Neelika Malavige: a viral immunologist from Sri Lanka reflects on challenges and opportunities in global health

The spotlight series is an interview-based profile series by McGill Global Health Perspectives. The series focuses on researchers and practitioners in global health outside of high-income country settings (and) or representing marginalized groups. For our first spotlight profile, we are featuring Professor Neelika Malavige of the Sri Jayawardenapura University of Sri Lanka.

Professor Malavige focuses on immunology and molecular medicine as her primary research discipline. Her research interest primarily focused on Dengue virus which affects approximately 50,000 of Sri Lankans annually, with some years over 100,000 being affected. She currently heads the new center for Dengue Research in Sri Lanka housed in the Sri Jayawardenapura University. However, with the emergence of the SARS CoV-2 virus which resulted in the COVID-19 global pandemic, she used her research skills and capacities to strengthen the COVID-19 response in Sri Lanka and to provide technical support in the areas of testing for COVID-19, assessing the efficacy of the administered vaccines in Sri Lanka and in advocating for evidence-based policies for COVID-19 response efforts. Most recently she was selected to join the World Health Organization (WHO) Technical Advisory Committee on COVID-19. In this interview we focus on her journey as a researcher, her efforts to move research efforts in immunology and molecular medicine forward within Sri Lanka, the challenges, and her expectations for the future of global health.

Can you speak to your introduction to academic research and your journey as a researcher?

I gained my medical degree from University of Colombo and while in university I recognized that I wanted to focus on an academic career based on my research interests. As we were training to be medical doctors clinical focused research was encouraged within the system so that was my initial introduction to research. I think my research interest became more focused on dengue especially after four children died in 2001 due to Dengue. I started initially focusing on serosurveillance and clinical features of dengue following my internship at the Sri Jayawardenapura hospital in Sri Lanka. My interest grew as I conducted more research on dengue and it mattered to us personally as it was affecting our communities.

So, this was my introduction to research and how I started focusing on dengue as my primary research interest.

So, what were the next key developments in your research career?

Perhaps my next key turning point was being able to study for my Ph.D. at the University of Oxford. I was fortunate to receive a Commonwealth Scholarship due to my academic achievements (Editor’s note: Dr. Malavige graduated being recognized as the top student her cohort (batch) at the University of Colombo). For me, going to Oxford was eye opening in many ways, first I had so much energy and enthusiasm to learn, and there was so much to learn. Additionally, unlike the university settings in Sri Lanka where we had limited research resources at the time, at Oxford I had access to resources and equipment learn and conduct my research. I learned a lot both in and outside the lab as I completed my Ph.D. in viral immunology at MRC Human immunology Unit at the Weatherall Institute of Molecular Medicine at the University of Oxford. Although, I could have looked at options for staying back, I decided to return to Sri Lanka for both personal reasons and for professional reason of wanting to continue move research forward in Sri Lanka. So, my next challenge was figuring out how to carry this research forward in Sri Lanka.

Yes, that seems like a significant challenge. Can you speak to how you overcame those challenges to bring it to the stage of initiating a Dengue research center in Sri Lanka?

As I returned, it was definitely challenging to start anything. We have to remember that there was a war going on as I returned in end of 2008. Also, I had two young children; and so, both circumstantial and personal situations posed challenges for me to move my research forward. Lack of funding was a key factor. We did not receive some of the funding due to the instability in the country. But this is where my mentors and networking efforts played a huge role. My mentor from University of Oxford Professor Graham Ogg, has always been very supportive of me pushing this research forward and he played a huge role in taking our research forward in Sri Lanka. As our research grew and became noted in international conferences organized by NUS, Singapore and National Cheng Kung University, Taiwan and ICGEB, New Delhi , I also was able to meet others who used their social and academic capital to support me. One such professor was Dr. Deheragoda, a professor of geography at the University of Sri Jayawardenapura.  Another researcher who supported me after meeting me at a regional conference was Professor Mah Lee Ng from Singapore. These efforts were partly due to their recognition of my research work and partly because I was open to explaining my work to anyone who shows interest.  There was a lot of personal efforts that somewhat luckily translated into funds and technical support. So, we were able to subsequently get more funding, material and technical support from various places such as the University of Oxford, World Bank, National Health Institute of the United States,  the Foreign and Commonwealth Office, WHO and the Government of South Korea (an educational grant to establish our department). Our research work also led to an international patent related to identifying specific peptides in Dengue virus in 2011, which paved the way to get funding from the Sri Lankan government.

These efforts also led to you winning awards such as the Best Young Researcher in Health Sciences award from the Government of Sri Lanka in 2008. Now, as a recognized scientist how do you move these efforts forward with others?

Mentorship played a huge role in my career. So, I think each and every mentor was crucial. For example, as Prof. Graham Ogg played a huge role in molding me into who I am today and still supports me in an unimaginable way. As a mentor now, I support and create pathways for my students to move the field forward. For example, I have supported students to go to Oxford University and complete doctoral studies on infectious diseases related subjects. After completing their studies some have joined me as colleagues to work on infectious diseases in Sri Lanka. So, we hope to continue these efforts to advance scientific research in Sri Lanka, by equipping young researchers with expertise. This will lead to better recognition for our research, hopefully more funding  and will allow us to bring perspectives to the field from our experiences.

Due to the pandemic lot of us had to shift our focus onto COVID-19. Could you talk about your research and other efforts related to COVID-19?

I think given our focus on viral immunology and since there was huge need for us to support COVID-19 efforts, we were able to prioritize COVID-19 research. As we dedicated our efforts to support national level testing for SARS-CoV-2 using RT-PCR testing, we had to work around the clock and also be cognizant of the risks, especially at the initial stages in 2020. We also reached out to our international research partners for support both equipment and technical which allowed us to keep our research aligned with global standards. As you know, the COVID-19 situation in Sri Lanka changed with multiple waves and so we had to make sure that we kept up with those changes. Currently, we are conducting research on efficacy of vaccines, leading the SARS-CoV-2 genomic studies and also looking at seroprevalence. Sri Lanka provides interesting data because we have vaccinated our population from all four WHO approved vaccines and also with Sputnik V. So, there is a lot of interesting comparative analysis that we can do.

Informing the public about the ground level situation and bringing awareness to the shifting nature of the pandemic was important, so it led to efforts in public and policy advocacy both nationally and at the regional level.

So, as we move forward, hopefully recovering from this pandemic what challenges do you see for research in Sri Lanka?

Many of the challenges are systemic challenges that affect students and researchers in low- and middle-income countries (LMICs). For example, research environments and facilities differ between high income countries and LMICs. So, students do not have opportunities for exposure to highest levels of research facilities. Although, we try to create pathways for students, there are always added challenges such as funding and visa related barriers. Even though we can financially support some students, increasingly stringent visa processes and regulations make it very difficult for students to pursue higher studies in high-income country institutes. This is a challenge that existed pre-COVID. This barrier affects students across the board in LMICs.

Another challenge is related to publishing. First, there are challenges accessing journals behind paywalls and we do not have institutional funds to subscribe to these journals. Second, I think there is a preference in journals for articles from high income country institutions and that is an uphill battle for us to fight against these pre-conceived perceptions about the quality of work originating from low and middle income countries.

So, I think as we look to improve as a collective, providing opportunities to learn and minimizing barriers to publish quality work for researchers in LMICs are important factors. These changes are relevant to move my specific field of research forward but also in general for the field of global health.

About the Author:

This is a collective effort of the McGill Global Health Perspectives Team. Shashika Bandara, led the interviewing and the writing for this conversation with Professor Neelika Malavige.

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