Quarraisha Abdool Karim
CAPRISA/Columbia University
Salim S. Abdool Karim
CAPRISA/Columbia University
For illuminating key drivers of heterosexual HIV transmission; introducing life-saving approaches to prevent and treat HIV; and statesmanship in public health policy and advocacy
The 2024 Lasker~Bloomberg Public Service Award honors Quarraisha and Salim S. Abdool Karim (CAPRISA and Columbia University), for illuminating key drivers of heterosexual HIV transmission and introducing life-saving approaches to prevent and treat HIV. The prize further recognizes them for their statesmanship in public health policy and their advocacy. The Abdool Karims have influenced AIDS programs across the globe and they have played pivotal roles in developing South Africa’s scientific capacity. Throughout their careers, they have championed science and its potential to benefit the world’s citizens.
Growing up under apartheid in South Africa, Quarraisha and Salim Abdool Karim gained a deep grasp of how societal inequities undermine health, education, and quality of life. Discrimination and segregation had limited their educational choices, and they recognized the broader effects as well. Drawn to correct wrongs, they have consistently juggled professional advancement with activism.
When Quarraisha, a research scientist, and Salim, a medical resident in clinical virology, met over a temperature-controlled ultracentrifuge that was available only in his department, their common interests and shared values sparked. The resulting bond was strong enough that she accepted his intercontinental marriage proposal, issued while he was doing a fellowship at Columbia University in the late 1980s. She joined him in Manhattan and dove into epidemiology and public health as the AIDS epidemic erupted.
The Abdool Karims witnessed this plague’s effects on the city’s inhabitants and soaked up information about it in seminars. AZT had recently become available, and it was delivering extraordinary effects: Suddenly people with AIDS were living. When the Abdool Karims went back to South Africa in 1988, they decided to study HIV there, which few others were doing at the time.
Science that transforms policy
HIV hadn’t yet announced itself in South Africa, given its long latency, so the Abdool Karims conducted a community-based survey to determine where the virus was lurking. The results, which they published in 1992, were jaw dropping. HIV’s overall prevalence was slightly greater than 1%, but it showed up in more than three times as many women as men. Moreover, it was almost nonexistent in boys; it didn’t appear until men were in their 20s. For girls, prevalence peaked in the teen years.
Clearly, teenage girls were not getting infected by teenage boys, but rather, by older men. Some people in the field were skeptical of these data. After all, in other countries, HIV affected primarily men. Yet the Abdool Karims had correctly pointed toward who the virus would hit the hardest in Africa.
To avoid acquiring HIV, girls were told to abstain, be faithful, and use condoms, yet these measures fell short. Older men possessed societal power and could thus pressure girls into having sex; even if the girls were monogamous, their partners often were not; and girls did not hold enough sway to negotiate condom use. These observations underscored the profound impact that power dynamics can exert on the physical wellbeing of disadvantaged groups—not only in South Africa, but everywhere.
The Abdool Karims started searching for methods with which girls and women could protect themselves. The researchers began with a compound called nonoxynol 9, a spermicide that kills HIV in test tubes. In 1999, they reported that subjects who used the agent carried more virus and experienced more side effects than did those who received a placebo; that option was off the table.
The Abdool Karims persevered for 18 years, assessing numerous candidate products on thousands of people in clinical trials. Success remained elusive; many colleagues called them experts in failure.
Most of the drugs that didn’t pan out aimed to block HIV from entering cells. So the Abdool Karims decided to test a chemical, administered as a vaginal gel, that instead allows cellular access but stops HIV from replicating once inside.
In 2010, they announced that the drug, tenofovir, reduced the incidence of new HIV infections by 39% in women who used it for 2 1/2 years. The Abdool Karims had placed in women’s hands, for the first time, an antiretroviral agent that protects them from HIV. Further studies showed that tablet-form tenofovir was cheaper, easier to take, and highly effective. In 2015, the World Health Organization (WHO) recommended this intervention—tenofovir-based Pre-Exposure Prophylaxis, or PrEP—for high-risk individuals. It is now a crucial element of HIV prevention in scores of countries.
The team led by the Abdool Karims subsequently pinpointed other factors that affect women’s susceptibility to HIV. For example, genital inflammation increases the risk of HIV acquisition—and it impairs tenofovir’s effectiveness. The vaginal microbiome also contributes. This work opened new avenues toward combating HIV.
In the meantime, the Abdool Karims tackled another public health challenge. At the 13th International AIDS conference in 2000, the global community committed to providing antiretroviral drugs to Africa, but a problem immediately crystallized. On that continent, the majority of people with AIDS also had tuberculosis, and clinicians worried about undesirable interactions between AIDS and TB drugs, overlapping toxicity, and other potential harm from simultaneously treating the two infections.
The Abdool Karims undertook a study to probe how best to take care of individuals who were coinfected. They found that integrating TB and HIV therapies dramatically decreases the one-year mortality rate. In 2009, within weeks after these results were published, the WHO altered its recommendations to reflect the findings. Five years after South Africa implemented the changes, annual deaths dropped by more than 50%.
Through the decades, the Abdool Karims continued deciphering the transmission cycle of HIV within Africa. Eventually, they sequenced thousands of variants and clustered people who were infected with the same virus or one that was closely related, thus tracking the microbe’s trajectory through a population. As they had originally asserted, adolescent girls and young women acquire HIV from men who are, on average, almost 9 years older; later, women who carry the virus couple with male peers; 39% of those men have sex with a much younger female.
The Abdool Karims presented these data at the International AIDS conference in mid 2016, and later that year, UNAIDS released a report that prominently highlighted their findings on age-disparate sex and the implications for the countries hardest hit by AIDS, in which older men were driving the epidemic by infecting teenagers and young women. This publication informed several African countries as they crafted new policies. The Abdool Karims’ insights had already inspired the United States President’s Emergency Plan for AIDS Relief (PEPFAR) to target resources to adolescent girls and young women. A large-scaled initiative—Determined, Resilient, Empowered, AIDS-free, Mentored and Safe women (DREAMS)— aimed to break the cycle of HIV transmission by fueling self sufficiency among members of this demographic.
Cultivating research capacity
Alongside their investigatory work, the Abdool Karims built South Africa’s scientific infrastructure and cultivated the next generation of infectious disease experts. In 2002, they obtained funding from the U.S. National Institutes of Health (NIH) to launch CAPRISA (Centre for the AIDS Programme of Research in South Africa). Under its auspices, they conducted their HIV and tuberculosis studies; when Covid-19 arrived, CAPRISA scientists pivoted and expanded to address this new microbial scourge.
Salim and Quarraisha discuss a new CAPRISA project. Drawn to correct wrongs, they have consistently juggled professional advancement with activism.
The Abdool Karims and their colleagues deployed their sequencing capabilities, developed for HIV analyses, to understand SARS-CoV-2 variants. They published the first scientific article on omicron when it emerged in November 2021 and predicted that it would spread easily and quickly. The paper drew enormous attention and helped inform the ongoing response to the pandemic.
In addition to establishing CAPRISA with Quarraisha, Salim spearheaded the creation of four other major research centers in South Africa and, for each, served as the first director. To forge these institutions, he gained financing from the Wellcome Trust, the NIH, the Howard Hughes Medical Institute, and the South African Government.
Through a Fogarty-funded collaboration with Columbia University that began in 1993, the Abdool Karims have trained more than 600 South African HIV and TB investigators, and these individuals now undergird the enterprise of South African science. The Abdool Karims’ contributions have rippled over the continent, as they have helped to build and link HIV research centers of excellence in other countries, including Zambia, Nigeria, and Senegal.
Fighting disinformation, guiding global leaders
The Abdool Karims have steadfastly fought false narratives. In 1999, Thabo Mbeki became the president of South Africa; he claimed that HIV didn’t cause AIDS. According to him, deaths from this devastating illness arose from TB and malnutrition; he withdrew support from clinics that were providing antiretrovirals to prevent mother-to-child HIV transmission.
When his government refused to buy nevirapine, one of these drugs, the activist Treatment Action Campaign challenged him in the South African Constitutional Court. Quarraisha presented expert evidence at the trial. The court ruled against the government and forced it to offer the medication to women who would benefit.
The Abdool Karims established a prominent presence on TV, radio, and in print. Salim appeared regularly on the front page of the country’s newspapers, disputing AIDS denialists, including the president. Later, the Abdool Karims pushed back against Covid anti-vaccination campaigns and took a strong stand against ineffective treatments such as hydroxychloroquine and ivermectin. During the first three years of the Covid pandemic, Salim was quoted in the media, on average, more than once an hour every day, commonly outside of South Africa. Outlets such as CNN, Voice of America, BBC, and Al Jazeera broadcast his words.
The Abdool Karims have played central roles in molding African and global science policy. Leaders of the most influential health agencies routinely seek them out and trust them to provide solid, evidence-based information and sage guidance. For example, Quarraisha co-chaired the 10-member panel that counsels the UN Secretary-General on how science can promote the 2030 Sustainable Development Goals, and Salim serves as Special Advisor on pandemics to the Director-General of the WHO. They contributed significantly to the UN High-Level Declaration on Ending the AIDS Epidemic by 2030.
The list goes on and on. They have assumed senior advisory roles at UNAIDS, Africa’s CDC, and PEPFAR. In 2022, The World Academy of Sciences elected Quarraisha president; she is the first woman to serve in that position. She has also been appointed the UNAIDS Special Ambassador for Adolescents and HIV. In addition to their formal positions at the highest international levels, the Abdool Karims have advised the U.S. Congress and U.K. Parliament.
Quarraisha and Salim Abdool Karim have always understood the continuum between applied science and social justice, and they have dedicated their talents and efforts to help vulnerable people across the planet. They have saved lives through innovative research, evidence-based policy proposals, public education, and courage to speak truth to power.
by Evelyn Strauss
The boogie-woogie approach to creativity in art and science
The Dutch painter Piet Mondrian, famous for his geometric grid paintings, was an ardent jazz fan. In the late stage of his career, he became intrigued with boogie-woogie music, which inspired him to paint his masterpiece, Broadway Boogie Woogie.
Award presentation: Margaret Hamburg
Thank you Claire, for that warm introduction. It’s such a pleasure to be a part of the Lasker Foundation Family.
This year, I had the privilege of chairing the jury that selects the Lasker~Bloomberg Public Service award winner. It was a process that left me inspired by the incredible efforts underway around the world that are putting medical science to work for public health.
The Lasker~Bloomberg Public Service Award recognizes exceptional public health, policy, and advocacy initiatives that improve lives and advance the greater good. The award feels especially important at a time when we are asking a lot from anyone involved in medical research and public health endeavors. It’s no longer enough to just to be an expert in a particular area and achieve prominence in your field. We need you to be expert communicators, engaging with the public and politicians. We need you to be expert collaborators, building new partnerships and mentoring a new generation talent. We need you to be expert capacity builders, attracting investments for state-of-the-art laboratories and clinical trial networks.
This year’s winners, Quarraisha and Salim Abdool Karim, have embraced all these challenges. And their achievements in each area have been extraordinary. Their accomplishments are especially impressive because for more than 30 years they have worked as both professional partners and life partners. They have adjoining offices at CAPRISA—the Center for the AIDS Program of Research in South Africa. They share an administrative assistant. They even share a Twitter account. It’s hard to say whether they should co-author a book about their professional achievements or a guide to a successful marriage.
Let’s reflect for a moment on what this amazing couple has accomplished.
Their contributions to HIV prevention can in many respects be traced back to Quarraisha’s work in the early 1990s when she led South Africa’s initial efforts to understand community spread of HIV. It was a time when HIV prevalence was still relatively low in South Africa. She and her team found that infections were rising rapidly in teen-age girls. Her interest in developing new ways to prevent infections in women led to her a breakthrough collaboration with Salim.
In 2010, they reported evidence from a CAPRISA clinical trial showing that a vaginal gel containing the anti-retroviral drug tenofovir could prevent sexually acquired HIV. The study spurred one of the biggest breakthroughs of the HIV pandemic: the development of antiretrovirals as pre-exposure prophylaxis or PreP. The couple is now working on a long-acting version of PreP. They also are leading the development of an HIV monoclonal antibody. They want to determine if it offers another way to provide long-lasting protection while also informing efforts to develop an HIV vaccine.
Their ground-breaking work in the fight against HIV includes a major advance against a leading cause of death among HIV patients—co-infections with TB. They led a trial which showed that combining antiretroviral treatments with TB treatments greatly improves survival. This has now become a standard of care globally. In Africa, it’s credited with averting more than one hundred thousand deaths a year.
Few who knew of their work were surprised that the Abdool Karim’s were immediately front and center when the world was faced with a new pandemic: Covid-19. They were highly visible in mainstream media outlets in South Africa and across the region. They were effective communicators, pushing back against Covid falsehoods just as they had done earlier in their careers with HIV. In 2020, the John Maddox Prize for promoting sound science was split between two people: Anthony Fauci and Salim Abdool Karim.
The Abdool Karim’s also published studies examining how the new Covid virus affected HIV and TB patients. And their interest in Covid-19 variants provided the first evidence of the dangers posed by the omicron variant.
The couple is also leaving a lasting legacy of research capacity and talent. Twenty years ago, they led the creation of CAPRISA. It is now widely recognized as a global hub of innovation and discovery for HIV and other infectious diseases. They also created South Africa’s HIV Prevention and Vaccine Research Unit and Salim developed a biotech research center and a TB research institute in South Africa. Along the way, the couple has trained over 600 African infectious disease scientists. And they have been role models and inspirations to countless others.
Both are trained as infectious disease epidemiologists. Salim has said that he leans somewhat more to the laboratory side of things while Quarraisha may at times focus more on the role of human behavior in the spread of infectious diseases. He said they tend to meet together several times each day to discuss their research projects.
Salim uses a scientific term to describe how two people can be so successful as both colleagues and spouses. He said it comes down to chemistry.
There are more than a few true chemistry experts here today, but even for those of us with more rudimentary skills, I think we can all appreciate how when two or more chemical elements combine they form a compound. We are all fortunate that the very special, unique, and highly active chemical compound consisting of Quarraisha and Salim Abdool Karim emerged to save hundreds of thousands of lives, fight for scientific integrity and public trust, and build a new biomedical research infrastructure in South Africa that is now a major force for global health. They embody the Lasker’s Foundation commitment to generating support for medical research by recognition of scientific excellence, advocacy and education.
Thank you Quarraisha and Salim for your work. You are truly an inspiration for us all.
Acceptance remarks
Acceptance Remarks: Quarraisha Abdool Karim
Our lived experience of growing up in apartheid South Africa, has had a profound effect on how we see our role as scientists. As young anti-apartheid activists involved the daily struggle for freedom, human rights and justice, we know the importance of human dignity and inclusiveness in all facets of life including in our scientific endeavours. We also benefited from the wisdom and guidance of several mentors who were both great scientists and deeply committed anti-apartheid activists. We remain eternally grateful to them for their guidance and advice, which reinforced for us the notion that science in service of humanity and social justice are two sides of the same coin. In particular, we are grateful to President Nelson Mandela who shaped our perspective on the role of scientists in serving society, as he eloquently outlined in the Foreword he wrote in our book on AIDS.
It is therefore not surprising that our careers veered towards public health and that we have spent over three decades focusing on the health of the most disadvantaged in our society – young black women. Some 35 years ago, when the world’s attention was on HIV in men who have sex with men, we found that in Africa, young women bore the brunt of the HIV epidemic, largely due to sex with men who were about a decade older. And so, we focused our research on developing and testing technologies that empowered women to protect themselves. Our contributions to HIV pre-exposure prophylaxis were one small but important step in the larger social challenge of gender-power dynamics, that highlights the powerful role that science can play in social transformation.
We are in a tumultuous moment globally—a time when science is needed more than ever to tackle several of the world’s most complex challenges—pandemics, climate change, man-made famines in the midst of conflicts and widening inequalities within and between countries. Our hope lies in the ubiquity of science, on it transcending political and cultural barriers as the universal language to build bridges between the peoples of this world. Our interconnectedness and shared vulnerabilities underscore the importance of working together as scientists in service of humanity to generate knowledge and innovations to make the world a better place for everyone.
In March 2021, the NIH announced a new program, CIPRA—Comprehensive International Program on AIDS—to create a small set of AIDS research centres of excellence globally. It was a marked departure from the usual NIH grants in that only non-US investigators and institutions could be leaders of the application. In response, Quarraisha and I brought together a group of 10 of South Africa’s leading medical scientists and so CAPRISA—the Centre for the AIDS Program of Research in South Africa—was born 22 years ago.
At that time, colonial-type relationships were the order of the day – where developing country researchers were reduced to being collectors of patients and samples for developed country scientists. CIPRA bucked that trend. It set out on a path of partnership, where there was no master and no servant, but rather partners working together for a common purpose and mutual benefit. CAPRISA itself was a similarly mutually beneficial cross-Atlantic partnership involving Columbia University and 4 South African research institutions—all as equal partners.
About a year after CIPRA, PEPFAR—the US President’s Emergency for AIDS Relief—was created as the biggest global solidarity initiative by a single country to address a health challenge. To save lives with treatment, PEPFAR served as a mechanism for the people of the US to assist poor countries with their AIDS response. A visionary humanitarian initiative, it took shared responsibility in a pandemic to new heights.
In accepting this Lasker award, we are recognising the power of global solidarity for global impact, which has been deeply imbued in our work on HIV prevention and treatment over the past 35 years. While we provided the initial evidence that antiretrovirals prevent sexual HIV transmission as PrEP, today PrEP is used in over 100 countries. If a patient with HIV and Tuberculosis co-infection anywhere in the world, including here in the US, is being treated according to WHO or CDC guidelines, that patient’s treatment is based on research conducted in South Africa by a multi-country CAPRISA team.
In a world wracked by division, conflict and anti-immigration hatred, this award is a sober reminder of how science reminds us of our shared humanity across the globe. We stand here today because of the power of global solidarity and partnerships in science that have saved tens of thousands of lives and helped make the world a better place for generations to come.
