MRTC in Bamako
Gates Package, pp.115-118 · gates:email:00087
Page text: p.115, p.116, p.117, p.118 · original PDF
- Date
- 2013-04-08 14:30
- Type
- email · email
- sender
- Harold Varmus
- to
- Gray Handley
Gray, as you may have heard, I am developing a series of lectures to be given in the UK about three examples of US
involvement in medical science and health abroad: the Uganda Cancer Center, PEPFAR, and the Malian MRTC.
To help
gather information for these lectures, I've been doing interviews with some of the people involved.
In talking with some
people in Bamako, I realized that I don't have facts and figures about the extent and duration of support that NIAID has
provided there.
Is it possible for you to summarize the history of our spending at the MRTC from 1990 to the present?
I
don't need many details, just overall all levels and perhaps a couple of categories (salaries, grants, other support).
I have also learned that NIAID has supported other programs like the MRTC, even some (like the one in Lahore) that have
been called MRTC. Do you have any information about them and how they related to the efforts in Mali?
Thanks for whatever you can provide.
Harold
Research for Health: The Experience of the US/ Mali
International Center for Excellence in Research
Background
The reasons for initiating efforts for improving the research capacity in developing
countries are many and varied. In some cases, it may be the policy of a national foreign
assistance program or international agency to sponsor institutional strengthening. In such
programs the goal is usually to improve a countries capacity to better solve those health
problems that are of greatest concern. In such programs the involvement of partners
and/or experts from more developed institutions may be transient or long lasting, but in
the end, the goal is the improvement of a national capacity. These partners are usually
functioning as contractors to the donor and basically are providing a service to the
recipient.
Other programs may be stimulated by the need for a research institution to develop a
mechanism for extending its programs into areas where diseases are endemic, not just
academic. Such programs are intrinsically less altruistic, but in the end can often serve
not only their own needs, but effectively work to strengthen the research capacities of the
country in which they have chosen to work.
In the late 1980s it became clear that the medical entomology program of the Division of
Intramural Research (DIR) of the National Institute of Allergy and Infectious Diseases of
the US National Institutes of Health required a field research component to complement
its laboratory based research efforts on the development of transgenic mosquitoes. The
implementation of a strategy for malaria control based on altering the capacity of vector
populations to transmit the malaria parasite required a better understanding of the
population genetics of these populations in the field. Mali was selected as the site to
establish such a program because of the presence in that country of Dr.
Yeya Toure and a recognized team of Malian researchers already working on the genetics
and cytogenetics of Anopheles gambiae. An. gambiae is the primary vector of malaria in
sub-Saharan Africa and was the mosquito targeted by the NIH for genetic manipulation.
Dr. Toure had achieved an international reputation for his work on mosquito populations
and for his skill in managing and implementing medical research programs. Indeed, in
1989, in addition to his faculty position as Professor of Biology and Genetics at the
National School of Medicine and Pharmacy (ENMP) of Mali, Dr. Toure was serving as
Director-General of the National Center for Scientific Research and Technology of the
Republic of Mali.
The medical entomology program at the ENMP was part of the unofficial department
(DEAP) started by the French under the direction of Dr. Phillipe Ranque. In the 1980s,
Dr. Ranque selected a number of outstanding Malian scientists to be trained in Europe. In
addition to Dr. Toure, the group included Dr. Anatole Tounkara (now deceased), who
subsequently became Dean of the Medical School in Bamako and Head of the NIAID
ICER HIV/AIDS (SEREFO) research program, Dr. Constance Souko a senior scientist in
the ICER Leishmaniasis program, and Dr. Amadou Diallo, previous Rector of the
University of Bamako.
The research program which proved to be the basis of the NIH/Mali collaboration was
initially focused on the role of the mosquito vector in the epidemiology of malaria and
was funded by the WHO (TDR) / Rockefeller Foundation partnership program. Dr. Yeya
Toure was the PI in Mali, Dr. Mario Coluzzi headed the Rome component of the program
and Dr. Robert Gwadz was responsible for the NIH segment.
To provide a structure to manage this research effort, the Malaria Research and Training
Center (MRTC) was established in 1989 by agreement between the Dean of the
University of Bamako Faculty of Medicine and the Director of the Division of Intramural
Research, NIAID. Dr. Yeya Toure was named the first Director of the MRTC and was
the person primarily responsible for working with the NIH in developing the MRTC
infrastructure and new laboratories. When Dr. Toure took a posting with the WHO in
Geneva in 2001, Drs. Ogobara Doumbo and Sekou Traore were named co-Directors of
the MRTC by the Dean of the Medical School.
Based on the success of the WHO/RF program additional support was solicited from a
number of donor agencies. With funding from the US Agency for International
Development (USAID), the program was expanded to include clinical and
epidemiological studies of malaria and Dr. Richard Sakai was posted at the MRTC as the
NIH Resident Scientist in Mali. Dr. Sakai had a wealth of international experience before
going to Mali and since 1990 has been responsible for coordinating NIH activities at the
Center. His efforts for the program and the people of Mali have become legendary and he
has been honored by the President of Mali with the award of "Chevalier of the Nation."
From the inception of the MRTC, significant support has been obtained from a number of
USAID programs including the USAID Mission, Bamako, and from the Combating
Childhood Communicable Diseases (CCCD) and Health and Human Resources Analysis
for Africa (HHRAA) programs of the AID Africa Bureau in Washington.
Beginning in 1992, USAID funds allowed the expansion of the scope of work in Mali to
include studies of the genetic basis of malaria parasite resistance to anti-malarial drugs
and the effects of various human hemoglobinopathies on the pathogenesis of malaria.
USAID funds were also used to significantly expand and improve the research
laboratories and support facilities at the MRTC. USAID can justifiably take credit for
much of what constitutes the infrastructure of the MRTC today.
Additional support for the MRTC was obtained from the International Atomic Energy
Agency (IAEA), the WHO, NASA and the MacArthur, SatelLife and Dreyfus Health
Foundations.
In 1997, USAID ended direct support of MRTC activities, but in March 1998, President
Clinton in a speech in Kampala, Uganda, singled out the MRTC of Mali for recognition
and made the promise of continued support. Since 1998, virtually all activities in Mali
have been supported by NIAID.
In September 2000, laboratory space within the MRTC was more than tripled with the
opening of
a new laboratory building and the renovation of laboratories adjacent to the
original laboratories. These new laboratories are focused on supporting work associated
with the development and evaluation of malaria vaccine candidates.
In 2001, the MRTC became part of the ICER (International Center for Excellence in
Research) program, an initiative launched by NIAID to recognize a select group of
overseas research facilities, make them part of the regularized budget process of the
Institute, and develop and sustain research programs through partnerships with local
scientists.
All administrative functions of the various ICER programs including payroll
for Malian staff and support of day to day operations were placed under the direction of
the Core ICER staff. The Mali ICER is one of three ICERs in the world. The other two
are located in Uganda and India.
The ICER is involved in all aspects of research on malaria. All work at the Mali ICER is
directed at the development and testing of appropriate strategies for the eventual control
of malaria and the reduction of the burden of disease in the people of Mali, the region,
and all of Africa. The ICER program is
based on the clear understanding that not enough
is known today to control malaria in Africa, and most current programs are failing
because of a lack of adequate tools and techniques. The ICER seeks to bring to bear the
best methodologies for understanding and attacking this difficult problem. Newer
programs have been initiated within the Mali ICER including basic and clinical studies in
leishmaniasis and its vectors, mosquito proteomics and bioinformatics, filariasis
acarology and tick borne diseases, and Lassa fever.
It is important to note that the Mali ICER serves as the primary research and training arm
of the Malian Ministry of Health. The ICER works closely with the Director of the
National Malaria Control Program.
In 2002, the NIH through the NIAID Division of Clinical Research (DCR) and the
NIAID Division of AIDS
initiated a major research program on HIV/AIDS and TB