Africa Analysis: Finding a niche in malaria research
Africa needs to up its game in malaria research, but by doing what it does best, not by replicating Western research, says Linda Nordling.
African scientists are participating more in malaria research than they did 20 years ago. But much of the research on the disease still takes place in high-tech laboratories in developed countries — a point illustrated by the list of invited speakers to last month's Molecular Approaches to Malaria (MAM) conference, held from 19–23 February in Lorne, Australia.
Of the 40 invited speakers identified in the programme, only two live and work in Africa. There were fifteen from Europe and thirteen from the United States.
The call for 'Africanisation'
There have been calls for malaria research to be 'Africanised' — that more research should be done by Africans in African laboratories, including Western institutions whose work is based on the continent.
In a thesis published in 2010 , Gunilla Priebe examines the Africanisation of malaria research and outlines discrepancies between the way malaria was described during her medical training in Sweden, and the reality that met her when working as a nurse in Huambo, Angola.
"[In Sweden] malaria was painted as an acute and deadly disease that requires immediate treatment with specific medicines," she writes.
But in Angola, locals described the disease differently. "In Huambo there was talk of the acute form of malaria, but mostly malaria was described as an everyday physical discomfort," she writes.
Many medical professionals and scientists express the same surprise the first time they see how the disease is viewed locally — no more troublesome than the common cold, treated only in severe cases.
Historical evidence backs up the view that location matters. The foundations of modern malaria research were laid by European and US scientists looking for ways to keep the disease at bay among troops and missionaries visiting the tropics, not local communities.
The location of early malaria expertise had a big impact on what was studied, says Priebe. And a growing realisation that the Western focus of research had occurred at the expense of finding ways of preventing malaria in endemic areas resulted, in the late 1990s, in the creation of the Multilateral Initiative on Malaria (MIM).
Through MIM, researchers and funders working in Africa were invited to present what they didn't know about the disease — gaps in knowledge such as the link between anaemia and malaria, and acquired immunity in local communities.
There have also been efforts to build Africa's own research capacity. Research centres in unassuming African towns like Kilifi in Kenya, and Ifakara in Tanzania have gradually given the African experience of malaria a higher profile in international research.
However it still needs more visibility, says Kevin Marsh, director of the KEMRI-Wellcome Trust Research Programme in Kilifi. Marsh relocated to Kenya twenty years ago because he felt malaria research was out of touch with the majority of sufferers.
Today, his unit reports to international research meetings from the frontline of the ever-changing situation with malaria. For example, the drastic drop of up to 90 per cent in severe malaria cases seen on Kenya's coast in the past 5–10 years has reduced natural immunity in the population, making the search for an effective malaria vaccine even more urgent, says Marsh. This kind of information could be gained only by researchers in the area.
But, he adds, there is a delicate balance between expanding Africa's high-tech research capacity and rushing into it without first building up the critical mass of researchers that can carry out the work.
Playing to Africa's strengths
Kelly Chibale, a medical researcher at the University of Cape Town in South Africa, says that one way that Africa can strike the balance is by playing to its strengths, and by making sure that scientific questions drive capacity building.
"The challenge in Africa is to find unique areas where Africans can do something that others can't do", he says.
This probably means continuing to have a strong focus on clinical research — the area where Africa has built the most research capacity through collaborations with foreign donors and institutes.
In the past, this focus has sometimes been counter-productive, as institutions have acted as mere testing sites or sample gathering facilities for Northern institutions. To avoid this, African research institutes need to think long-term about their research goals.
African scientists should also focus on gathering better medical data, which is patchy in many African countries, and use it to build a better foundation for in-country research on how to treat the disease more effectively.
African scientists deserve more of a say in global malaria research, and need to find their niche. But they must do this with a long-term plan for expansion that builds on Africa's skills and limitations — and with a firm grounding in science, not in ideology.
Journalist Linda Nordling, based in Cape Town, South Africa, specialises in African science policy, education and development. She was the founding editor of Research Africa and writes for SciDev.Net, Nature and others.