Lessons from Ebola and HIV
Professor Peter Piot FMedSci, London School of Hygiene & Tropical Medicine, UK
Research in the Democratic Republic of Congo, and in particular by Professor Muyembe, has contributed greatly to our knowledge about the two defining epidemics of our time – Ebola and HIV/ AIDS. Both infectious diseases exploit fault lines in society, health systems and beliefs, thrive on stigma, and disproportionally affect vulnerable populations. At the same time slow responses promoted the spread of both viruses. The rapid adoption of science and innovation played a major role throughout the global response to AIDS, in the first place the discovery of effective antiretroviral therapy. Whereas epidemiology, virology and clinical trials were the main initial scientific disciplines involved, HIV research in Africa now includes multiple biological and social science disciplines.
There have been major spin offs of HIV research, such as the development of anti-viral therapies for HBV and HCV infections, and research capacity strengthening in many low and middle income countries. In comparison Ebola research was quite on the margins until the current Ebola epidemic in West Africa. For the first time during a major outbreak, clinical trials with candidate Ebola drugs and vaccines have been conducted, resulting in the demonstration that ring vaccination with a VSV based vaccine is effective. New mechanisms to support the development of vaccines for neglected and emerging infections are needed.
Four decades of Ebola outbreaks experience in Democratic Republic of Congo (DRC)
Professor Jean-Jacques Muyembe-Tamfum, Institut National de Recherche Biomédicale, Democratic Republic of Congo
When Ebola Virus Disease (EVD) emerged in Yambuku, DRC in 1976, it was first mistaken for a severe and unusual presentation of typhoid or yellow fever. We initially investigated the etiology of this mysterious, deadly, and unresponsive disease to common drug therapies, collecting blood and liver necropsy with our bare hands. As blood culture and Widal tests began to rule out typhoid, and liver pathology from deceased patients turned up negative for yellow fever, we began to understand the clinical manifestations of this novel disease while taking care to provide compassionate care to patients, including successful convalescent blood transfusions. Ebola virus was further identified by the Institute of tropical medicine in a blood sample of a sick Belgian nun we transferred to Kinshasa. We pieced together an epidemiologic picture of the transmission and amplification of EVD in hospital settings and in communities during traditional funerals. Over the course of this and other isolated outbreaks, we developed a national strategy comprised of simple public health interventions to effectively quell the spread of disease with the help of international partners. This strategy includes strong community engagement, passive and active case detection, contact tracing, multisectorial case management, hygiene and sanitation, social mobilisation, and psycho-social support for survivors and their families. With strong national leadership coordinating all control and research activities, we have successfully guided DRC through several subsequent EVD epidemics and have also helped other nations manage outbreaks in the Congo basin and beyond. Our longstanding and exceptional experiences with Ebola make DRC a leader in disease comprehension, management, and control strategy implementation.
Effect of maternal antibodies to major pneumococcal proteins on the nasopharyngeal carriage of the pneumococcus in early infancy
Dr Martin Ota, World Health Organization Regional Office for Africa, Democratic Republic of Congo
Invasive pneumococcal diseases, caused by over 90 serotypes of Streptococcus pneumonia, are responsible for about 1 million deaths among children under 5. Although pneumococcal polysaccharide conjugate vaccines are effective, they protect only against a limited number of serotypes, and the prospect of increasing the serotype coverage is restricted by both technical complexities and high cost. There has been increasing interest in the development of pneumococcal protein vaccines with antigens that could overcome these limitations. However, there is neither a functional assay nor a known concentration of antibodies against these proteins that is associated with protection. Therefore this study evaluated the relationship between maternally acquired antibodies to some major pneumococcal protein antigens at birth and nasopharyngeal colonisation of infants during the first two months of life.
Concentrations of antibodies against three of the major pneumococcal protein antigens, pneumococcal surface protein A [PspA], pneumolysin (rPly), and choline binding protein A [CbpA] were determined at birth, one and two months of age and related to nasopharyngeal carriage of the pneumococcus. There was significant maternal transfer of antibodies to these pneumococcal protein antigens measured from the cord blood, and the concentrations waned in the first two months of life except for PspA. Nasopharyngeal carriage of the pneumococcus was also variable and increased with time after delivery. The relationship of nasopharyngeal carriage of the pneumococcus and antibody concentrations to the major pneumococcal protein antigens will be discussed.
Research to policy in Africa: a changing narrative
Professor Collins Ouma, Maseno University / African Population and Health Research Center (APHRC), Kenya
Low uptake of research evidence in policy formulation has been associated with inadequate approaches in supply of evidence to policy makers, including inabilities of researchers to effectively communicate their research and knowledge for policy influence. Critical areas of focus entail carrying out research in which knowledge is produced, packaged and communicated by researchers and intermediaries who know the local context, needs and capacities of policy makers; communication and planning of research and information involving strategic thinking and appropriate timing; and involving policy makers in the initial planning stages of research projects for effective implementation of the research evidence. Advocates of evidence-informed policy making processes maintain that the depth and quality of knowledge used by policy makers influences the effectiveness of policies. The uptake of research evidence in the policy making process is on the front burner of global discourses on approaches and strategies for development. Low- and middle-income countries, face challenges in using research evidence when compared with high-income nations. Given that many institutions and training providers use self-assessment as a major tool for assessing capacity, it seems likely that capacity gaps are frequently underestimated. In addition, networks and linkages, even when well developed, do not address the lack of demand of research evidence from policy makers despite the fact that these channels can help raise awareness of research amongst policy makers and serve as a conduit for knowledge flow where the demand exists. We have undertaken a unique approach to improve the translation of research evidence and learning into policy and practice for effective maternal, newborn and child health (MNCH) interventions in 5 African countries. The focus is to identify and maximise opportunities for policy influence for MNCH issues in the countries, build consensus for MNCH issues to drive policy outreach at national and regional levels and to strengthen the capacity of Implementation Research Teams for long-term and systematic engagement with decision makers in their respective countries for more effective uptake of the evidence they generate. Key evidence generated will impact on the quality of healthcare, health, general health systems, community health workers on maternal and child health within the various African countries.