In January, the milestone was celebrated at an international research conference in Nairobi, Kenya.

The partnership between the two institutions has been recognized as a best-practice example of North-South research collaboration. It is regarded as a model global health initiative and has received millions of dollars in funding from the Canadian Institutes of Health Research and the Bill and Melinda Gates Foundation.

The partners’ landmark discoveries include that HIV can be transmitted from mother to child through breastfeeding; that STIs such as gonorrhea and chlamydia increase susceptibility to HIV infection; and that some individuals have natural immunity to HIV.

“The collaboration has made a huge impact,” said Keith Fowke [B.Sc.(Hons.)/88, PhD/95], head of medical microbiology and infectious diseases in the Max Rady College of Medicine.

“U of M has been a global leader in making cutting-edge contributions to understanding HIV and other sexually transmitted infections, thanks to this partnership.”

At the conference, Dr. Ruth Nduati, professor of pediatrics at the University of Nairobi, spoke of the opportunities that the partnership has given to Kenyan scientists.

“This collaboration has been a gift to the young people of Kenya,” she said. “It has given them the possibility to dream that their work can be part of transforming the world.”

The collaboration began in 1980, after two doctors from opposite sides of the world met at a conference. Dr. Herbert Nzanze, head of medical microbiology at the University of Nairobi, convinced Allan Ronald [MD/61, B.Sc.(Med)/61, DSc./11], a UM research pioneer in infectious diseases, to come to Kenya to help combat sexually transmitted chancroid infections in men.

A small lab was opened in Nairobi, and Manitobans started travelling back and forth to operate it. Ronald brought in one of his star students, Frank Plummer [MD/76], and engineered links with infectious disease specialists at other institutions, including the University of Ghent in Belgium and the University of Washington in Seattle.

Seeking to track down the source of the chancroid infections, the group opened a clinic in the shantytown of Majengo to assess female sex workers. They soon brought chancroid under control. But in 1985, they were shocked to discover that a high percentage of the sex workers had HIV/AIDS. They changed their focus to the growing epidemic.

More students came to join them, not just from Manitoba but from Belgium and Seattle. Kenyan medical students started going to Winnipeg and Seattle to further their training.

In the late 1980s, Plummer led a team – including Fowke, then a graduate student – in discovering that some Kenyan women sex workers who had been exposed to HIV infection were naturally immune to it. This breakthrough provided vital new information for HIV vaccine and drug development.

In 2007, a team led by UM professor Dr. Stephen Moses demonstrated that circumcision reduces men’s risk of HIV infection by as much as 60 per cent. This insight led to expanded circumcision programs throughout eastern and southern Africa.

The Manitoba-Nairobi partnership also developed HIV prevention and control strategies that included opening free clinics‚ educating sex workers and distributing condoms. Many of the strategies have successfully been implemented by other countries.

Today, the University of Nairobi STD/HIV/SRH Collaborative Research Group includes several other universities in addition to Manitoba, Ghent and Washington, including the University of Toronto, McMaster University and the University of California.

To mark the 40th anniversary, attendees at the conference included then UM President and Vice-Chancellor Dr. David Barnard and University of Nairobi Vice-Chancellor Dr. Stephen Kiama.

Reflecting on 40 years, co-founder Ronald, now distinguished professor emeritus in medical microbiology and infectious diseases, emphasized the links between science, public policy and clinical practice, and the priority of getting research results implemented so they can save lives.

“Global health needs to be further defined as a shared responsibility between scientific and academic leaders, governments and implementation processes that are demonstrated to the public, and to funders, as able to reduce disease burden,” he said.

Kenyan professionals have been vital to the collaboration’s research and clinical success. A number of Kenyan students who went abroad to study at universities affiliated with the collaboration eventually assumed health-system and research leadership roles in their home country.

Omu Anzala [PhD/97], currently director of the Kenyan AIDS Vaccine Initiative, earned his PhD at UM. Dr. Joshua Kimani, who became chief clinician for the collaboration, recalled a visit to Winnipeg that influenced his career path.

Back in 1987, Kimani was a third-year medical student when a Canadian – Dr. Frank Plummer – came to lecture his class on sexually transmitted diseases. “HIV had just come,” Kimani remembered. “People didn’t really understand it.”

Kimani and another student were so intrigued by Plummer’s talk that they volunteered at the Majengo clinic. That experience influenced them to specialize in infectious diseases. In 1989, they received funding from UM to spend three months in Winnipeg.

They did rounds at local hospitals and were awestruck to meet senior figures like Ronald, Dr. Robert Brunham and Dr. Joanne Embree, who were well-known members of the collaboration with their names on numerous research papers.

“By the time we came back home,” Kimani said, “we had seen a different world and been opened up to the opportunities in public health.”

Fowke, who has made more than 40 trips to Kenya in his career, said it was moving and inspiring to mark the 40th anniversary in Nairobi with an international network of colleagues and friends.

“With five generations of UM and UN researchers represented at the meeting, I felt tremendous pride in the vision of the founders, immense hope for the future – seeing the excellence of our students – and honoured to be part of this collaboration,” he said.

“UM researchers and students have improved the health of Kenyans and people around the world, and we should all take a moment to celebrate that accomplishment.” 

LARRY KROTZ and RADYUM STAFF

Remembering Dr. Frank Plummer

The celebration of the 40-year University of Manitoba-University of Nairobi partnership gave way to sorrow on Feb. 4, 2020 with the sudden passing in Nairobi of esteemed scientist Frank Plummer [MD/76], a leading figure in the collaboration.

The day before his passing in Nairobi, Dr. Frank Plummer was reunited with Hawa, a research participant who was found to have natural immunity to HIV nearly 30 years ago.

The world-renowned infectious disease expert was 67 years old. Just days before suffering a fatal heart attack, he had spoken at the 40th-anniversary conference and enjoyed reuniting with many of the Kenyan women whose natural immunity to HIV his team had discovered in the late 1980s.

“Frank Plummer’s contributions to public health on a global scale were immense. Today we lost a giant,” said Brian Postl [MD/76], dean of the Rady Faculty of Health Sciences and a medical school classmate of Plummer. “Frank distinguished himself as a true leader and visionary.”

The Winnipeg-born Plummer, who joined the UM faculty in 1984, spent 17 years in Nairobi leading the collaboration. His work not only produced vital knowledge about the HIV epidemic in Africa, but led to prevention and control strategies that influenced worldwide health policy on sexually transmitted infections, saving tens of thousands of lives.

In Canada, Plummer’s leadership roles included serving as scientific director general of the National Microbiology Laboratory in Winnipeg and director general of the Centre for Infectious Disease Prevention and Control in Ottawa.

He led the Canadian laboratory response to the SARS outbreak in 2003 and the H1N1 influenza outbreak in 2009. At the time of his passing, he was distinguished professor emeritus of medical microbiology and infectious diseases at UM and was working to develop an HIV vaccine.

“The work of Dr. Frank Plummer has had a tremendous impact on global public health, and he was a prime example of dedication and passion in one’s profession,” said Dr. David Barnard.

Plummer’s many prestigious honours included the Order of Canada, the McLaughlin Medal of the Royal Society of Canada, the Prix Galien Research Award, the Canada Gairdner Wightman Award and the Flavelle Medal of the Royal Society of Canada.

“He was an outstanding, world-class researcher who was a dear colleague, mentor and friend to many of us lucky enough to work with him, and beside him,” said Keith Fowke [B.Sc.(Hons.)/88, PhD/95], head of medical microbiology and infectious diseases. “He will be dearly missed by all of us in the academic and scientific community.”

The paper, published in the journal Antibiotics, found that UM professors were linked to five of the 100 most-cited papers that span the past 60 years. This is more contributions than larger institutions like Harvard University, Stanford University, University of Toronto and The University of British Columbia.

The analysis looked at keywords related to the field of antibiotics to compile the most-cited papers.

“I think it really shows the great work that the University of Manitoba infectious diseases and microbiology has done over time,” said Dr. Anand Kumar, professor of internal medicine in critical care and infectious diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences. “I think there are a lot of places that demonstrate excellence for a decade or so, but really what this is indicating is that there has been a high level of excellence at the University of Manitoba for a very long time.”

Dr. Jude Uzonna, associate dean (research), Max Rady College of Medicine, said he was pleasantly surprised to discover that the University of Manitoba had the most contributions.

“Thinking about it, ‘I should not be surprised because we are doing good science here,” Uzonna said. “We’re doing great work so this reflects the overall excellence in the kind of research being conducted at the Rady Faculty of Health Sciences and the University of Manitoba.’”

Kumar’s 2006 paper demonstrating that the faster a patient with septic shock is treated with antibiotics, the better the survival, was ranked number seven on the top 100 list and remains highly quoted. The paper, titled Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock, has been cited more than 5,000 times according to Google Scholar.

“It is one of the most widely quoted papers citing how critically important it is to rapidly treat sepsis,” said Dr. Kelly MacDonald, professor and head of the section of infectious diseases, department of internal medicine and a researcher in medical microbiology/infectious diseases, Max Rady College of Medicine. “It is a very important paper.”

The 33rd most-cited paper was a 2001 Annals of Internal Medicine publication authored by multiple-renowned UM faculty, including dean emeritus of medicine Dr. Nick Anthonisen, demonstrated that when patients with exacerbations of chronic obstructive pulmonary disease were given antibiotics, along with standard treatment, they did significantly better than without antibiotics. The paper, titled Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease, was cited more than 3,000 times according to Google Scholar.

“That paper changed clinical management. It was quoted widely for many years,” MacDonald said. “That was a seminal paper.”

Dr. Eric Bow, professor and past chair of the section of oncology and member of the section of infectious diseases in internal medicine, co-authored two papers in the top 100. As a dual research specialist in treating infections in leukemia, he was involved in Infectious Diseases Society of America (IDSA) guidelines for the use of antimicrobial agents in neutropenic patients with cancer. The 2008 guidelines are ranked 49th (more than 1,700 citations on Google Scholar) and the 2000 guidelines are ranked 58th (more than 2,700 citations on Google Scholar) on the list.

“These guidelines from Dr. Bow and the IDSA committee have been tremendously impactful,” Kumar said.

Former University of Manitoba professor Dr. Marc Gurwith’s 1981 seminal paper was the first to describe clostridium difficile colitis, a now widely-recognized serious cause of hospital-acquired diarrhea. The paper, titled Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia, is ranked 73rd and was cited more than 1,600 times according to Google Scholar.

“Dr. Gurwith’s paper described a new disease for the first time,” Kumar said. “So that’s pretty cool.”

Bow attributed the success of these papers and their authors to the outstanding leadership the department has had over the decades.

“I think Dr. Allan Ronald is the one who had the insight and vision to put the University of Manitoba on the global map in the area of infectious diseases,” Bow said.

MacDonald said that while the department of microbiology and infectious diseases is well known for its international health work in the field of STDs and HIV, this clinical and translational research shows that infectious disease clinical researchers also have been making an impact internationally in other areas as well.

“I think it’s important that people understand the breadth of expertise that has come and is still coming out of this centre,” MacDonald said. “We have some of the best researchers in the world right here at home in Manitoba.”

Just because you’ve been tested for COVID-19 and your test came back negative does not always mean you are free of the infection, warns a UM clinical scientist.

In a story on CBC News, Dr. Kelly MacDonald (MD/87), head, infectious disease program at UM, explains that there’s a one per cent chance that a false negative can be the result of a COVID-19 test. It’s possible – although unlikely – that the person was tested too early, or that a swab of the back of the nose didn’t enter far enough to grab some of the infected cells.

“What we tell everybody is, if they have symptoms, and their test is negative, that it doesn’t mean that they are home free,” MacDonald said. “Everybody is warned that there is a chance of a false negative, and that they’ve got to go home and act as if they have COVID-19, regardless of the test results.”

In addition, false positives can occur, which MacDonald said are usually caused when the COVID-19 test picks up a different, local coronavirus strain.

“If they still have a fever and a cough, or symptoms consistent with a viral illness that could be COVID-19, we tell them to continue to isolate and assume that they have COVID-19 … If you deteriorate seriously and all your instincts tell you that this is a serious thing, then you need to be seen by a physician,” she said.

MacDonald said it’s more common than we realize that a person will test negative for COVID-19, but actually have the disease – false negatives can run as high as 10 per cent. She said lab tests are not the only way to determine status and affected people should take the advice of Health Links in determining their quarantine measures.

Here is the entire CBC News story.

Dr. Kelly MacDonald, the head of the section of infectious disease in the department of internal medicine for the University of Manitoba and the Winnipeg Regional Health Authority, says some people feel they’re healthy, not realizing they could be a carrier.

“What you have to do is find a way to override that sense of personal invincibility,” she said. 

“Explain to them that the numbers are such that even if they have a very low chance of getting sick and only infecting one person … the downstream numbers of people that could get infected from that could be in the hundreds — and those people could be immuno-suppressed.”

MacDonald says in crises like this, people play an important role in holding their friends, family and people in their sphere of influence accountable.

“There are ways one step less of shaming to not endorse that kind of behaviour.”