Using Genomic Sequencing to Treat Disease in the Horn of Africa 

Souad Elmi is an ISR community member and public health microbiologist who works in the National Reference Laboratory at Peltier General Hospital in Djibouti. She has experience in medical laboratory and public health initiatives, including infection control, epidemiology, antimicrobial stewardship, malaria, and tuberculosis (TB).  

She is passionate about using genomic sequencing to identify and treat the complicated diseases that plague her region in the Horn of Africa.

The International Science Reserve spoke to Souad about her goals to achieve health, sustainability, and well-being for all people. 

How did you get started in public health?  

My journey into public health and infection control began with my work as a medical laboratory scientist, where I witnessed the devastating impact of infectious diseases, particularly TB, HIV, which are complicated by antimicrobial resistance. Seeing patients suffer from preventable and treatable illnesses due to gaps in diagnostics and public health interventions motivated me to specialize in public health microbiology. My passion for health equity and disease prevention grew as I realized the urgent need for improved surveillance, diagnostics, and sustainable solutions to control infectious diseases in vulnerable populations, especially in the Horn of Africa. 

What projects are you currently working on?

Currently, I am working on molecular diagnostics related to TB in the National Reference Laboratory at Peltier General Hospital in Djibouti. My research focuses on drug resistance patterns and genomic sequencing to track TB strains and improve treatment strategies. Additionally, I am involved in antimicrobial stewardship initiatives, aiming to combat antibiotic resistance through laboratory-based surveillance and policy recommendations. These projects are crucial in strengthening disease control efforts and informing public health interventions in the region. 

Djibouti has one of the higher rates of tuberculosis in the world, but in recent years, the country has made efforts to reduce that number and close the gap. What have you seen as successful practices on this public health issue?  

Djibouti has made significant progress in TB control through enhanced case detection, rapid molecular diagnostics, and patient-centered treatment approaches. The introduction of GeneXpert technology, which allows for the detection of specific genetic material in a biological sample using a technique called nucleic acid amplification, has improved early detection of drug-resistant TB by reducing the time to acquiring diagnostic results from weeks to hours. Community-based interventions have increased treatment adherence by patients. Strengthening laboratory capacity and integrating TB care with HIV services have also played a vital role in reducing TB incidence. However, investment in genomic surveillance, social support programs, and health system strengthening is essential to further close the gap. 

What more could scientists be doing to work together on persistent public health issues that you study, like malaria and tuberculosis?  

Scientists need to foster greater collaboration in genomic research, data sharing, and interdisciplinary approaches to tackling infectious diseases. Strengthening regional laboratory networks, expanding access to sequencing technologies, and integrating artificial intelligence for disease surveillance can significantly enhance early detection and response efforts. Additionally, partnerships between researchers, policymakers, and local communities are crucial to developing sustainable solutions that address both biomedical and social determinants of health. Investing in capacity-building and mentorship programs will also empower young scientists in resource-limited settings to contribute meaningfully to public health advancements. 

Why did you join the ISR, and why would you encourage others to join too? 

I joined the ISR because I believe in the power of scientific collaboration to address global health crises, particularly in regions facing resource constraints. Being part of an international network allows me to engage with experts from diverse fields, access cutting-edge research, and contribute to global preparedness efforts for emerging diseases. I encourage others to join ISR to collaborate on innovative solutions, share expertise, and strengthen scientific resilience in the face of complex public health challenges. Together, we can drive impactful change and improve health outcomes worldwide. 

Scientists and experts can help prepare for record shattering heatwaves

Last year, the world shattered a record we never should have hit: our warmest year ever.  In response, UN Secretary General Antonio Guterres remarked that we are in an “era of global boiling,” as he called for swift action on human-induced climate change.  So far in 2024, global temperatures have continued to break monthly records as prolonged heatwaves are impacting millions of people worldwide, from India to Mexico. 

Researchers from the World Meteorological Organization (WMO) also found that for the average person on Earth, there would be 26 additional days of extreme heat this year, compared to if climate change was not happening. In certain regions of the world, that number reaches as high as an extra 120 days.  

Urban residents, who represent more than 55% of the world’s population, are particularly at risk from these warmer temperatures due to urban heat islands (UHIs), which occur when a city’s infrastructure, like roads, parking lots, and rooftops, absorb and remit heat more than natural landscapes like forests. In effect, UHI makes urban environments hotter than rural locations. 

The greenhouse gas emissions that humans have already emitted into the atmosphere means that extreme heat is not going away anytime soon, even if we rapidly reach climate targets and zero emissions. That’s why, as a network of scientists and experts concerned about crisis, we can be thinking of new ways to collaborate to inform, prepare, and reduce harm to humans and ecological systems during extreme heat waves.  

The Limits of Heat on the Human Body 

Climate change is already affecting human health. There are risks to human bodies from extreme heat, particularly for residents in cities, and within communities that are more vulnerable to its adverse impacts.  Extreme heat is more dangerous for children, older adults, and outdoor workers – particularly those who do not have labor protections to keep them safe. 

Of particular concern to human health is when heat and humidity remain high in combination, especially at night. It becomes difficult for the body to rest, relax, and stabilize – and that can put the body under significant stress.  

More and more experts are calling for decisionmakers to gauge upcoming risks to the public by using a wet-bulb globe temperature (WBGT) reading versus temperature alone. WBGT is measured through temperature, humidity, wind speed, sun angle, and cloud cover. Tropical and coastline cities, for example, are already reaching critical “wet bulb” temperatures, where the human body cannot cool down through its normal sweating process because sweat is not able to evaporate in high humidity. Dry heat is cooler for the body, for this reason. 

Experts define 95 degrees Fahrenheit (35 degrees Celsius) as the upper limit of WGBT for young and healthy people. During India’s recent heatwave, the WGBT reached at least 100 degrees (37.8 degrees Celsius), making the chances of heat exhaustion, stroke, and even death much higher for vulnerable populations. 

Cities in China, Bangladesh, Pakistan, India, the Arabian Peninsula, and the African Sahel are among the highest risk zones for dangerous levels of WGBT.  Jacobabad, Pakistan is often called one of the hottest cities on earth and has experienced at least four extreme wet bulb events in recent years. Many cities lack the infrastructure or resources to deal with extreme heat, in some cases because in the past they did not need it. 

Understanding the Toll of Extreme Heat 

Unlike hurricanes, earthquakes, or tornadoes, heat disasters often go unseen by decisionmakers because the public health impacts often happen inside homes or go undiagnosed by health professionals as heat related.  

In the US, the National Weather Service (NWS) cites that heat has been the deadliest form of extreme weather over the last decade. But many researchers believe current counts of heat illnesses death are vastly underestimated. In sub-Saharan Africa, for example, there is little to no accurate tracking of heat deaths.  In 2022, a groundbreaking study found that approximately 70,000 people died in Europe due to the summer’s extreme heat. Europe is considered the fastest warming inhabited continent, and many countries lack common cooling mechanisms, such as air conditioning, in older buildings.   

Additionally, the burden of heat is not often shared equally. In India after recent heatwaves, schools closed, agricultural supply chains were disrupted, and workers lost significant income. According to a recent report by the UN, the rising temperatures in India will reduce daily working hours by at least 5.8 percent by 2030. Loss of economic opportunity also acutely impacts women and girls. 

 
What Experts Can Do to Respond and Save Lives 

Just like with a hurricane or earthquake, the world’s most vulnerable cities need stronger preparation and mitigation measures to prevent and reduce severe health impacts. First and foremost, the rapid phaseout of fossil fuels is the most critical step to take to reduce harm.  

Second, if scientists and health experts begin to treat extreme heat like other disasters, the public will be equipped with more tools to take the proper steps to help prepare for it. Early warning systems remain as one of the most effective ways to keep people safe, and countries with “limited early warning systems” are experiencing heat-related deaths at a rate eight times higher than countries that have comprehensive warning services. 

In the US, the Centers for Disease Control (CDC) and NWS recently created a new scale that helps the public gauge health risks associated with extreme heat. HeatRisk considers several factors, such as time of year and length of heatwave, and models where elevated risks exist to help leaders better communicate on a clear scale of 1-4.  

Scientists and health experts can also help the public better understand what to do once a warning about elevated risk occurs, including educating them on action steps like:  

• Having a plan to acclimatize your body safely over time by gradually increasing activity outdoors,  
• Staying in cool environments, 
• Hydrating quickly and drinking electrolytes, when possible, 
• Removing restrictive layers and wearing light layers, 
• Taking a cold shower or bath when overheated, 
• Avoiding alcohol and caffeine, and 
• Reducing work in the sun. 

Several major cities have also taken to hiring Chief Heat Officers who create Heat Action Plans, or roadmaps to help urban dwellers deal with heat. The World Economic Forum and Adrienne Arsht-Rockefeller Foundation Resilience Center (Arsht-Rock) also created the Heat Action Platform, a free online resource that provides cities with tools to assess, plan, implement, and evaluate their heat plans.  

Energy supply is also critical to preparations. Given the pressure on the energy grid in many countries, there has been an increase in rolling or prolonged blackouts due to high demand during heatwaves. Air conditioning therefore cannot be seen as the only stable solution to cool down. In just one month in Mexico, for example, over 32 states including Mexico City experienced blackouts. The loss of power can lead to life-threatening situations for people with disabilities, health conditions, and older adults. In the mid- to long-term, in order to reduce harm in many countries, there needs to be major updates to the power grid that are powered by renewable energy and stabilized through weatherizing of buildings for energy efficiency and planting more trees for shade and cool roofs. 

If you want to learn more about how to collaborate with other researchers on scientific issues related to heatwaves, please join the International Science Reserve and RSVP for our upcoming heat webinar at the United Nations General Assembly (UNGA)’s Science Summit this September. 

Q&A with Chike Aguh: ISR’s newest Advisory Council Member  

The International Science Reserve is pleased to announce that Chike Aguh, former Chief Innovation Officer at the U.S. Department of Labor, has joined ISR’s Advisory Council. 

Under the Biden administration, he led efforts to use data, emerging technologies such as AI and quantum computing, and innovative practice to advance and protect American workers. We sat down with him to talk about what he learned from previous crisis response experiences and why it’s not a time for business as usual.   

As an advisor to the ISR, you are applying your expertise in data innovation to ensure that scientists worldwide have the resources to prepare for and respond to the next crisis, such as climate-related disasters or the next pandemic. What role do you believe data and innovation can play in crisis response? 

Data and innovative technology or practice are critical to crisis responses, respectively. During the fast-moving times of a crisis, data that can tell us what is happening and what has happened previously can be scarce. Who has access to data can be a life-or-death situation: people or governments who have it will weather the storm and those who don’t will be swept away by it. Whether it is mapping what symptoms people are searching on Google to determine what type and where pandemics may spring up, to analysis of large research data sets to mitigate these crises, data helps increase the confidence interval of the interventions that leaders must take to keep us all safe.  

Whether practice or technology, innovations are also indispensable during a crisis because the general operating procedures generally do not have the scale or speed required to stay ahead of the crisis. Innovations allow us to operate at “the speed of the fight” as my old boss, US Army General Stan McChrystal used to say.   

At ISR, we help researchers connect to emerging technologies and resources for collaboration across borders to address the worst impacts of crises. What are some lessons from your time in the Biden administration that could apply to researchers in ISR’s network?  

The lessons I learned were elegant and devastating in their simplicity. One, even the most cutting-edge technologies are not a replacement for strategy. Leaders must do the hard intellectual work of identifying the key problems and questions to be solved in a crisis. Only then can these technologies be applied intelligently and effectively.  

Two, sociology will overwhelm technology every time.  In the space of collaborative research, we can only achieve the collective brilliance of all involved if we have the goodwill and effective means of working together.   

And three, the most important power of these technologies is to help us think outside the parameters of normal practice and try things we would never attempt in normal times.  We should not simply use these technologies to do the same old things with incrementally better speed or effectiveness, but rather use them to take quantum leaps in impact. 

You once said that for any problem we are solving, “Those problems cannot be solved by any one person, one organization, or one sector alone.” Do you believe that more people are thinking and operating through a lens of collaboration in the aftermath of the COVID-19 crisis? What more could we do to implement this new way of working within crisis response?  

I do. Some of the greatest successes of the COVID-19 response, from vaccine development, testing innovation, treatment deployment, to the High-Performance Computing Consortium (HPCC) show what is possible when traditional siloes are sublimated for the sake of helping everyone.   

The key question is: how do we make this new collaborative lens not simply a feature of crisis response, but a key part of operating procedure for all of us?  My biggest recommendation is to keep the institutions that we have created like the HPCC running.  Then, they can be applied not simply when responding to crises but can help prevent crises before they ever start.   

ISR pre-positions resources, like high-performance computing, remote sensing, and geospatial models, so that scientists can connect to them quickly across borders to address the worst impacts of a crisis, without a long wait or extensive application.  Why should businesses make data innovations more available to researchers worldwide during crisis? 

When crisis events like COVID-19 occur, we have seen the impact on the economy and how it hits the bottom line of businesses. It is in a company’s best interest to do anything it can to fight and end these crises as quickly as possible, and that means making data and cutting-edge technology available to the scientists who are working on just that.   

Secondly, I also believe that business and business leaders feel a sense of duty to their communities and their countries.  This is a tradition that we have forgotten but one can go back to businesses like Bell Labs, who helped develop critical technologies like radars that helped during WWII.  We need to remember and keep this tradition alive now.  Business and the world will benefit as a result.