Tanzania’s research sector is recovering from a year-long official denial of COVID-19, during which researchers did not have the freedom to study the pandemic. Much of what transpired in the research community during that time, and what has changed since, can be best told by people who were at the core of decision making.
Dr Paul Kazyoba, is the director of research coordination and promotion at the National Institute for Medical Research (NIMR). In this interview, he speaks to Syriacus Buguzi, a Science Editor at ResearchCOM (www.researchcom.africa), who began by asking:
Local scientists, including researchers, were at some point blamed for not speaking up publicly against the government’s denial of the COVID-19 pandemic in Tanzania. What exactly happened and was there any COVID-19 research agenda in progress at the time?
That’s a very pertinent question. It makes one think about where we have come from and where we are, and what we have gone through. Way back in March 2020, when the first case of COVID-19 was reported in this country, being the coordinating institution of all medical research in the country, we immediately started developing the Rapid Response Research Agenda for COVID-19. So we developed the research agenda with the aim of guiding researchers on what should be done rapidly to support the national response. So, we engaged about 12 institutions in the preparation of the agenda. The main question was: What do we focus on COVID-19, considering how fast the virus was spreading around the world. By that time we read about the outbreak in China, but still there was limited literature on COVID-19.
So, we identified the focus areas, and went through the gaps analysis. The main frame of reference was the health system in Tanzania. We contextualized the problem. Then the final draft of the rapid response research agenda for COVID-19 was in mid-April 2020 submitted to the Ministry of Health for adoption and approval. That became our guide and direction for COVID-19 research in the country. To date most of proposed research agenda are still valid. Topics such as COVID-19 genomics, sero-prevalence studies, investigation on COVID-19 interventional products etc all continue to be valid today.
Does it suffice to say the rapid response research agenda was implemented?
Before a temporary suspension of research on COVID-19, researchers were interested to find out what was happening in our country. As this is the role of research after all, to generate evidence which informs decisions and best practices. It’s our role to advise the government on whether the strategies are working or not, and why? Depending on what the evidence and the data tells us. Before a temporary suspension, there were about four projects which received approval from the MRCC; they were on WASH, Epidemiological study, KAP study, and a clinical study on NIMRCAF. Before a passive suspension, there were so many projects and so many people interested to see how COVID-19 was behaving in Tanzania, of course to share the experience with others. Just as much as we were reading what was happening in South Africa, China and elsewhere. Most interesting was the national response style or approach we devised as a country. It is referred to as “bottom-up” approach. This was quite different compared to many countries around the world, most of which adopted the top-down approach. The latter was a bit authoritative in the sense that order are given from authority, such as lockdown, night curfews and no going around for some weeks. For Tanzania, the late President said no to locking down he rather called upon citizenry to fight the outbreak through multiple approaches, faith, traditional medicine, complying to globally advocated preventive measures like hand washing, sanitization etc. This approach brought a sense of inclusivity with every citizen feeling the need for them to act so as to stop transmission.
But there were lots of caveats in the approach that Tanzania used against the pandemic.
Absolutely. I am happy you understand that.
What were the lowest moments for you?
If there was a time I have been kept busy and stretched with research demands, it was during that time of the first outbreak in March to July 2020. Most of the existing research projects needed amendments to integrate some aspects of COVID-19. You know we have several private institutions which survive on research, that if they couldn’t do research on COVID-19 meaning they had limited institutional overheads. Lack of overheads from research projects implies no operations. Majority of the sponsors were actually repurposing the funds—from probably TB, they would want you to integrate COVID-19. Most of the researchers however, applied for amendment but unfortunately by then there was a passive suspension of research on COVID-19. But if you ask me or any other researcher, they will say research was needed that’s why we coordinated the preparation of the rapid response research agenda for COVID-19 from the onset of the outbreak
So, as we speak, what is the fate of the COVID-19 research agenda?
From February, March and then in April this year, things began changing. The demand for evidence increased. As we were asking ourselves: Do we know what strain is circulating in the country? Have we collected enough information from the hospitals and communities about the pandemic? Do we know the exact symptoms and the dynamics of the disease in the country? In the context of this, there was a need for a change of tactic or rather approach. So we were asked to share a list of projects or proposals to the national response committee which sought approval from MRCC to conduct research on COVID-19.
The committee discussed the projects, and provided the way forward. Though the process was a bit slow, but we started seeing light at the end of the tunnel. Things have completely changed when the new government came in and allowed research. Currently there are several projects on COVID-19 which are implemented in the country.
I am reliably informed that the approval process for research projects is taking too long, while the science of COVID-19 keeps changing very rapidly. How can this be overcome?
When it comes to approvals, let me put this in two ways. One, when we prepared the rapid response research agenda, we also designed the approval to be quick. We said most of the submissions are going to be given priorities, not necessarily because the application is through an accelerated or expedited process but even under normal submission. That was the direction. When the passive suspension was eased, we had to put all submitted protocols on the review process. However, we had to reach out to principal investigators and asked whether they still wanted to proceed with their research plan. As some were still skeptical. The majority of the PIs said yes and their protocols were put on an accelerated review process.
So, when the review process is complete, and this may take within ten to fourteen days, the certificates are prepared for endorsement by the MRCC. Two signatories are involved, the MRCC Chair Person and the Chief Medical Officer. You must remember that, the two principles are quite busy, with tight schedules, hence, there are times certificates may get signed timely, or some other times may take a few days before they are signed. Unfortunately our clients do not see this, so we just have to accept the blame. In this case, we are planning to address this challenge by introducing a digital signature, which may be done even when the signatories are working away from their offices.
What about the use of technology? Can that not ease the process?
Yes. The challenge has taught us something. We asked ourselves: Should we continue with physical signatures as we are currently doing or ride the tide of technology? And, what innovation should we put in place so that the approvers at MRCC and CMO at the Ministry of Health can easily press a button and have a signature on the certificates irrespective of their tight schedule? Yet, we also need an innovation that is safe, because ethical clearance entails legal documents and if they are forged, anything can happen in the field.
What has been done so far to make that possible?
I tabled this before the National Research Ethics Review Committee for them to digest the information and they concurred we adopt the digital signature. Since we communicate certificates through our electronic system, the research ethics information management system, and all the certificates are actually uploaded online, we will not need a hard copy. So, it will be possible to have an electronic signature, so that it’s a matter of reviews and approvals, and then the MRCC Chairperson and the CMO will press a digital signatures on the certificates.
And is that being implemented?
It’s already work in progress. We agreed, together with the committee that we have to do that. So the programmer is working on that. Our expectations are that probably early next year, we should be 100% digital. And that is going to solve a lot the delays. Because the review takes a few days but when it comes to signature it may take two to three weeks or even more.
Africa is contributing little research output on COVID-19. Is this something on the priority agenda in the research community here in Tanzania?
Yes. It is an agenda. We’ve not stopped discussing it and we are not even getting fatigued in discussing about it. One of the biggest problems facing African countries, with the exclusion of South Africa, is that our governments commits limited funds for research. Well, we know the economies are small hence the budget is limited. However, if you have an emergency, what is it that will tell you whether the interventions are working or not? It is research! If an outbreak is causing people to die so fast, and no available or working intervention for it, of course you will do trial and error to intervene, and slow it down etc. But remember that when you are doing all that, research has to be part and parcel of that process to inform further on the best way to counter the outbreak. And also to inform the world on what you are doing to fight the outbreak. So if research is limited, obviously the output will be also be limited. Africa as a continent need to increase the funding levels for research if we are to see an increased output across the continent.
Much of our research is financed by international funders. What does this mean in terms of how these studies show impact locally? This has also been termed ‘research colonialism’. How can we get out of this?
That’s very pertinent. You see, over 90% of our health research undertakings are funded foreign agencies. I think there are dangers on too much reliance on foreign funding for research. Although it’s not entirely bad to get foreign funding. But it has to be complementing what we have already. This is because, the funding agent will fund areas of interest which will address their agenda first. No one is investing money for nothing. In this context, the government should strive to budget for research fund annually. I always say, we don’t have to put a lot of money, but establish a working model for funding research activities. For instance, in South Africa, when you publish a research paper, from each publication the research group etc receives some funds as an incentive. The funds are used to strengthen the research group to do more in the areas of their research. Here at home the incentives for us to publish is to grow our careers, and scholarship. These help in attracting research funds from international agencies. With the limits in terms local funding, researchers keep wandering for research funds. If TB has more funds, then many will go for TB research, and when the funds becomes limited, they will go for another area which has funds and so on and so forth. This keeps our researchers wandering for research funding.
Who is supposed to make sure that this wandering stops?
It is the government.
What do you mean by ‘government’?
First of all, the data which is collected on this land, must first be owned by the government of Tanzania. Fortunately, there is an institutions mandated with commissioning of research activities in the country. There is a National Fund for Advancing Science and Technology, at COSTECH. This is where the government is supposed to be pumping money to support research in the country. Then, when this fund is disbursed there, then they will fund research as per the each sectors priority areas. Of course, they also focus on the national development agenda.
Where do you see Tanzania in the next five years in terms of COVID-19 research? Do you see prospects for change?
In terms of COVID-19, I should state that a lot has changed in the last few months. So many new ideas have come up and many programs are in the making. In the next 12 months, I am seeing a very different picture in terms of COVID-19 research. We are likely to see long-term research programs, integrated programs. We are likely to advance in terms of monitoring respiratory tract infections. I know our institutions will attract funding for more research on COVID-19 because so far, we still have so much about the pandemic that we don’t know about Tanzania and in Africa. But we will need to be more transparent as we move forward.
Is there a sense of self-censorship among researchers currently?
Censorship, not much. Probably some hesitation based on personal fear. I can agree that there are still some mixed feelings among researchers, though. After the next 12 months I could tell you a different story. Things have greatly changed.
This interview was held as a follow up on discussions about COVID-19 research in Tanzania that took place in Dodoma during the 8th Tanzania Health Summit( 12th October 2021).