Professor Esayas Kebede Gudina, MD, PhD, is a professor of Medicine at the Department of Internal Medicine, Institute of Health, Jimma University in Ethiopia. Dr. Arne Kroidl, MD is a senior researcher and specialist in internal medicine, infectiology and unit head for HIV and co-infections at Ludwig-Maximilians-Universität in Munich. In this blogpost, these esteemed professors discuss the importance of their research under the CoVICIS consortium, challenges that have been overcome and implications for future pandemic preparedness.
WHY IS THE RESEARCH CONDUCTED UNDER YOUR PARTNERSHIP IMPORTANT?
Having multisectoral, multi-country partnerships has been very important. In Ethiopia, we haven’t had many before. It has been important from both a scientific and partnership point of view, because it strengthened our relationship with LMU and other organizations in Africa and Europe.
Scientifically, it has been vital to understanding the transmission dynamics of SARS-COV-2 in Ethiopia. We have generated a large databank of epidemiologic data which has helped us understand the epidemiology of COVID-19 in Ethiopia, with 1,000 persons who have been exposed to the virus at least once in the last two years from Addis Ababa and Jimma. This comprehensive dataset has provided valuable insights into the epidemiology of COVID-19, particularly among healthcare workers, community members, and individuals living with HIV. Our analysis to date has not identified significant differences in immune responses and reinfection rates across these groups.
For a European tropical institute, it is very important to link with African partners. CoVICIS has provided a profound way of partnering with our Ethiopian colleagues, not only because of COVID-19 but also as an approach to pandemic preparedness and dealing with other infectious diseases that occur. This also helped us win another Horizon Europe grant, related to antimicrobial resistance. This partnership helped us better frame and strategize our research. It helped us strengthen the research infrastructure, from financial management to scientific networking, and helped a lot also to engage in further international research on infectious diseases.
For example, related to COVID-19, we need to better linkage of diagnostic services for infectious disease detection. How do we engage the respective patient groups, what are the respective tools that are needed, and how do we transform this into policy and guidelines? This multi-disciplinary approach showed us examples how those targets can be better achieved. CoVICIS helped us to develop methodology and tools to assess different specific areas of pandemic preparedness, and how to realize them in settings that are different, e.g., European University and African hospitals.
In addition, the partnership helped with infrastructure and capacity development in Ethiopia. It was difficult to procure certain supplies and equipment locally, the partnership helped us to secure the necessary resources. Now we can do polymerase chain reaction (PCR) on our own, sequencing our own samples. We started some of these things in our research unit for the first time. We have also created a new opportunity for PhD students through this project.
The interaction between African and European institutions supported by Europe really depends on infrastructure that enables procurement. Implementation, especially in European – Developing Country Partnerships, is a continuous process which requires a certain degree of flexibility that otherwise complicates the realization of a project within provided funding periods. The Horizon Europe research institute (DG RTD) should address challenges related to equipment and consumable supplies for these settings.
WHAT CHALLENGES HAVE BEEN DIFFICULT TO OVERCOME?
As mentioned above, getting materials has been difficult. We cannot analyse all the assays we want. We don’t have proper courier to transport samples from Ethiopia to Europe. The previous approach cost a huge amount of money. We overcame this by creating our own service to transport samples to Europe, which has enabled us to manage this transport of samples to Europe.
One of the big advantages of COVICIS is the network, and the strong leadership of partners for managing the obstacles of collecting and sharing data, as well as shipment of supplies and bio-samples based on material and data transfer agreement. Overcoming the differences requires time and a common understanding with the Ethiopian authorities.
It’s not that complicated if it’s transferring reagents from lab to another for extended analysis. Requirements like open source sharing to provide open data and biorepository information are very useful but involve regulatory challenges that may not be adequately reflected within national guidelines and policies. We need to maintain openness and transparency while maintaining ownership and especially leadership on the African side, where the institutions are the main providers of data and samples. There are high expectations that do not really align with the policies and guidelines that are available in Ethiopia and other African countries. We would like to expand and resolve these, but it can’t happen in one funding period, and so it remains an obstacle, like procurement.
We need African-European networking and continuous investments in pandemic preparedness activities because we never know when the next pandemic will come. This involves trust and continuous networking among partners and transparency among partners. CoVICIS is a good example, because there are multiple, multidisciplinary layers – whether social-behavioural, communication, or influence on policymaking – that need some kind of framework to fit within the national health strategy or program, including for reporting purposes. These can continuously be established, as essential for pandemic preparedness, because it does not reside only in one place but requires international collaboration. Rules and regulations that are currently defined by Europe but should also be defined by Africa, where the data comes from.
The South African regulatory board is much more established in terms of regulatory research trials, so they are perhaps more prepared to work in international environments than Ethiopia. In Ethiopia, the regulatory board is improving and less prohibitive as compared to 10 years ago, when it was very difficult to transport samples. Since COVID-19, the Ethiopian regulators tried to open up, to be pragmatic and accommodate the challenges that we had locally and trust the researchers. That sometimes puts an extra burden on African researchers. Now, we have new freedoms and new responsibilities.
WHAT IS NEXT FOR THIS WORK? HOW WILL THE WORK YOU HAVE CONDUCTED UNDER COVICIS SUPPORT EMERGING HEALTH SURVEILLANCE AND PANDEMIC PREPAREDNESS EFFORTS?
Pandemic Prevention, Preparedness and Response (PPPR) is not very high on the agenda anymore. However, the secret to successful PPPR is sustainable investments in support. When a project is not renewed, you have to be creative to maintain a flow of scientifically justified project finance so that the relationships continue to build on top of what was already learned and the trust and communication chains that were already started. LMU was able to get another grant focused on antimicrobial resistance (AMR), which is a huge problem, especially in African countries, including Ethiopia. This is not PPPR, but it can help us continue to strengthen our work in infectious disease identification, control, treatment, cost-effectiveness, knowledge attitude, and practices through multi-disciplinary approaches. The AMR grant will help us continue to build on the CoVICIS work and continue to strengthen this partnership.
In Ethiopia, COVID-19 broadened our thoughts on how to develop infrastructure in detection of infectious pathogens. We want to expand our partnership on AMR but also on PPPR, not just COVID-19 but also other respiratory pathogens. We have developed an infrastructure that can work for respiratory pathogens without much support, other than supplies. We think AMR is a hidden pandemic, which is affecting all of us around the globe. We want to sustain our partnership, infrastructure and services. To do this, we need to remain open-minded about grant and partnership opportunities.