In 2018, Integrum Scientific was formed by “global innovators” in response to “the need to address the deficiencies” and “broaden the benefits” observed in the international Ebola response of 2014-2016. Integrum is preparing for future threats and reducing their effects in the most vulnerable regions of the world.
“Integrum is dedicated to improving the effectiveness of clinical research and promoting prevention, preparation, and awareness.”
Here at VaccineNation we were lucky to meet the Integrum team in Washington last month. We spoke to CEO Joseph Sgherza, along with colleagues Dr Julius Lutwama, Brigadier-General Professor Foday Sahr, and Dr John Dye about the work they are doing. We are so grateful that the team made time to speak to us and we hope that you enjoy their perspectives!
Introducing Integrum
We heard from CEO Joe Sgherza about his vision for Integrum. He explains that it is a “readiness response company” with an infectious disease board comprising experts from around the globe. Many of them were involved in response activities during the Ebola crisis of 2014. They now act as “sentinels” across the world in their personal capacities.
“Ensuring that we can make a difference, and help the greater good of research.”
What does a response look like?
Joe kindly explains the importance of uniting “stakeholders and players” in a global crisis. He emphasises the role of “in country experts” and “communicating effectively”, which is what he hopes Integrum achieves. As we hear from Dr Dye later, Integrum focuses on working with local experts in a disease outbreak to understand their needs.
The importance of communication
We asked Joe about how Integrum maintains this close relationship with local experts during crises, and how we can better encourage their inclusion during global health threat responses.
“In one word, it’s communication.”
Joe states that the “take home message” is asking key stakeholders “how can we be effective right now”, a message repeated by Dr Dye below. Furthermore, it is “more important than ever” to offer services where there are “gaps” by communicating with everyone involved.
“Not where you think you can fit in, but where you actually can make a difference in helping their situation.”
Putting this into practice
It’s one thing to have good intentions when coming to support a community in crisis, but it’s another to effectively implement these intentions. We asked Joe to explain how this works at Integrum. He presented the example of the Sudan and Marburg outbreaks, during which Integrum worked with Dr Lutwama to set up a research board with representatives from different “acumens”. It was led by Dr Lutwama “in country” to enable the team to “ask questions”, be “available immediately”, and to “disseminate the information of what’s happening real time”.
“We’re able to actually find out what the numbers are, what do they need, and then how does that impact the current clinical research we’re doing there?”
Coming to the Congress
What, then, is Integrum looking to gain from the Congress? Joe suggested that “more collaboration” was on the cards. Demonstrating to colleagues the “value” that the team can add was a key focus for the event.
“Being a small organisation, we are very nimble, and we’re able to get into places to assist.”
Joe describes Integrum’s ability to support with a “scientific need for convalescent plasma or for serum collection”. With current collaborations including work with CEPI and USAMRIID, the potential to “add value” continues to grow.
Next, we spoke to the other members of the team on site, so keep reading to hear from Dr Julius Latwama, Professor Foday Sahr, and Dr John Dye!
Introducing Dr Julius Lutwama
Dr Lutwama is the Head of Department of Arbovirology, Emerging, and Reemerging Infectious Diseases and Deputy Director of the Uganda Virus Research Institute. His specialisation is in surveillance for a range of infectious diseases.
“My department is the one that normally announces, or comes up with, all of these new diseases that are announced in the country.”
This is a huge responsibility on a national and international scale; Uganda is known to have “very many diseases”, according to Dr Lutwama, who encounters lots of these in his daily routine. Some of our community will remember that it was UVRI who released a statement in September 2022 about the Ebola outbreak.
The burden of disease in Uganda
As Dr Lutwama has already explained, Uganda has “very many diseases”. He tells us that “almost 40 diseases” have been identified for the first time in the country. This is partly because of the “many mosquitoes” and “many ticks”. Diseases circulating in Uganda include Zika and Chikungunya.
“Uganda is a hotspot for diseases.”
The importance of surveillance
Dr Lutwama’s role is centred on surveillance. We asked him about the importance of this in the context of disease, specifically in Uganda.
“It is very, very important.”
With so many diseases, often occurring in “rural areas”, people will suffer morbidity and mortality. In particular, surveillance helps to identify diseases before they spread “over a wide area” and become more widely noticed.
“When you do surveillance, you can get these diseases very quickly before they affect many people.”
Furthermore, the tragic reality of these diseases is that we rarely have approved vaccines. Therefore surveillance enables experts like Dr Lutwama to find them “as quickly as possible” and reduce the number of deaths from disease.
Introducing Professor Sahr
Professor Sahr is the Vice-Chancellor at the University of Sierra Leone, but also serves as Brigadier-General in the Republic of Sierra Leone Armed Forces Joint Medical Unit. In this role he assists the Ministry of Health and Sanitation with looking after the health of the country. During outbreaks in particular this support is critical.
Outbreaks in Sierra Leone
As Professor Sahr’s experience is deeply rooted in outbreak responses in Sierra Leon, we asked how prepared the country is for future threats. He indicates that from Ebola “some structures were established”; the government invested in structures such as supply chain and laboratories.Therefore, when COVID-19 emerged as a threat to the country, the response was “faster” because there was “some baseline”.
“That doesn’t mean that we are out of the woods.”
As always, there is “still room for improvement”. Within his role in the armed forces, Professor Sahr is encouraging training and developing clinical guidelines with the Ministry of Health and Sanitation.
Emerging diseases in Africa
Professor Sahr described the potential for “improvement” so we asked him to outline some of the threats that Sierra Leone is facing in the future. He suggested that the situation “does not stop” at Sierra Leone: “it goes across”. He shares with us his experience with “diseases that we thought are non-existent”.
“To me, when Ebola struck, it was not really a surprise.”
Thanks to the growing surveillance capabilities in his area, Professor Sahr suggests that emerging and reemerging diseases become less of a shock, allowing for a more appropriate response.
How does Integrum help?
Up next in our whistle-stop tour of the team is Dr John Dye, Viral Immunology branch chief in the US Army Medical Research Institute of Infectious Diseases. He kindly outlined some of the work that is being done in countries like Uganda and Sierra Leone, with the help of his colleagues. He tells us that the team collects samples from survivors of outbreaks.
“The idea is that we can look at their immune system, and how it has changed over time, to help us develop better vaccines for the future.”
A global ecosystem
Clearly, the work that the Integrum team is doing is critical. However, it can be hard to draw attention to this, particularly when the diseases that they are investigating are often contained in one region. We asked Dr Dye about keeping interest and investment high. As he acknowledges, many of the diseases are like “flash fires”: “they come up, and then they quickly retract”.
“It has been very difficult, but I think the world is starting to learn that we are all one ecosystem.”
With increasing globalisation, “the world is one backyard”. For Dr Dye, this means we need to “worry about everyone”. As this mindset spreads internationally, so does an understanding of the importance of Integrum’s work. Therefore, it is easier to secure funding and convince people to consider everyone in our “global ecosystem”.
How does Integrum promote fair access?
Although it’s important to increase global awareness and investment in areas where these diseases are rife, it’s imperative that when treatments or vaccines are developed, they are made accessible. Dr Dye explains that “anything” that the team develops is shared because the investigators in each country are “co-investigators”.
“They have intellectual property.”
When we asked Dr Dye what he was looking forward to at the Congress, his answer was simply “being able to moderate a session with two incredible African leaders”. He was excited to hear their experience and their own versions of “what they really need for outbreak response”.
“Not what we tell them they need, but actually what they need.”
We are so grateful for the time and energy that the Integrum gave us. It is fantastic to hear from an organisation so invested in learning from the communities it supports, and adapting to suit their needs. We hope to continue these conversations at future events. To stay updated as we release more interviews, make sure you have subscribed to our weekly newsletter.
