Vital Signs

The worst-ever Ebola epidemic claimed more than 4,000 lives, largely in Sierra Leone, Guinea, and Liberia. Above, a member of a Liberian Red Cross team in Monrovia, Liberia, on October 14, 2014. Photo by Marcus DiPaola/NurPhoto/CorbisThe worst-ever Ebola epidemic claimed more than 4,000 lives, largely in Sierra Leone, Guinea, and Liberia. Above, a member of a Liberian Red Cross team in Monrovia, Liberia, on October 14, 2014. Photo by Marcus DiPaola/NurPhoto/Corbis
By Deborah Blagg

Every year, the Academic Ventures program at the Institute convenes 35 private workshops and seminars to advance early-stage knowledge across disciplines and even continents. At this workshop, infectious disease experts connected on Africa-based initiatives.

“The people in this room have done amazing research utilizing everything from basic science to new technologies,” said Thumbi Ndung’u, the scientific director of the HIV Pathogenesis Programme at the University of KwaZulu-Natal, in Durban, South Africa, and cochair of an October Radcliffe workshop that convened 30 leading infectious disease experts from Harvard and Africa. Ndung’u and Phyllis Kanki, a professsor at the Harvard T.H. Chan School of Public Health, organized "Focus on Africa: Infectious Diseases” to encourage information-sharing and collaboration among those who work on the front lines of research on Ebola, HIV/AIDS, malaria, tuberculosis (TB), hepatitis B, and other diseases that disproportionately affect populations in sub-Saharan Africa and increasingly threaten to spread across the globe.

“We have the tools, but we need to coordinate our efforts,” emphasized Ndung’u. “By getting to know each other’s strengths, we can broaden the impact of our research nationally and regionally.”

The urgent need to build Africa-based research capacity was a recurring theme throughout the two-day workshop. On a continent that carries 25 percent of the world’s disease burden, Ndung’u noted, there are just 400 researchers per 1 million people. “And only 1 percent of disease researchers in Africa are Africans.”

Kanki has spent more than two decades studying HIV with colleagues in Senegal. She led Harvard’s participation in the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in Botswana, Nigeria, and Tanzania and plays a key role in Harvard’s component of the Medical Education Partnership Initiative in Nigeria, a consortium of six Nigerian medical schools working toward improving curriculum and research capacity.

After its launch, in 2003, Kanki said, “PEPFAR gave tens of thousands of patients access to treatment. But there was no funding for research to determine what protocols were most effective.” Advocacy for facilities and equipment to monitor treatment and care has since led to upgrades such as the three genome sequencers now operating in Nigeria. “Sequencing technology is critical for scientists working on problems such as drug resistance,” she noted.

Locally available sequencing technology is especially useful in the midst of health emergencies. Nathan Yozwiak, a project manager and infectious disease specialist with Harvard University and the Broad Institute, talked about the importance of genome sequencing during the most recent Ebola outbreak in Sierra Leone. Previous work on Lassa hemorrhagic fever with research partners in West Africa made it possible “to quickly sequence 70 percent of all Ebola cases in Sierra Leone in the first three weeks of the epidemic,” he said. For public health officials, Yozwiak explained, information from DNA sequencing can help identify the source of the virus, show mutation rates over the course of an outbreak, and track geographic spread within countries and across borders.

Keeping the focus on Ebola—which, like TB, has made a recent comeback in Africa—Amadou Sall described the 2014 outbreak as “a wake-up call.” “We need to be innovative when it comes to surveillance,” said Sall, a research director at the Institut Pasteur de Dakar, in Senegal, and the leader of a program to establish mobile diagnostic facilities in multiple locations across West Africa. Noting that “the world is crisis-oriented,” Sall called for “regional champions” who will stay focused on research and response plans for priority diseases between outbreaks. “Ebola is not gone, and other diseases are coming,” he cautioned.

Also in Senegal, where Souleymane Mboup serves on the faculty of medicine at Université Cheikh Anta Diop de Dakar, an estimated 11 percent of the population suffers from chronic hepatitis B (HBV), which often coinfects people who have HIV and leads to fatal liver cancer. Mboup shared details of an ongoing clinical trial aimed at determining whether HBV treatments that show promise in Europe can be effective in West African populations. “While there is still no centralized program for HBV in Senegal,” he said, “the government has started to make treatment a priority.”

Drug-resistant TB is another deadly disease that frequently coinfects AIDS patients. Anne Goldfeld, a Harvard professor and long-time advocate for health and human rights, shared encouraging results of a study that showed outstanding success treating multidrug-resistant TB in Ethiopia with a regimen of standard drugs, intensive side-effect monitoring, adherence strategies, and nutritional supplements. “With enough support and infrastructure for delivery of care,” Goldfeld said, “you can increase survival rates, even in the most challenging conditions.”

“Treatment as prevention,” an oft-repeated catch-phrase during the workshop, is being tested in a Botswana-based study described by Max Essex, founding chair of the Harvard AIDS Initiative and the Botswana Harvard AIDS Institute Partnership. Essex’s study, the Botswana Combination Prevention Project (BCPP), is under way in 30 villages, testing the impact of antiretroviral drug therapy on HIV-infected individuals with high viral loads and high potential to transmit the virus to others. “By weakening the infection in those who are sickest,” said Essex, “we believe the rate of new infections will decrease.”

Compliance is a significant factor in the success of studies such as the BCPP, and it is crucial in patient treatment and recovery. Helen Lee, a professor and director of research at the School of Clinical Medicine at the University of Cambridge, observed, “Patients in remote areas who travel miles to a clinic only to be told they will have to wait a month for test results often don’t come back.” SAMBA (an acronym for simple amplification-based assay) is a new device developed by Lee that makes it possible to test HIV levels in blood samples closer to the source of care, saving time and increasing the efficacy of treatment. “For critically ill patients and especially for infants,” she said, “this can be lifesaving.”

In the ongoing effort to attract funding, develop in-country research and treatment, and broaden education opportunities for young African infectious disease scientists, there are reasons for optimism. Harvard Medical School professor Bruce Walker serves on the steering committee of a 10-year initiative funded by the Howard Hughes Medical Institute that has built a state-of-the-art TB/HIV research facility in South Africa. With such high-tech tools as “advanced flow cytometry, mass spectrometry, and confocal microscopy now close to the center of the epidemic,” Walker said, “anything we can do in Boston, we can now do in Durban.”

At the workshop’s end, Kanki cited the Radcliffe Institute’s role in inspiring new insights and strengthening connections among her colleagues from Harvard and Africa. “Everybody came away with at least one or two ideas about new things they might like to do, new projects, new approaches,” she said.

“The signs are good,” concurred Ndung’u, citing the rapid growth of African economies and scientific output that is increasing at an annual rate of 21 percent, versus 9 percent worldwide. “There are many creative minds in sub-Saharan Africa, and they have the capacity to change the future.”

Deborah Blagg is a freelance writer.

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