Vaccine Development is Sexy Again. This PSI Board Member Shares Why.

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January 2021 marked the exciting start of a new term for PSI’s Board of Directors. We are conducting interviews with the Board members, delving into their backgrounds, personal and professional journeys, as well as their call to PSI and its mission to deliver consumer-powered healthcare.

Below, we talk with Tariro Makadzange, the Senior Director of Biology at Gilead Sciences.

 

PSI: Tell me about your background, your areas of expertise and your professional journey.

TM: I am from and grew up in Zimbabwe. I went to Smith College in Massachusetts before going to Harvard Medical School, all at a time when the HIV epidemic was starting to have a significant impact globally and even more so here in Zimbabwe. Halfway through medical school, and after experiencing a family loss, I decided that I wanted to work on fixing the problem. I was determined that I was going to make a vaccine for HIV and that it would end the epidemic.

So, I applied for graduate school at Oxford in the U.K. and was fortunate to attend as a Rhodes Scholar. While there, I worked with a group that was trying to develop an HIV vaccine. I went on to spend quite a bit of time in Kenya doing field research and immunology research. It was a great experience because I saw what science in Africa could look like; there was quite a bit of capacity building for the Kenya HIV/AIDS Vaccine initiative, which was exciting.

But I can never stay away from Zimbabwe. After graduate school, I went back to medical school and spent a lot of my fourth year on electives in Zimbabwe, where I realized there was a huge problem of cryptococcal meningitis, which is a fungal complication of HIV. My focus, therefore, expanded.

After graduating medical school and doing an internship at Boston Children’s Hospital, I took some time off to come back to Zimbabwe and do a clinical trial looking at cryptococcal disease. At the same time, I helped my cousin build an HIV program in Harare. It was an interesting time because we were just starting to get antiretroviral therapy (ART) and so we got to witness the “Lazarus effect” – namely, people arrived at the clinic on stretchers but, with access to antiretrovirals, could live, and would come back months later looking healthy and different.  I rapidly realized I needed more clinical training and so after a few years in Zimbabwe, I went back to the U.S. for a residency fellowship. I became faculty at Massachusetts General Hospital in Boston but, of course, went back to Zimbabwe soon after. There, I spent half of my time working in the clinic I’d started with my cousin, and the other half building research capacity, doing a lot implementation science research working with the city clinics, building immunology research inspired by the experience in Kenya, building a lab and doing basic immunology work.

PSI: What stood out to you during your second stint in Zimbabwe focusing on antiretroviral therapy?

TM: I was surprised to realize that after I had gotten all this infectious disease training, there wasn’t a need for infectious disease doctors to deliver HIV care; people were coming into care much healthier, thanks to antiretrovirals. We could decentralize care out to the community, nurses could run care, and even trained counselors and community people could deliver care. So the landscape had changed dramatically and positively.

Over time I realized that some of the missing pieces within the treatment cascade – identifying patients, keeping them in care – were really important but required a different skillset from what I provided, and that wasn’t where my talents were best suited. It seemed to me that what was missing was decongesting the clinics, which meant the need for long-acting antiretrovirals. Instead of daily pills, could we create three- or six-month injections to minimize the frequency of clinic visits? Could we do the same for PREP or ultimately could we find a cure?

As an immunologist, that was something I could contribute to. And it just so happened there was a job opening at Gilead to work on prevention and cure and I thought this would be a good way to use those skills. So I decided to leave Zimbabwe, move to California and work with Gilead. I was fortunate when I joined Gilead: there was an interest in developing therapeutic vaccines for HIV and I had the opportunity to lead the program working on vaccine development.

PSI: Your ambitions years ago to work on developing an HIV vaccine have come full circle!

TM: Yes, all those years ago I wanted to work on developing the HIV vaccine and here I am. People have been working on HIV vaccines for three decades; it is such a complicated problem. It is interesting to contrast that with COVID-19; people are excited about vaccines again.

In fact, Jeremy Farrar of Wellcome was interviewed the other day and he said vaccines are suddenly sexy And I agree. In the past, we were trying to make vaccines against hard things, like HIV, TB and malaria. I am still trying to work on the hard things. But we are lucky that with COVID, it is pretty easy to make the immunogen and make a functional vaccine. It has been much, much harder with things like HIV, TB and malaria.

PSI: And out of all of your incredible work, how did you come to know PSI and what resonated with you about PSI’s work and mission?

TM: I came to know PSI in the Zimbabwe context when we were working on our clinic back in 2005-2006. Before ART was available, PSI was the main resource for people to get testing and counseling and peer support, and so we interacted a lot. As we started to get ART, PSI referred patients to our clinic. I have had the privilege of watching PSI evolve from community peer support groups, to providing some of the most robust testing and counseling services, then later on providing ART care and then taking on the male circumcision component. So I have had a front seat watching PSI evolve, seeing the work that they do and I was always impressed.

One of the most memorable times was working with Dr. Karin Hatzold, PSI’s Director of the Unitaid flagship HIV Self-Testing Africa Project. At the time, she was the country lead in Zimbabwe. Her energy and drive was (no pun intended) infectious! I remember working with her on the Global Fund round eight application in 2008 and I was really impressed by the dedication that she gave to helping the country and the application.

I came onto the Board at the recommendation of Maureen Erasmus, my fellow Zimbabwean, we were connected through the African Leadership Institute. I was thrilled and honored to join the Board, especially given the history of what I know about PSI’s important work.

PSI: What does PSI’s focus on consumer-powered healthcare mean to you?

TM: This is what I find the most attractive about PSI: it is consumer driven and people-focused. This enables PSI to be thoughtful about what it engages in and very focused on the types of services that are provided. And it is an interesting model; sure, there is a standard NGO component to PSI but because of the market and consumer driven approach, it is broader than a standard NGO. We saw this in Zimbabwe with the condom provision and subsequently the ART and the circumcision services. PSI has always been thoughtful about what the market needed and provided those services in response.

Since being on the Board and learning about the other services, whether it is PSI’s water and sanitation portfolio or sexual and reproductive health services, PSI’s consumer powered health care makes PSI unique among its peers in the impact and innovation it delivers.

PSI: It is interesting to hear you describe your perspective on the evolution of PSI’s work. And with the consumer-powered health care approach and self-care, we’re seeing PSI take on yet another iteration.

TM: Self-testing is going to be huge; it was starting to be discussed and rolled out when I was transitioning away from my active on-the-ground HIV work. Trying to figure out how you do self-testing, how you not only provide the test kits but also provide the right supportive services – for HIV services and beyond.

For example, to get my COVID test here in California, I ordered it online, I self-swabbed, sent it to LabCorp, and it was seamless and easy. It is an interesting area because a lot of people would like, if they can, to do testing in the privacy of their homes and have things be much more seamless. This is self-care.

PSI: Obviously COVID looms large but it is still a new year, what are you looking forward to in 2021?

TM: I am looking forward to seeing how things evolve out of COVID. We’ve spent the last 12+ months sheltered in place; how will business and society evolve as things open up and vaccination rates go up? How will we deal with work, offices and gatherings? I personally love working from home and I enjoy being able to work from Zimbabwe for a company in California. I will be very curious about how that unfolds. I feel like we’re in a large sociology experiment and we know that things have to change.

I am also really excited about the research space, specifically around vaccines. Pre-COVID, vaccines were forgotten, there was zero commercial interest in them. But vaccines are leading again! How will nation states and international actors deal with vaccines? What will vaccine nationalism and vaccine diplomacy look like? As a viral immunologist, it is also really interesting to see the variants emerging and how we will deal with it. We are part of history in the making.

PSI: Once we are in the all-clear, what are you looking forward to doing? 

TM: I am itching to travel. Italy is at the top of my list, especially as Stanley Tucci documents his adventures across Italy. His CNN show makes me think of my past trips to Italy with my sister and those magical vendors selling gelato on the street.

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