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Research and Capacity Building for Control of Neglected Tropical Diseases: The Need for a Different Approach

  • Thomas Kariuki equal contributor,

    equal contributor Contributed equally to this work with: Thomas Kariuki, Richard Phillips, Sammy Njenga

    Affiliation: Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya

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  • Richard Phillips equal contributor,

    equal contributor Contributed equally to this work with: Thomas Kariuki, Richard Phillips, Sammy Njenga

    Affiliation: KNUST School of Medical Sciences, Komfo Anokye Teaching Hospital, Kumasi, Ghana

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  • Sammy Njenga equal contributor,

    equal contributor Contributed equally to this work with: Thomas Kariuki, Richard Phillips, Sammy Njenga

    Affiliation: Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya

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  • Ole F. Olesen,

    Affiliation: Neglected Infectious Diseases, Infectious Diseases Unit, DG Research, European Commission, Brussels, Belgium

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  • Paul R. Klatser,

    Affiliation: Royal Tropical Institute (KIT), KIT Biomedical Research, Amsterdam, The Netherlands

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  • Riccardo Porro,

    Affiliation: Fondazione Cariplo, Milano, Italy

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  • Sarah Lock,

    Affiliation: The Nuffield Foundation, London, United Kingdom

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  • Maria Hermínia Cabral,

    Affiliation: Fundação Calouste Gulbenkian, Lisbon, Portugal

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  • Martina Gliber,

    Affiliation: Fondation Mérieux, Lyon, France

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  • Detlef Hanne mail

    hanne@volkswagenstiftung.de

    Affiliation: Volkswagen Foundation, Hanover, Germany

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Beyond “operational research”: a scientific strategy for the control of neglected tropical diseases

Posted by emoreno on 21 Jun 2011 at 16:59 GMT

The essay of Kariuki et al., offers relevant insights into the need of a fresh perspective for research and capacity building in the control of neglected tropical diseases (NTDs) in African countries and, by extension, in other low-income countries (LIC). However, we were deeply concerned with some of the viewpoints put forward by the authors concerning the type of research that needs to be promoted and supported in these countries.

The fact that African researchers identified the same direct scientific challenges as their colleagues from the North did not come as a surprise. Indeed, similar strategies to control infectious diseases have been used worldwide. What alarmed us was the proposal that African researchers should focus more strongly on “short-term applicability of research”, and that “instead of concentrating on pure basic research and scientific impact”, the efforts should be directed “to operational research” and “better application of the existing tools”. This is the wrong message for a change. Up to now, this has been the predominant perspective that has guided international agencies and donors, which generally limit research groups of LIC to small funds, focused on “applied”, translational, or immediate-problem-solving research, rather than financing basic and innovative research as well.

It is true that the relevant diseases affecting LIC have caught the attention of granting agencies. It is also true, however, that a large proportion of the funds provided by international agencies to investigate NTDs prevalent in LIC have been directed to large research groups in high-income countries (HIC) [1]. For instance, a quick search in the PubMed reveals that among 320 manuscripts on AIDS in African countries from January to June 2011, local teams led less than 4% of those papers. Moreover, research in some of the so called “lesser” NTDs have been also dominated by groups in HIC. Indeed, from close to 40 papers published in Dengue Fever in Africa during 2010, local groups just led less than 3%. Therefore, the good news is that a significant group of donors, policymakers, and public health officials have been interested in supporting research on NTDs prevalent in LIC; the bad news is that the involvement of LIC researchers in these efforts is marginal, and highly dependent on the agenda settled by HIC, which control the funds.

Based in our experience in Central America [2], we have proposed that the control of maladies and the establishment of a minimal critical mass of scientific capacity in LIC can only be achieved if resident scientific groups perform high-quality research locally and, at the same time, establish fruitful international collaborations [1-3]. Therefore, rather than concentrating only in “short-term applicability” of research developed elsewhere, and in operational research, scientists of LIC should build a solid scientific base for understanding NTDs, and should steadily incorporate international accepted criteria to assess scientific performance and impact. Moreover, efforts should be also concentrated in the development of efficient local systems for the management of research funds, in order to get the attention of agencies and donors. Science and technology policies in LIC should be based on an integrated approach including basic science, operational and translational research, and innovation in the context of creative strategies to promote sustainable development.

The relevance of involving resident teams in the investigation of diseases lays in the proposal that they, more than others, know the social, economic, cultural, institutional and political contexts in which these maladies occur. Thus, they are able to study these pathologies from an integrative perspective, and are more prone to envision successful strategies for controlling health problems. It is unlikely that complex diseases can be understood with avant-garde research performed in rich countries alone [10]. Instead, the concourse of high quality integrative research performed globally, with the involvement of both LIC and HIC, is required.

Excellence in scientific research is essential for development. Although this is an obvious internationally accepted concept for HIC, it has been difficult to put forward in LIC, owing to chronic weaknesses in regional science development policies. Clearly, nations capable of performing effective preventive measures in public health are those that have a pool of investigators in different areas, able to understand the diseases and to develop and adapt new diagnostic, preventive and therapeutic strategies to solve local health problems [1,3], something that is unlikely to be achieved if efforts are concentrated in “operational research” only. The assumption that NTDs can be understood without the involvement of local research groups in LIC is misleading. Within this context, the long-term vision of funding and cooperation agencies has to change in this direction, and should support efforts to built core facilities for the management of funds, as well as both basic and operational research activities in LIC.

1.- Ijsselmuiden CB, Kass NE, Sewankambo KN, Lavery JV (2010) Evolving values in ethics and global health research. Glob Public Health 5: 154-163.
2.- Moreno, E., Gutierrez J-M, Chaves-Olarte E (2011).The struggle of neglected research groups: ten years of NeTropica efforts to promote the investigation in tropical diseases in Central America. PLoS Negl Trop Dis. (in press)
3.- Aksoy S (2010) Solutions to neglected tropical diseases require vibrant local scientific communities. PLoS Negl Trop Dis 4: e662


Edgardo Moreno
Programa de Investigación en Enfermedades Tropicales, Escuela de Medicina Veterinaria, Universidad Nacional, Heredia, Costa Rica; Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
emoreno@racsa.co.cr

José-María-Gutiérrez
Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
Jose.gutierrez@ucr.ac.cr

Esteban Chaves-Olarte
Centro de Investigación en Enfermedades Tropicales, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica; Programa de Investigación en Enfermedades Tropicales, Escuela de Medicina Veterinaria, Universidad Nacional, Heredia, Costa Rica.
esteban.chaves@ucr.ac.cr

No competing interests declared.

RE: Beyond “operational research”: a scientific strategy for the control of neglected tropical diseases

Hanne1 replied to emoreno on 17 Jul 2011 at 19:27 GMT

We thank Moreno et al. for their comments. They argue for the necessity of a strong research base in NTD endemic countries, mostly therefore to Low Income Countries (LICs), and they criticize the African researchers’ views on the importance of short-term applicability of research findings and their relevance for national health systems.

We fully agree with the Moreno et al. that it is essential to establish or develop internationally competitive researchers and research institutions in LICs and to enable them to become (more) equal partners in research collaborations. In this respect the criticism expressed is not valid for either our article or the European Foundations Initiative for African Research into Neglected Tropical Diseases (EFINTD). In fact, the EFINTD Initiative exactly complies with their call by offering this opportunity to postdoctoral fellows in Africa as part of a career development scheme. The program goes further than just funding research itself - offering soft-skill training and mentorship support, and fostering scientific partnerships between African researchers and their centers. Compared to other funding schemes EFINTD focuses on relevant research questions in the African context and insists that projects are in line with national health priorities. More importantly, the program differs to other programs in that the African postdoctoral fellows are the applicants with their own ideas and do not depend on external partners from High Income Countries (HICs).

The viewpoint of the African scholars that research should focus more strongly on applicability and relevance is a statement arising directly from the workshops held by EFINTD, and it is not an interpretation. Since the views of African scholars are not often heard in the international policy arena, this statement should be respected. It does not contradict the necessity for a strong research base in LICs, but rather challenges the international scientific reward system and the priority setting of funding schemes. The scientific careers of scientists in Tropical Medicine in HICs are – in simple terms – based on solving “basic” research questions, mainly through lab-oriented work, and by publishing in high impact journals. This process is enhanced by most funding agencies and publishing houses, with “basic” research receiving more attention and higher rewards than “applied” research. In contrast, researchers in LICs have a clear interest in solving the burning health problems in their home countries, especially when considering the scarcity of applicable diagnostic tools and drugs for NTDs. Therefore, it is only logical that researchers in LICs are calling for research that is relevant and for methods and tools which are applicable as quickly as possible, because they are seeing hundredths of millions of people suffering and dying on their doorsteps. The African scholars in the workshops described this conflict of interest – one that goes beyond the statements of Moreno et al. and that needs to be addressed by and solved between research partners in HICs and LICs. At the same time, funding agencies and publishing houses need to find ways to adequately reward applied research to create viable research and career opportunities in applied research.

In the name of all authors,

Detlef Hanne

Dr. Detlef Hanne
Volkswagen Foundation
e-mail: hanne@volkswagenstiftung.de

Competing interests declared: I am responding on behalf of all authors of the original article by Kariuki et al.