Thirty years on, the cure for HIV/AIDS remains elusive, but researchers from various corners of the world are making enormous efforts and as the quest ensues, one Motswana woman, Dr Catherine Koofhethile, an immunologist, is in the thick of things and among those in the forefront to enhancing HIV/AIDS Cure research, ANGELA MDLALANI writes.
Despite the fact that both the vaccine and cure for the Human Immunodeficiency Virus (HIV) have eluded the researchers’ inquisitive eye for three decades now, Dr. Catherine Koofhethile believes that a breakthrough for an HIV cure is nigh. Having spent almost all her career life in HIV research, Koofhethile is of the strong view that more focus should be placed on cure research.
During her PhD studies, her research focussed more on the understanding of the mechanisms of HIV control during the chronic stage of infection but the turning point was in 2014 when she was nominated to attend the 64th Lindau Nobel Laureate (Medicine and Physiology) meeting in Germany. There, she met and interviewed the esteemed Professor Barré-Sinoussi who received a Nobel Prize for co-discovery of HIV.
“That was big for me, as I was fortunate enough to be meeting this woman who has taken great strides in HIV work. We discussed a variety of topics with regards to HIV research. And when she gave her talk, she encouraged work towards cure research. Her talk motivated me and pushed me to think about having my post-PhD career be focused on cure research.”
Further, she was propelled by revelations by Prof Barre-Sinoussi’s assertion that she had interacted with HIV infected people who had revealed that they were tired of taking medication and wanted to be cured. Today, Koofhethile is based in the United States in Boston, Massachussets at the Harvard T. H. Chan School of Public Health. Under the mentorship of Professor Max Essex and Dr. Vladimir Novitsky, she still researches on HIV.
Prof. Essex is among HIV experts who have been researching on HIV since the beginning of the epidemic. Currently, Koofhethile’s research focuses on understanding the architecture; size and structure of the proviral reservoir in HIV infected individuals undertaking antiretroviral treatment (ART) in Botswana.
She uses a combination of Immunological and Virological assays to monitor proviral reservoir in HIV infected individuals. She works in collaboration with a local Investigator, Dr. Sikhulile Moyo, a Virologist based at Botswana Havard AIDS Institute Partnership (BHP) in Botswana where she also holds a Research Associate position. Here, she is actively involved with research and also mentors and supervises some of the upcoming researchers and students who are attached at the lab.
“When HIV infects the cells, mostly CD4+ T cells, the majority of these infected cells eventually die but only a small proportion go in to a ‘resting state’ creating what we call ‘reservoir’. This is a situation where by the virus can sort of hide in different parts of the body. The reservoir sites can be in tissues such as the lymph nodes and spread across the body including central nervous system and the gastrointestinal track. This reservoir is the major obstacle to finding a cure for HIV,” she revealed.
“My current research therefore is focused on trying to understand this reservoir. In order to completely eradicate the virus from the body, we must eliminate the reservoir but in order to get rid of the reservoir, there is need to understand its dynamics.”
Just last month, Koofhethile flew into the country and gave her first ever Public Lecture at the University of Botswana. And fittingly, it was hosted in her homeland. The Public Lecture addressed her previous PhD and current post doctoral research work, which she revealed to this publication, was going well. She also gave a summary of the current global HIV cure research – an update of where we are in terms of finding a cure.
The public lecture was well attended, including by her family who got to see firsthand the kind of work she does, since she is not based in Botswana. “It was very humbling to see my family and friends in the audience; they have greatly supported me throughout my career. And for them to see my progress meant a lot to me. They now understand the kind of work I am involved in and are very proud.”
The current study, she and Dr. Moyo started last year November will be completed hopefully at the end of this year (2018). The study involves teenagers who were born with HIV, started ART soon after diagnosis and have been on therapy for many years. “It is a very important project that will give us a better understanding of the HIV reservoir and enhance HIV cure research. We are still recruiting for this study but already I am hopeful about it,” she said.
The making of the great Doctor
Koofhethile has almost always known she would end up in science. She grew up at a time when HIV had just been discovered, and the stigma and fear of AIDS was rife. She would go on to hear more about this monstrosity at school, although not much was known about the disease then. So curious was the young Koofhethile that she at that young age took a life decision that she would grow up to one day help end that epidemic.
Fast forward to some years later, now a qualified microbiologist and immunologist, the Harvard Post-doc Fellow is among those at the forefront of the worldwide effort working towards HIV cure research. Right from her primary school days, she had always performed well in Mathematics and Science, it was no surprise then when after the Junior Certificate she went on to do Pure Sciences and Add Maths.
She proceeded to do her Tirelo Sechaba (National Service) at the Botswana National Youth Council as an Admin Assistant and occassional peer educator on HIV/AIDS before proceeding to do her first year at the University of Botswana. She spent only her foundation year (formely known as BSc Part 1) at UB and she was then offered a scholarship for a four-year Bachelor of Science Degree with Honours in Medical Microbiology at the University of Surrey in the United Kingdom.
Upon graduating, she returned home and was offered a job at BHP as a Fogarty Fellow. After 2 years, she decided to go back to read for her Masters Degree in Immunology at the University of Birmingham, still in the UK, albeit this time as a self sponsored student. “My family contributed a lot towards my school fees and upkeep and I’ll forever be grateful for their unconditional support,” said Koofhethile.
All along, she was itching to get her hands on HIV research, but there were no dedicated research projects on HIV. Eventually, after her second degree, she decided to contact a Professor at Oxford University who was only impressed she would want to work with HIV research. The Professor in question is Phillip Goulder, whose work has had a major impact in the field of HIV research throughout the world. A renowned paediatrician and researcher, he is lauded for his great contributions towards HIV research.
Dr. Koofhethile spent 2 and half years at Prof. Goulder’s lab, working as a Graduate Research Assistant. “My time at the Goulder lab was fulfilling in many ways. Most of my research techniques I employ in my HIV research were learnt from the Goulder lab,” she said in an interview. She would want to continue studying under Goulder’s mentorship, but this time in Africa, at the “at the epi-centre of the epidemic”.
“During my time at Oxford, I already knew I wanted to proceed to a PhD and that I wanted to study in South Africa under the mentorship of both Prof. Goulder and Prof. Thumbi Ndung’u who used to work in Botswana. And I knew both professors would be fantastic mentors since they are experts in the field of HIV research.” In 1998, Goulder and some colleagues founded a state-of-the-art lab at the University of Kwazulu Natal (UKZN), in Durban South Africa, the university Koofhethile had in mind for her PhD.
“It really made sense for me to study in Africa than elsewhere because we are the hardest hit by HIV. When at home, you get to experience how people affected relate with the research,” she highlighted further. So, she decided to take up her studies, focusing on the Immunology of HIV. “I was basically trying to understand why some people get infected and do not fall sick and while some get infected and their health deteriorates very fast.”
Her PhD research entitled “Protective HLA Class I Alleles: Investigation of Viral Control and Lack of Control in Chronic HIV-1 Subtype C infection,” in fact, has brought scientists a step closer to understanding the phenomenon whereby a rare group of individuals control HIV-1 infection without antiretroviral therapy.
Her PhD studies were supported through scholarship from the Organisation for Women in Science for the Developing World (OWSD) and partly by some of Prof. Ndung’u’s grants. The OWSD is a non-profit making entity whose objective is to strengthen women scientists’ role in the development process and promoting their representation in scientific and technological leadership.
As fulfilling as her work has been thus far, Koofhethile harbours plans to return home and do more with regards to HIV research, women’s development and science development. However, she believes that there is a great number of women involved in science and research in Botswana, but they are not celebrated enough. So, we need to celebrate these wonderful women in science in order to make science careers more attractive to the young girls.
This will increase the Global numbers of women in science. We also need our government to direct funding towards basic science research in Botswana to allow us to do research in our own country as Batswana and solve problems affecting us as a nation,” she asserted. She envisions an Africa that would be the hub of research, science and technology and be able to attract more research funding.
Health workers are at the front line fighting the deadly, contagious COVID-19. These workers have an immense challenge of welfare and government has since turned a blind eye to dares and crushing odds throttling health officers, particularly nurses.
Botswana Nurses Union (BONU) has once more called on government to invest in the country’s nurses and give the nursing profession dignity.
In May 2020, BONU President, Obonolo Rahube said government should, in line with the advocacy of World Health Organisation (WHO) invest more on nurses and midwives, and further advised government to address challenges that nurses are faced with. The proposal was made on International Nurses Day.
At the time, Rahube urged government to provide subsidised accommodation for nurses and midwives as it has emerged that during the fight against the Corona-virus, accommodation for nurses and midwives is very important. Rahube called on government to provide nurses and midwives with 100% medical cover.
He also called on government to introduce risk allowance for nurses and midwives, noting that as frontline workers during the pandemic, they are at high risk. Nurses also demanded Personal Protective Equipment (PPE), a matter which they lost with costs in court. Also critical during the COVID-19 era for health workers, psychological support is what BONU maintains is still lacking.
In the same year (2020), the Union raised a number of other challenges they are being faced with. These challenges, they asserted, make it testing for them to undertake their duties, especially now that COVID-19 has shaken Botswana’s already weak health system.
BONU expressed disappointment at nurses’ pay, nurses who tested positive for COVID-19 at an alarming rate, violence against nurses, nurses’ contracts which were never renewed and a poorly coordinated vaccination plan for health workers.
Clearly, nurses are not only battling the COVID-19 virus, but also government who has since refused to come to the party.
This week once again, BONU tested waters and slammed government with more demands, some of which have turned into an everyday song while COVID-19 continues to kill more nurses.
At a press conference on Tuesday, BONU President Rahube said over 800 nurses have been infected with COVID-19. Of this number, 34 nurses lost their lives due to COVID-19 related infections.
WHO and other health experts say for countries to emerge victorious from the COVID-19 pandemic, they must fast-track the roll out of vaccine. In Botswana, there is no clear explanations of how the vaccination plan is going.
The situation around vaccination is chaotic, and this is evidenced by only 28% of nurses who have been vaccinated. President Mokgweetsi Masisi is also disturbed by the COVAX programme as Botswana vaccines arrive in the country missing, every time.
Debates in Parliament on which vaccine to adopt are failing to conclude, in fact, they never gained energy. Rahube told members of the media that nurses are overworked.
“Shortage of nurses puts those available at risk. Some nurses are on isolation, quarantine and some passed on. Nurses do both testing and contact tracing so they end up working stretched hours, at times from 6am to 10pm. There is no how nurses will be able to deliver while exhausted,” he said.
He further indicated that infection control practitioners are not recognised and deployed appropriately, and some regions have shortage of commodities and supplies such as water resistant gowns (nurses are forced to re-use those availed), masks, gloves, scrubs and uniforms.
Oxygen supply is said to be in shortage, something that mounts COVID-19 deaths.
“Patients lose their lives whilst still awaiting to be put on oxygen. Psychological services are in serious need as nurses continue to lose their significant others, faced with resource constraints and many of them are not vaccinated,” said Rahube.
Accommodation still remains a huge challenge for nurses. BONU President said nurses overcrowd with families and colleagues.
In Kauxwi, four nurses share a single house, in Moshaweng two nurses share a single bedroomed house together with their families, with no electricity yet the village is powered. In Kazungula, there are only two staff houses for 11 nurses and their families.
The union stressed that the Chief Nursing Officer is not coming to the party, and the expectation is that the office should be coordinating all nursing issues at the Health Ministry. Rahube indicated that transfers have been frozen, promotions stalled and they continue to lose nursing posts to other Ministries.
In a number of recommendations, BONU urged government to consider compensation and risk allowance for staff affected by COVID-19 related deaths and those infected. “COVID-19 has been declared an occupational health illness, in essence, the employer should facilitate its occupational health division, and there are lots of occupational health nurses who are wrongly deployed, who could be running such programs at the facilities.”
In regard to vaccinations, BONU underlined that there should be clear information relating to vaccines and they should be made accessible. “Local franchise manufacturing of vaccine could use Botswana Vaccines Institute (BVI) and government should be clear and transparent concerning procurement of vaccines. It should also allow stakeholders with capacities of procuring vaccines to do so.”
Government is moving swiftly to completely overhaul public procurement — a new Bill has been tabled before Parliament this week by Minister of Finance and Economic Development, Peggy Serame and is scheduled for debate in the coming days of the current parliament sitting.
Through this Bill the country’s purse bearer seeks to dismantle existing public procurement pieces of legislation, transform, merge and form a new public procurement arrangement. The existing public procurement high command base — the Public Procurement and Asset Disposal Board (PPDB) would cease to exist.
This organisation will transition and assume the reigns of a regulator and oversight authority; the actual procurement; floating of tenders, accepting bids, adjudicating and awarding tenders will be fully taken over by Government departments accounting officers.
Accounting officers are Permanent Secretaries and statutory organisation heads and directors or any person who is responsible for the administration and day-to-day management of the affairs of a procuring entity, and any other person, who may be designated as such by the Minister under the act.
Speaking to this Bill this week, Serame revealed that the current Public Procurement and Asset Disposal arrangement will be merged with the local authority’s procurement Act.
“We will now have procurement under one roof, all overseen by accounting officers, it’s all government money coming from one port,” she said.
Minister Serame explained that PPADB will no longer be player and referee at the same time, with a view to improve efficiency and effectiveness in the regulation and management of public procurement processes.
According to Minister Serame, the new public procurement Act will promote competition among suppliers and contractors, and also provide for the fair, equal and equitable treatment of all suppliers and contractors.
PUBLIC PROCUREMENT REGULATORY AUTHORITY
Should parliament pass this bill the current Public Procurement and Asset Disposal Board (PPADB) will transition into a new body called Public Procurement Regulatory Authority.
The new Authority will be mandated with setting standards and practices for the public procurement system, regulate and control the public procurement system, ensure the application of fair, equitable, competitive, transparent, accountable, efficient, non-discriminatory, honest, value for money and public confidence in procurement standards and practices.
Furthermore the Authority will monitor and enforce compliance with the new Act and any relevant law by a procuring entity.
For standardization and ensuring of world class procurement best practices the Public Procurement Regulatory Authority will monitor, assess, review and report on the performance of the public procurement system to the Minister and advise on desirable changes, and further issue standardized bidding documents to all procuring entities
This oversight and procurement regulator will conduct periodic inspections of the records and proceedings of a procuring entity to ensure compliance with the Act.
The regulator will institute periodically, in respect of any procurement —a procurement audit during a tender process, a contract audit in the course of execution of an awarded tender, a performance audit after the completion of a contract, and an investigation at any stage of a procurement process.
The Authority will continue to keep and maintain an up-to-date register of contractors, known as the “Contractors’ Register”, in works, services and supplies, or any combination thereof, however classified.
The new Public Procurement Regulatory Authority will be governed by a board of nine (9) non-executive directors appointed by the Minister of Finance and Economic Development.
The Public Procurement Board will be charged with directing the affairs of the Authority. Day to day executive activities of the Public Procurement Authority will be run by a Chief Executive Officer who will be appointed by the Minister on the recommendation of the board.
PROCURING ENTITIES AND ACCOUNTING OFFICERS
The actual procurement will now be handled by the Accounting Officers who will lead their procuring entities. The entities will consist of the procurement oversight unit, a procurement unit, an ad hoc Evaluation Committee, the user Department; or any other appropriate structure put in place by the Government.
The Accounting Officer will be in charge of establishment of appropriate procurement structures to undertake the procurement functions under the new act, which shall be staffed at an appropriate level in line with the model structure issued by the Public Procurement Regulatory Authority.
The Accounting Officer will also be charged with establishment, as may be prescribed, of a committee within a procuring entity which will oversee procurement activities, establishment, as may be prescribed, of an oversight committee to monitor procurement activities in a procuring entity.
The primary role of the Accounting Officers will be adjudication and award of tenders, including the adjudication of a bid recommendation submitted to him/her through a procurement oversight unit.
The Accounting officer will have powers to cancel a tender process and reject a tender offer at any time prior to entering into a contract, in the manner as may be prescribed, and the Accounting Officer shall not compensate the bidder of a tender that has been cancelled.
Under this proposed Act new set of regulations and guidelines will direct procurement complaints and appeals.
COMPLAINTS & TENDER DISPUTES
A procuring entity will, after the publication of an award decision — allow a cooling-off period of 10 days in order for the procuring entity to receive and address complaints, if any, from any contractor who is aggrieved by the award decision; and not enter into a contract relating to the award before the expiration of a cooling period.
A contractor who is aggrieved by a breach of any provision of this Act or claims to have suffered or is likely to suffer loss or damages due to a breach of a duty imposed on a procuring entity shall, at the first instance, lodge a complaint before an Accounting Officer for review.
A contractor who lodges a complaint shall have the right to participate in the review proceedings before an Accounting Officer. A contractor who fails to participate in the review proceedings shall be barred from subsequently lodging the same complaint.
Under this proposed Act an Accounting Officer will not entertain a complaint after a contract has entered into force. After considering a complaint and determining that the complaint is a frivolous or vexatious complaint, Accounting Officer shall dismiss such complaint.
Notwithstanding subsection (1), an Accounting Officer may refer a complaint considered and determined to be frivolous or vexatious to the Tribunal for the Tribunal to take any appropriate action as may be prescribed.
An aggrieved person shall submit his or her complaint in writing to an Accounting Officer within 10 days from the date of the publication of an award decision by the Accounting Officer, relating to the complaint.
The Accounting Officer will not entertain a complaint unless it is submitted to him/her within the period referred to under subsection.
A contractor who is aggrieved by a decision of an Accounting Officer may appeal to the Tribunal within 14 days from the date of the decision of the Accounting Officer.
Where a contract has been concluded by a procuring entity, based on an award decision of an Accounting Officer, the contract shall be irrevocable and its execution shall proceed without interruption whether the award decision by the Accounting Officer may in itself remain disputable by a contractor through the Tribunal.
Notwithstanding subsection (5), the Tribunal may suspend and subsequently revoke or terminate the execution of a contract if in the opinion of the Tribunal, sufficient evidence has been adduced to demonstrate that the execution of the contract may cause substantial loss to the public revenue or prejudicially affect public interest.
A complainant who wishes to lodge a complaint shall exhaust the dispute resolution processes provided in this Act before the complainant refers the complaint to a court.
PUBLIC PROCUREMENT TRIBUNAL
The Tribunal will be a body established independently from Public Procurement Regulatory Authority, and shall constitute retired High Court judges or practicing attorneys who qualify to appoint high court judge.
The Tribunal shall adjudicate over any matter brought before it by a complainant for a breach of any of the provisions of this Act, or any appeal brought in accordance with the provisions of this Act.
The COVID-19 pandemic which weakened world economies had left a devastating impact on Botswana Investment and Trade Centre (BITC) existence in 2020. According to the group’s 2019/2020 Annual Report, Foreign Direct Investment (FDI) was sluggish for the first two quarters at P126 million and P426.96 million respectively. They then took an upward trajectory in Q3 and 4 at P1396 million and P1456 million respectively.
The year closed with a reduced performance at 73% for Q4. According to the financial report, export earnings opened the year at 83% which is approximately P671 million, before dropping to 81% (P1299.55 million). However, Quarter 3 experienced a slight rise in performance to 82%, or P1978.42 million before a drop in performance to close Quarter 4 at P74.9%, which was P2403.91 million.
Even if that is the case, the Centre continued to promote local investors by facilitating for local entrepreneurs to produce and find markets for their products both locally and internationally. The trend for Domestic Investment/Expansions indicated a continual upward performance surge from Quarter 1 through Quarter 4.
In percentage points, performance results reflected opening of 93% performance followed by a dip in performance to 82% Quarter 2, and then an increase to 100% in Quarter 3 and closing performance of 84.2% in Quarter 4.
For this financial year under review, BITC posted solid financial results with a surplus of P872.968, representing a decline from the previous year’s surplus of P13.991.337. The Centre started on track from the beginning of the financial year with successful execution of activities planned for the year.
However, following the subsequent onset of COVID-19 in the last quarter for the financial year, a few of the activities were negatively affected resulting from restricted cross border transfers. The impact is expected to be severe in the following financial year, especially on the Centre’s financial statements, clearly reflecting the negative impact of COVID-19.
In the financial year ended March 2020, BITC received a total subvention of P96.504.860 which represents a 5% decrease from the previous year’s subvention of P101.830.560. the Grant subvention received for the past 5 years has not been constant due to the financial constraints that the government has experienced over the years which prompted for alignment of financial resources to cover the Centre’s strategic imperatives.
For the year under review BITC’s annual FDI capital inflows realised stood at P1.456 billion against an annual target of P2 billion, which is largely attributable to more than expected performance from the Financial Services sector. The total Domestic Investment for the period was P875.5 million against the set stretched target of P952 million. The total number of jobs registered by the organisation during the year under review was 3329, against an annual target of 3340.
Notwithstanding that, BITC realised high level achievements for the year under review. Chief Executive Officer Keletsositse Olebile said facilitated to establish the Selibe-Phikwe citrus project, which has a job creation expectation of 1000 vacancies as well as the expansion of Kromberg and Shubert Company through the allocation of land for construction of 7000 square metres factory to manufacture wire harness for Mercedes Benz, with over 800 jobs expected this year.
Further, the Centre continued to deliver improved investor facilitation services to both local and foreign investors through the Botswana one Stop service centre (BOSSC). “BOSSC houses relevant government departments under one roof to provide prompt, efficient and transparent services to investors. The services offered by this Centre have grown from slightly above 130 applications for government authorisation in 2013 to 752 in the year under review,” said Olebile.
BITC continued to monitor Botswana’s performance in global competitiveness indicators such as the World Bank’s ease of Doing Business Index. “In an endeavour to improve the investor facilitation mechanism in the country, we have motivated for the drafting of a Business Facilitation Law, which will expedite the setting up and operations of businesses in Botswana.”
ECONOMIC DIVERSIFICATION DRIVE
BITC continued to respond to government’s call to stimulate direct investment and growth of local companies by procuring goods and services from locally based manufactures and services providers. The message to promote locals to actively grow the national economy has been driven through campaigns such as ‘PushaBW’ which utilised an Integrated Marketing Communications (IMC) approach. As at March 2020, local purchases constituted 84% (2019:85%) of the total procurement with foreign purchases at 16% (2019:15%).