NEB Podcast #52 -
Transcript
Interviewers: Lydia Morrison, Marketing Communications Writer & Podcast Host, New England Biolabs, Inc.
Interviewee: Abdul Sesay, Head of the Genomics Strategic Platform at the Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine
Lydia Morrison:
Thanks for joining us for this episode of the Lessons from Lab & Life podcast, brought to you by New England Biolabs. I'm your host, Lydia Morrison, and I hope this podcast offers you some new perspective. Today I'm joined by Dr. Abdul Sesay, who is Head of the Genomics Strategic Platform at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine. Dr. Sesay joins us to talk about how The Gambia dealt with the COVID-19 pandemic and how this experience has influenced the country's preparedness for future viral outbreaks. Dr. Abdul Sesay, thank you so much for joining me today.
Dr. Abdul Sesay:
Thank you so much, Lydia. Thank you for the opportunity to talk to you.
Lydia Morrison:
Yeah, so I wanted to talk to you about the COVID-19 pandemic, and I think we can all agree that the pandemic exposed some longstanding challenges around the world with preparedness for infectious diseases. Can you tell us about The Gambia's level of readiness for disease outbreak before March 2020, and what kind of infrastructure was in place?
Dr. Abdul Sesay:
Actually, I'm fortunate in some way from where I work. I mean, I work at the Medical Research Council Unit at The Gambia, and it's actually quite a well resourced department. Compared to the country, we really well resourced. And really, right at the beginning of this, even before the pandemic, we respond to outbreak. People from the units have gone to other countries to support them with microbiology and genomics. So, in that way, the unit was prepared. The country, that was a different matter. I think that it's like with every other countries and especially lower-middle income countries, there wasn't much of a preparedness. Of course, they had a system going for Ebola that they could bring back in terms of rapid response and in contact tracing. So those were because of Ebola, those systems were in place. But yeah, so I think that's as much as I can say in terms of the country preparedness. They were trying, but it wasn't as advanced as you would think.
Lydia Morrison:
Yeah, I don't think anybody's response was as advanced as we might have hoped for. What were you doing when the COVID-19 pandemic hit and how did that change your role in response to it?
Dr. Abdul Sesay:
Okay, so before... Well, and... As soon as COVID had hit some part of the world, I had this idea, because it's my field, and I started... Although genomic surveillance was important, it wasn't as widespread as you would think. But actually had the idea and I was talking to colleagues about, if COVID hits the country, then we should be in the position to make sure that we have the facility to sequence any of the COVID samples. So the units was actually prepared because the units had the only two isolation ward in the country.
I mean, this is the only two isolation wards in the country for infectious disease that might affect other people in the world. So, that was, in a way... The unit was prepared. And also, I was prepared that if we are positive in the country, we would do that. In terms of changing the way I worked, it changed a lot because actually, the unit had some kind of relationship with the government. It wasn't as strong as it could be. And I think COVID changed that. I mean, because I got involved a lot during COVID, the pandemic, with the government. So I actually did a lot of work with the government.
Lydia Morrison:
Well, that's really interesting. And so, has that been a positive thing to sort of strengthen ties between the government and the unit?
Dr. Abdul Sesay:
Yes, I think that was really very important. Actually, one of the things that happened is that, when COVID did hit Gambia, the first cases was actually a case that came for... Because the unit has a hospital, so the case... The person came for some kind of diagnosis and the young lady had just come from the UK. The young lady was admitted in the isolation ward, and the units already also had set up for... They sent somebody to actually learn how to do the diagnosis. So the unit was the only diagnosis center for COVID in the country. So they were able to diagnose the case, and within couple of days I had the sample sequence to know what COVID type... The variant it was. I mean, we were talking that the person... We confirmed that genomically that the person had COVID and we sequenced a few of the samples.
But at the time, the unit was the only one that was doing genomic diagnosis. And that was strange because I know... Think about it actually just having one center doing diagnosis wasn't sustainable because the unit wasn't the public health system. So quite quickly I had this idea that the government should be doing their own diagnosis. So I supported them to set up their molecular lab so they will be able to do their own diagnosis. So on side of it... So in the end what happened was, in fact the government asked that 50% of my time should be spent with them supporting the public health laboratory.
Lydia Morrison:
Wow. It sounds like that was really essential to the government's response to the pandemic outbreak.
Dr. Abdul Sesay:
So yes, I was fortunate I was here and also had some of the skills that was needed to train and make sure that they are... In fact, at the beginning they had to even borrow the equipment from the units. I keep saying the unit, that's the unit that I work and to at least start it. But in the end come to the pandemic, 80 to 90% of the samples that were tested in the country were done by this laboratory that we set up. So it was quite a really positive aspect of the pandemic that we were able to at least get the government at a public health facility, the public health lab, the national public health lab, to have the capacity to do their own diagnosis.
Lydia Morrison:
Yeah, very important work. So as we emerge from the COVID-19 pandemic and sort of enter this new endemic phase, how do you see the infrastructure and expertise that's been built up around the last three years being utilized in the future?
Dr. Abdul Sesay:
I think one of the things that is, I said actually setting up the diagnosis... I mean this is what I would call the lower end genomics is the higher end, although it's becoming really very, very important and issued a lot. In fact, when we had the lockdown in Gambia, it showed how effective lockdown was because you can see that we stopped having imported variants coming to the country. We had local transmission from across the border where we could not control and we closed the border for air travel, but we couldn't control the land border. So the genomics really helped to really pinpoint what's coming in, who's giving what to who, and that really helped a lot. But that really the diagnostic part, the molecular diagnostic, what we having is that we've repurposing all of the equipment that was the National Public Health Lab have had for COVID, they repurposing that for learning how to diagnose monkeypox, Marbug and all of those things.
So it's really been very positive that there have been lots of resources that have come into the country and resources from COVID have been repurposed and be ready for any other outbreak that might hit us. And really where we are, we have other outbreaks that we should be scared of. There is dengue, for example, in Senegal, we've never been able to diagnose dengue in the country, but because the lab is ready, we have a molecular lab, then it means that we could do that. So there is few surveillance that are going on to making sure that we can capture this. Because the early detection is the most important part really to know whether something has entered the country and how it's spreading is really the most important thing.
And most of the country should have that capacity because it's not about sending sample out, it's about making sure you do things in a real time. So yeah, that's been a really positive because of COVID, resources have been coming, the labs have improved in terms of what they do. They've had things like our sample transportation, all of those things are really as a result of the pandemic. So it's had a kind of a positive impact in terms of where the labs are.
Lydia Morrison:
Yeah, it sounds like a good silver lining sort of from the COVID-19 pandemic. It sounds like the country is much more prepared to deal with infectious disease moving forward and really it sounds like has built up the infrastructure for genomics and diagnostics testing that can really help better facilitate understanding how these viruses are spreading within the country.
Dr. Abdul Sesay:
Yes.
Lydia Morrison:
I took a look at your social media presence and it really indicates that you're a big supporter of the Oxford Nanopore Technology sequencing platform. How has that platform changed the game for researchers and health departments around the world, particularly in areas with more limited access to traditional platforms like Illumina or Ion Torrent sequencing?
Dr. Abdul Sesay:
Actually, it is really funny. We had some visitors from the UK and they both basically called me the Oxford Nanopore African boy, whatever that meant. Actually, it's really weird because most of my training is sequencing... And I started on the Illumina platform, which actually do have... We still buying Illumina platform. We have quite a few Illumina platform in the unit. But really one of the things that right at the beginning when Oxford Nanopore opened up this early access, they had 1000 devices that you pay $1,000 for was basically to raise money. I actually thought that it was perfect for low and middle income countries. It was perfect. I mean a small device, movable and you could take it to source. And even then a lot of scientist colleagues, I mean we actually don't do... We set in our way so we don't change. So really at the beginning of the pandemic and most people who said, well you can't... The error rate for Oxford nanopore was too high. You cannot sequence COVID on that.
One of the things that I said, but you actually don't understand that even error... If you can do something repeatedly, many, many, many times, if you can afford to do it repeatedly many, many times you don't make the same mistake. So you know when there's a mistake, so it's a technology that would work. And then what happened was the Chinese bought 200 pieces quite early on. So people thought, well if the Chinese buy it, it means that it's actually a good platform. It's worked out well for me. For training, excellent. I can put it in my suitcase, I can take the flow cell in my backpack and I can go somewhere. There's no cold chain, not a really strong cold chain mechanism for the flow cells and some of the reagents. So it means that even training people from different countries, I can do that by just packing reagents and taking it to them and then do the training in one week. And they could do their own sequencing.
So for me it was not because it seems like I'm an advocate for it, but it actually a fit for purpose. It fits for the purpose that we want to make sure that labs that cannot afford big machine, that might not have huge good infrastructure for electricity and all of those things, for service contracts, for funds and all of those, you could get a lab, almost a lab in a suitcase and plant it within the same day you arrive. You could start sequencing and that's what the Oxford nanopore has showed. And it's the only platform when we think about it that is that possible. So naturally it's worked out really well for what I've been trying to do, which means that nobody should be sending samples when you have an outbreak, you should be trying to deal with it at real time.
The real time is the most important aspect because again, if you want to know, there was I think an outbreak where some team of mine got involved in pneumococcal and the clinical diagnosis was different from when they did the genomic diagnosis and they were able to get the right vaccine and the right treatment for people. And I think it's really very important that we have a technology that... It'd be nice for it to be at the bedside. It's not at that level yet, but I think that it's something that in terms of outbreak, in terms of remote areas where the people don't have access to big machines, then it fits in really well.
Lydia Morrison:
Yeah, I think you're absolutely right. And I think you highlighted really nicely some of the benefits of the ONT technology that was most useful to you. Really that price point is really accessible I think for a lot of labs. And the transportability I think makes it really important. And as you said, it's almost at a sort of point of care position. You mentioned training. I know you've been an advocate for training students in biosciences in The Gambia and across West Africa. Can you tell us a bit about your efforts in support of that and how labs outside of West Africa can help?
Dr. Abdul Sesay:
I mean, so we do the thing about... The fact that I think it's really important, one of the really big reason for me to be back in Gambia... In fact it wasn't an idea of mine, it was an idea of my lab line manager who happened to be the head of the unit, the MRC unit I worked in the UK. And he basically said to me... Because he was part of the global leadership for... So he was responsible for the unit. So he was visiting the unit and he said, but it'd be nice of you to go and work there. Why don't you think... If there's any opportunity for you to work in The Gambia, you should do that. And really I had this idea that the training aspect, what I've learned, what I know and really try to pass that around would be quite important to do.
So it was natural. So when they said there was an opportunity to come to work in Gambia, that was the first part. So he basically said, yes, I'm working now in Africa. So COVID really accelerated the second part of my kind of dream is that, could I train other people to do what I do? How quickly would it be? So again, in fact at the beginning of COVID I applied for a grant to get money to not just train people but to also provide them with equipment. So I would turn up in labs, these are collaborative labs and I will come with equipment so that they will do the sequencing with no cost to them and I train them. I leave some machines, some equipment with them and then move on. So it is been very useful. But he said again, what can people outside of the country will do?
Firstly, the fund that I took was from the MRC. It really be nice... I mean one of the things that NEB, I'm not plugging them, is that whenever I say that I want to go... And actually the relationship with not just maybe academic but even commercial company can help. First thing is that for most of the reagent that we buy, we pay more in Africa than you pay in the west, which is actually quite weird to think about it. Where there's no money, you pay more for something than where there is lots of money. So that's 20 up to 40, 50% more than what you would pay in the west, which is really very difficult for you to do science in our region, to do research in our region to actually do that.
But one of the things that NEB does when I'm going training and which could be done by other companies, not NEB. A lot of reagents get thrown away, gets spoiled because of the really tightness of sell by date. For training, you could use those reagents. For schools, you can use those reagents. There's no go back on it. Before people throw reagents or people throw equipment that doesn't need much servicing. I think that we need support. I mean I'm really actually using this podcast to appeal to anybody that wants to really... Even skillsets, if you want to work, people do volunteer to work in school.
But scientists, I've just spoken to a colleague who would love to come and work in Africa as a volunteer and there's a lot of options for you to transfer skills. I mean I'm one person and I've been traveling a lot and much more than I want to is because there's not many people that will do what I do. But actually there is a lot of people like me in the west that could do what I do. And if they have a one month holiday, why not spend it come and teach few Gambians or few Burkino or few people how to do a particular technique?
If you got a reagent, before you throw them away, why don't you offer it to someone to use it to do some training on it? So I'm advocating that there is a lot of things that the west can do that doesn't cost a lot of money. It's just repurposing what they have, equipment, that we change equipment in the west quite quickly. But a PCR machine doesn't go off, it doesn't go off. So if you have a PCR machine, and you've bought a newer model, but it didn't actually fail, if it doesn't need any servicing, give it to someone to basically run it in a school. I mean it will be very, very useful. So yes, having people outside of the Africa to support, because I get support from the MRC UK and I got money to support other labs from the MRC and UKRI to do that. But it'd be nice if this is much more wider, the support that we get for helping other labs to be prepared. Because it doesn't cost a lot.
Lydia Morrison:
Yeah, I think you're absolutely right. And yeah, NEB has had its training and course support reagent donation program for a long time. And as you say, those are reagents that might be going out of date soon, but there's no reason why they can't be used for training purposes and learning purposes. And I think you highlighted that nicely and I think the plea for knowledge transfer is really important too. You've told us today a lot about how impactful your own knowledge transfer has been within the country, but as you say, you're busy and you're just one person. So I love that idea. I'll be sure to include all the information in our podcast transcript and links out to reach you. If people would be interested in donating their time and transferring their knowledge.
Dr. Abdul Sesay:
That will be fantastic. And I really appeal to this idea that a lot of school children do this and lots of people would love to do kind of... And this is very different. It's not really like you're going treating people. If you're treating people equitably which is really very important because you're treating them with respect. You're treating them that you know something, they're very interested in knowing and they have the capacity to be able to absorb it and really to spread it to other people. So top down learning. So my appeal is actually around that one person cannot do this. It's not even the diaspora people that never thought about whether they should come back to African work because it's challenging. I'm not here because of money. Money cannot be the reason why I'm here, otherwise I will go back. It's challenging the environment itself, the type of work that you would do, but the reword is higher.
I mean it's the most diverse continent in terms of genomics and really in terms of even infectious diseases. If you really want to know the source and learn the source of infectious diseases, then you should be working in Africa, not working in... Your doing TB, but you're working in London. I mean the cases of TB in Africa is huge and cases of antibiotic resistance is huge in our continent. So yeah, I'm appealing the knowledge transfer is important and knowledge sharing and working equitable. And this is not about coming because you have famine, because you really want to spread knowledge and make sure people are at the same level as you are. So that's really what I'm appealing to.
Lydia Morrison:
Yeah, I think that's such an important message and thank you so much for being with us today to share it, Dr. Sesay and I hope that we get the chance to speak again someday
Dr. Abdul Sesay:
Thanks for the opportunity to chat with you and it's been a pleasure. Thank you.
Lydia Morrison:
And you as well. Thanks for all that you've done in terms of transferring knowledge. I think it's appreciated even from the other side of the world and I'm glad we got the opportunity to speak about it.
Dr. Abdul Sesay:
Excellent. Thank you so much, Lydia.
Lydia Morrison:
Thanks for joining us today. I hope you can catch our next episode when we'll dive into the world of molecular cloning. I'll be joined by NEB scientist, Rachel Carver Brown, and we'll be exploring current techniques from mutagenesis. So be sure to tune in because you don't want to miss our cloning 101 podcast series.
