Interview with Prof. Collet Dandara: A Pioneer and Advocate of Multiomics Science and Health Innovation in Africa

Introduction

The current issue of OMICS is featuring this exciting interview article with Professor Collet Dandara, PhD, a pioneer and senior expert in multiomics research, life sciences, and health innovation.

For many countries worldwide, multiomics research and system sciences are relatively new. Although individual omics fields do exist in various countries, they are often implemented in a patchy or piecemeal manner. In other words, focusing on a narrow technology vision or a singular omics platform can limit the broader vistas available from systems biology at a whole organism scale. In this context, a critical understanding of the ways in which multiomics and integrative biology are emerging in different geographies would help inform the journal global readership.

Prof. Vural Özdemir (Editor-in-Chief, OMICS: A Journal of Integrative Biology): Collet, many thanks for your time and interview with OMICS. You have written for the journal readership on many occasions, reporting on the latest advances in multiomics science, and health innovation. First, please tell us what sparked your interest to pursue a career in biology and health innovation specifically, and system sciences more generally?

Prof. Collet Dandara: My science career was shaped, initially, by the unfortunate rise of the HIV/AIDS pandemic. When I was pursuing undergraduate studies, in the early 1990s, HIV/AIDS epidemic was a crisis and the brunt of the disease and deaths were a tragedy of immense scale. There was a race to find cures and vaccines, however, while the HIV-related deaths spread like a wildfire, and eventually within a short space of time, everyone knew of someone close to them who had died of this then-mysterious disease. I was concerned and intrigued with what appeared like population and geographical differences in prevalence and spread of this disease, triggering questions on mechanisms of person-to-person and between-population variations in both susceptibility and treatment response at that time. This was my first attraction to and interest in molecular biology and, eventually, genomics and multiomics system sciences.

I am interested in understanding what underlies human illness and suffering at a molecular and systems level as well as how best to decipher and intervene on social and political determinants of health. The latter often remains neglected or underappreciated in health innovation and yet is the “cause-of-the-causes” for many public health challenges. It is only when we adopt systems thinking to bring together molecular insights with sociological and political determinants of human and planetary health that we can have truly enduring and robust breakthroughs toward health innovation.

Prof. Özdemir: Share with the readers your opinion on most exciting and actionable prospects for multiomics R&D for health innovation in Africa.

Prof. Dandara: Africa holds the most diverse genomes and thus offers veritable potentials to understand the genetic basis of variability in response to medicines and susceptibility to complex diseases and infections. However, African participants have been absent or sparingly included in clinical trials that are pivotal for the development of safe and effective therapeutic interventions, or have been examined only in retrospect, after introduction of new medicines in clinical practice. Oftentimes, this has led to lack of appreciation of genomics, multiomics sciences, and host–environment interactions across the world in drug development, resulting in emergence of unanticipated and often adverse drug effects (ADEs).

In my opinion, with the current burden of infectious diseases and the rising epidemic of cardiovascular diseases, Africa is well poised for unprecedented strides in the study of drug–drug and drug–herb interactions using multiomics technologies, especially in diseases that are common in Africa in particular as well as worldwide. Pharmacogenomics, the study of genome-by-drug interactions, has an indelible major potential for biomarker and precision medicine innovations in health care. Data we have generated on African populations over the past several decades at the University of Cape Town and by colleagues across Africa have clearly shown that there are both quantitative and qualitative differences in pharmacogenomic variants among different world populations. Africa is expected to present with the most diversity due to the out-of-Africa human origin.

Thus, there is a huge potential for actionable innovations, for example, in the use of statins for dyslipidemia, antiretroviral drugs for HIV/AIDS, chemotherapy in cancers, and management of hypertension, if pharmacogenomics knowledge were made part of the clinical care equation. This landscape of African genomics research is now rapidly transforming with multiomics science so as to triangulate and validate genomics data across the biological continuum of proteins and metabolites at the University of Cape Town and other research-driven institutions in Africa (Fig. 1).

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FIG. 1.

Institute of Infectious Disease and Molecular Medicine at the University of Cape Town. Multiomics science and its applications in life sciences such as pharmacogenomics, pharmacoproteomics, and pharmacometabolomics are increasingly important to decipher the mechanisms of individual and population differences in treatment outcomes and disease risks in Africa and worldwide.

Prof. Özdemir: Tell us your opinion on key challenges for multiomics R&D in a context of health innovation in Africa.

Prof. Dandara: Multiomics science in resource-constrained settings faces many barriers. The most significant is of economic nature, governments in such environments barely put resources toward research funding. Nongovernmental agencies and international funders tend to fill this gap; however, this compromises research independence, particularly at the level of local needs and priorities. In the majority of cases where funding is coming from international outside bodies, African researchers have to balance their “interests” and those of the funder. This raises difficult challenges where local research priorities are not synchronized with the international partner. The second barrier pertains to technologies to execute research. Most of the technologies in multiomics field are expensive; not only are they expensive, but also they change rapidly, thus, it is often difficult for researchers in resource-limited countries to acquire such technologies and quickly adapt to the ever changing skills required due to technological changes.

Third, and probably quite important, is how Africa is viewed in the eyes of international collaborators working with African researchers. Sometimes I feel Africa is treated like a big “laboratory” where African research counterparts are expected to play the role of sample collector for research studies by their international collaborators who have access to both technologies and skills required to answer pertinent research questions. Fourth, and something that is debated, is the ethics of research in multiomics R&D. Ethics of doing research in resource-limited settings can end up in a top-down approach if international partnerships remain only in words or not grounded in equal political power and agency. Adequate care should be taken in this regard so that partnerships are truly partnerships from study design to implementation of health innovation and grounded in equal power among collaborating partners.

Importantly, who frames the questions in science and research ethics, toward which social, economic, and political ends, ought to be questioned, as much as what ethics issues are deemed essential and how the ethic issues are interrogated. For example, individual broad-based consent conflicts with the communitarian structure of decision-making in African populations, which would require possibly a mixed model. Even more important is that without addressing the history and residual legacy of colonial era power relationships in global health, a topic that is unfortunately often not discussed enough, research ethics and innovation partnerships run the risk of being hollowed out and being aspirational rather than actual (https://ojs.ub.uni-freiburg.de/behemoth/article/view/685).

Prof. Özdemir: How can life sciences and health innovation contribute to societal and equitable economic development in Africa?

Prof. Dandara: The economies of African countries are hemorrhaging financially. Both infectious and noncommunicable chronic diseases are huge challenges. Africa cannot afford to continue treating patients on a trial-by-error basis, which results in failure of treatment of up to 70% in some disease groups or drug categories. I am convinced that addressing the genomics and multiomics drivers of individual and population variability in health intervention outcomes pays off in the long run for population and planetary health. This would also result in savings by taxpayers and governments, savings that could be invested in further research and unmet health innovation.

Prof. Özdemir: If you had unlimited research funds and resources, tell us three ways in which you think the global competitiveness of African life sciences can be achieved to cultivate robust health innovation?

Prof. Dandara: This question frees my mind from constraints of money and allows me to focus on real-life needs and priorities in Africa. Africa's initiatives, be it on economy, health, democracy, poverty alleviation, and science, fail to be impactful because of the nonintegrated approaches where initiatives are started in many places but with little support across the board, which leads to very little progress and noncompletion of initiatives. Here are three possible ways that I think could foster African life sciences global competitiveness: (1)

African innovation ecosystem needs a unified identity when looking at problems that it faces. Once this is achieved, move away from the current “silo-approach” where every country tries to replicate every initiative in another country. Africa needs to identify the core infrastructural needs to support life sciences, such as multiomics platforms, clinical research centers, field research centers for plant and veterinary medicine, marine biology, and so on and adequately equip them. These centers should be strategically located and accessible by all who need them across Africa. The centers need adequate resourcing and they should be built around responding to real-life challenges that Africa faces, than just mirror-imaging or copying what is happening outside Africa but not necessarily relevant locally.

Prof. Özdemir: Thank you for sharing your thoughts, Collet, with the OMICS readership. The vision and analysis you have shared here are broadly relevant and timely, not only for multiomics science but also for how best to make emerging technologies responsible, tangible, legitimate, and experiential, and to a vast number of people across Africa and around the globe. You also raise important questions on critical governance of new scientific practices and technologies. Our readers might be interested in a recent big picture article on science and technology policy by David Guston in this context: (https://onezero.medium.com/the-legacies-of-apollo-11-6c8df29fbb3a). This interview also complements a recent analyses on science governance in the current century by Daniel Sarewitz (www.thenewatlantis.com/publications/saving-science) and the former OMICS interview with Erik Fisher on responsible innovation (www.liebertpub.com/doi/10.1089/omi.2018.0066).

I should mention there is growing consensus that the unchecked assumption that “scientific community can be left to govern itself” is false, especially in the case of emerging technologies and scientific fields (www.nature.com/articles/522413a). For example, it has been emphasized in the latter article by Sarewitz that “risk is more a political and cultural phenomenon than it is a technical one. Turning its framing over to scientists and other privileged experts, such as ethicists and social scientists, is to turn politics and culture over to them as well..”

A question highlighted earlier this year by Robert Frodeman is also very pertinent in this context: “When Plato (more exactly, Juvenal) asked who guards the guardians, he was questioning whether any group can be trusted to look past its own interests for the common good” (www.tandfonline.com/doi/full/10.1080/23299460.2019.1613612). This means the question “Who will guard the guardians?” ought to be extended beyond the scientific community to technology regulators as well. Once we broaden our governance questions from “which social issues emerge from a new technology?” to include who should be framing science and technology policy (and why?), it could then be possible to agree on a new and more democratic social contract on human and planetary health.

Those interested in state of the art on science and technology policy might want to read these five big picture articles mentioned.

The biography for Professor Collet Dandara is available at the end of this interview article for readers who wish to learn more about his research and new ideas.