Getting Local With Clinical Research Capacity

GENEVA – Rwandan Sen. Richard Sezibera spelled out the challenge this way: Ebola in 2014. Zika in 2016. Plague in 2017. Ebola again in 2018.

“Microbes have always been on the warpath, and they are reminding us they remain on the warpath,” Sen. Sezibera said at a World Health Assembly side-event yesterday.

“The world invests $1.6 trillion in all research—including health research—but a minute amount of this money is [spent] within low- and middle-income countries and yet that is where the systems are weak and where outbreaks occur,” said Sezibera, a co-chair of the International Vaccines Task Force. “Therefore, we need to develop ways to deal with it.”

Preparedness for the next outbreak, naturally, is essential but where to start? One key area is improving clinical research capacity in developing countries, according to a new IVTF report.

Why clinical research capacity? Think about a lethal viral outbreak in a developing country. Western scientists drop in with an experimental vaccine to try to help during the crisis. The people don't know them, may not speak their language or understand what they are trying to do. Mistrust abounds.

“If they don’t understand, the people on the ground, the community leaders, they just believe they may be serving as guinea pigs. Why [be subjects of] research for others with factories to go and make money?” said Agnes Binagwaho, an audience member and former Minister of Health for Rwanda.

African scientists explaining the need for vaccine research trials during an outbreak will have greater success with policymakers and community leaders than outside scientists, she said. It should be “the children of the nation doing [this] in partnership with Western scientists,” she said. “You need your brothers and sisters telling you it is good for you,” Binagwaho said.

A country with its own robust research and development capacity could make an emergency vaccination campaign more likely to succeed, according to a panel of experts from the Coalition for Epidemic Preparedness Innovations, the World Bank Group and other organizations.

“When the proverbial something hits the fan and when we have an outbreak, there’s an enormous need for knowledge. It’s often not there,” said Tim Evans, senior director for Health, Nutrition and Population Global Practice at the World Bank. “Every country needs to strengthen its research capacity in order … to manage those threats we know about and those threats we don't know about.”

A critical goal is to make the financing of health systems more sensitive to needs of research. “I have to say quite frankly we not very good at it. We need to do better,” he said.

To that end, the new report offers 15 recommendations that chart a way forward for low- and middle-income countries, development partners, research organizations and the private sector, said Marie-Paule Kieny, director of Research for INSERM and IVTF co-chair. The recommendations cover how to secure political commitment and raise funds and support that will build research and development capacity and improve outbreak preparedness.

The additional benefit of increasing in-country education and training is that it can help across a range of issues, Kieny said. “You can’t create this kind of capacity 1 time, 2 times to test CEPI vaccines,” she said. “It should be about clinical research capacity and not specifically about clinical trials for vaccines.”

 

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