Small Steps to Tackle Big Problems

The announcement in Nature Medicine of a cheap and portable blood test¹ that could provide a breakthrough for diagnosing infections in poorer countries has focused attention again on the huge chronic challenges of healthcare in the developing world. Meanwhile, commanding less high-profile media attention, but making a consistent contribution to treatment as opposed to diagnosis, clinical trials work proceeds steadily through the EDCTP to boost delivery of effective therapies in Africa. EDCTP? Not snappy initials. The full title isn’t very snappy either: the European & Developing Countries Clinical Trials Partnership. So not an obvious candidate for a quick headline.

But as EDCTP’s just-released annual report reveals, by the end of 2010 EDCTP-funded projects were being conducted in 29 sub-Saharan African countries, with the participation of 14 European countries, involving 140 research institutions in Africa and 51 in Europe, as well as 39 not-for-profit institutions and 20 private/industry organizations. Among the highlights of the year, an EDCTP trial in HIV-positive mothers with a combination of three antiretroviral drugs (ARVs) during pregnancy, delivery, and the breastfeeding period showed significant reduction of the transmission of the virus to their babies—and informed the new WHO policy on the Prevention of Maternal to Child Transmission of HIV. Another 30 projects completed were a multi-center comparison of the efficacy of four artemisinin-based combination drugs in the treatment of uncomplicated malaria in different regions of sub-Saharan Africa, and a Phase Ib clinical trial in Ethiopia of a sub-unit tuberculosis vaccine.

More broadly, EDCTP is taking on the challenges of promoting healthcare in the developing world through improved clinical research infrastructure and strategy too. Its current reflections range across central questions such as coordinating research with development, improving synergies between clinical research and capacity development for health systems, and strengthened good governance and good practice across research and aid, as well as how to bridge the gap between product development and the actual delivery of new medicinal products to target populations. Crucially, it is looking at how to build sustainable local capacity, including retaining expertise within research and healthcare systems. One of the studies it launched last year tackles the problems head-on, with aim of gaining a comprehensive insight into the impact of clinical trials on health services in sub-Saharan Africa—and especially with regard to the quality of the services delivered to women and children. And the EDCTP system of senior fellowship grants is also helping ensure the return of African scientists to Africa.

Until now, EDCTP has concentrated on Phase II/III studies. Plans are afoot for it to extend its activities to all phases of clinical trials, to other neglected tropical diseases, and to collaborate in research with other developing countries outside sub-Saharan Africa. On a continent with some 500 million inhabitants, and current projections that the population will rise to 2 billion by 2050, EDCTP may also need new money: in 2010, it operated with just €60 million.

¹Microfluidics-based diagnostics of infectious diseases in the developing world,  Nature Medicine (2011), Published online 31 July 2011