Dakar — Infectious diseases continue to be the major causes of deaths in Africa. The burden of existing, emerging and re-emerging diseases like malaria, tuberculosis, HIV/AIDS, cholera, schistosomiasis, lymphatic filariasis, sleeping sickness, Ebola and SARS continues to grow - and once you move beyond mortality statistics, the huge s ocio-economic costs - care and treatment, hospital admissions, productivity loss, and disability reveals a heavy toll on the continent.
And this was before the knock West Africans received during the Ebola crisis that plagued Guinea, Liberia, and Sierra Leone from 2014 to 2016, and the Covid-19 pandemic affecting the whole continent at the end of 2019.
Globally the leading causes of death and disability moved from communicable diseases in children to non-communicable diseases in adults over the past two decades, while in 2019 WHO reported that communicable, maternal, nutritional, and newborn diseases continue to dominate mortality rates in Africa.
In 2003, the Bill and Melinda Gates Foundation launched the Grand Challenges initiative in order to find scientific solutions to these health challenges. Initially, the initiative focused on 14 scientific challenges including focusing on creating effective single-dose vaccines that can be used soon after birth, discovering drugs and delivery systems that minimise the likelihood of drug-resistant micro-organisms, creating therapies that can cure latent infection, and developing needle-free delivery systems.
"We started Grand Challenges with two goals. In a narrow sense, we wanted to spur specific advances we thought could lead to breakthroughs. In 2003, we listed ... priorities like creating therapies that could cure latent TB infection - and supported researchers who had exciting ideas in those areas. In a broader sense, we hoped to inspire more brilliant scientists to share big ideas about transforming health in low-income countries. We hoped to create a scientific community that was supported to sustain R&D (Research and Development) for the benefit of billions of people who had been neglected," said co-chair of the Bill & Melinda Gates Foundation Bill Gates during his opening remarks at the Grand Challenges meeting held in Dakar, Senegal.
Grants worth over U.S.$450 million were awarded for research projects with an additional supporting project addressing ethical, social, and cultural issues across the initiative, and as the years went by, new challenges were launched.
At this year's meeting, Gates opened by announcing new investments of U.S.$40 million to advance access to messenger ribonucleic acid (mRNA) research and vaccine manufacturing technology that will support low- and middle-income countries to develop high-quality, lifesaving vaccines at scale.
During this keynote address, Senegal President Macky Sall said the race for vaccines during the Covid-19 pandemic revealed the lack of preparedness.
"The pandemic taught us that in the face of challenges which know no boundaries, no country can feel secure while others are still vulnerable. The need for collaboration is only too obvious for scientists and policymakers. I commend the financing announced for vaccine production but also the support to African scientists and innovators," he said.
"This annual meeting is part of the spirit of solidarity and human fraternity. It is indeed for the scientific community, funders, policymakers a platform for exchange and dialogue to stimulate research and innovation, and the financing in order to take up the measure challenges in health and development. We need these efforts hence the theme for this year Science Saves Lives. Indeed by contributing to improving our understanding of diseases, and prevention through diagnoses, especially treatment, but scientific projects have a cost in order to be efficient and address the needs of the majority. Scientific research must be supported and financed adequately,' said Sall.
Speaking to AllAfrica's Nontobeko Mlambo, Gates explained how the U.S.$40 million will be used, the importance of vaccines, and how science and innovation can solve some of the greatest challenges in global health.
"mRNA is actually a very new technology. The Gates Foundation funded a lot of pioneering companies in that space, Qoubac, and Maderna to make vaccines, when the pandemic came along the fact that mRNA established itself as the best platform. Not the only platform, but the best platform. It was amazing. And now mRNA is going to be used for ... animal vaccines, cancer vaccines, as well as the most important missing infectious disease vaccines, which are malaria, TB, and HIV. It's not the only approach being used, but it's most likely that mRNA will be used for those so making it so we have more capacity, including here in Africa, to manufacture those vaccines, but do it in the self-contained systems that makes sure you are going to have high quality and they're simple enough that you can actually have low costs. That is very exciting," Gates said.
The Institut Pasteur de Dakar (IPD) based in Senegal and South Africa's Biovac will receive U.S.$5 million each, they will use an mRNA research and manufacturing platform that was developed by a Belgian company, Quantoom Biosciences. U.S.$10 million will go to other companies that have not yet been named while the remaining U.S.$20 million is going to Quantoom Biosciences to continue working on the technology.
Gates said it is early days to know exactly what kind of vaccines will be produced as a result of this grant.
"We do think most new vaccines, including some that are specialized, like for Lassa fever, wouldn't be a super high volume vaccine but would have a lot of benefits. And some of the animal vaccines would be regionally targeted because of unique diseases. So in five years, we will see a lot of additional vaccines because of this low-cost platform people will be able to design," he said.
Vaccine Equity and Hesitancy
In 2020 during the pandemic, the Gates Foundation launched Grand Challenges Global Call-to-Action to build on lessons from the Covid-19 pandemic. The initiative aimed at funding science projects to prioritize global health objectives and support locally-led research.
While well-developed economies were rushing to get vaccines to protect their citizens from Covid-19, the African continent was last in line to receive vaccines as many could not afford the vaccine costs due to the level of poverty and other negative factors, including debt. Another challenge for African countries was vaccine hesitancy. Many questioned the safety and effectiveness of the vaccines because of the time periods it took for them to be developed.
Vaccines are scientifically proven to be the most critical tool for preventing diseases and saving lives but despite all the positive benefits of taking vaccines to protect against diseases, there is still widespread hesitancy to get vaccinated.
The hesitancy is also there in the uptake of Human Papillomavirus (HPV) vaccine as parents question why the vaccine has to be given to young girls between the ages of 9 to 12 years old. There has been a lot of misinformation leading to some parents not allowing their children to take up the vaccine, especially in Africa.
HPV is the most common sexually transmitted infection worldwide and its prevalence is among the highest in sub-Saharan Africa at an average of 24%. It causes different types of cancers, including cervical cancer, which is the leading cause of cancer deaths among women in Sub-Saharan Africa. In efforts to accelerate the fight against cervical cancer, the World Health Organization (WHO) in 2020 introduced a plan to eliminate cervical cancer as a public health threat by 2030. The goal is to have 90% of girls fully vaccinated against HPV by the age of 15 years.
Gates said every country has a challenge and responsibility to communicate the incredible benefits of vaccines and he believes that vaccines are a miracle tool.
"A lot of the new vaccines we added were infant vaccine schedules in the six weeks, 10 weeks, 14 weeks, and six months, so-called Expanded Program on Immunization (EPI), and so when somebody goes in, they are just getting the number of vaccines and they don't have to think about it all that much. It just hopefully becomes a standard practice but with HPV we can't vaccinate when you're an infant, we wait until you're older and so it's a special delivery time. Typically 10 to 12-year-olds are targeted so we need to explain to people what this disease is and why we are asking them to get a shot," he said.
He said in some countries like Rwanda the demand for it is high.
"The manufacturer (of the HPV vaccine) had only shown that it worked when you had two shots, but in fact, we saw how powerful the vaccine was. And even though the manufacturer wasn't that enthused, we proved that a single dose works so you can essentially vaccinate twice as many people for the same cost which makes a huge difference in the impact," Gates said.
As a result, a number of countries in Africa have adopted HPV as the latest Global Alliance for Vaccine Immunization (GAVI) vaccine.
Health, Climate and Agriculture
The link between health, the climate emergency, agricultural activities, and conflict are becoming more evident. When 10 African countries faced cholera outbreaks, and over a thousand died in Malawi, the WHO cited the climate and humanitarian crises as contributors to the outbreaks. The outbreak started after tropical storm Ana hit a few Southern African countries in January 2022, followed by Cyclone Gombe in March 2022. Damage by the cyclones caused floods, leading to the displacement of communities, crops being destroyed, and lack of access to safe water, sanitation, and hygiene - leaving Malawi facing its worst cholera outbreak in two decades.
"Helping farmers is at the top of the list because if you don't do that, then you get malnutrition and if you get malnutrition, your health status is far worse. Malnourished kids are at risk of dying when they get diarrhoea, pneumonia, and malaria. If a kid is actually very well nourished, their risk of death is a quarter and of course, their quality of life because of their physical and mental development will be much better. So for the individual and the country in the world, these improvements in food and therefore nutrition are very important," Gates said.
The Gates Foundation co-founder urged African farmers to embrace the latest technology to mitigate climate change-related challenges, and to increase agricultural productivity to ensure food security.
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Philanthropic Efforts in Africa, Grand Challenges and Lessons Learned
Looking back on when the Bill and Melinda Gates Foundation started its first Grand Challenges meeting in 2003, Gates said there's reason to celebrate. He recalls that two million people died of HIV/AIDS that year, and two and a half million more died of malaria and tuberculosis (TB). He also said that despite the huge numbers of deaths at the time very little amounts of money was spent on science to save lives.
Gates remembers spending time with his wife at the time, Melinda French Gates, reading "quite a bit about why children die".
"What are the health inequities? And to find that malaria was killing over a million children a year (at that time) had essentially no money going into it? And that even though markets work very well for things like cancer, or heart disease, where the rich countries have a huge burden. But for many conditions, including the condition that killed the most children, there really was no effort to take the current science and apply it to those diseases," he said.
Gates said he still gets excited to meet the partners and the scientists behind the research and go out to meet the mothers whose children are now being protected by bed nets or their mothers who volunteer for the minimally tissue sampling invasive autopsy called CHAMPS, a research method that helps understand child mortality to ensure that scientists are working on relevant products.
Some of the achievements and developments that Gates is most proud of are progress in the fight against TB and malaria. He said the research that is under way about gene drives on mosquitoes was part of the earlier grant to reduce the mosquito population and stop disease transmission. Gates said the original idea of the project, now called Target Malaria, was to use homing endonuclease genes ( enzymes that cleave the phosphodiester bond within a polynucleotide chain (namely DNA or RNA) to drive a bias for male offspring so that it was inherited preferentially from generation to generation, gradually preventing mosquitoes from reproducing themselves.
"We have added new things like microbiome that weren't on the original list, although we had nutrition and bio-fortified foods, it was a few years after the first Grand Challenges were this idea of the bacteria in the gut - the microbiome - became clear and the Gates Foundation funded the original study showing how important that was and that's driving a lot of work now. So in the early TB work, early mosquitoes work, those have really paid off and then things like microbiome and mRNA came later but those are going to have an incredible impact," he said.
