Ebola Virus Disease: Platform for North-South Collaboration Urgently Needed

Solomon Nwaka and colleagues summarize the outcomes of the September meeting of the Board, and Scientific and Advisory Committee (STAC) of the African Network for Drugs and Diagnostics Innovation (ANDI) on Ebola, and outline the next steps for combating EVD.

The World Health Organization (WHO) has characterized the current Ebola Virus Disease (EVD) crisis as not just a public health crisis, but also a social, humanitarian and economic crisis, and a threat well beyond the outbreak zones. Indeed, the disease has been reported in Spain and USA. The UN General Assembly has established the United Nations Missions for Ebola Emergency Response (UNMEER), to join governments and international partners to respond to the Ebola outbreak. A number of developed and emerging countries, World Bank, African Development Bank, Philanthropic Foundations, and Non-Governmental Organizations including Doctors Without Borders, have made financial and logistical contributions to control the spread and reduce suffering. These resources have been deployed to provide surveillance and contact tracing, mobile testing facilities, isolation and treatment facilities, medical staff, as well as to help the expedited development of potential therapeutic agents. Despite these efforts, the EVD outbreak in West Africa continues, with over 17,256 cases and 6,113 deaths as of December 4, 2014; and estimates of up to 1.4 million cases of Ebola infection by January 2015.

Within Africa, countries such as Nigeria, The Gambia, and Botswana have made monetary contributions in support of the crisis, while others like Malawi, South Africa and Democratic Republic of Congo have provided medical supplies. The Economic Community of West African States (ECOWAS) is implementing a strategy for accelerated response while the African Union has approved a humanitarian mission called the AU Response to Ebola Outbreak in West Africa (ASEOWA). The long awaited establishment of an African Centre for Disease Control and Prevention (ACDCP) now appears to have been fast tracked by the AU, to help in addressing emergencies in a timely and effective manner. An African Public Health Emergency Fund (APHEF) provided initial support to affected countries, but was inadequate to cope with the rage of the epidemic due to poor subscription by countries.

The magnitude of the EVD epidemic has attracted an impressive number of partners, but the arena could be weakened if the efforts are only temporary, dispersed and/or experiences not harvested for posterity. Indeed, cases of EVD outside of Africa fuels fear of a pandemic and calls for a comprehensive approach that will bring a long lasting solution. Consistent with this, the World Bank has called for a USD20 billion global health fund to prepare for and tackle such emergencies in a sustainable manner.

The African Network for Drugs and Diagnostics Innovation (ANDI), is a pan African agency that facilitates the discovery, development, manufacture and delivery of quality, easy to use, and affordable technologies in Africa for diseases that disproportionately affect the continent. ANDI’s mission is to promote and sustain African-led health product innovation to address Africas’ public health needs through the assembly of research networks, and building of capacity to support human and economic development.

At the 4^th Board meeting of  ANDI held in Addis Ababa, Ethiopia (16-17 Sept 2014), the Board commended all stakeholders that have contributed in various ways towards resolving the EVD outbreak, and emphasized the criticality of the current outbreak as a mechanism for deriving lasting answers to questions in the various aspects of the disease – ranging from pathogenesis to interventions.  ANDI’s vision is to help create a sustainable platform for health innovation in Africa to address the continent’s health needs. The board therefore requested the ANDI Secretariat to convene a technical working group meeting on EVD of relevant ANDI Centres of Excellence as well as African and international experts. The meeting would aim to develop a strategy to better leverage existing expertise and capacity in Africa to support partnerships for research and development of technologies required for enhanced surveillance, diagnosis, and management of EVD and future emergent infections. ANDI presently comprises 32 research centres and 6 manufacturing entities engaged in drug, diagnostic, vaccine research and development across a wide spectrum of neglected infectious diseases that are prevalent on the continent.

More importantly, ANDI envisages North-South collaboration in the array of potential drug, diagnostics and vaccine agents for EVD now in development by western companies or institutions (Figure 1). WHO has implemented some consultations on potential new interventions for EVD and is now coordinating the clinical evaluation of some promising therapies and vaccines with the support of partners. This initiative will certainly benefit from African institutions with relevant expertise and interest to partner in addressing these issues. Expertise does exist in Africa in various fields relevant to EVD, but institutions need to be empowered and strengthened. ANDI can help in establishing such linkages and partnerships with the relevant African institutions and countries.  Such North –South collaborations will provide a practical example of the much needed capacity and health systems strengthening, that will contribute to lasting solutions to the health challenges facing Africa. A recent publication in Science on the sequencing of the Ebola genome demonstrates the power of such collaborations. This work involved authors from the United States of America, Sierra Leone, Nigeria and United Kingdom but it is good to see that the multiple corresponding authors come from Sierra Leone and USA.

Finally, a meeting of African experts is scheduled for 20^th – 21^nd January 2015, in Addis Ababa, to formulate a strategic roadmap on EVD for enhancing the establishment of systematic capabilities, processes and technologies, particularly:

• Improvements in understanding of disease pathogenesis
• Enhancement in clinical grading and staging of disease
• Identification of biomarker, diagnostic, and therapeutic targets
• Development of surveillance capabilities, including clinical databases
• Best practices in palliative/supportive care of patients
• Zoonotic reservoirs of the disease and animal-human transmission mechanisms

EVD is now considered one of the most serious public health crisis of the 21^st century. It is believed to be one of the most virulent diseases known. The increasing calls for implementation of the most forceful control measures demand, therefore,  co-ordination with African experts to assuage concerns about management of the epidemic that have been at the root of resistance by affected populations against health care case detection teams. Scientists and biomedical researchers from Africa may have unique learnings and experiential perspectives on the disease from which the rest of the global community working on this problem can benefit. Garnering such local capacity to help fight this outbreak may help equip and prepare the continent for such challenges in the future, for example through a better equipped early warning and response systems.

Authors:

Solomon NWAKA, PhD:  nwakas@andi-africa.org; @solonwaka; @andi_africa is the Executive Director of ANDI and former head of various R&D units at WHO/TDR, Director Drug Discovery-Medicines for Malaria Venture.

Vince Thomas is a Programme & Technical Officer at ANDI. His previous posts include Assistant Professor, Dartmouth Medical School; Head of Economic Strategy, Roche Diagnostics. 

Martin Ota is the Immunization Research Officer at the WHO Regional Office for Africa in Brazzaville. Former head of vaccine Research, MRC The Gambia, and researcher at Johns Hopkins University USA.

Barthelemy Nyasse is Deputy Vice-chancellor – Research & Cooperation, University of Bamenda; Prof of Chemistry, University of Yaoundé and former Director, Ministry of Higher Education Cameroon. 

Peter Atadja is the Head of Drug Discovery at the Novartis Institute for Biomedical Research in Shanghai, China and the Former Director of Cancer drug discovery at Novartis, Cambridge, MA, USA.

Sanaa Botros is a Professor of Pharmacology and head of Drug Evaluation and Discovery unit; Excellence Center on Antitrematodal R&D, and former head of Pharmacology Dept., TBRI, Giza, Egypt. 

Feng Zhao is the manager for Health at the African Development Bank and former, Senior Health Specialist at the World Bank.

John Reeder is the Director of Tropical Disease Research, WHO. Former Director, Centre for population health, head international health research at the Barnet Institute Melbourne, Professor at Monash University.

Tshinko Ilunga is the Managing Director of Health Development Consultancy firm. Former manager of Health and Acting Director of Human Development at the African Development Bank.

All authors but Peter Atadja (Novartis) declare no conflict of interest.