How Africa
In this article we travel all over the continent to learn about ten great things happening in health that should excite all of us.
Transforming Public Health Research for Africa
Prof. Osman Sankoh from Sierra Leone is leading INDEPTH’s efforts to pursue groundbreaking work in population health. In his own words, INDEPTH is “a vibrant global organisation of currently 42 member health research centres in 20 countries in Africa, Asia and Oceania.” INDEPTH’s head offices are in Ghana, but their work on three continents is revealing the patterns of health and diseases that are affecting people in these regions. This network is implementing clinical malaria vaccine and drug development trials across ten countries in Africa, while also undertaking the first African-led evaluation of current antimalarials on the continent. They are researching the efficacy of child health interventions in Africa and Asia by advancing work to bring an oral cholera vaccine to market, investigating how to improve family planning, and studying how aging impacts health in low- to middle-income countries globally. Doing long-term studies on over 3.5 million people is creating health surveillance systems and databases that will be more and more critical to evidence-based decisionmaking related to population health, as well as for the development of more effective policies and practices.
Transforming Medical Education and Healthcare Delivery for Africa
Dr. Agnes Binagwaho returned to work as a pediatrician to help rebuild her homeland of Rwanda in 1994 right after the genocide. Her work eventually led her to become Rwanda’s Minister of Health and now to lead the newly-created University of Global Health Equity (UGHE) as its Vice-Chancellor and CEO. Agnes is “very proud to be part of a group of dreamers who have created a new university to further the spread of the important ideas that all lives are worth fighting for and that the science of health service delivery needs to be taught and explored further with preferential focus to the vulnerable, so that across the world, more can be done for breaking the cycle of diseases and poverty now and in the future.”
That human rights are an “all” and for all, meaning that all human beings deserve all human rights, because this is a universal and indivisible truth.
In this new university, we embrace an approach to quality service delivery that is full of compassion.
We help our students to find their way to the truth about their patients by analyzing the socio-determinants of health challenges they face using biosocial tools with a comprehensive view, and with the cultural sensitivity that we all need.
UGHE is a place where our students are comfortable to question us, or certain “truths” of the world in which we live, especially the truths that should not exist in a world that is just.
UGHE educates health leaders to focus on inclusive management of health programs that ensure the vulnerable are not left behind in receiving quality health services and that building a health sector is imbedded in human and nation development. UGHE aims to train leaders from all over the world to understand that being healthy is an economic asset for families, communities and countries because it spurs wealth creation. UGHE is creating a global forum for health delivery-focused teaching, research, clinical care, implementation sciences and innovations. This African-led initiative to scale equitable access to quality health services is definitely something to be excited about.
Universal Health Coverage
Half the births on the planet between now and 2050 will happen in Africa. Ensuring access to affordable and quality care for all is critical to this growing population as well as for the control and prevention of global pandemics. For Dr. Marie-Gloriose Ingabire, a health economist by training and a Senior Program Specialist at the International Development Research Centre in Canada, the emerging leadership taken by African countries to achieve universal health coverage is something we can all be excited about. African countries “are moving towards universal health coverage by improving access to needed health services for all and without financial hardship” is a win/win for all globally. “Beyond the traditional facility-based services, countries are increasing their investments in the provision of community-based health services, trying to reach the marginalized and most vulnerable populations. At the same time, countries are developing and putting in place mechanisms to provide financial protection for their populations”.
Advances in universal health coverage, according to Professor Kevin Marsh, Senior Advisor African Academy of Sciences and Professor of Tropical Medicine at the University of Oxford “has helped reduce childhood mortality by over 50% in last twenty years”, bringing “massive gains in malaria control, with malaria deaths down by 66% in Africa from 2000”. Kevin also credits high vaccine coverage to polio elimination in almost every country on the continent.
How Design is Improving Hospital Standards in Africa
The Liberian Ministry of Health and Social Welfare wanted to develop National Healthcare Infrastructure Standards and Guidelines for the country, emphasizing investment in decentralized rural care networks paired with the development of specialized referral centers. They partnered with the nonprofit Mass Design Group based in Boston and Kigali to undertake a comprehensive assessment of existing facilities and as part of a situational analysis. According to Yves Iradukunda, “MASS produced architectural and engineering standards and guidelines for all scales of facilities, including clinics, health centers, and hospitals throughout Liberia.” This has resulted in improved health infrastructure standards that combine beautiful design with patient-centered care, something we all can appreciate when we find ourselves in the vulnerable position of needing or accompanying a cherished person for hospital care. In Rwanda, “MASS has developed a set of principles driven by design to improve health outcomes that can be adapted to the specific needs of each site’s context and programmatic requirements. An individual exemplary facility is not enough to achieve systemic change, and prototypical buildings poorly implemented can cause disastrous effects. Creating a model of high-quality infrastructure that can be easily adapted to the context and needs of the individual project can have a transformative effect on the way health infrastructure is developed globally.” In Malawi, this has led to an award-winning Maternity Waiting Village. With half of the births on the planet between now and 2050 projected to take place in Africa, this is something we can all cheer for.
Building Africa’s Response to Health Threats
The Africa Centres for Disease Control and Prevention (Africa CDC) – Dr. Kevin Marshis also excited about the establishment of the Africa Centres for Disease Control and Prevention. This Africa-wide public health agency was launched on January 31, 2017 in Addis Ababa, Ethiopia, to coordinate the needs of increasing and more intensive population growth and migration across Africa. The threat of new or re-emerging infectious disease agents to turn into pandemics, including Ebola, the growing challenge of antibiotic resistance, the increasing incidence of noncommunicable diseases (e.g. diabetes) and injuries, the need to lower maternal mortality rates and pressures posed by environmental toxins require rapid response and prevention to become central to Africa’s health ecosystem. This Africa CDC will establish a continent-wide, science-based, transparent, accountable, and credible leadership resource to guide public health policy design and implementation.
The African Vaccine Regulatory Forum (AVAREF) – Dr. Kwasi Nyarko, Advisor to the Director General, Biologics and Genetic Therapies Directorate, Health Canada/Government of Canada, who is of Ghanaian origin, is most excited about his work in building the capacity of the AVAREF initiative to allow African countries to align interests and resources to ensure the control of preventable infectious diseases driven by African leadership on the continent. Dr. Nyarko sees increased transparency through social media and its use by youth and the impacts this has on all sectors as important for promoting more ethical leadership in Africa. These transformations are critical to advancing AVAREF and will allow Africans to bridge the regulatory gap which exists on the continent so that innovation that benefits local health systems can be adopted faster, but with all needed precautions.
The Potential of Innovation to Make the Sustainable Development Goals (SDGs) a Reality
Kedest Tesfagiorgis
For Kedest Tesfagiorgis, a Program Officer for Discovery & Translational Sciences in the Global Health Program of the Bill and Melinda Gates Foundation from Ethiopia, many examples of progress give her hope. “Over the course of history, we’ve seen how scientific discoveries and innovations from vaccines to contraceptives have driven health and development in Africa and globally. Building on progress, I’m excited about the potential for new and emerging innovations to help African countries achieve the SDGs.” You may wonder what SDGs have to do with advancing global health. Africa remains the continent most affected by neglected tropical diseases. UNSDSN.org
According to Tesfagiorgis, “Today, scientists are hard at work developing innovations that could be game-changing for African countries – such as new ways to protect health workers from Ebola, manufacture of vaccines to make the process cheaper, and eliminating disease-carrying mosquito populations. While African countries have the furthest to go to achieve most SDG targets, especially related to poverty and disease, these and other scientific innovations, if successful, could get us significantly closer.” As a past recipient of Grand Challenges Exploration grants from the Bill and Melinda Gates Foundation, I have seen firsthand the amazing advocacy work Tesfagiorgis is engaged in to support efforts being driven by African scientists and researchers. Her work with many talented African scientists and researchers via the Grand Challenges Programs have nurtured a family of initiatives fostering innovation to solve key global health and development problems. As part of this family, Grand Challenges Africa, launched in 2015 by the African Academy of Sciences, the New Partnership for African Development and the Bill & Melinda Gates Foundation will support novel homegrown solutions to the continent’s health dilemmas.
Grand Challenges Africa’s headquarters are based in Nairobi, Kenya. This young organization is blazing forward to shape African research agendas to enable local researchers to respond to important local problems.
The Development of Thoughtful Partnerships Because it “Takes a Village”
According to Tesfagiorgis,“Great minds alone are not enough to drive the innovations needed to address Africa’s challenges. Currently, to be blunt, there are not enough resources available for innovation in Africa, and we don’t get the most out of the resources that are available because they are so fragmented. Moreover, few stakeholders have the remit to think about the long-term investments and policies needed to build a thriving African science and technology sector that responds to the needs of the African people.”
Dr. Thomas Kariuki and Professor Berhanu Abegaz
Aligning all existing resources is critical to strengthening an African Health Innovation Ecosystem that will benefit all. The Coalition for African Research and Innovation (CARI) is addressing this challenge. “CARI, an initiative under the auspices of the Alliance for Accelerating Excellence in Science in Africa (AESA), aims to create a platform within Africa from which a coalition of stakeholders can build a highly coordinated, well-funded, innovative African R&D community together. CARI was recently introduced at the World Economic Forum in 2017, and is now solidifying its strategic direction in partnership with African government leaders and partners from across the private and public sectors,” according to Tesfagiorgis.
I met Professor Berhanu Abegaz, a brilliant natural product chemist from Ethiopia, in 2008. He was a professor at the University of Botswana at the time. Abegaz was bringing African chemists together all over the continent to harness Africa’s biodiversity to identify novel medicines that could be critically important for the continent’s health. Abegaz was the Executive Director of the African Academy of Sciences (AAS) from 2011 to 2016. He took the organization from being in the red to now being the umbrella organization behind the Alliance for Accelerating Excellence in Science in Africa (AESA).
This initiative of AAS, along with the New Partnership for Africa’s Development (NEPAD) Agency, is pioneering African science grant funding and capacity-building through a variety of programs. These include Grand Challenges Africa, Climate Impact Research Capacity and Leadership Enhancement (CIRCLE), Developing Excellence in Leadership, Training and Science (DELTAS) Africa, Good Financial Grant Practice (GFGP), Human Heredity and Health in Africa (H3Africa), as well as the AESA- Regional Initiative in Science and Education (RISE) Postdoctoral Fellowship Program. AESA also launched the Africa Science Desk to build the reporting capacity of African science journalists.
AESA is putting forward hundreds of millions of dollars to tackle Africa’s health and development challenges. AESA’s aim is to establish a billion-dollar trust fund to ensure continuity of its transformative agenda-setting and funding platform. For Dr. Thomas Kariuki, a Kenyan and the Director of AESA, “Africa must take the initiative to lead its science and developmental agenda even as it receives global support. Collaboration will amalgamate different voices and ideas to promote and conduct research relevant to the continent’s needs.” For Professor Nelson Torto, the new Executive Director of AAS and the founding Chief Executive Officer of the Botswana Institute for Technology Research and Innovation, continuing to promote “the development of science, technology and innovation on the continent [and] pushing this agenda forward to ensure science adequately plays its role to improve the lives of African people” will be his focus.
Advancing the Concept of ONE HEALTH for Africa
Animal agriculture is a very important part of African economies and culture. As incomes rise across the continent, demand for meat protein will increase and animal agriculture will likely become more intensified. This development will change the kinds of challenges faced by veterinary medicine in ways that have to be anticipated. Importantly, many of the diseases faced in animal agriculture are similar to those encountered in human medicine: they are caused by parasites. Uniting research and control efforts and learning from each side of this problem is encompassed by the “One Health” concept, which encourages the exchange of ideas and principles for disease control across all medical boundaries and the environment. Many of the drugs we now use to treat and control parasitic infections in humans were originally developed for use in veterinary medicine and the cross-flow must continue, with researchers collaborating for the benefit of humans and their livestock.
According to Professor Momar Ndao from Senegal, an Associate Professor at McGill University’s Faculty of Medicine, Division of Infectious Diseases in Canada, Director of the Canadian National Reference Centre for Parasitology, and an Executive Committee Member of the World Federation of Parasitologists, “Worldwide, parasitic diseases represent a substantial cause of mortality and morbidity in human population. Humans, and their domestic livestock, across sub-Saharan Africa carry a disproportionate amount of this disease burden due to combinations of socioeconomic and environmental conditions that favour parasitic disease establishment and transmission. One example is schistosomiasis, considered by the WHO to be the most important human helminth infection. The actual number of infected humans by Schistosoma mansoni, S. haematobium and S. japonicum, has long been underestimated and may surpass 400 million. Schistosomiasis is also a disease of substantial veterinary importance, with S. bovis, S. mattheei and S. curassoni being major causes of intestinal schistosomiasis in domestic livestock.
Image Courtesy of The Outbreak
Currently, the most significant concern related to human and animal Schistosoma spp. is hybridisation (i.e. a S. haematobium- S. bovis hybrid can be more virulent and infect both humans and animals). Another example is Strongyloidiasis, a public health concern around the world.” Ongoing efforts to identify an efficacious vaccine against Schistosomiasis combined with the use of Praziquantel in annual or semi-annual mass drug administration programs that aim to eliminate this public threat health will be essential to achieving eradication.
According to Professor Timothy Geary, Director of the Institute of Parasitology at McGill University in Canada, “The recent eradication of rinderpest, a huge problem in ruminants in Africa and elsewhere in the world, was based, in part, on the principles developed for smallpox eradication.” Another example of “One Health” achievements is the recent progress towards a commercial tapeworm vaccine for pigs, a very critical step towards the elimination to transmission and prevention of neurological damage in humans.
Preparing the Next Generation Intellectual Capital to Drive Global Health in Africa
Dr. John Amuasi’s mission in life is to grow African research networks to take leadership on how we tackle neglected tropical diseases (NTDs). Africa carries 85% of the global NTD burden. Dr. Amuasi envisions an African continent free of NTDs. This visionary Ghanaian is the Executive Director of the African Research Network for Neglected Tropical Diseases (ARNTD). He established this network in 2013 with other African former postdoctoral research fellows who had been supported by the European Foundation’s Initiative for NTDs (EFINTD), formed in 2008 by five European foundations led by the Volkswagen Foundation in Germany.
ARNTD is filling a critical gap in NTD control and elimination, that of multidisciplinary research on urgent research questions needed to move control and elimination goals to reality in Africa with African research leadership. ARNTD’s strength is that it brings together a variety of disciplines across the health, social and management sciences, including policy makers. This transdisciplinary approach is critical to ensuring long-term impacts of current ARNTD funded and future initiatives. Today, over a hundred scientists from some 32 French, English, and Portuguese speaking African countries and in the diaspora are active members of ARNTD.
Dr. Kelly Chibale
For Dr. Kelly Chibale from Zambia, the most exciting thing he is doing is the creation of science jobs and not just training doctoral (PhD) students. “We need to couple training with investment in infrastructure and support for entrepreneurship so we can create jobs and provide careers that collectively will contribute to making science attractive.” African-led innovation from a research and development perspective has historically been hampered by an insufficient critical mass of skilled scientists, as well as very poor access to infrastructure and enabling technologies.
Dr. Chibale is a Professor of Organic Chemistry at the University of Cape Town, South Africa Research Chair in Drug Discovery, Director of the Extramural South African Medical Research Council Drug Discovery Unit and Director of the University’s Drug Discovery and Development Center, H3D. Dr. Chibale led an international project team that discovered the first-ever small molecule clinical candidate for any disease researched on African soil by an African drug discovery centre from a high throughput screening campaign using modern pharmaceutical industry drug discovery approaches. This malaria clinical candidate is now in Phase 2 human clinical studies.
H3D is an example of an entrepreneurial pocket of excellence in Africa with a world class integrated drug discovery research infrastructure, as well as a proven, demonstrated, and measurable established track record of delivery of scientific milestones and creation of science jobs, while also providing an absorptive capacity to attract and retain talent in Africa and beyond. This centre is actively participating in the creation of an African pharmaceutical R&D industry that will generate science jobs to encourage brain gain and commercialize value locally.
For Dr. Peter Atadja, a Ghanaian who is the Executive Director & Head of Drug Discovery at China Novartis Institutes for BioMedical Research, preparing the next generation of intellectual capital to drive global health in Africa is what most excites him. Dr. Atadja spent the whole of 2016 as full-time Professor and Dean of the School for Basic and Biomedical Sciences, University of Health and Allied Sciences (UHAS), and currently combines leading drug discovery at Novartis Shanghai with his biomedical research capacity development work at UHAS, Ghana.
Dr. Atadja, an expert in the epigenetics of cancer, has led teams to make scientific discoveries that have brought new cancer therapies to market. Epigenetics is a critical area of research that studies how environmental conditions affect the expression of DNA, our genetic code. Dr. Atadja is bringing his decades of experience in the pharmaceutical industry to study how genetic profiles, specific to African populations, can be the source of new health innovation tools from diagnostics to therapies for a healthier continent. Dr. Atadja sees the digital revolution leveling the playing field in terms of access to information, an area critical to Africa becoming a leader in developing approaches in telemedicine and other data-driven health technologies. The unique African perspective has been largely missing in the global sphere of intellectual innovation and discoveries for far too long. As the Dean of SBBS, mentoring the next generation of African health researchers is Dr. Atadja’s way of growing the intellectual capital needed to drive improvements in global health in Africa.
The Next Einstein Forum (NEF), established by 2008 TED Prize Winner and cosmologist, Neil Turok, is taking intellectual capital building on the continent to a new level. This entrepreneurial South African’s vision is for the next Einstein to be African. He established the African Institute for Mathematical Sciences to achieve this ambitious goal, but that isn’t all. He also established NEF Fellows, a select two-year program that recognizes Africa’s best young scientists and technologists. “These top-rated researchers and emerging leaders, at least 40 percent of whom are women, have the opportunity to advance their scientific careers by, among other opportunities, presenting their work at unique NEF Spotlight Sessions at NEF Global Gatherings.”
NEF Global gatherings bring emerging African scientists into contact with Nobel Prize winners, leaders in technical industries, and high-level policymakers to help shape a knowledge- and innovation-driven African future. Of the 19 newly-announced Next Einstein Fellows, 7 are in the biological sciences and health. They come from Egypt, Ghana, Guinea, Tunisia, and South Africa. These young scientists (all under 42) are exploring the use of nanotechnology for cancer therapy, medical microbiology, human genetic diversity, stem cell biology, noninvasive ways to measure health, and policy and systems research. Their work is focused on benefiting society, raising Africa’s scientific profile, and nurturing the next generation of scientific leaders.
According to Youssef Travaly from Senegal, the Director of Programs and Content at the NEF, “Policymakers must build a road map to show a vision of the most promising areas of science where they can invest and develop a well-balanced portfolio of people with skills ranging from researchers to developers and engineers.” NEF Global Gatherings are ensuring that an enabling ecosystem is unfolding to support this road map.
The Promise of Precision Medicine for People of African Descent
Dr. Collen Masimirembwa
Dr. Collen Masimirembwa, from Zimbabwe, is the founding president and CEO of the African Institute of Biomedical Science and Technology (AiBST) based in Harare. He is leading work in precision medicine to fine-tune doses of retroviral drugs used for therapy of HIV/AIDS to enhance their safety for African populations. Precision medicine is the tailoring of therapeutic treatments to specific sensitivities present in people that can be traced to specific DNA differences. Genetic diagnostic tests can reveal these differences.
According to Collen, AiBST’s innovation is a “genetic test and dosing algorithm for the safe and effective use of Efavirenz in the treatment of HIV patients. The product is called GeneDose-EFV”. This innovation won the First Prize in Innovation for Health during the South Africa 2016 edition of the Gauteng Accelerator Program (GAP). The prize is allowing AiBST to expand their work in South Africa with laboratory space at the Innovation Hub in Pretoria.
The precision medicine body of work related to HIV/AIDS, including AiBST’s contribution, has led the World Health Organization to recommend dose reduction from the 600 mg to 400 mg to prevent neurological toxicity in sub-populations highly sensitive to this treatment. What AiBST suspects is that 20-30% of HIV patients in Zimbabwe and possibly other parts of Africa may require an even smaller dose of 200 mg for efficacious and safe treatments. With funding from NEPAD, AiBST is working to investigate this possibility. This area of research, called pharmacogenomics, is critical to understanding how genetic diversity affects treatment efficacy and safety and can correlate differences in drug metabolism with particular DNA variations.
AiBST is working with H3Africa to build capacity for bioinformatics analysis on the continent to advance precision public health in Africa. Most genetic studies are based on analysis of people of white European descent. These data are used to evaluate the safety and efficacy of many drugs for global use. Although health issues of people of African descent are often associated with unfavorable socio-economic determinants, precision medicine is revealing a different explanation for some cases. Codeine, a common pain killer any of us might receive after a root canal, converts to morphine in a majority of Ethiopians and can lead to death based on standard doses used in Europeans, and has been banned there. Precision medicine is revealing that some gene variants that have been critical to survival on the African continent may be correlated with the incidence of other health issues.
Expanding this work with continent-wide clinical studies will help ensure long term health for patients of African descent on the continent and globally. Towards this, AiBST has been awarded a European & Developing Countries Clinical Trials Partnership training grant to build capacity for Clinical Pharmacogenetics in Africa through initiating a Master’s degree program in Genomic Medicine.
