Published originally on Ciência Hoje [CH; Science Today] - Valquíria Daher
It is not easy to surprise a scientist as experienced as Carlos Medicis Morel, general coordinator of the Center for Technological Development in Health (CDTS) of the Oswaldo Cruz Foundation (Fiocruz), former president of the institution and former director of TDR, Special Program for Research and Training in Tropical Diseases of the World Health Organization (WHO). But this is exactly what happened in February 2017, when the researcher visited China for the second time. The surprise appeared in a city that he had never heard of before, Shenzhen. “There, I visited the hospital where the structure of the Zika virus was elucidated, the Beijing Genome Institute and the China National Gene Bank, where I saw, in one large room, hundreds of DNA sequencers working night and day. That’s when it hit me. I was fascinated by a world I did not know”. Upon returning to Brazil, he was determined to convince the board of Fiocruz of the importance of a partnership. He succeeded. In November 2017, Fiocruz and the Chinese CDC (Center for Disease Control and Prevention) entered into a deal and, months later, expanded to include four other Chinese institutions. Today, the bonds between the scientist, Fiocruz, Brazil and the Asian country are stronger; he is one of the coordinators of the Brazil-China Project, a collaboration between the Brazilian Academy of Sciences and its Chinese equivalent. In this interview, Morel discusses this collaboration, the battle against epidemics and the Brazilian science scene.
Ciência Hoje [CH; Science Today]: Is international collaboration fundamental to science?
Carlos Morel: It depends on the type of science. For astronomy, it has to be international, you cannot be isolated. But if you are researching on the waiting lists of SUS (Brazilian Unified Health System), it is more of a local matter. Research should be synchronized with the problem being studied. In 99% of the cases, international collaborations are very important; without them, you risk rediscovering gunpowder or reinventing the wheel. A researcher must be supported by what has already been done. It is as the phrase attributed to [Isaac] Newton says: “If I have seen further it is by standing on the shoulders of Giants”.
CH: What are the benefits that partnerships with China can bring to Brazil?
CM: There have already been tangible results. We have held three bilateral seminars, two sequencing machines have been installed in Fiocruz that were donated by China and an article was published describing the structure of the Chikungunya virus in the journal Cell, where we are co-authors, myself and Leonardo Vázquez, PhD a post-doctorate at the Federal University of Rio de Janeiro (UFRJ) and who is a member of the CDTS who stayed in China for a year. But new paths are in the horizon. For example, the Brazilian Academy of Sciences is assembling a grand Brazil-China project together with the Chinese Academy of Sciences, focusing on five main areas: biodiversity and biotechnology; biological and biomedical sciences; agricultural science; space science and technology; earth and climate change sciences. I had the honor of being invited to coordinate the biological and biomedical area with my partner in China, Dr. Georges Fu Gao, the director of the Chinese CDC and who invited me to visit Shenzhen in 2017. I have proposed we work in two areas of interest to our two countries: (i) research for prevention and control of epidemics; (ii) genetic diseases, gene therapy and personalized medicine, including cancer. China is really advanced in both areas; the country has become a leader in scientific advances.
CH: How do you see this collaboration in medium and long terms?
CM: Brazil does not have the condition to move as fast as China. I go there one year and, when I go back the next, there is a new building that is already fully equipped. The physical labs of the CDTS/Fiocruz has been under construction for the past 12 years, and there are 3 more to go. I am 76 years old, and my hope is that it will be ready before I am 80... Yes, the Chinese are going to move faster than us, it is a fact. But Fiocruz, connected to the Ministry of Health, has a globally recognized capacity and can enjoy this partnership and really advance. We can make deals exploring their scientific and financial capacity and Fiocruz’s strategy capacity. When our partners visit us, they get impressed. The director of the hospital, where the structure of the Zika virus was determined, was impressed by the fact that Fiocruz is not just a hospital, but has also basic research, teaching and quality control areas. He told me they are inspired by Fiocruz and are altering their master plan. July of this year, the vice-mayor of Shenzhen came to Fiocruz and I asked: what is your interest here, as you are more advanced? She replied: “We can be technologically advanced, but regarding the health system, we have a lot to learn from you and SUS.” I had to listen from a Chinese person an obvious thing that our politicians do not understand! In 120 years, Fiocruz has been through many situations, good and bad, learning so much. We do not have the financial power of China, but we do have excellent human resources and a scientific capacity that is not to be dismissed.
CH: During the presidential campaign, president Jair Bolsonaro was really critical towards China. Does this affect the partnerships?
CM: At first, we worried because he had a really strong speech against China, which could mean cuts or restrictions. That changed when he went there and saw with his own eyes, the current potency that is China, the third largest trading partner of Brazil. We know that a scientific collaboration of the priority areas for the country is welcomed and well seen by the Minister of Health [Luiz Henrique Mandetta], with whom Fiocruz maintains a good relation.
CH: Is it possible to compare the investment in science and technology between Brazil and China? And compare the results of the investment in this area?
CM: In the areas of technology and innovation, few countries invest as much as China. The country is not (yet) the first technology potency of the world and they know it. While several potencies are stable or declining, they are rising. That is the fear of the United States. As for Brazil, we have been missing lots of opportunities. Our idea is to maximize the partnership with China to evolve to a more advanced position. A clear example: Brazil does not have maximum biosecurity labs, called P4, those in which you work with standard biological hazard suits, as we see in the movies. We already have a deal with the P4 of Boston University [USA], which has the NEIDL [National Emerging Infectious Diseases Laboratories], but the access to similar installations in China shall be really important to our research into the control of epidemics and mapping of the called ‘Global Virome’. With such partnerships, we shall have access to facilities and brains that are missing here. It is important to remember that today China leads in several fields and patents more than the United States, Japan and Korea together.
CH: Your visit to China that promoted this partnership was motivated by the Global Virome Project organization. What is this?
CM: It is a global scientific cooperation to detect unknown viruses that can threaten the health on our planet. The purpose is to reduce the risk of future viral outbreaks. The project was proposed in 2016, in Bellagio - Italy, in a meeting financed by the University of California in Davis [USA] and the United States Agency for International Development [USAID]. In 2017, we met again in Beijing to implant the China Virome Project and, in 2018, we published an article on Science, and we were really optimistic. Next, Nature published an opinion article contrary to the project that threw a bucket of cold water on the project. Recently, an article was published in Lancet that emphatically reaffirmed the importance of the project. The greatest obstacle to moving forward is that we have counted on substantial financing by the NIH [National Institute of Health - USA], but the the president [Donald Trump], as Bolsonaro did here, has made significant cuts in the areas of science and technology. The China Virome Project is moving forward, and we hope that, with our partnership, we can make the same progress here in Brazil. The ideal situation would be a joint global advance, as a virus can arise from anywhere worldwide.
CH: What are the most dangerous epidemics and threats?
CM: The potentially most dangerous are those that arise and we do not know yet. At the same time, we must not minimize the ones we know and that can resurface, such as a flu like the Spanish flu of 1918, so deadly that the unburied dead pilled up on the streets of Rio de Janeiro.
When I was working at the WHO, in Geneve, the greatest fear of specialists was the emergence of an “Ebola with wings”, a figure of speech for layman to understand. As the Ebola virus is transmitted directly by contact with blood or other body fluids, it is primarily restricted to places in Africa. Viruses such as measles and the flu are transmitted by air and have much more potential for an explosive dissemination. A mutation in the current Ebola virus, giving it ‘wings’, that is, a capacity for transmission byair, would have a worldwide impact. Of the epidemics in circulation, hemorrhagic fevers, such as Lassa and Marburg, are among the most dangerous ones. In Brazil, an epidemic that we know well, and that kills, is yellow fever, for which we are fortunate that there is a vaccine that works when used at the right time. We must not forget the arboviruses that are currently present, such as dengue and Chikungunya, and what we went through in 2015-2017 with the Zika virus that is now dormant but can surprise us with a new outbreak.
CH: Can you talk a little about your work with diseases in neglected populations?
CM: Now we are entering another area, the area of the National Institutes of Science and Technology [INCT]. In 2009, when we won our first INCT, the name was: innovation in neglected diseases. In the second proposal, in 2014, we decided to change for innovation in diseases of neglected populations so we would not be limited to diseases listed as neglected by the WHO and/or the Ministry of Health. If we went to a place and it did not have a listed disease, we would have nothing to do there. It was a very positive change to synchronize our activity with the epidemiological situation in Brazil.
CH: Is this view of neglected population also being discussed in the partnership with China?
CM: China is not a country as developed as Switzerland, Denmark or the United States, for example. They have managed phenomenal advances in the area of health and reduced poverty, but there are still a large rural, poor and needy population, with serious problems, including animal health. Therefore, [the Chinese people] are very involved with a modern concept of health that is the ecohealth, a way to ecologically think about health, including environment, animal health etc.
CH: Is this wider view of health also in the horizon for Brazil?
CM: Brazil is in a complicated transition, with a government system limiting the access to science and technology and that does not invest in excellent human resources. It is releasing all kinds of pesticides. In science, we are seeing challenges that we thought would never return. We were so happy with the creation of the INCTs, the Science without Borders! For the first time, we had programs with solid budgets; it was not an ideal situation yet, but it was significant progress in the right direction. Now, we in a very critical situation, with budget, programs and grants for students being cut and under the threat of being disassembled. The science and technology institutions, such as Fiocruz and the universities, have the responsibility of fighting against it and showing that there is not a future without science, technology, health and education.