Francoise Barré-Sinoussi won the Nobel Prize for Medicine in 2008 for her role in the discovery of HIV. As she detailed in her plenary lecture on Monday 28th June, she considers a combined approach of mainly Western-led lab-based research and locally based education and treatment centres in developing countries as crucial for the control of the disease.
Martin Fenner and I talked to Professor Barré-Sinoussi on Thursday afternoon, covering topics including how to make a marriage work when one of you has a demanding job, her work in Africa and how to judge the merit of scientists based on more wide-ranging criteria than publication history.
LW: We wanted to start with the comment that you made [during Monday's plenary lecture] about being in the lab on your wedding day - how have you found it being a woman in science? And how was it for your husband that you are obviously very passionate about you work and that that can involve working long hours? Do you find he had to sacrifice his own career to support you?
FBS: No, I don't think he sacrificed his own career. He had his own career. He was not working in science at all; he was working at the National Radio. And of course, I think we were fine together because he had his own work; he needs some autonomy. You have to find the right partner with your own personality. So it's probably why it has worked very well together. He knew that I enjoyed my work since we met. He knew that my prioirty in my life is my scientific career; it's my passion. And he knew that I would not be happy in life if I could not express myself and he would not have been happy if I had not been happy as well. There is a balance and I think he was happy as well. I must say though that he died the year of my Nobel nomination but during his disease of course at one point I wanted to be closer to him and to take care of him and I found out that he was not happy at all that I was staying at home so often. So one doctor, colleague and friend who was taking care of him told me one day "Please have your life, like before. He's not happy."
MF: Was it easier or more difficult that he was not doing work related to science?
FBS: I think it really depends on each personality. For me, it was easier. It was easier becuase when I was at home or with him, we could have discussions outside of science. I think it was good for me to think outside and to have friends also not only in the field of science but working on National Radio to see how other people had other problems and a different life.
LW: Were your friends who weren't in science interested in what you did? Did they understand what you did?
FBS: Yes, I would almost say, unfortunately, because they were asking me a lot of questions. They were very interested.
LW: Do you think being a woman has had any benefits in your area of research? You have a very integrated approach to HIV - it's not just about the lab work, but about the social factors. Do you think being a woman has made this easier, or in any other way?
FBS: Difficult. It's difficult to say. Again it depends on each personality, I think because I know even male colleagues who have exactly the same approach as me and I know women who do not have the same approach so for me it is not a question of gender, it's a question of personality.
MF: So should there be special programmes or support for women in science? Or should we just treat them the same?
FBS: That's a good question. Of course in one way I think that we should facilitate the promotion of women in science because in the past it was quite difficult, not to stay in science, but to get to the higer levels. If I remember well, when I started at the Pasteur Institute, almost 40 years ago there was only 4 or 5 women maximum that were professors in charge of a department. Now I think it's not far from 40%. I think it's the right evolution, but I'm not a feminist. Of course I am for equality, but taking into account the competency and qualification. Otherwise, if women are just getting higher positions because we just need to rebalance, then I am against that.
LW: Coming back to the more integrated approach for treating, managing and finding a cure for HIV, do you have a feeling whether we will eradicate it by social facors alone?
FBS: No, I believe in a combined approach, I don't believe in only one approach. I think it will be very difficult to eradicate the disease but we can reduce, as much as we can, the incidences of infection around the world. So the social approach is just one approach and should be combined with the biomedical approach. Today we have the treatment as prevention which is a very good approach and of course it depends on visibility, but we should include that approach everywhere. When we have a vaccine we will have to improve the vaccine, of course, and we will have to work very hard on issues of injustice and the respect of human rights.
I think scientists have their own territory or place where they are competent. They should stay in the position where they are competent, even if it is for political action.
LW: There's obviously a big social and political impact of the work you are doing. Do you think scientists in general should be taking an interest in, science politics, either to do with things within their field, or maybe even beyond that?
FBS: I think scientists have their own territory or place where they are competent. They should stay in the position where they are competent, even if it is for political action. Of course for myself, when I push for governments to take decisions about things, it is about HIV/AIDS because that is the thing I know best. I can provide the scientific evidence that I know and I'm sure I can convince better because I have the expertise in this field. In other fields where I don't have expertise, how can I convince?
LW: Do you find now that you have the Nobel Prize that people come and ask for your opinions on things that aren't your speciality?
FBS: Yes! For sure they ask for my opinion on everything! [laughs]
LW: And do you tell them?
FBS: They think that with the Nobel Prize you know everything! I just don't answer, of course. I say look, just because I have the Nobel Prize it doesn't mean I know everything. It's impossible. They ask me to open conferences on Mathematics [laughs] No way! That's not my place.
MF: Do you think that the interaction between scientists and politically organisations works well, expecially coming into contact with developing countries, not just in France.
FBS: It's really a diverse situation of course because it is a diverse situation in different countries so I cannot give a global answer and it can even change over time. I can give you the example of Cambodia. When we started in Cambodia, it was nothing. It was just after the genocide - there were no doctors. There were just starting to get somewhere again but without evalulation because they just needed someone in the medical field. So this country had to start from zero so me, and all the others - the NGOs and other international organiations were in realtionship with the authorites and the outcome was very fruitful. Of course, by providing scientific evidence we started to convince the authorities to take the decision to have a strong national programme on HIV/AIDS, they did, it's working. It's the first country in that region that this year, in 2010, they will reach the target for the number of patients that are treated that need to be treated. This is an example of a very positive example that is becoming negative because the local authorities, of course, they are very proud and they are starting to say "look, everything is going very well, we don't need international support, we know how to apply a development fund, we have money to run the programme and I'm a little bit concerned. I'm a little bit concerned because everything is going well in quanity, but in quality of the treatment they have to very careful and they don't listen any more really because they think they are the best.
Another country, where I personally thought when we started with them, that it would be easier, because they already had competencies and infrastructure, still only today is it just starting to work - that's Vietnam. And the problem there was political, it was hard to convince the political leaders of this originally communist country that they had to make policy for drug addicts and prostitutes. Since the epidemic started it took a long time to really convicne the authorities to have a strong tack. And they have started now as of a few years ago. When they saw that pregnant women were affected they realised that they had to do something, but it was a long delay. So there is progress now, but it has been very long compared to the very close country, Cambodia, which is a poorer country. I give you these two examples to show you the diversity of the problem.
MF: It's almost as if you've learned a second job: you need almost as much patience as you do in research.
FBS: Sure, but of course one of the qualities scientists should have is to be very patient [laughs]. And of course with politicians you have to be very peristent.
Usually when I go for the first time to a country, I'm not implementing anything, I'm just listening and visiting a lot.
MF: The Bill and Melinda Gates Foundation did something rather dramatic to help with HIV/AIDS in developing countries. Is this something you welcomed very much becaise it has progessed things or has it complicated things because it is so much money?
FBS: In principle I am very positive, but with a few modulations. Very often their programme is too much directed by the Gates foundation and they don't consider enough the local situation. So most of the programme they want to support is based on their own processes and procedures and it's not working that well because you have to adapt yourself in those countries. You have to adapt to policy, to local regulation, to culture, local traditions; to listen. Usually when I go for the first time to a country, I'm not implementing anything, I'm just listening and visiting a lot. I like to go to visit the hospital, to discuss with the patients and to meet the communities, to go to the market. To try to progressively have my own view of the local situation. Of course I know it is impossible to penetrate them completely and it is very important to maintain contact with your partners who are present in the local area, and to keep contact with communities. I think we cannot implement any programme if it is not based on local priorities. Then when we make a programme it cannot be something that is written in Paris or London or Washington DC, it should be defined with the community, on site.
And then when the program is written, you have to adapt according to the organization they have locally. Of course you they must accept ethical regulations. If they don't respect, in their country, the international ethical regulations, that we can't accept. You have to tell them that. The rest you can adapt. And we should adapt. With some of the programs I maybe had a bad experience, because I felt that they wanted to establish a project under the umbrella of saying we are going to implement reference centers in developing countries, but after a while I was wondering whether they really wanted to implement reference centers and network with reference centers locally, or whether they only wanted to collect samples for American laboratories for research. To be very direct and very frank with you. Just to make you understand why I have some reservations, even though I am in principal very positive.
MF: Is basic HIV research done in developing countries?
Very little basic HIV research is done in developing countries, and I am not encouraging them. It is not their priority. Maybe one day it will be their priority, and I would be very pleased. However, today I think the priority is clinical and operational research to provide the scientific evidence to convince the leaders and also the communities in their country. Of course sometimes you can have more basic science associated with this, but not determining the structure of a protein in the middle of the Central African Republic. You have to associate local people so that they can be trained in more basic science, like immunology or genetic susceptibility of infectious diseases for example, an important topic. And it is important for them because we know that the disease progresses differently according to the genetics. So they need to have this information locally, so this kind of program we can do, we just have to train them and to transfer the technology on site, because for me they shall do this themselves, and not to take the samples from the clinical research, bring the samples back to France, England or the United States. We must implement a program locally, and of course also supervise them locally in order to teach them, educate them, so that they can be the future in that country.
Of course some people tell me that I am crazy, that I am doing this for free, meaning that I will not be associated with the publications from this project. And I say "Yes. So what?"
MF: How many days per year do you spend outside of France?
I was in Cambodia when the Nobel Prize was announced. I used to go to Cambodia and Vietnam twice a year, about 10 days on each trip. On my first trip I try to analyze the situation, to get a general idea. Alone I don't have all the competencies, so I start to contact colleagues, either in France or in other countries, giving them a short report of my visit. I tell them that we need their competencies and whether they would be ready to get engaged. I first start with a small network of people and then we decide to go together into the country to meet the local people. We try to find two or three people on whom we can rely and we start to train local people. It is of course easier in countries like Cambodia or Vietnam, as we have a Pasteur Institute there. It's easier because they are 100% on site, some, like in Vietnam, are national Pasteur Institutes with no French people at all. But quiet a significant number of researchers has already been trained in France or in other countries. So we can rely on them and start from the Pasteur Institute. It is similar with the Welcome Trust, and the Welcome Trust program is also in Vietnam. The idea is to have a team on which you can rely, so that you don't need to go there too often.
Of course I will go myself if it is a program where my lab is involved. In some programs my lab is not involved. I will organize, I will find the right people, I might give advice, but nobody in my lab will be involved. Of course some people tell me that I am crazy, that I am doing this for free, meaning that I will not be associated with the publications from this project. And I say "Yes. So what?" I don't ask to be on publications of work that I have not been involved with.
MF: Do you think that women behave differently in this regard compared to men?
There are all kinds of different people, because I know women that will not do what I am doing, and I am working with men that are doing exactly the same.
It's not what many people think is important, like publications, but receiving friendship, and close human relationships, that is what is important in life.
LW: There is an argument as discussed earlier in the week, that you are trained by public money so you should give what you can when it is appropriate.
FBS: When I say I'm doing this for free, this means free in terms of publications. But for me, what I receive in exchange is a lot of friendship. Take for example the reaction when I was awarded the Nobel Prize, I was in Cambodia at the time to meet this group of Cambodian people, not only doctors and biologists working at the Pasteur Institute, but also a group of patients that came to me with flowers, some of them were crying. I said "Look, you don't have to cry, you should be happy." I took them into my arms, and this is of course something that I will remember forever. It's not what many people think is important, like publications, but receiving friendship, and close human relationships, that is what is important in life.
LW: Do you think that science will evolve to encompass more of that?
FBS: We had the discussion two days ago at the breakfast with young researchers, the topic was "How science can serve society?". And one young researcher said, and she was right: "To tell you the truth, I'm not even thinking about this question yet. Maybe I will think about it one day. I am at the end of my PhD, my only objective is to publish, and even after my PhD I will do a postdoc in a laboratory where I can publish as much as possible, good publications in the best journals." At one point I stopped her and said that of course she was right, that she was right at this level of her career. But we have a problem with our system of evaluations. So it's not your fault, of course, you are a victim of this system. Of course I also think about publications, because it is one indicator. But it should be one indicator, not the only one.
Of course it will take time, probably several generations, to change this system of evaluations. It can work only if we change this at an international level, and I was explaining to the young researchers exactly what you said. Take this example. You have two young scientists, same age, one is in a very good laboratory with a very good advisor in a very nice scientific environment, in the UK, in Germany or in France, and he has wonderful publications in Science, Nature, whatever, high impact factor journals. And on the other side you have a young researcher with the same age, also at the postdoc level. He decides, instead of going to the UK or United States, to go to Africa. And of course he is not going to publish in Nature or Science. Of course he will not have the same supervision as you have in a laboratory in the UK. However, what he is doing on site is implementing, outside of his own research, a program in collaboration with local people, he is training local people to improve the competency and human resources, he is associated with implementations of health interventions, all something that you can't publish. After five years he will have publications, even the same amount of publications, but not with high impact factors. Both apply for a permanent position, the one from the UK will get the position, and the one who worked in Africa will not get the position. This is not acceptable for me. Because if you take the one in the UK and you move him to Africa, you will see what the one in the UK will be able to do in Africa. Nothing. Not all of them, I know some situations where they were doing well, it is again depending on the personality.
I'm not against taking into consideration publications as one criterium, but it seems to me that the number of indicators is too limited.
LW: But how far can we go with non-publication credits? Should it for example also include science communication?
FBS: Of course, because I think that communication is also one criterium that should be considered for evaluation of a scientific career. I'm not against taking into consideration publications as one criterium, but it seems to me that the number of indicators is too limited. If we had a list of indicators that is larger than the one we have today, and if we can succeed - it is complicated to change the mindset of the reviewers, because it is not only indicators, it is also that the reviewers are using the conventional approach. They should be more open, they should have an open mind for the future.
MF: Do you think you a minority in this thinking among your colleagues?
FBS: Yes, I feel we are a minority, because when I say conventional that means the majority. Unfortunately. But even a minority can sometimes succeed. I once belonged to a scientific review committee, and the situation that I just mentioned happened. And I said almost what I just said, and finally the guy who had spent five years in Africa was recruited, actually both of them were.
LW: But that was because you had the experience and you valued it?
FBS: Probably. But maybe also because I was trained at the Pasteur Institute, and the situation I just described was in a scientific committee of the Pasteur Institute. It was of course an international committee and not all the members were from Pasteur. But I was telling the Pasteur members that they are forgetting their mission. They were recruited to this Institute, and the mission of the Pasteur Institute is not only research, but it's also to be active for public health, everywhere in the world.
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