The Alliance for International Medical Action (ALIMA)A view from Africa by Dr Marie Jaspard, Coordinator of ALIMA hemorrhagic fevers research program
As COVID-19 completely dominates the world’s attention, people in Nigeria continue to die from Lassa Fever, far removed from the media spotlight. And while the Ebola outbreak in the Democratic Republic of the Congo (DRC) occupied the media spotlight six months ago, nearly 1,000 people who survived the disease are waiting for researchers to implement a “survivors follow up” program. In terms of international medical research, one disease can chase away another. But outbreaks occur in developing countries regardless of the attention paid, and research is essential if we are to find the necessary tools to fight these diseases.
The Alliance for International Medical Action, ALIMA has been conducting such research for 10 years now, especially regarding viral haemorrhagic fevers like Lassa and Ebola. Teams conduct this research while providing emergency medical care in dozens of countries in crisis in West, Central, and East Africa. Headquartered in Dakar, Senegal, the ALIMA research model links physicians providing emergency medical aid in the field with international researchers from institutions such as INSERM in France, the National Institute for Health (NIH) in the United States, or Oxford University in the United Kingdom.
Lassa Fever kills thousands of people every year in West Africa, especially during the outbreak period from January to April – in other words, right now. Because of its lethality, the World Health Organization (WHO) has designated Lassa as a priority disease for research. Ribavirin is the only recommended treatment for Lassa Fever, but little is known about its effectiveness. So studies are urgently needed to determine Ribavirin’s efficacy, as well as to evaluate other drug candidates. ALIMA, in collaboration with INSERM and local and federal authorities in Nigeria, started a cohort study of patients confirmed with Lassa Fever in April 2018 to have a better understanding of the disease, and to pave the way for further such studies.
In North Kivu, DRC, ALIMA has aggressively responded to the second largest outbreak of Ebola virus disease in history – and the first ever in a war zone – by treating more than 700 patients. At the same time, ALIMA joined forces with international researchers to conduct a randomized control trial that evaluated (and found!) new treatments for Ebola. Our research team is also working on a retrospective cohort to describe how we were able to improve the standard of care for patients thanks to innovations such as individual isolation units, or CUBEs, systematic lab analysis, and oxygen or echography guided resuscitation.
Again, ALIMA conducts this sophisticated research in remote areas while simultaneously providing emergency medical care to people trapped in crisis. As one can imagine, we need to overcome all sorts of difficulties to conduct research in such circumstances: setting up proper, robust data collection, developing on-site bio-secure laboratories, and more. But the main obstacle we cannot seem to overcome is finding the short- and long-term financial support that is needed to transform the medical response to these diseases.
But these challenges can be met. Indeed, they must be. Because only through a better understanding of a disease can we build a better response. With Lassa Fever, for example, we will soon start a phase 2 clinical trial evaluating a new specific drug in southern Nigeria based on our findings from the cohort study. A vaccine trial is also being set up to evaluate candidates in another phase 2 trial.
For Ebola, a study is being developed in order to evaluate several sequelae (psychological, neurological, ophthalmological) that can occur in people cured of the disease. This is particularly important because many patients during this outbreak received treatments for which long term effects are not yet known. We are also developing a study on the interaction between specific Ebola treatments and the Ebola vaccine.
Based on our clinical practice in the field, ALIMA tries to answer scientific questions through these clinical studies in order to have a greater impact on patient care and, in the end, to save more lives. Unfortunately, this important research depends on a funding landscape in which decisions can be based more on media noise around a disease rather than public health impact. More than two billion dollars were spent to respond to the last two important Ebola outbreaks. Perhaps only a few million dollars would have been needed if research had been conducted over the past 20 years, and not just in the past 20 months. Despite this being known, we still struggle to fund obviously important research programs on Lassa fever.
Augustin Augier
CEO ALIMA on COVID-19 in Africa
