The End of Disease Surveillance: Why African Countries Shouldn’t Rethink Their Centralized Epidemic Susceptibilities
Correspondingly, Tomori thinks African countries should revamp their centralized disease surveillance systems. He says that if public health agencies concentrated their activity in one place, it would be 1000 miles away from where disease is occurring. He advocates a bottom-up approach in which every person watches over their community’s health and knows how to get help if something is not right.
He’s not upset about global health inequalities because he believes they will happen. He says that the real issue is that African countries rely too much on the West. Western aid is always too late, says Tomori. But more important, he stresses, “your help is not helping us. It is making us more dependent.
The Africa Centres for Disease Control and Prevention has set up a network to detect Pathogens. This consists of national public health institutes and genomics laboratories, such as ACEGID.
In 44 of the African countries, there is not even one physician per 1,000 people, with the lowest being zero physicians per 1,000. If you include nurses and midwives in the estimate, Africa’s density increases slightly but only to 1.55 health-care workers per 1,000.
The hub-and-spoke model of mRNA vaccine development in a swampy area of the South of the Republic of Congo
Perhaps the most infamous example was during the West African Ebola epidemic when it took nearly three months to identify the virus in Guinea. WHO reported that the country took so long because “Clinicians had never managed cases. No specimen had ever been diagnosed by a laboratory. No government had ever witnessed the social and economic upheaval that can accompany an outbreak of this disease.” The virus was already “primed to explode” when it was finally identified.
Likouala Prefecture is one of the least developed regions of the country and is a swampy area. He calls Likouala a “paradise for pathogens,” rife with everything from the disease-causing bacteria treponema to the viral disease Rift Valley Fever. “You know something terrible is going to come out of that area,” he says. It is only a matter of time without proper pathogen monitoring.
Public health agencies have an important role to play in empowering locals with educational programs and coordinating the response. Indeed, the best early warning system might come from those living on the frontlines of novel diseases. “If you take care of that first case, you can prevent an epidemic,” he says.
Mombouli’s team visited the same number of villages in the north of the Republic ofCongo as they did in the south. They explained to locals that they need to not touch or bury the carcasses of animals that have been diagnosed with the Viruses and need to contact the surveillance network immediately.
What is the solution? There’s something called the hub-and-spoke model, where one “hub” aggressively develops novel vaccine technology and then freely transfers it to the “spokes,” local manufacturers that can scale up production. Currently under development, this strategy adopts the philosophy that Africa’s value chain must be independent of high-income countries.
But building the value chain for novel health threats has proved more elusive. mRNA vaccine technology in the case of COVID-19 is a closely guarded secret.
“If the company decides to leave, we go back to square one,” he says. As one concrete example, Johnson & Johnson partner Aspen Pharmacare may soon shut down its South African plant making COVID-19 vaccines because of insufficient demand due to hesitancy and difficulties distributing the vaccine (among other reasons ).
It will take a lot of time, with both Afrigen and the vaccine expected to go through clinical trials by the year’s end. African countries can contribute immediately in other parts of the value chain, according to Tomori. For instance, one might manufacture glass vials, another rubber stoppers, another testing swabs and so on. Each country doesn’t need to produce everything end-to-end, but Tomori says they should all be starting somewhere instead of patiently waiting for international aid.
Things are starting to change. One of the four African countries that have surpassed the WHO’s threshold is Namibia, with 10.28 workers per 1,000.
This policy only helps the efficiency of the health care system and does not increase the number of providers. The first school of medicine was established in 2010, by the University of Namibia, which has since trained hundreds of practicing doctors who are advocates for the poor, underserved and marginalized in our society. A call from Namibia’s founding president to invest 50% of the national budget in education and health care emphasizes the country’s steadfast commitment to progress.
While it’s critical to continue building more medical institutions, such as the Kenyan General Electric (GE) Healthcare Skills and Training Institute and the University of Global Health Equity in Rwanda, there must also be a focus on retention.
In the British Medical Journal there was a study about the effects on sub-Saharan African countries of doctors moving abroad. “Africa has to look inside and start paying salaries that people deserve so they don’t leave the continent for other countries”, says Happi. As one example, the Zimbabwean Nurses Association says that most nurses in the country earn only $53 a month, a salary lower than the World Bank’s international poverty line.
It wouldn’t stop the exportation of health-care workers, but it could help replenish the workforce of African countries. “You cannot deplete a Continent of its own resources if you are honest”, says Happi.
That’s not to say that partnerships with Africans shouldn’t be pursued. After all, it was Sikhulile Moyo, the laboratory director at the Botswana-Harvard AIDS Institute Partnership and a research associate with the Harvard T.H. Chan School of Public Health, who first identified the omicron variant. Similarly, Happi collaborates with Broad Institute computational geneticist Pardis Sabeti, and together they deployed COVID-19 tests in hospitals in Nigeria, Senegal and Sierra Leone well before any U.S. hospital had them. The 200 million dollar Paul E. Farmer Scholarship Fund was recently announced by partners in health to “educate future health care leaders in Africa.”
The challenges of tackling pandemics in Africa: how genomics is progressed in Africa, and how to make the most of it
An American journalist named Simar Bajaj has written for The Atlantic, TIME, Guardian, and more. He studies the history of science and chemistry at Harvard University and is a research fellow at Massachusetts General Hospital. He has a profile on the micro-blogging site, http://soundcloud.com/simar.
First, H3Africa has made it easier for Africans to pursue genomics on the continent (see ‘Tapping the potential’). This has been made possible through establishing sequencing facilities, including in South Africa, Gambia, Nigeria, Ethiopia, Uganda and Botswana, and setting up training programmes, for example in bioinformatics6. African institutions have been given grants so they can design projects and training for their own countries.
Every country has it’s own priorities. Some are driven by diseases that were neglected or decreased during the Pandemic, which is why there are some that are driven by that, according to a rhythym expert based in Sri Lanka. Dengue is coming back with vengeance this year.
Many people are trained in interpreting COVID-19 data, but don’t know how to apply it to other diseases. “There’s still a global paucity of trained workforce.”
Funds for a major genomics programme in Africa will run dry this year. A chance to address global inequity in health-related genomics by building on the success of this initiative must not be missed.
Sequencing machines also cost tens of thousands of dollars each year to maintain. And the reagents required are expensive; they can also cost more in regions without established supply chains, says Pronyk, who says solving the distribution gaps will be a priority for Asia PGI.
In some places, it can take months to repair a broken machine, says David Blazes, a leader in pathogengenomics at the Bill and Melinda Gates Foundation. Work is also needed to develop standardized processes for sequencing pathogens other than SARS-CoV-2 and to bring the costs of sequencing down, say researchers.
H3Africa: Exploring African Genomes for the Study of Huntington’s Disease-like 2 and Other Diseases: Towards a Knowledge-based Diagnosis
African genomes have a longer evolutionary history, and contain more variation than people with European ancestry, so they offer a richer source of variant genes linked to certain diseases. Studies are revealing the incredible potential of African genomes: for developing ways to diagnose diseases across diverse populations; uncovering new therapeutic targets; and identifying genetic markers that indicate how someone might respond to a particular drug.
H3Africa requires that all projects involve some level of community engagement in order to enhance education and awareness about genomics across the continent. For example, Genome Adventures, an initiative of an H3Africa-funded network of organizations called the Collaborative African Genomics Network, is likely to have contributed to the high retention rate of participants in the network’s research project. A series of workshops, comic books, and social media were used to teach community stakeholders and the public about basic science research.
Health benefits are further away in other areas. A lack of data and genomic medicine services are some of the reasons why treatment of common, non-infectious conditions like Diabetes can be done. However, it is becoming clearer what needs to happen next.
A Huntington’s disease diagnosis can be made through a variation in a gene on the fourth cell in the human body. Huntington’s disease-like 2 is a form of the disease that is clinically indistinguishable. This is caused by a glitch in a part of the body. There have been all cases of HDL2 in people with African ancestry. This suggests that individuals who have Huntington’s disease symptoms but do not have the chromosome 4 mutation should be tested for the mutation on chromosome 16.
Source: https://www.nature.com/articles/d41586-023-00222-x
How could the African Population and Health Research Center be adapted for language, culture and population needs? A case study in Western Africa using the Lyfe Languages initiative
One encouraging sign is a funding award to help establish the African Population Cohort Consortium. Last year, the African Population and Health Research Center in Nairobi received funding from Wellcome to develop and co-lead this consortium with the Africa Health Research Institute in Durban, South Africa. It will collate health-surveillance data and biospecimens to provide a resource for large-scale population studies.
This would be aided by more government investment. Public–private partnerships are also key. Major pharmaceutical companies are increasingly expressing interest in scaling up translational genomics in Africa. At the American Society of Human Genetics annual meeting last October, for example, an emerging consortium of seven firms met with H3Africa investigators to discuss how current fragmented initiatives might be transformed into an integrated public–private partnership.
Matched funding schemes, whereby funds are provided by a donor on the condition that the receiver also contributes resources (similar to those implemented by the UK Newton Fund in selected African, Asian and South American countries), could help to shift trends in Africa away from over-reliance on donorship.
The responsible engagement of industry — based on principles of African ownership, and the equitable distribution of credit and benefits — could help to resolve crucial needs, such as the lack of maintenance staff for sequencing machines, affordable reagents and reliable supply chains.
Genetic services and electronic health records. In the United States, there are 2 medical geneticists and 7 genetic counsellors for every 500,000 people14. In South Africa, the most extensive medical genetics service is available, with both numbers less than 0.2.
Engagement with participants in research must also be tailored to the cultures and languages of people living in Africa. Some 2,000 languages are spoken in Africa, representing a significant barrier to communication. A model for how this can be achieved is presented by the Lyfe Languages initiative, a project that was developed in Western Australia. The project provides Indigenous-language translations of terms often used in clinical-genetics research20.