses in people that we want to reproduce by vaccines, therefore feeding into vaccine design, through testing new vaccines, all the way to surveillance on established vaccines to determine how they should be best used and to calculate their cost effectiveness.

Examples of vaccines we’ve worked on include Ebola vaccines, where we were one of the sites that was able to very quickly do a phase I study to show the immune response and safety of the vaccine before it was used in West Africa. An example of one of the later phase trials we’ve done is on Yellow fever vaccine, where we’re interested in defining more precisely the best dose to be used to make the most of the available vaccine stock.

One of our largest areas is clinical research, where we are generally looking for research findings that will have an impact on policy. For instance, oxygen provision to hospitals across Africa is a major challenge to health systems, and we are doing trials to define more precisely the benefits of oxygen, the children that should have oxygen and the ways in which oxygen should be delivered. Those are findings which could be immediately implemented in hospitals once we’ve got them.

We work in population health, taking on international problems and data sets, asking questions about the extent of malaria transmission across Africa, or the provision of healthcare facilities across Africa and the average time an individual would have to travel in order to get emergency care.

The final area is in health systems, the entities that have to deliver healthcare, and there is a science behind how they best deliver healthcare. This covers issues ranging from how healthcare is paid for, how insurance works, through to issues regarding the degree of autonomy in individual health facilities, and that area is also particularly important for policy.

Those scientific themes are all delivered based on specific platforms supported by the Wellcome core award. This includes everything required to deliver research, such as office spaces and basic finance facilities.

We have an extensive community engagement platform, which includes engagement with the public, and also engagement with policy makers and other bodies such as universities where we want to make an impact and strengthen our ties.

We have made major investment in a laboratory, which contains facilities for all cellular and molecular immunological work and sequencing work that one would expect to be able to do in a high-income setting laboratory. This allows our work to proceed quite rapidly here in Kenya without relying on shipping samples overseas, and also that work can be done in a way that builds capacity here and offers individuals an opportunity to develop their own scientific careers based in Kenya.

The reason all of this matters is both immediate and long term. The immediate reasons why these areas of research matter are all linked to their specific area. For instance it’s pretty obvious why an Ebola vaccine mattered, and without centres like this one there wouldn’t have been a regulatory testing pathway to get that vaccine into the field.

Some of the things we do will matter not so immediately, but it will matter in 10 or 15 years’ time, maybe even longer. For instance, knowing what components a malaria parasite releases into the circulation to have an impact on the infected person won’t immediately help anyone, but it does allow people to start thinking about how you would design drugs or even vaccines to interrupt those mechanisms to then prevent malaria causing disease.

There are a lot of individual reasons we could give why individual research projects matter. The centre as a whole matters, not just because the sum of those parts, but because it is developing something sustainable, and developing the next generation of scientists who will be part of Kenyan scientific capacity. This is something that will endure much more long term, and that matters because Kenya needs to develop its own scientific agenda and needs to develop capacity to be in control of that and to steer it.

This interviews was recorded in May 2019.