Dr Glenda Gray trials SA-first HIV vaccine and is included in TIME Magazine’ s list of Top 100 influencers.

Pioneering medical researcher, scientist and HIV activist, professor Glenda Gray, who recently cracked TIME Magazine’s prestigious list of 100 most influential people in 2017, has dedicated her life’s work in the search of a vaccine for HIV/AIDS. Great news: She might find it…

Last year’s World AIDS Day brought hopeful news that could alter the course of our history, and bring an end to our biggest modern-day plague.

Global headlines were dominated by the announcement of a large-scale clinical trial to test an experimental HIV vaccine regimen that could lead to the first licensed vaccine against the vicious and rapidly mutating virus.

HIV/AIDS has killed 35 million people worldwide since the pandemic began in the 1980s. South Africa was particularly hard-struck. According to Statistics South Africa, an estimated 7 million South Africans are currently living with HIV/AIDS – the largest infection rate than in any other single country in the world.

Former President Thabo Mbeki’s state-sponsored HIV/AIDS denialism and the Minister of Health’s promotion of beetroot, garlic and African potatoes as adequate treatment for AIDS, allowed the virus to escalate rapidly and go unchecked throughout most of the 2000s.

Leading the HIV vaccine trial is a quartet of top female physicians and scientists from South Africa, including director of the Perinatal HIV Research Unit at Chris Hani Baragwanath hospital, Drs Fatima Laher; deputy-director of the Desmond Tutu HIV Centre at the University of Cape Town, Linda-Gail Bekker; deputy-director of Setshaba Research Centre in Soshanguve, Mookho Malahleha; and spearheaded by president of the Medical Research Council (MRC) in Cape Town, Dr Glenda Gray.

It would seem appropriate that the four scientists leading the trial are women from Africa. Globally, women make up half of the 36 million people living with HIV. Eighty percent of infected women live in sub-Saharan Africa and most infections are transmitted heterosexually. For biological, socioeconomic and cultural reasons, women are more vulnerable than men to acquire HIV/AIDS during sex.

Despite South Africa being severely crippled by the HIV/AIDS pandemic during the early 90s and 2000s, today paints a slightly different picture. We’ve made incredible progress towards reducing HIV infections, especially with mother-to-child transmission. The MRC reports that prevention strategies have brought the risk of infant HIV infection down to an estimated 1.4% in 2015 – a far cry from the 20–40% measured in the absence of intervention strategies.

Much of this success can be directly attributed to Dr Glenda Gray, and researchers like herself, who worked determinedly and relentlessly to find solutions for South Africa.

She spent the greater part of her career working at the Chris Hani Baragwanath hospital in Soweto. Here HIV was the most common cause of death in children and adults. She planned on being a doctor, not a researcher and HIV activist, but the ensuing crisis forced her to be all three at once.

Together with Dr James McIntyre, they founded a perinatal HIV clinic in Soweto in 1993 – one of the first in South Africa to offer HIV testing and counselling for pregnant women and outreach to the surrounding community. In 1996, the clinic became a research unit of Wits University.

Included in her long list of accolades and achievements, is the honour of being included in TIME Magazine’s 2017 list of the 100 most influential people in the world. She has made a name for herself, not only as a pioneer in groundbreaking research in the field of HIV, but also as an activist for the prevention of the disease.

Gray grew up in a house of activists, fought to desegregate South African hospitals, organised strikes and treated people injured in anti-government protests. During the 70s, her phones were tapped. Tyres were slashed and dead cats were thrown onto her lawn. In the 90s, when government denialism was at its worst, Gray joined demonstrations outside the Chris Hani Baragwanath hospital, blocking traffic by lying in the road in protest.

Nearly 20 years later, with her sights set on a sustainable HIV vaccine, she is once again at the forefront of a struggle, this time making sure that the science of HIV – and the conversations around it – never stops evolving.

Where did your love and passion for medical science come about?

GG: We grew up under difficult circumstances. My father was a mechanical engineer on the mines and my mother worked as a labourer on our farm in Boksburg. My father passed away when I was very young but he always had big expectations of us.

When I was six years old, I knew I wanted to be a doctor. I can’t really recall why, but my parents tolerated the idea. After I excelled in physics and chemistry at school, I went to Wits Medical School where I qualified as a medical doctor. In 1992, I qualified as a paediatrician from the College of Medicine SA in Johannesburg. This was around the time that the HIV/AIDS pandemic exploded in South Africa. I wasn’t so much an HIV activist as I was a scientist.

At the time, HIV denialism dominated headlines and HIV-positive mothers were being denied life-saving anti-retroviral (ARV) drugs. Seeing how the burden of HIV affected mothers and their children, I knew that I had to use my love for science as a tool to advocate the reality of the situation and try to prove that ARVs could prolong the lives of sufferers in South Africa. I love how science can improve and change lives. For anything in life, you need evidence, and science is the proof.

Congratulations on your inclusion in TIME’s 100 Most Influential People of 2017. Do you feel that this inclusion is a reward for years of hard work in your field?

GG: I guess so. I think the work we’ve done with HIV prevention has captured the imagination of the journalists and reporters who nominated me for the accolade. Although I’m humbled by the accolade, I think in the bigger scheme, it has significant historic purpose. Many people still question science, like global warming for example. The award puts science, and the work we do around HIV/AIDS prevention back in the international spotlight.

So yes, I think the award was well timed and not because it was coming to me, but because it puts global focus on science and medical research and particularly, medical research in the field of HIV/AIDS.

You’ve been recognised for your research and work in finding an HIV vaccine that’s currently in the trial stages. How successful has trialing been so far and how close are you to releasing the world’s first ever HIV vaccine?

GG: The trial stages of vaccine HVTN702 is underway and like with all medical trials, it’s a lengthy process. About 5 400 men and women will be enrolled over a 20-month period and hopefully, it will induce a new response that will protect people from HIV acquisition. The volunteers will be monitored over a 36-month period, so we’re looking at around 2020 to see whether we’ve achieved the desired results.

The trial stages will establish how potent and durable the vaccine is. But we’ve come a long way. We’ve been working tirelessly on the vaccine since 2009. HVTN702 is a modified version of the RV144 vaccine that was evaluated in Thailand back in 2009. HVTN702 was modified to reflect South Africa’s particular HIV sub-type and involves inserting antigens that have been genetically engineered from sub-type C isolates.

We think this vaccine will work by inducing non-neutralising antibody responses and antiviral properties. If we can prove that this vaccine is at least 50% efficacious, it could lead to the first licensed preventative HIV vaccine in the world.

Are you confident that the trial vaccine will deliver the desired results?

GG: Vaccines can be applied across entire populations and a successful HIV vaccine would be the most powerful weapon imaginable against the HIV pandemic. Even a moderately effective vaccine would significantly decrease the burden of HIV disease over time in countries and populations with high rates of HIV infections, such as South Africa. We’re extremely hopeful that we have designed a vaccine approach that may be successful, but there’s also a great deal of hard work involved, as well as a bit of serendipity. The results from the vaccine will show us the way forward and what we need to do in finding a clinical way of preventing HIV, which currently can be treated through a lifelong drug programme, but it’s not easily prevented.

You’ve seen people severely affected by HIV/AIDS during the 90s and 2000s when the pandemic was at its worst. What has changed since then? Have we (partially) lifted the burden of HIV in South Africa?

GG: There’s been a slight decline in the average number of infections between 2005 and 2015, yet hundreds of thousands of people are still being infected each year. The availability of ARV drugs has prolonged the lives of many people in South Africa. We’ve managed to improve the quality of life for those burdened with the disease. Thanks to ARV therapy, we’ve made incredible progress towards reducing mother-to-child transmission of HIV, which is a dream come true for us. However, we haven’t been able to find a successful vaccine that’ s sustainable. But that’s the goal we’re working towards.

What benefits do these international exposures have on your research and work?

GG: I think the biggest benefit is that it promotes medical science and research. The list doesn’t just consist of entertainers, musicians and politicians, but people who’ve made a difference in other areas too. This recognition highlights the importance and value of science, which I feel is amazing.

Are you seeing enough young medical scientists coming through the ranks?

GG: The lack of medical researchers and scientists coming through the ranks is a cause for concern. I think the problem starts with our education system. Many young people feel that you need to be smart to be a scientist. The medical industry doesn’t need clever people; it needs curious people. Science is a tool in answering the many questions in life. It’ s imperative to develop and retain the necessary skills to ensure a high level of medical research productivity.

Who are your role models?

GG: There are a few that come to mind. I have great respect for health ombudsman Malegapuru Makgoba for his efficient handling of the recent Life Esidimeni disaster. World-renowned paediatric expert and HIV/AIDS researcher, professor Hoosen ‘Jerry’ Coovadia, is another great individual who continues to contribute to the field of medical research. I’ve had the privilege of meeting Nelson Mandela on several occasions, but one moment that really sticks with me was when Madiba, former president Jimmy Carter and Bill Gates senior (father of Microsoft billionaire Bill Gates) came to visit us at Zola clinic in Soweto during 2002. I remember us gathering around them when the three men cradled tiny HIV-positive babies and called for the treatment to be made available to people with AIDS and end the stigmatisation and discrimination of those with the disease. It was a surreal experience. Mandela was an incredibly humble person and he really walked the talk. For him to add his voice to our cause helped significantly in the fight against the pandemic.

What advice would you give to young women in South Africa who aspire to be medical scientists?

GG: You need passion for medical science and research. Be willing to make a difference. Be resilient and work hard. The rewards are immense. There’s a lot of work for medical scientists in South Africa and we have a lot to offer the world.

What is the value of science and funding science for a country’s citizens, and does the South African government contribute enough with funding?

GG: At the moment, government is overwhelmed with service delivery and there’s a general belief that science is a luxury and not a necessity. But in fact, the opposite is true. The quickest way to get a country out of poverty is through science. Look at how countries like Vietnam and Malaysia have improved significantly through medical research. Our government needs to invest in innovation and the development of STEM (science, technology, engineering and mathematics). But we need to make the case for investment in medical science. But it needs to resonate with everyone in government.

Failure has been a big part of the process. What motivates you to keep going?

GG: Failure is a big challenge in our field. HIV is a modern-day plague and I’ve seen families decimated by the disease. But you have to keep going and keep fighting to overcome the disease. It’s part of human nature. It’s what makes us civilised.

What are the challenges of working in your field?

GG: Apart from dealing with constant failure, medical science is a long-term career. Funding is always a constant challenge. It appears that lately, some organisations and institutions in South Africa suffer from ‘AIDS fatigue’ and would rather spend money somewhere else. But people simply have to put spade in the ground if we are to beat this disease. However, I have the privilege of working in a field that can change people’s lives dramatically. Not many people get the opportunity to impact so profoundly on the lives of others.

Do you think we’ll see a world free of HIV in your lifetime?

GG: I’d like to think so! We’ve already nailed it. I’m still young and we’ve done great work, so I’m positive about seeing an HIV/AIDS-free world in the future, and I’m hopeful of the progress we’ve made. But it does take time. Medical intervention, innovation and lots of learning are key to its success. Patience is everything.

Awards and accolades
• 2002: Awarded the Nelson Mandela Health and Human Rights Award for pioneering work in the field of mother-to-child transmission of HIV-1
• Awarded the IAPAC “Hero of Medicine” award for work done in the field of HIV treatment in children and adults
• 2009: Received the N’Galy-Mann lectureship, along with James McIntyre, in recognition of their HIV research contribution in South Africa
• 2011: Became a member of the Academy of Science of South Africa – a foreign associate of the US Institute of Medicine
• 2012: Received a DSc (honoris causa) from the Simon Fraser University, Vancouver for her work in the field of mother-to-child HIV transmission
• 2012: Admitted into the American Academy of Microbiology
• 2013: Received South Africa’s highest honour, the Order of Mapungubwe, granted by the president of SA for achievements in the international area which have served South Africa’s interest
• 2017: Included in TIME Magazine’s list of ‘Most Influential People in the World’

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