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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.
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