The challenge

Africa is at risk of a multitude of emerging and re-emerging infections, including Ebola and other viral haemorrhagic fevers, yellow fever and plague. If not controlled effectively, outbreaks can have a catastrophic human and economic impact – the 2014–16 Ebola epidemic claimed 11,000 lives and cost the three countries affected an estimated USD 2.2 billion in lost GDP in 2015 alone.

Clinical evaluation of new interventions for emerging infections is particularly challenging as new vaccines, drugs and diagnostics can only be tested during emergency outbreak situations. At these times, public health responses are, needless to say, focused on treatment and prevention of spread. Outbreaks, however, provide an opportunity when much can be learned that could improve treatment and prevention of future outbreaks. It is therefore vital that research is embedded in these responses.

Professor Peter Horby of the University of Oxford, United Kingdom: “Behind the headlines and graphs are patients; people who are suffering and whose families and friends are suffering. For many of these people, the care they are offered has hardly changed over the past 25 years. There have been great advances in the treatment of malaria, HIV and TB, but sadly little progress in the care offered to patients with Lassa fever, Ebola or plague. We are trying to change this”.

The project

ALERRT is a multidisciplinary consortium building a patient-centred clinical research network to respond to epidemics across sub-Saharan Africa. A sustainable clinical and laboratory research preparedness and response network can reduce the public health and socio-economic impact of disease outbreaks.

Prof. Horby, who coordinates the ALERRT consortium, says: “ALERRT was created because we believe that everyone deserves to benefit from the fruits of clinical research, even though doing such research during epidemics is very challenging. In fact, perhaps because it is so challenging, we are even more determined to apply modern scientific methods to find ways to reduce the impact of these diseases. It is a matter of ‘science equity’.”

ALERRT has already been called into action, following a formal request from the Republic of Congo for help with control of an Ebola outbreak in 2018. The consortium provided advice on local surveillance activities and diagnostic tools and organised training on the rapid and rigorous review of research proposals for emergency situations.

The 2014–16 Ebola epidemic illustrated that the world was poorly prepared to organise and coordinate clinical research during outbreak situations when vital information could have been obtained on new vaccines and drug treatments. Alongside global initiatives to coordinate research during emergency situations, and together with PANDORA-ID-NET (a complementary EDCTP-funded initiative) ALERRT aims to ensure that African countries are better prepared to prevent and respond to infectious disease outbreaks and minimise their impact.

Prof. Horby: “In the short term, we have already seen that ALERRT is able to catalyse important research in response to major outbreaks. At the same time, however, we need to make sure we invest in our broader goal of establishing the network capabilities so that the network can deliver a research response that is both of high quality and sustainable. Ultimately, we want to be able to show how the research that ALERRT has driven has answered important questions and changed clinical care and public health practices for the better.”

Prof. Peter Horby
United Kingdom

Speedy response is critical in emergency situations. Therefore, the capacity for clinical research and response procedures must be established in advance and maintained at an appropriate level of readiness to allow rapid mobilisation when needed. The ALERRT network aims to enable researchers to design and launch rapidly high-quality and ethical clinical studies in response to outbreaks.

Its work spans the development of laboratory infrastructure, IT platforms to support research and training to ensure rapid initiation of operations. Extensive community engagement will be undertaken to ensure that these activities are accepted and welcomed by local communities.

Prof. Horby: “Research is not a ‘luxury’ that cannot be afforded during outbreaks and health emergencies. Patient care and public health responses must be based on the best available evidence, and rigorous research is the proven pathway to progress. In fact, the impact of this clinical research is even greater than for other diseases. Better diagnosis and care, and a better understanding of the infection and disease process not only benefit individual patients but also can help to reduce disease transmission and the scale of the outbreak. Our aim is to build a multi-disciplinary, patient-centred research network which is able to respond to outbreaks in sub-Saharan Africa and rapidly implement research in support of patient care and outbreak control efforts”.

Impact

Photo: ALERRT project staff members and volunteer (Lassa fever)

Photo: ALERRT project launch on 10-11 March 2018 in Addis Ababa, Ethiopia

The challenge

The 2014–16 Ebola epidemic, which claimed the lives of at least 11,000 people, illustrated the devastating impact of emerging infections. Recently, African has experienced multiple other outbreaks, including yellow fever, plague and Ebola-related viral infections. In addition, given the growth in international air travel, Africa is at risk of importing emerging infections from other regions, such as the respiratory syndrome coronavirus (MERS-CoV) from the Middle East. Finally, there is an ongoing risk that entirely new infections will jump species from animals to humans, with potentially devastating consequences.

Central to the control of emerging and re-emerging infections is early detection and rapid response, to treat those affected and to initiate measures to halt further spread of infection. Countries, therefore, need to be prepared for outbreaks, with effective epidemiologic surveillance for infections and mechanisms in place for a rapid response when a new outbreak is detected. As infectious diseases are no respecters of national borders, international cooperation is essential.

The project

PANDORA-ID-NET is a large new international consortium that is strengthening outbreak response capabilities across Africa, in partnership with national governments and other key stakeholders in Africa and Europe. Given the intimate relationship between humans, livestock and wild animals, and the potential for transmission from animal and environmental reservoirs, the consortium has adopted a ‘one health’ approach, with key input from both human medicine and veterinary science.

PANDORA-ID-NET has already been called into action, following a formal request from the Republic of Congo for help with control of an Ebola outbreak in 2018. The consortium provided advice on local surveillance activities and diagnostic tools and organised training on the rapid and rigorous review of research proposals in emergency situations. In the longer term, together with the ALERRT (the African Coalition for Epidemic Research, Response and Training, a complementary EDCTP-funded initiative), PANDORA-ID-NET will help to ensure that African regions are better prepared to prevent and respond to infectious disease outbreaks and minimise their impact.

Prof. Ntoumi: “PANDORA-ID-Net will have improved clinical trials and regional laboratory infrastructures which will enhance Africa’s capacity to conduct research on emerging infections. The PANDORA-ID-Net approach aims to create meaningful and trusting cooperation between animal and human health sectors in Africa, which at the moment is far from the case”.

Prof. Francine Ntoumi
Republic of Congo

Professor Francine Ntoumi, the coordinator of the PANDORA-ID-NET consortium: “This consortium aims to close the capacity gap in countries with no laboratories able to identify local circulating pathogens responsible for clinical cases and deaths. Our vision is to ensure that what is developed is sustained so emerging and re-emerging infections can be controlled”.

Impact

Photo: UNZA and HerpeZ team collecting arenavirus samples in Zambia

The project will work with national governments and public health bodies to promote a wider awareness of the importance of infectious disease control and outbreak preparedness. It will establish rapid response teams that can be mobilised within days in all four African regions. It is also developing capacities for research on emerging infections, before and during outbreaks.

Prof. Ntoumi: “PANDORA-ID-Net is fully engaged to involve politicians, policymakers and global public health agencies at the highest level during all stages of our programme. The involvement of Africa CDC and national governments will ensure long-term sustainability”.

Photo: PANDORA-ID-NET kick-off meeting, in Rome, Italy on 18 April 2018