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Africa: Africanizing Malaria Research

AfricaFocus Bulletin
Nov 20, 2005 (051120)
(Reposted from sources cited below)

Editor's Note

Research on malaria must increasingly be centered in Africa and be led by African researchers, stressed participants in the Fourth Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference held last week in Cameroon. In addition to a wide variety of scientific papers on the latest research, the conference featured the designation of researcher Genevieve Giny Fouda Amou'ou as recipient of the Young Malaria Scientist Award, and the announcement of the move of the MIM secretariat from Stockholm, Sweden to Dar es Salaam, Tanzania.

This AfricaFocus Bulletin contains (1) two press releases from the Multilateral Initiative on Malaria, focused on new efforts to build sustainable malaria research infrastructures based in Africa. and (2) two profiles of African malaria researchers. Other announcements and researcher profiles from the conference, held from November 13-18 in Yaounde, Cameroon, are available in both English and French at http://www.mim.su.se/conference2005.

For additional coverage of the conference, visithttp://www.kaisernetwork.org/mim/index.cfm

For previous AfricaFocus Bulletins on health issues, including malaria, see http://www.africafocus.org/healthexp.php. See in particular:

May 4, 2005 Africa: Rolling Back Malaria?
http://www.africafocus.org/docs05/mal0505.php

and

Apr 19, 2004 Africa: Malaria Action at Issue
http://www.africafocus.org/docs04/mala0404.php

For current news on malaria in Africa, visit
http://allafrica.com/malaria.

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

African Malaria Scientists Celebrate Arrival of MIM Secretariat to African Soil

The Multilateral Initiative on Malaria (Dakar)

Press Release

November 17, 2005

MIM is an international organization dedicated solely to building a sustainable malaria research infrastructure in Africa. In 2006 MIM will officially move its headquarters to Dar es Salaam, Tanzania, under the auspices of the African Malaria Network Trust (AMANET).

"While the work of scientists from outside Africa continues to be critical, the fact remains that African malaria researchers need to be involved in parallel if we are going to successfully implement new research findings and begin to reverse the situation in malaria endemic countries," said Andreas Heddini, secretariat coordinator for MIM.

MIM's move to Tanzania means that mobilization, capacity building and coordination of malaria research will be directed from Africa - the continent which has the highest incidence of malaria and suffers most from the devastating human and economic impact of the disease. Malaria places a continued unacceptable burden on health and economic development in over 100 countries. An estimated 350-500 million cases of malaria occur per year - children, pregnant women, people living in poverty and people living with HIV/AIDS being particularly vulnerable to the disease. More than one million people die from malaria every year. Estimates suggest that malaria accounts for up to 40% of all public expenditures on health and 20-50% of hospital admissions in many countries.

MIM is calling for a new initiative that would focus on competitively awarded long-term grants that would be dedicated to developing new "centres of excellence" in malaria endemic areas of Africa. These centers would serve as hubs for training new scientists and assembling interdisciplinary teams for conducting malaria research. In addition, an African malaria research and control forum will be established to translate malaria research results into action which will be coupled with renewed advocacy to promote malaria awareness to the general public and among policy makers and politicians for political goodwill and increased African investments in malaria research and control.

Training and capacity building would occur within the context of new investigator-driven research projects directed by African scientists and aimed at developing better tools for fighting malaria.

"The transfer of MIM headquarters to Tanzania is an enormous opportunity. This move is an investment in the future of African scientists and, indeed, the future of the African continent itself." said Wen Kilama, Managing Trustee of AMANET (http://www.amanet-trust.org).


Multilateral Initiative on Malaria Seeks International Effort To Fortify Africa's Malaria Research Capacity

The Multilateral Initiative on Malaria (Dakar)

November 17, 2005

Yaounde

Achieving victory over malaria in Africa, a disease that each year kills millions and imposes costs that cripple entire economies, requires a new internationally funded effort dedicated to training and supporting a critical mass of African malaria researchers, according to a new plan launched today by the Multilateral Initiative on Malaria (MIM) at the Fourth MIM Pan-African Malaria Conference in Yaound‚, Cameroon.

"While the work of scientists from outside Africa continues to be critical, the fact remains that African malaria researchers need to be involved in parallel if we are going to successfully implement new research findings and begin to reverse the situation in malaria endemic countries," said Andreas Heddini, secretariat coordinator for MIM.

MIM is an international organization dedicated solely to building a sustainable malaria research infrastructure in Africa. This year it will officially move its headquarters to Dar es Salaam, Tanzania, under the auspices of the African Malaria Network Trust (AMANET).

A 1999 MIM survey reported that there were only 752 trained malaria researchers in sub-Saharan Africa, the area of the continent that each year endures the brunt of the world's 500 million malaria infections and 2.7 million deaths. The number of scientists is growing, Heddini said, noting that there are 1,000 African malaria researchers attending this week's MIM conference in Yaounde. But he said many more malaria experts are needed, and, to keep them in Africa, they must be supported by a system that can provide sustainable long-term funding and adequate facilities.

MIM is calling for a new initiative that would focus on competitively awarded long-term grants that would be dedicated to developing new "centers of excellence" in malaria endemic areas of Africa. These centers would serve as hubs for training new scientists and assembling interdisciplinary teams for conducting malaria research.

Training and capacity building would occur within the context of new investigator-driven research projects directed by African scientists and aimed at developing better tools for fighting malaria. These would include new drugs, vaccines, diagnostic tests, treatment strategies, and mosquito control techniques.

"We're not asking for a quick fix here but an investment that allows us to establish a research culture focused on malaria, one that begins attracting scientists at the undergraduate level," said Wen Kilama, Managing Trustee of the African Malaria Network Trust (AMANET), which is based in Dar es Salaam.

"We also know that creating a sustainable malaria research infrastructure in Africa does not involve simply training 'malaria researchers,'" he added. "Given the complex questions that must be answered to defeat malaria, when you talk about capacity you are talking about scientists with expertise in parasite biology, entomologists who can focus on insect control, and toxicologists who will understand the effect of drug compounds. You also need epidemiologists, biostatisticians and experts in bioethics, and you need the information technology and other resources that allow you to take the research directly to where the problem is."

As ambitious as it sounds, the good news, Kilama said, is that Africa would not be building a malaria network from scratch. Though insufficient in number, there is a core group of highly trained African experts working in malaria endemic areas, and, in just the last few years, their numbers have been growing. For example, Kilama said that when he returned three decades ago to Tanzania, there were only a couple of PhD's with a good understanding of malaria. "Now there are at least 20, and I think we have seen a tremendous increase in human resources focused on malaria across Africa," he said.

So a new initiative targeted at building capacity would be taking advantage of an existing momentum that has brought tangible progress to Africa-based malaria work. But Wilfred Mbacham, coordinator of the Fourth MIM Pan-African Malaria Conference, said unless there is a long-term commitment to their development, there is a danger that Africa's new cadre of malaria experts will go the way of many of their compatriots-to Europe and North America.

"That is always the dilemma with training African scientists," he said. "They become experts and are then encouraged to go work overseas. But if they see there is a future to develop professionally in their home countries, most will choose to stay."

Ogobara Doumbo, director of the Malaria Research and Training Center at the University of Bamako in Mali, said there are many areas where having trained African scientists leading malaria research teams can accelerate efforts to find new ways to fight the disease. For example, he said while there is an urgent need to conduct more clinical trials in malaria-affected areas, without extensive knowledge of local social and cultural conditions, it can be very difficult to recruit patients and obtain informed consent in an ethically sound matter.

"In our work in Mali we have developed our own procedures for obtaining informed consent that are quite different from what a scientist would do in the West," he said. "But without this approach, it would have been impossible to accomplish what have been very valuable clinical trials. And as we see more and more drugs and vaccines that need to be tested in African populations, the presence or absence of well-trained African scientists could become the critical factor in their success or failure."


To narrow the gap between science and ordinary life

Francine Ntoumi, MIM/TDR, Hopital Albert Schweitzer in Lambar‚n‚, Gabon

- One of my relatives in Brazzaville recently fell very ill in malaria, recounts Francine Ntoumi over the phone from her outpost in Tuebingen, Germany. The man is well educated, and has a lot of respect for me. He wanted to take his ordinary Chloroquine, as he used to do all his life when hit by malaria. I told him it is counterproductive because of resistance, and to go to the Medical doctor. He refused. He said: "You have your theoretical knowledge, but I know malaria more than you because I experienced this disease all my life. Maybe I need to extend my treatment with Chloroquine a few days extra, but that will do it!"

This gap between scientific knowledge and practical use is one of the biggest problems in the handling of malaria in real life in Africa today, says Francine Ntoumi.

-If I couldn't convince this educated man of the reality of resistance, how can I approach those many, probably the majority, who believe that death from malaria is brought by witchcraft. Actually they don't even regard malaria as a disease to start with; it is just something that happens now and then. Just a fact of life and quite different from HIV/AIDS, which is thought to be very dangerous and taboo. You are not even supposed to speak about that.

In Europe one could think of the general attitude towards "common cold". Although science tells us that its origin is not in the chill of winter or the wet of autumn but in viruses that are disseminated between people, mothers keep asking their children to put on an extra pullover "so as not to catch cold". Most humans stick to their beliefs, even if scientific thinking is spreading quicker in some parts of the world.

For Francine Ntoumi this gap between belief and science is very vivid. She says scientists need to learn a lot more from social scientists of how to word their messages, how to explain the background and how to overcome the fact that people tend to regard researchers as dreamers, who live in another world somehow. She herself says she can understand the way people think. Her parents let her be educated in France from 12 years of age, but she spent most summer vacations in the Congo, and finally decided to return and work there, although she had specialized in something as exotic as the neurobiology of the mink. But it was unrealistic to envisage research in a topic not relevant for the needs of her country

- I wanted to contribute to the academic development in my country, so I had to change the subject of my research. Not that my old knowledge is waste, I could use a lot of my experience also in the field of malaria research. But the urgency of this matter makes it easier to attract students and funds. Nowadays I am involved in research activities in Gabon, Congo and Germany. In Brazzaville, I collaborate in developing research activities at CERVE with Dr. Mathieu Ndounga. In that perspective I train Congolese students in molecular epidemiology of malaria parasites and immunology. Equipment has become much handier and cheaper, so they can do a lot of lab work in Africa, and then come to Germany to acquire new cutting edge technologies and adapt them for use at home. These students represent the future generation of the lab at CERVE.

Most African scientists she meets in Europe do not really understand her high involvement in research activities in Congo which was troubled by the civil war some years ago. Maybe the very fact that she left Africa so early in life increased her feeling that "home is home". Francine Ntoumi has a son of 15 who has lived with her in France, Gabon and Germany. She has always relied on the support of her parents, but she says it has not been easy to develop a carrier as a scientist and be a mother as she would like be at the same time. Much travelling and much late work. On the whole it is not easy to be an African Woman Scientist. Gender balance is still an issue and women are still regarded as neglected entity. But she has made her choice.

She is the coordinator of one of the MIM/TDR networks, MIMPAC, MIM/TDR immunology and Pathogenesis Consortium which consist of researchers from eight research groups in Nigeria, Ghana, Burkina Faso, Sudan, Cameroon, Gabon and the republic of Congo. They share research protocols, develop common research projects and students exchange, within the network and with Northern partners like University of Stockholm, University of Tuebingen and University of Marseille.

- MIMCOM is a revolution! says Francine Ntoumi. This is the means by which malaria research groups in many African countries have been granted access to the Internet and to the scientific community. Something that has changed their whole position compared to the old days. Now they can follow the international scientific development and keep updated even if they live in remote parts where the infrastructure is lacking. This may actually help them to carry on their work in Africa without feeling inferior vis-…-vis colleagues in other parts of the world. It has also benefited malaria research locally, as other institutions realize that it is an important and prestigious field, says Francine Ntoumi. The Medical research unit in Gabon and the CERVE in Brazzaville have benefited a lot from MIMCOM.


The grand old man of African malaria research

Professor Wenceslaus Kilama, African Malaria Network Trust, Dar es Salaam, Tanzania

He is something like the Grand Old Man of malaria research in Africa, Wen Kilama formerly at the University of Dar-es-Salaam. He was the lead founder of AMANET (African Malaria Network Trust) which succeeded African Malaria Vaccine Testing Network. He holds several prestigious international posts in the field, and is one of the founders of MIM. He says modestly that his interest in malaria has resulted in a few significant publications, but the list of institutions he founded and headed is important. Among them the National Institute for Medical Research in Tanzania.

Today, 65 years old and "chronologically retired" as he puts it, he is mainly concerned with the ethical side of research in Africa, especially malaria research. There are several hot issues, for instance the principle that research involving vulnerable Africans should only be performed if it benefits people in Africa. Drug trials aiming at finding good preventive methods for tourists should be carried through with tourists and not with people living in malaria endemic areas, who have enough problems as it is.

-We have trained some 200 people to form Ethical Review Committees, which now exist at universities and research institutions in many African countries. But there is a need for further training so that the committees will not grow into merely a bureaucratic hindrance, but really carry through their task of making sure that scientific research respects the individual, does no harm, upholds confidentiality and so on. I have come to appreciate this as a very important and serious part of research, says professor Kilama.

Wen Kilama was born in Bukoba, western Tanzania, where malaria affects almost everybody. In his childhood, children used to get scarification over their enlarged spleens in the belief that it was curative. At school when the children undressed for swimming or bathing this was a very common sign of how widespread malaria was. Nowadays medication is quite widespread and enlarged spleens are rare. There is however still a common lack of understanding of such characteristics as anaemia or psychiatric complications of malaria, says professor Kilama.

He himself went to the US for further studies, and decided to major in biology, since that was closer to the needs of his country than the arts where he started out. His PhD thesis was on the genetics of mosquito susceptibility to malaria.

Kilama has worked a great deal through non governmental organisations both to disseminate knowledge and to develop African researchers. But he feels malaria would need strong advocacy groups like those of people with HIV/AIDS. There is much too little of that, he says, even if he recognizes that efforts within malaria research have been stepped up recently.

-Another worry of mine is that prevention to-day relies so heavily on one group of chemicals for insecticide treated bed nets. Once the mosquitoes manage to develop resistance against any of this set of chemicals, we will be in a very bad position. We really shouldn't put all our eggs in the same basket like this.


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

AfricaFocus Bulletin can be reached at africafocus@igc.org. Please write to this address to subscribe or unsubscribe to the bulletin, or to suggest material for inclusion. For more information about reposted material, please contact directly the original source mentioned. For a full archive and other resources, see http://www.africafocus.org