Looking at the Future of TB Research as an Early Career Researcher

Despite the discovery of the causative agent of tuberculosis (TB) (Mycobacterium tuberculosis) by Robert Koch in 1882, there are still many questions regarding the pathophysiology of TB that remain unanswered—particularly in the differentiation and marked variability between latent (asymptomatic, non-transmissible) and active (symptomatic, transmissible) stages of infection. In 2020 the World Health Organization (WHO) estimated that 10 million people contracted active TB, resulting in 1.5 million deaths globally, with nearly 1/3 of these individuals contracting multi-drug resistant TB (MDR-TB). This is just under the reported death toll due to COVID-19 in 2020 at 1.8 million deaths globally (although both figures are likely under-reported with concern for closer to 3 million total COVID-19 deaths in 2020). TB is already uniquely adapted to evade the human immune system and continues to develop resistance factors to our first and now second-line agents, making the prospect of multidrug-resistant TB (MDR-TB) a formidable pathogen already identified on a pandemic-level scale. Moreover, we currently lack an approved, efficacious vaccine to reliably prevent the spread of TB. With all of this space left for scientific inquiry, innovation, and global equipoise, we had the chance to virtually chat with several of the Stop TB Partnership Working Group on New TB Vaccines’ (WGNV) international cadre of early career researchers (ECRs) to discuss their journey into TB research, projects currently under way, and any advice they may have to burgeoning scientific researchers as we look forward to the ambitious goal of ending TB by 2030.

We were fortunate to sit down with Dr. Sara Suliman, Assistant Professor in the Division of Experimental Medicine at the University of San Francisco (UCSF); Dr. Virginie Rozot, Research Officer at the South African Tuberculosis Vaccine Initiative (SATVI); and Carly Young, PhD candidate at SATVI and part-time intern involved in science communication at IAVI as part of WGNV. Each individual shared their unique, not always linear, path to TB research and advice for future generations of scientific researchers.

In October 2021, Dr. Suliman opened the doors to her new lab at UCSF in their Division of Experimental Medicine, focusing on the biological mechanisms for TB progression with the hope of expansion towards host-directed therapies in the future. Looking back at her winding path to TB research, leukemia was Dr. Suliman’s entryway into scientific research with her mother being an Oncologist. However, while completing a PhD in Immunology at the University of Toronto, she developed a particular interest in host-pathogen relationships, moving far away from the field of cancer that brought her there and towards the unique pathophysiology of TB. Her first major foray into TB research was through a Postdoctoral fellowship studying T cell biology at SATVI, which she found through Nature Immunology’s job posting site. Beyond the similar lines of scientific interest, she noted the team chemistry of the lab and relocation to Cape Town as important factors that brought her to SATVI. Her primary focus was on cohort studies for vaccination over her four years there but felt the need to focus more intently on the biology of TB. After an impromptu interview over a wine tasting at a conference in Australia, she relocated to Boston’s Brigham and Women’s Hospital as a Postdoctoral Fellow studying large multinational epidemiologic cohorts comparing TB exposure and genetics. Her recent relocation to UCSF is merging much of her prior work with cohort studies and the biology of TB towards new lines of inquiry. As an ECR, she enjoys that TB research does not feel like an overly crowded space. In reflecting on the challenges of the COVID-19 pandemic and her shift to work on COVID-19 diagnostics, Dr. Suliman encourages ECRs to “be open minded to opportunities that do come up…and always think about how to link them back to your primary passion.”

Dr. Rozot “fell in love” with TB during her PhD, which led her to move to Cape Town as a Postdoctoral Fellow at SATVI. She is currently starting a phase III study for a TB vaccine to replace the BCG vaccine, several other vaccine trials, and a new multi-site investigation on how TB behaves in different visceral tissues post-mortem—the central focus of Carly’s PhD. Her advice for other ECRs is that “to be an academic, you need to be kind of stubborn,” which as we learned more about Dr. Rozot’s career that definitely rings true. She started her career path as a child wanting to be a military pilot but her vision impairment pushed her away from that career. After a close relative’s struggle with cancer, she initially planned to become a medical doctor but instead pursued a biotechnology degree. She had a friend who was very passionate about immunology, which initially piqued her interest into this field. However, she was uncertain about going straight into academia, so she completed an engineering degree where she then went into industry working on optimizing penicillin production followed by work on epilepsy. She eventually found her way into an immunology lab specializing in HIV research at the University of Lausanne in Switzerland as an engineer and after having learned about the complexities of TB while processing specimens in the lab decided to pursue a PhD on this topic. She eventually landed in Cape Town to do a postdoctoral fellowship working with mass cytometry and TB after having had an impromptu interview with her current director (which was over coffee in London’s Heathrow Airport). Through her varied experience, she worked on the first prevention of infection trial with the BCG vaccine. During her previous TB work, she had always wondered how to assess the effect of TB on tissues, so she started chatting with the hospital’s anatomy and physiology professors, opening the door to her current line of inquiry on postmortem visceral characteristics of TB. As Dr. Rozot reflected on her pathway to academia, she noted the need for a “piece of passion” for her field of study in TB due to the financial, lifestyle, and industry career pressures felt as an academic. However, being an ECR with one’s own funding sources, allows for a newfound sense of freedom to apply your own unique ideas and passions within the field.

In addition to Carly’s full time PhD work, she serves as an intern at the WGNV through IAVI where she directs their social media presence and provides support to myriad projects within the organization. From a young age, Carly identified with the “strong women” she saw in the media looking into microscopes with their white lab coats. Much like Dr. Rozot’s “stubbornness,” Carly’s spark towards academia came from a discouraging high school science teacher who recommended she drop science altogether for fear she would not pass. Emboldened to prove her wrong, Carly worked tirelessly and became the valedictorian of her high school in Port Elizabeth, South Africa. She found a position working towards a Master Degree at Stellenbosch University, allowing her to move to Cape Town and begin the translational research career that she had been pushing towards. This position forced her to overcome her fear of blood and needles due to her need to collect clinical samples from operating theaters for her Principal Investigator at the time. Her work required the use of Dr. Rozot’s specimen processing machines, which is how she first made the connection with Dr. Rozot. Reflecting on this time, Carly saw Dr. Rozot as an aspirational mentor and was quick to accept a PhD position with her at the University of Cape Town on Dr. Rozot’s study investigating TB’s effect on visceral tissues through postmortem sampling. Carly’s key to success is her drive to “say ‘yes’ even if you don’t know how…you’ll figure it out.”

Talking with three strong women working in academic research, they all acknowledge the regular need to overcome barriers and prejudices along their career development pathways. They note the tremendous value supportive mentors played in their individual paths to encourage them along.  The group echoed the importance that the words spoken by mentors carry a tremendous amount of weight both positive and negative. Much the same as Carly’s science teacher, Dr. Suliman voiced a struggle she had early on with a research mentor dissolving her position without offering directional support and making derogatory comments on her way out of that lab. Dr. Rozot notes that the field of academic research definitely is changing for the better, but there is still much to be done to create an inclusive, collaborative work environment.  As ECRs, they feel the burden of responsibility to now provide that supportive mentorship and are reckoning with the imposter syndrome it brings despite their specialized, decorated knowledge. Dr. Rozot emboldens ECRs to “push through” this imposter syndrome in order to be successful in academic research.

In looking towards their future research, we sought to understand how best they and the field of TB research could move forward. Having now been through years of the COVID-19 pandemic, seeing the global attention, effort, and funding funneled towards this singular disease felt at times “frustrating” through the lens of TB research­—though they acknowledge the present need for this focus on COVID-19. The knowledge that the global pandemic of TB is still killing 1.5 million people globally (albeit not to the degree of COVID-19 in the “streets of Paris or New York”) but the global awareness of this disease and its pandemic-level threat remains vastly insufficient. Dr. Rozot requests we provide the focus, funding and passionate future researchers TB requires to make significant progress on this disease for years to come. She went on to suggest that the world likely needs a well-publicized documentary exposé to bring TB into the homes of people everywhere to raise the needed awareness. Carly echoes Dr. Rozot and encourages more cooperation between researchers rather than the competitive environment in academia at present. In the context of ECRs in the future space of TB, Dr. Suliman stresses “it’s important to put our names and our TB work on the map and assert our presence as ECRs in the infectious disease space. The space may feel like it is saturated with established senior researchers, but the reality is that there is far more work to be done, and a pressing need for fresh ideas to think outside the box. Lastly, the platform should be given to more underrepresented investigators, especially in low- and middle-income countries (LMICs), and especially in countries where TB is endemic. The colonial model of global health research needs to crash and truly give way to a more inclusive model.”

We are tremendously grateful for the time of our three guests and their great work as the future generation of TB researchers.  Keep an eye out for Drs. Suliman, Rozot, and Carly Young as they move forward in their bright careers pushing the boundaries of what we know and how we treat TB.

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