This is my first Annual Report as Chair of the EDCTP General Assembly, and I must start by paying tribute to my predecessor, Dr Mark Palmer, who has made an excellent job of steering the EDCTP2 programme since its inception. I would also like to thank the Board members who recently completed their terms of office for their tireless efforts, and to welcome our four new Board members from Europe and sub-Saharan Africa.

This is a very exciting time to be taking up the role of Chair. Over recent years, EDCTP has consolidated its position as the focal point for collaboration in health research between Europe and sub-Saharan Africa. Many innovative projects have been funded, and promise to accelerate the development of much-needed new vaccines, drug treatments and other interventions, particularly for vulnerable and disadvantaged groups such as children and pregnant women.

Equally importantly, EDCTP’s commitment to capacity building – embedded in its clinical trial support and through specific grants – is laying the foundation for the research of the future in sub-Saharan Africa. Through its fellowship schemes, EDCTP is building human capacity for research, while capacity-building support is helping to develop essential infrastructure for clinical research. Collaborations with European laboratories are enabling sub-Saharan Africa researchers and institutions to absorb the latest scientific thinking and adopt emerging scientific methodologies and techniques.

One important consequence has been the creation of platforms that can be repurposed to address the threat posed by COVID-19 in sub-Saharan Africa. Our epidemic preparedness networks are playing important roles in the response to COVID-19 and our research collaborations have created the capacity for studies of the SARS-CoV-2 virus, its spread, its impact on people and its control.

We should also not forget that Europe benefits significantly from these partnerships. European researchers gain from access to patient populations and local expertise and experience of disease, and have much greater opportunity for their research to make a difference to people’s lives. Europe as a whole benefits because control of infectious disease in low-resource settings is central to global health security.

The past year has seen existing partnerships and collaborations strengthened and new ones created. We have reached out to potential partners in the public and private sector, and organisations such as product-development partnerships that span the two. While our main axis of collaboration remains between Europe and sub-Saharan Africa, we have increasingly been forging productive relationships further afield, in regions such as Asia, Latin America and North America.

These achievements have all been dependent on financial contributions from the EU and from EDCTP member countries in Europe and sub-Saharan Africa, through direct contributions and submission of Participating States’ Initiated Activities (PSIAs) to the EDCTP portfolio. PSIAs provide an important mechanism for aligning activities within Europe. We also appreciate the contributions made by third-party organisations for joint activities in areas of common interest.

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EDCTP has consolidated its position as the focal point for collaboration in health research between Europe and sub-Saharan Africa.

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One important point we must always bear in mind is that we cannot ‘boil the ocean’. Our resources are limited, and spread too thinly would achieve too little. By focusing on specific priority areas, we can ensure that we achieve true impact, and can be more strategic in the kind of support we provide. By recognising our niche, we can also better identify potential partners and ensure our activities align and complement those of others.

A further reason why this is an exciting time to be taking up the reins as Chair is that we are planning for the next iteration of the EDCTP programme. Research and development can be a long and difficult process, beset by challenges and uncertainty. We need to maintain the momentum to propel promising interventions down the ‘pathway to impact’ – to ensure their introduction into health systems to meet the needs of communities. We need to consolidate our position and recognise where we have developed areas of strength, and coordinate with others to ensure that we are not duplicating efforts or overlooking major priorities.

But we also need to be aware of some of the major emerging challenges in sub-Saharan Africa. Antimicrobial resistance is undermining the effectiveness of treatments for some of the most common infections in the region, and threatens the very future of medicine by compromising our ability to control infection. As COVID-19 has illustrated, emerging infections can have a devastating impact on health and countries’ economies. Climate change is having many consequences, including impacts on the epidemiology of infectious disease and human population movements that increase exposure to infectious agents. Research will be an essential component of the public health response to these challenges.

No country can tackle these challenges alone. Success will depend on collaborative and focused efforts through regional partnerships and North–South collaborations, including a wider range of global partners. More than ever, global health is truly global.

Professor Yazdan Yazdanpanah
Chair, EDCTP General Assembly

EDCTP must choose carefully who, where and what it funds. Scientific excellence is, of course, essential – poor-quality research wastes resources and is potentially dangerous if it gives a misleading picture of the efficacy, effectiveness and safety of medical interventions. Open calls for proposals, competitive application processes and peer review are well-established mechanisms to ensure excellence, and central to EDCTP’s ways of working.

But excellence is not the only criterion we care about. A second key factor is potential impact, the contribution a project or initiative could make to the achievement of EDCTP objectives. We also consider the quality and efficiency of the implementation plans proposed, as we need to be sure that grantees can deliver what they promise.

These criteria have served us well, but as the number of projects in the EDCTP2 portfolio continues to grow, we must increasingly look not just at individual proposals but also at our portfolio as a whole. And we need to ask ourselves some searching questions. Are we truly tackling the questions that matter to sub-Saharan Africa? What can funding agencies like EDCTP do to strengthen links between projects to avoid duplication and promote synergies? How can we ensure that scientific findings influence policy and practice, so that people in the region actually benefit?

We also have to take a step back and consider the wider context in which research takes place. Are all countries equally placed to carry out high-quality clinical research? What obstacles are compromising the competitiveness of individuals, institutions and countries? Are countries’ health systems in a position to take advantage of emerging new evidence from research?

Questions such as these require us to think more strategically about our funding. In terms of relevance, the consultative development of our annual strategic research agenda highlighted key evidence gaps and priority areas for research, which feed into our annual workplans and calls for proposals. An analysis of our funding to date suggests that we are effectively focusing support on the questions that matter.

However, after six years of funding in the current programme, we have established an extensive portfolio of projects in our priority areas. Rather than just adding further to this portfolio, we also need to examine how best to ensure the success of projects, their lasting legacy, and the use of research findings within health systems – to ensure that people in need reap the rewards of research. In particular, we need to consider how some of the core principles that underlie our work – such as collaborative international partnerships and a commitment to capacity development – can be mobilised to address these challenges.

Evidence of this new mindset can be seen in areas where EDCTP has developed particular strengths, such as TB vaccine development and malaria drug development. Here, we are supporting activities to build connections between projects, to create an environment that focuses time and resources on the most promising interventions, and to align stakeholders to accelerate the ‘pathway to impact’.

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We have established an extensive portfolio of projects in our priority areas.

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This approach also requires us to consider our niche in a much larger ecosystem, and how we can align and coordinate our work with others. We have developed highly constructive partnerships with academic research institutions, product development partnerships, and industry partners.

Indeed, recent years have seen us extend our range of partners, in Europe, sub-Saharan Africa and beyond. Much of this reflects the unstinting efforts of our High Representatives. For example, we now have strong relationships with the WHO Regional Office for Africa (WHO-AFRO) and with the Africa Centres for Disease Control and Prevention (Africa CDC), as well as with bodies such as the African Vaccine Regulatory Forum (AVAREF) and the African Medicines Quality Forum (AMQF), under the umbrella of NEPAD’s African Medicines Regulatory Harmonisation initiative. In Europe and further afield, we have also explored opportunities for collaboration with various industry partners, foundations, national development cooperation partners, as well as the EU development agency, DEVCO.

The desire to achieve a lasting legacy has fuelled our approach to capacity development, which is integrated into our clinical trial funding and also supported through specific grants schemes. Our extensive fellowship programme, for example, which has so far funded 130 researchers, is supporting regional research leaders as well as the next generation of up-and-coming leaders. These researchers are addressing key local health challenges, but are also globally networked – providing opportunities to absorb new scientific thinking and to adopt innovative new research methodologies.

Recent years have seen significant investments in developing national ethics review and regulatory capacity, with EDCTP-funded activities in 27 countries in sub-Saharan Africa. These projects are essential for developing an environment for research that protects the interests of participants in clinical studies but also facilitates the trials that are needed to evaluate new interventions with the potential to improve people’s health.

In 2019, a specific focus has been the ‘digital divide’. Digital technologies are revolutionising clinical data collection but also offer opportunities to increase the efficiency of the submission, review and oversight of clinical research proposals. The EDCTP ethics call in 2019 included opportunities for funding to digitalise these critical processes.

This kind of funding recognises that certain countries, and groups of individuals such as women, are disadvantaged and are less able to compete for funding. The risk is that individuals are unable to achieve their potential because of their sex or location, and that funding becomes ever more concentrated in countries and institutions that have a head start.

We are taking a range of steps to ensure that all can compete on a level playing field. We are paying special attention to the obstacles that women face in science (generally and in sub-Saharan Africa specifically), monitoring gender representation, and wherever possible taking steps to avoid unconscious bias.

Dr Michael Makanga
EDCTP Executive Director

For countries, we are attempting to address the language barriers that disadvantage French-speaking and Portuguese-speaking countries, for example through grant-writing, project and financial management workshops in French and Portuguese. Developing the capacity of countries with less mature health research systems is a key aim of our four regional Networks of Excellence. We have also piloted an extension of our senior fellowship scheme, ‘senior fellowship-plus’, through which senior fellows are paired with researchers from countries with less well-developed health research systems, who benefit from mentoring, support and networking opportunities.

We have also sought to leverage the critical mass of EDCTP funding by encouraging the development of links between research networks and consortia. We now support multiple networks, including international research collaborations, regional Networks of Excellence, the EDCTP fellows alumni network, and two pandemic preparedness networks (ALERRT and PANDORA-ID-NET). Importantly, these provide a platform that can be repurposed to address emerging health threats – such as the COVID-19 pandemic.

The long-term aim of EDCTP is not just to save lives through the accelerated development of new medical interventions, but also to ensure that sub-Saharan Africa has the capability to identify and address its own health challenges through research. We have worked with WHO-AFRO to map the capabilities of national health research systems using its ‘barometer’ tool. The last survey in 2018 revealed encouraging progress in several areas. The next survey in 2020 will hopefully show that this momentum has been maintained and accelerated.

More than six years after the launch of EDCTP2, we can therefore say with confidence that we are on track to meet our objectives. In some areas, we have already surpassed our targets – including the numbers of countries in sub-Saharan Africa participating in EDCTP studies. Health gains inevitably take many years to achieve, but clearly the ground is being laid not just for the introduction of new or improved medical interventions but also for fully functioning and sustainable national health research systems. EDCTP is both promoting and facilitating national ownership of health challenges and the capacity to address them – not least emerging threats such as COVID-19.

On behalf of the entire partnership I extend our sincere appreciation to all of you who have contributed to the success of EDCTP through the years.