Africa Health News July-aug 2009 Final

A WHITAKER GROUP PUBLICATION

JULY/AUGUST 2009

AFRICA HEALTH NEWS PARTNERSHIPS

AFRICAN INSTITUTIONS TO LEAD GLOBAL HEALTH CONSORTIA More than 50 research and development institutions in 18 African countries are to take part in seven international consortia under a £30 million ($49 million) initiative funded by the United Kingdom-based Wellcome Trust. The aim of the initiative is to strengthen institutional capacity to support and conduct health-related research on the continent and to increase African leadership on the search for solutions to some of the world’s deadliest health challenges including HIV/AIDS, malaria and tuberculosis. The partnerships, each to be led by an African institution, will include both African partners and partners from Europe, the United States and Australia. “The Wellcome Trust initiative represents a truly innovative mechanism to position African scholars and institutions as leaders in the collaborative efforts to rebuild research capacity in the region,” said Dr. Alex Ezeh, Executive Director of the African Population and Health Research Center in Kenya. “It holds strong promise of creating a new class of highly-networked African scholars and institutions with the requisite skills to address the region’s health challenges.” Dr. Ezeh will lead the Consortium for Advanced Research Training in Africa (CARTA), one of the seven partnerships. CARTA will also include research institutions in Malawi, Nigeria, Rwanda, South Africa, Tanzania and Uganda, as well as Australia, Switzerland, the UK and the United States. Each consortium will operate independently and set its own agenda, but will have certain activities in common. These include leadership training and professional development, PhD and post-doctoral fellowships, improved infrastructure, competitive grant schemes and the provision of cutting edge equipment. The Wellcome Trust already funds major programs in Kenya, Malawi and South Africa, as well as individual research projects across the continent. The focus of the new initiative is to create partnerships to build a critical mass of sustainable local research capacity by strengthening universities and research institutions and developing research networks. “The African continent faces some of the world’s most serious health problems stemming from disease and poverty,” said Mr. Mark Walport, Director of the Wellcome Trust. “To tackle these problems, we need health research on the continent to develop in a vibrant research environment geared to national priorities. It is essential that the best and brightest researchers have access to training opportunities and career pathways in their home countries.” He added, “There is no use training excellent researchers in Africa unless a first-class environment is also available in which they can develop their careers and pursue their research. Outstanding researchers are also essential in African countries to provide leadership and to edu-

One goal of the African consortia initiative is to provide training for promising young scientists and provide them with the kind of world-class research environment and opportunities that will keep them in Africa. cate future generations of African students and scientists.” “The aim of this initiative is to ensure that African universities become more centrally involved in health research endeavors in Africa,” said Mr. Jimmy Whitworth, the Wellcome Trust’s Head of International Activities. “Through this initiative each consortium will focus on the needs of African universities to become platforms that can sustainably support internationally competitive scientific research.” The other consortia include: ■ One Health Initiative - African Research Consortium for Ecosystem and Population Health: Chad, Côte d’Ivoire, Ghana, Norway, Senegal, Switzerland, Tanzania, Uganda and the UK. Director: Professor Bassirou Bonfoh, Centre Suisse de Recherche Scientifique en Côte d’Ivoire. ■ One Medicine Africa-UK Research Capacity Development Partnership Program for Infectious Diseases in Southern Africa (SACIDS): Democratic Republic of Congo (DRC), Kenya, Mozambique, South Africa, Tanzania, the UK and Zambia. Director: Professor Mark Rweyemamu, Sokoine University of Agriculture, Tanzania. ■ Research Institute for Infectious Diseases of Poverty (IIDP): Côte d’Ivoire, Ghana, Mali, Nigeria, Switzerland and the UK. Director: Dr. Margaret Gyapong, Dodowa Health Research Center, Ghana Health Service. ■ Southern Africa Consortium for Research Excellence (SACORE): Botswana, Malawi, South Africa, the UK, Zambia and Zimbabwe. Director: Dr. Newton Kumwenda, Malawi College of Medicine. ■ Strengthening Research Capacity in Environmental Health (SNOWS): Denmark, Ghana, Kenya, South Africa, Sudan, Uganda and the UK. Director: Professor Esi Awuah, Kwame Nkrumah University of Science & Technology, Ghana. ■ Training Health Researchers into Vocational Excellence in East Africa (THRiVE): Kenya, Rwanda, Tanzania, Uganda and the UK. Director: Professor Nelson Sewankambo, Makerere University, Uganda.

PAGE TWO PREVENTION

IMMUNIZATION

WYETH LAUNCHES FINAL TRIAL OF DRUG TO PREVENT RIVER BLINDNESS

MALARIA VACCINE ONE STEP CLOSER

Wyeth Pharmaceuticals, in partnership with the World Health Organization (WHO), is launching the final clinical trial of a promising new drug that for the first time would stop transmission of onchocerciasis (river blindness) from infected to uninfected people. The trial will include 1,500 infected people in the Democratic Republic of Congo (DRC), Ghana and Liberia. They will be given the drug, moxidectin, which has shown in earlier trials to kill adult worms carrying the disease. If it lives up to its promise, the drug could potentially eradicate the disease in high risk areas within six years. The WHO estimates that about half a million people, mostly in Africa, are blind as a result of onchocerciasis, with more than 100 million people at risk of infection. Wyeth has been developing moxidectin for more than 10 years at a cost of $20 million, according to the company’s vice president, Ms. Henrietta Ukwu. The drug is designed to kill the adult worms that live in the carrier’s skin. The worms lay eggs that are then picked up and carried by black flies, which pass the infection on when they bite uninfected people. The worms can live up to 15 years in the human body. They spread throughout the body and when they die they cause intense itching and a strong immune system response that can destroy nearby tissue such as the eye. Oncho-

About half a million people, mostly in Africa, are blind as a result of onchocerciasis cerciasis is the third leading infectious cause of blindness. At present, the primary prevention method is black fly control, and treatment has been through annual doses of the drug ivermectin, which relieves the intense itchiness of the skin and eye tissue. Ivermectin also prevents the adult worms from producing additional offspring. Since 1987, global pharmaceutical company Merck has been providing ivermectin, under the brand name Mectizan, free of charge to endemic countries in Africa. The global community has made substantial progress in preventing the disease partly due to companies like Merck, and partly due to the efforts of global health organizations like the Carter Center.

RESEARCH NETWORKS

INTERNATIONAL NETWORK ESTABLISHED TO COMBAT MALARIA RESISTANCE An international network of malaria scientists is to be established, with the support of a $20-million grant from the Bill & Melinda Gates Foundation, to map the emergence of resistance to antimalarial drugs and to guide global efforts to control and eradicate the disease. The Worldwide Antimalarial Resistance Network (WWARN) will be administered from Oxford University and will provide the comprehensive evidence needed for policymakers to select the best antimalarial treatments and formulate strategies to control the critical problem of resistance wherever it arises. WWARN will integrate the efforts of researchers, NGOs and public health experts in malaria-endemic regions around the world,

and will work with the World Health Organization (WHO) to enhance antimalarial resistance surveillance. While the parasite that causes malaria has been resistant to older drugs such as chloroquine and sulphadoxine-pyrimethamine for some time, evidence is emerging that suggests that the parasite is developing resistance to the newer artemisinin-based drugs. Current guidelines stipulate that artemisinin should be given in combination with other antimalarials to protect as much as possible against the development of drug resistance. However, this approach is undermined by lack of access to artemisinin-combination therapies and the prevalence of poor quality and counterfeit drugs.

The United States Food and Drug Administration has given approval for the tentative testing in 2010 of a new malaria vaccine, with the hope that an effective vaccine can be developed for widespread use by 2015. The vaccine is being developed by Sanaria Lab of Rockville, Maryland, and will be tested in Africa. It builds on what scientists have long known - that people bitten by a weakened mosquito carrying the malaria parasite can become protected from the disease. Dr. Stephen Hoffman, Founder and CEO of Sanaria Lab, thinks he has found a solution for extracting the immunity-causing plasmodium falciparum parasite out of the weakened mosquito and transforming it into a workable vaccine. “What we’re reporting on now is that we’ve been able over the last five years at Sanaria to actually develop the manufacturing process that has allowed us to manufacture multiple clinical lots of the vaccine based on the whole parasite, one that we already know works,” Dr. Hoffman told Voice of America. Previously, scientists trying to develop a vaccine have struggled with the problem of extracting the parasite from the mosquito host, keeping it bacteria-free, then purifying the infectious material. Focusing on isolating and attacking specific genetic components of the parasite also met with limited success because the infection was extremely successful in changing its genetic make-up and becoming resistant to drugs. While he is hopeful that the new vaccine will be successful in protecting people against malaria, Dr. Hoffman cautioned that it was still necessary to maintain a multi-pronged approach to defeat the disease, including treatment, mosquito eradication, improved diagnostics and the distribution of insecticidetreated bed nets. He credits the success in a number of African countries in posting significant declines in infection to greatly raised awareness over the recent past together with a tenfold increase in funding. “The problem that I see for the future is sustaining that impact because malaria, if you let down your guard, comes back worse. So the drive that is going on to control malaria now needs to be sustained, and that’s difficult,” he said. Malaria kills nearly one million people a year, the majority of whom are African children under the age of five.

PAGE THREE EXPANDING CAPACITY

AFRICAN LEADERSHIP

ROCKEFELLER FOUNDATION UNVEILS GROUND-BREAKING INITIATIVE TO IMPROVE HEALTH IN AFRICA AND ASIA

ETHIOPIAN HEALTH MINISTER TO CHAIR GLOBAL FUND BOARD

The Rockefeller Foundation has pledged $100 million over the next five years to a ground-breaking initiative to help developing nations in Africa and Asia build better healthcare systems. The Transforming Health Systems project will pay for international advocacy and research to improve healthcare and make it more widely available and affordable to severely underserved populations. The initiative represents a new approach for a large foundation because it aims to improve whole health systems rather than target specific diseases. “While health spending has increased dramatically around the world, what is very clear is that access to affordable quality health services has not. And that’s particularly true in developing countries,” said Dr. Judith Rodin, President of the Rockefeller Foundation, at the initiative’s launch in Nairobi, Kenya, in July. The initiative has three major objectives: ■ To equip governments with the technology, tools and training to improve planning, financing and delivery of healthcare; ■ To engage the private sector in the search for innovations in providing and financing health services for the poor, including testing new approaches to integrate public and private resources to provide quality services with lower out-of-pocket costs; and ■ To expand the use of interoperable information technology, or eHealth, which will be facilitated by the expansion of fiber optic telecommunication cables and the rapid growth of mobile phone use in Africa. “While vertical interventions - including revolutionary new drugs and treatments - remain crucially important, we must also ensure that they get to the people who most need them,” Dr. Rodin added. “We must break the bottlenecks that restrict access to quality services because no matter how powerful the drug, it won’t do any good if consumers can’t reach the doctor that prescribes it, the clinic that provides it, and pay the bill if they receive it.” Initially, the Transforming Health Systems project will be launched as a pilot proj-

The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria announced in July that it had elected Dr. Tedros Adhanom Ghebreyesus, Ethiopia’s Minister of Health, the new Chair of the Board. Dr. Ghebreyesus has been widely recognized for his leadership in the field of global health and has worked to enhance Ethiopia’s active engagement in a number of international forums. A globally-recognized malaria researcher, he served as chair of the Roll Back Malaria Partnership until May of this year and currently chairs the United Nations AIDS Program Coordination Board. As chair of the Global Fund Board, Dr. Ghebreyesus will be at the helm of the world’s largest public-private health partnership, which brings together governments, civil society, the private sector and communities affected by HIV/AIDS, tuberculosis and malaria. “The honor of this overwhelming vote of support belongs to my country, Ethiopia, which I am very privileged to represent. I am deeply humbled by this election and recognize well the weight of the responsibilities that come with it,” said Dr. Ghebreyesus. “The Global Fund faces big challenges ahead, but I am also optimistic about the great opportunities we now have for ensuring that this unique and innovative organization continues to be a success over the coming years.” “Stronger partnerships, greater engagement of implementing constituencies and clearer demonstration of the Global Fund’s impact will be key,” he added. “We look forward to sharing our experiences in Ethiopia in implementing Global Fund-supported programs for expanding service delivery at the same time as building our health system.” Over the past five years, the Global Fund has financed treatment for 2.3 million people with AIDS and 5.4 million people with TB, and has paid for the distribution of 88 million insecticide-treated bed nets. It announced in July that over the past year the number of people accessing antiretrovirals (ARVs) through Global Fund-financed programs increased by 31%, the number provided with tuberculosis (TB) drugs grew by 38% and the number of bed nets distributed in malariaendemic areas increased by 49%.

The World Health Organization (WHO) estimates that every year inefficient and inadequate health systems result in 125 million people spending nearly half of their annual incomes on health care. Twenty-five million families fall back into poverty annually because of catastrophic health expenditures. ect in three countries - Ghana, Rwanda and Vietnam. Depending upon the success in those nations, it will be expanded to other regions of Africa and Asia. In spite of increased health spending in sub-Saharan Africa (SSA) over the past decade, the Rockefeller Foundation reports that under-5 mortality rates have decreased by only 15% since 1990, as compared to a decrease of more than 50% in Latin America and the Caribbean during the same period. In addition, the WHO reports that SSA shoulders 24% of the global disease burden, but benefits from only 3% of the world’s health workers. “Despite the global economic situation, investment in health systems that provide accessible, affordable and quality care to the developing world cannot wait,” said Mr. James Nyoro, Managing Director of Rockefeller Foundation Africa. The Rockefeller Foundation’s ultimate aim is to make universal healthcare available globally. Its newest initiative will coordinate with key grantees and partner institutions, including governments and NGOs, policy and research centers, the private sector and international development agencies and donors.

PAGE FOUR PRIVATE SECTOR INITIATIVES

LEADERS IN HEALTH

GBC ANNOUNCES 2009 AWARDS FOR BUSINESS EXCELLENCE

DR. SAM ZARAMBA DIRECTOR GENERAL OF HEALTH SERVICES, UGANDA

The Global Business Coalition (GBC), an alliance of more than 225 international companies, announced in June that it would honor eight companies for their innovative programs that are proving critical in the global fight against HIV/AIDS, tuberculosis (TB) and malaria. In announcing the awards, GBC’s President and CEO Mr. John Tedstrom emphasized the need for business engagement at a time when global recession is resulting in a contraction in government and other funding. “While the Obama Administration and other nations and international institutions have done their best to provide support for global health measures, there are undeniable gaps that must be addressed,” he said. “The way to get the job done is for everyone to work together. The fight against HIV/AIDS, TB and malaria cannot be won without the corporate sector stepping up and playing an active role.” The winners of the 2009 GBC Awards for Business Excellence include: ■ Chevron Corporation for Leadership. Chevron became the Global Fund to Fight AIDS, Tuberculosis and Malaria’s first Corporate Champion, committing $30 million over three years to Global Fund activities. Its healthcare work spans the globe, with many of the company’s 120 doctors and 600 healthcare professionals actively supporting comprehensive HIV/AIDS, TB and malaria policies and programs. ■ Levi Strauss & Co. for Leadership. Levi Strauss has been actively engaged in fighting the HIV/AIDS epidemic from its beginning in 1982. Today it is extending its comprehensive HIV/AIDS treatment and care, including access to antiretroviral drugs (ARVs), counseling, preventive care and education, to all of its employees and their families worldwide. Through a Clinton Global Initiative commitment, it is the first apparel company to provide such a global comprehensive program. ■ Warner Bros. Entertainment for Core Competence. Warner Bros., in partnership with the US President’s Emergency Plan for AIDS Relief (PEPFAR), developed an action-based videogame pilot that is delivering targeted HIV prevention messages to East African youth. ■ Shell Petroleum Development Company Nigeria for Partnership. The company’s Niger Delta AIDS Response

(NiDAR) program, in partnership with the Government of Nigeria and the NGO Family Health International (FHI), has helped build healthcare capacity in rural communities around Shell’s Nigerian operations. ■ Standard Chartered Bank for Community Investment. The bank’s Living with HIV program began as an internal workplace education campaign before it was rolled out, in partnership with business, foundations and academic instiMr. Daniel Luzinda of tutions, to local Standard Chartered communities. It Uganda takes the aims to educate bank’s workplace HIV/ one million peoAIDS program to local ple about HIV/ communities AIDS by 2010, using resources, models and tools that the company developed during 10 years of experience conducting HIV education for its employees. ■ Marathon Oil Corporation for Performance Measurement. Marathon Oil’s Bioko Island Malaria Control Project (BIMCP), implemented in partnership with the Government of Equatorial Guinea, has enjoyed extraordinary success, due largely to its robust monitoring and evaluation plan. The plan uses proven methodology to assess progress, detect and address shortcomings, and evaluate the capacity of the island’s healthcare personnel and facilities. ■ Unilever Tea Kenya Ltd. for Supply Chain Engagement. Working in partnership with the company’s own supply chain and local tea growers, Unilever has brought its comprehensive HIV/AIDS prevention and treatment model to more than 500,000 people in the region. The company used community members to broaden the reach of its program. ■ Anglo Coal South Africa for Workplace Excellence. Anglo Coal’s HIV/AIDS workplace program has resulted in voluntary HIV testing for 94% of the company’s workforce. The program educates, engages and safeguards employees through innovative approaches and a positive outlook. PREPARED AND DISTRIBUTED BY THE WHITAKER GROUP

Whether he’s addressing the challenges of healthcare delivery or monitoring outbreaks of infectious diseases, Dr. Sam Zaramba, Uganda’s Director General of Health Services, is one of Africa’s foremost voices on addressing the health challenges on the continent. This year, the member states of the World Health Organization (WHO) recognized Dr. Zaramba’s leadership by electing him Chairperson of the WHO’s Executive Board for 2009 and 2010. The Executive Board is made up of 34 representatives who are technically qualified in the field of health, each one designated by a Member State elected at the annual World Health Assembly. Before becoming Director General of Health Services in Uganda and the country’s chief technical officer, Dr. Zaramba was the Director of Clinical and Community Health in the country’s Ministry of Health. He was educated at Makerere University Medical School and practiced at Mulago National Referral Hospital for over 10 years as an ear, nose and throat surgeon. His experience practicing medicine in a resource-poor country inspired him to enter the field of public health and he has developed a specialty in managing neglected tropical diseases. It was in this capacity that Dr. Zaramba worked closely with former US President Jimmy Carter to combat guinea worm disease. Dr. Zaramba has advocated for integrated disease control and vector control both nationally and internationally, and has implemented successful strategies to improve child mortality through immunization, improved nutrition and distribution of insecticide-treated bed nets to combat malaria.

Dr. Sam Zaramba