Malik Peiris, world renown clinical virologist, co-director of the HKU-Pasteur Research Pole, of the WHO-H5 Reference Laboratory at HKU, director of the Centre of Influenza research at the HKU School of Public Health, and Affiliated Professor at the Institut Pasteur, has just been elected Foreign Associate of the US National Academy of Sciences on early May 2017.
He joins in this prestigious institution five researchers from Hong Kong, and five researchers from the Institut Pasteur. This election is a good opportunity to take a step back with him and consider his high-achieving career. With a lot of humility, this is rarely in terms of “I” as he prefers to remind that research is a collective undertaking. Interrupting the writing of a manuscript, Malik takes time to answer some questions.
Did you know you were going to be elected?
I knew I was nominated, because obviously I had to provide information for the nomination process about a year ago, but after that, I quite honestly didn’t take it very seriously so I didn’t know anything until a few days prior to the official announcement when the person who nominated me informed me that I had been elected.
You already have a lot of distinctions now, what does it mean to you to be elected as a Foreign Associate of the American National Academy of Sciences?
The foreign associate fellowship of The National Academy of Sciences of the United States, as well as the fellowship of the Royal Society of London, are two extremely prestigious honors, so I am really grateful to my colleagues in these respective institutions for nominating and electing me. I think it is important to emphasise that this achievement cannot be made by one person alone, it really is a reflection on the efforts of a great team of people who have been working together for the last two decades or so.
Who are these colleagues at your side, committed to research?
When I joined The University of Hong Kong in 1995, my initial task was to set up the clinical virology laboratory at the Queen Mary Hospital, the teaching hospital for The University of Hong Kong. In these efforts, I worked closely with Dr KH Chan (Chan Kwok Hung), Dr Seto Wing Hong and Dr (now Professor) KY Yuen. Given that our laboratory was very small, we had to focus our efforts. I chose to focus on rapid diagnosis of respiratory virus infections and infections of the immunocompromised patients. Within two years, H5N1 bird flu had hit Hong Kong and our lab was able to make important contributions in responding to this threat. Following on from this, with the strong encouragement from Dr Rob Webster, we set up a research program on avian and swine influenza viruses to inform zoonotic and pandemic threat. Guan Yi, Leo Poon and I worked on this program and gradually built it up from a handful of people to over 60 people today. Early on, I also built collaborations with other departments at HKU, such as Pathology, Paediatrics, Community Medicine and others to investigate influenza in multidisciplinary manner. It was in this context that SARS struck in 2003. The whole clinical virology lab and the influenza team was mobilised to respond to this threat and luckily we were able to quickly identify and characterise the causative agent as a novel coronavirus and to develop and deploy diagnostic tests to help contain the outbreak. Key collaborators in this effort included Chan Kwok Hung, Guan Yi, Leo Poon, John Nicholls, KY Yuen, WH Seto and many others. Subsequently, Guan Yi was able to identify game live animal markets as the animal human interface from where the virus crossed to humans.
After SARS, Guan Yi, Leo and I returned to our focus with influenza and other emerging viruses. I have been lucky to be able to build strong multi-disciplinary collaborative links with epidemiologists, statisticians and modellers (Gabriel Leung, Ben Cowling, Joe Wu, Eric Lau), pathologists (John Nicholls), paediatricians (Susan Chu, YL Lau) and immunologists (Wenwei Tu). Our collaborations also extended to other universities in Hong Kong. During this time, I also became involved with the HKU-Pasteur Research Pole and worked with Roberto Bruzzone to develop a research program on the cell biology of viral infections, again focusing on influenza and emerging viral infections. In due course, we were joined by the next generation of researchers including Michael Chan, Hui ling Yen, Renee Chan, and Chris Mok, Suki Lee, Sophie Valkenburg, Sumana Sanyal from the HKU-Pasteur Research Pole, as well as many others. Many of these younger scientists are now developing into independent researchers in their own right. This multi-disciplinary approach developing in one research institution to address one major problem, influenza, has been very exciting and somewhat unique.
I am most grateful for the support I have received over the years from my colleagues at the Institut Pasteur in Paris, and from the Institut Pasteur International Network. We have had good collaborations with Institut Pasteur Cambodia and Senegal. I would like to thank Christian Bréchot for nominating me as Affiliated Professor of the Institut Pasteur. We have also established a very strong collaboration with CIRAD, in Montpellier, France with whom we have many collaborative studies on influenza and MERS-coronavirus in animals. I am convinced that we need to apply the One Health approach, involving researchers working on humans, animals and the environment to tackle these problems.
Right now, what are you investigating?
Currently, my main focus is on the MERS coronavirus. For that, again, we have been collaborating with many people, in Saudi Arabia, in Africa, in South Korea, with the Center for Global Health at the Institut Pasteur in Paris, with the CIRAD in Montpellier. One major puzzle with MERS coronavirus is the following. The virus comes to humans from dromedary camels. The virus distribution in camels is very wide across the entire African continent and the Arabian Peninsula, and it has been circulating for at least thirty years in camels, maybe even longer. Wherever you find dromedary camels, almost invariably, you find that they have been infected with MERS coronavirus. However, the human zoonotic disease has not been reported from Africa. MERS cases have been reported in Algeria, Egypt and Tunisia but these have been acquired from the Arabian Peninsula, not within Africa. Same scenario with the outbreak in South Korea in 2015. We are very interested in trying to address this question: why is there this difference? Is it a true difference? It could be that cases also occur in Africa but are not reported. Or is there a difference in the virus itself? The strains circulating in Africa could be different. Or is it a difference resulting from different type of interactions humans have with camels in Africa compared to Saudi Arabia? We have some clues that we are working on at the moment…
For Hong Kong, and more generally for global health, what is motivating you to push you research further and further?
Helping the next generation of researchers to establish themselves and take their place in the international research community is fundamental to me. Some of our younger members of the research team are addressing some key questions.
Avian influenza viruses and swine influenza can cross species barriers to infect humans. There is wide diversity of influenza viruses out there in animals, hundreds of them. Then it becomes very important to have a rational way for assessing risks regarding these different viruses. One cannot make vaccines for every single animal virus that is out there. We also know that once a pandemic arises, it spreads across the world much faster than the process of vaccine development based on the newly emerged virus strain. For example, the 2009 H1N1 pandemic emerged in Mexico and we first heard about it in April 2009. By September that year, 40% of children in Hong Kong had been infected – long before a vaccine was ready. So we should try to get ahead of the virus if we can. We have been collaborating with WHO to refine a systematic framework to assess the risk of animal viruses for human health and pandemic threat. Such frameworks have to be better refined because the parameters we are using are still quite crude. This really is something we are eager to understand better. What are the determinants that allow an animal virus to cross to humans? This is an unknown area. Some of our teams are working to understand the basic science underlying this. Others are developing and evaluating tools to investigate how well an animal virus can infect the human respiratory tract. Of course, we cannot experimentally infect humans to find out. So our team have developed methods to culture human lung tissue in the test tube and use this to investigate how well animal viruses can replicate in the human airways.
And when you look broader, it is not only influenza viruses that come from animals to humans, there are many others. Coronaviruses are one other example. Trying to extend a similar framework that has now been devised for risk assessing influenza to other emerging viruses is a huge task, but at the conceptual level, it should be possible for us to systematically move forward towards this.
What do you expect from the fellowship at the American National Academy of Sciences?
As I do as a founding member of the Academy of Sciences of Hong Kong, I would like to actively take part in the activities of the National Academy of Sciences of the United States, on issues I contribute to. I hope it can also help me to be an advocate of science, of the role of science and the importance of bringing the scientific and evidence based approach to important policy decisions. It is essential to bring science to the general public and the younger generations, and highlight the relevance of science in everyday decision making at any level, especially in an era where the role of science is being increasingly challenged…
Also, being one of the few Sri Lankan [editor's note: the first] to be elected to the US National Academy or the Royal Society of London gives me a special responsibility to continue to promote science in Sri Lanka, by taking part in meetings large and small where I can promote research there. The conditions of doing scientific research in Sri Lanka, as middle income country, are very challenging: resources are limited, the scientific community is small, pressures are many, role models are few. Despite all these challenges, there are still some excellent researchers in Sri Lanka, and I think it is important to continue to inspire scientific careers.
Following your recent election, what are the issues for public health that you would like to make heard by the community?
Almost every year, emerging viral diseases appear to challenge us as a new, completely unexpected threats such as Zika, Ebola, MERS, avian flus, SARS, etc… The responses to these challenges have been very short-lived, fragmented and memories short. When they happen, there is huge concern and everybody wants action – vaccines, drugs, control measures, etc. Once immediate events have abated, everything just goes back to normal. A classic example is SARS. More than ten years ago the outbreak started, and a lot of progress was been made at that time, including developing vaccine and antivirals. For example, a vaccine candidate was developed by Ralf Altmeyer at the HKU-Pasteur Research Pole and tested in pre-clinical trials successfully. However, with SARS being controlled, funding and interest died down. So when a related coronavirus, the MERS coronavirus emerged, we had to go back to square one to develop these interventions. Politicians and science administrations remain to be convinced that emerging infectious diseases will continue to threaten us and that we need to have a sustained investment in this area, from basic research to applied research. Each of these events has impacted governments societies with economic costs in the billions of US dollars. SARS is estimated to have cost the global economy over 40 billion US$. After Ebola, four different commissions came out with many recommendations, but they are now again being forgotten until the next crisis strikes. To keep pressing and raising consciousness on these issues is essential to me and my colleagues.