Health starts at home
A network of African scientists, including researchers at the University of Science, Techniques and Technology of Bamako, Mali, has been conducting trials of antimalarial drugs for use on their own doorstep.
MARTIN LUTHER KING JR famously said that injustice anywhere is a threat to justice everywhere. In many ways, the same could be said of health problems. We are lucky enough to live in a world where threats like malaria – endemic in certain countries but absent in others – are not considered the sole problem of the people who live in affected areas. Rather, researchers all over the world have united in their recognition of a gross threat to human health, regardless of its geographical remoteness from their own homes. Although controversies over the cost of medicine in developing countries continue to arise, the overall picture is of a global community of scientists working to provide solutions for those most in need of them.
But while this approach may showcase some of the finer aspects of the collaborative human search for knowledge and innovation for the benefit of others, it does have its issues. Modern technology and travel make working with a disease prevalent on the other side of the world much easier than it has been in the past, but there is still no substitute for personal experience. Everyday observations have led, often by chance, to some of science’s greatest advances – but
they would not have done so without the close proximity between scientists and phenomena in their immediate environment. In terms of treating malaria, therefore, there is an argument that researchers native to endemic areas could be vital in combating the disease.
BUILDING A FRAMEWORK
Abdoulaye Djimde, PharmD, PhD
WANECAM Network Coordinator
The problem is that the areas most affected by malaria are usually in the most poverty stricken areas of developing countries and therefore access to trained scientists is often scarce. Beyond this, there is a more fundamental problem in that the infrastructure, education systems and regulatory bodies needed to train and make use of scientists are also frequently underdeveloped or not in place. An institution of science is needed within at-risk countries, and it cannot come from nowhere – for the future of malaria research, and research towards other infectious diseases prevalent in Africa, it is of fundamental importance to focus more time and effort on furthering the research capacity of the less developed parts of Africa.
Professor Agrégé Abdoulaye Djimdé is the project coordinator of the West African network for clinical trials of antimalarial drugs (WANECAM), and he believes the time for malarial research conducted by Africans, for Africa is now.
WANECAM conducts vital research into various artemisinin-based combination therapies (ACTs), which are the World Health Organization’s (WHO) chosen approach for treating malaria in endemic areas. In order to achieve this the network brings together scientists from Djimdé’s native Mali, as well as Guinea, Burkina Faso and The Gambia. With support from the European and Developing Countries Clinical Trials Partnership (EDCTP) and the Medicines for Malaria Venture (MMV), WANECAM is making a big difference to research in West Africa – especially in the area of malaria.
ACT ON ILLNESS
WANECAM’s studies focus on ACTs, which combine various antimalarial drugs with artemisinin, a compound derived from annual wormwood, which has been used as an antimalarial in some parts of Asia for thousands of years. They are a particularly effective form of treatment and, because of the variation possible when combining artemisinin with other drugs it is harder for the malarial parasites to develop a resistance to them. The efficacy can be further increased by developing new combinations, so, as Djimdé points out: “The more ACTs we have, the better it is for malaria patients”.
The WANECAM clinical study compares the incidence of uncomplicated malaria in children and adults treated with repeated ACT over a period of two years. The study makes use of populations in three of the countries covered by the network, and sees ACTs, pyronaridine-artesunate (PA) and dihydroartemisinin-piperaquine (DHA-PQP) each compared with artesunate-amodiaquine (ASAQ) or artemether-lumefantrine (AL). Whereas the majority of clinical trials focus on a single treatment and follow-up analysis, this study reflects real approaches to malaria more closely by following patient progress over a period of two years. In practice, these ACTs would be used repeatedly over several years to treat consecutive cases of malaria in the same patients.
The WANECAM approach therefore involves following patients over a prolonged period, and within a large sample size – allowing not only for a more realistic interpretation of how these treatments work in practice, but also the opportunity to catch any rare or infrequent side effects. As well as comparing the efficacy of the various treatments, the trial also aims to accomplish a number of important secondary objectives, directed towards gathering additional data on the treatments’ effects. The assessment of safety using each of the ACTs in repeated therapy; the search for novel molecular markers of antimalarial drug resistance; the comparison of re-infection and recrudescence rates by polymerase chain reaction; the comparison of gametocyte infectivity and parasite clearance rates; and the impact of immunity, pharmacokinetics and pharmacogenomics, will all be part of the study.
Not only has WANECAM made an important contribution to medical research in Africa, but the network has also made significant progress towards improving scientific infrastructure, training and networking activities in Guinea, Mali and Burkina Faso. These groundbreaking initiatives have come in many forms, but some of the most impressive steps have been the construction of new clinical research facilities – as well as the renovation and refurbishment of old ones – which in places required the installation of electricity, running water and high-speed internet. The cold chain required for sample storage and transport was also upgraded, or created from scratch where necessary, and these new facilities represent the infrastructure foundation necessary for further, even more ambitious studies into malaria and other infectious diseases.
Physical facilities, however, are only half the battle – something that the researchers at WANECAM understand very well. The development of human capacity for research is integral to growth in this area, which is why the network is training six scientists – three PhD and three Master’s students – in addition to offering short-term training to dozens of young scientists and staff in areas from good clinical and laboratory practice to ethics, finance and even driving. Most dramatically of all, the network has succeeded in enabling Guinea, a country previously lacking any facility for clinical research at all, to contribute more than 800 patients to the clinical trial. In a matter of years, a functional team and facility has been built from scratch – an incredible achievement.
NORTH AND SOUTH
This project has also brought the African scientists together with European researchers from Sweden, Germany, France and the UK. “Our northern collaborators bring to the table their vast expertise both in basic research as well as in field research. All of them have worked in various endemic countries and have accumulated important knowledge and know-how” Djimdé explains. In addition to their experience, the European partners also provide access to some of the technologies that even WANECAM has not yet been able to unlock. Collaborations between African countries and between developing and developed countries have been the secret of this project’s incredible achievements, as Djimdé affirms: “Together, we form a true winning team”.