AAfrica has the greatest diversity of human genes anywhere on the planet, but the world is failing to capitalize on it, according to one of the continent’s leading scientists, Prof Kelly Chibale, a man determined to change that . He believes the birthplace of humanity may hold the scientific key to its future.
About 18% of the world’s population lives in Africa – a proportion set at rise over the next few decades – and it accounts for 20% of the global disease burden. But only 3% of clinical trials takes place on the continent, and most of it in just two countries – South Africa and Egypt.
“I would argue that if you really want to have confidence in a clinical trial, it should start in Africa. Why? If it works in Africa, there’s a good chance it will work somewhere else, because there is great genetic diversity,” says Chibale, from the University of Cape Town.
Genetic differences affect how drugs are processed by the body. They can go through faster, meaning a standard dose is not enough, or slower, risking a toxic overdose. Testing a drug in people with a wider variety of genes, rather than the historical standard of a Caucasian male, means that the frequency and amount of a drug given to patients can be better calibrated for everyone before it is administered. come on the market. Some global regulators now require genetic diversity in trials before they will approve medicines.
This is an “opportunity”, says Chibale, but will require persuading more African people to volunteer for research, and governments will need to be more open to hosting trials.
He says it is important that encouragement for more Africans to get involved comes from people like him. There is deep distrust in many communities because of medical abuses under colonial and apartheid regimes. If calls to participate come from non-African outsiders, people will think “you are trying to use us as guinea pigs”, he says. “People are traumatized. But when I say that – because I come from there and I know it’s the truth. Who says it matters.”
The 2023 recipient of the Royal Society’s Africa Prize, Chibale was in the United Kingdom earlier this month at the institution to lecture on tailoring medicines to African populations. He leads the H3D research center at the University of Cape Towna unit he founded in 2011, which works on drugs to fight diseases such as malaria and tuberculosis, and fight antimicrobial resistance – conditions that predominantly affect people in Africa.
“Africans must take a lead in doing these things, because these are problems that affect us more,” he says. “The status quo is that innovative medicines are largely discovered and developed in the global north. Then, five to 10 years later, that innovative medicine is brought to Africa.”
This means that there is no certainty that those drugs will work in African populations, or fit in with the way medicine is practiced across the continent, says Chibale – and offers as an example a greater reliance on traditional drugs than the first option, which may mean that patients are present. later to hospitals than in Western countries.
“You have to do the discovery and development close to where the patients are, so you understand how to meet their urgent health needs in their social and physical environment.”
There are major challenges in conducting scientific research on the continent, Chibale admits, and a need for African governments to strengthen public health research infrastructure and smooth legislative and regulatory pathways.
Attempts to increase drug manufacturing on the mainland is welcome – it was “almost embarrassing” to have to source ingredients from China or India for H3D’s own trials, he says. “Every country has the right to prioritize their citizens […] if there are supply chain issues, you will be left behind.”
There are obvious health benefits for Africa if drugs are better adapted to local people, he says, as well as economic benefits. “They create jobs, they create infrastructure.”
And African institutions must act as partners. “In any kind of partnership you have to bring something to the table. You can’t just claim. It’s not always about money: sometimes [you need] just the right policy, the right climate for business to thrive, the right climate for research.”
Chibale was born in rural Zambia, a 10-hour walk from a bus stop. His father died when he was two months old and he had a nomadic childhood, moving between townships for his mother to find work. He would study at night by the light of a homemade paraffin lamp in the small room he shared with his brother.
He had malaria several times. “Every time I would go to the clinic for malaria medicine and be cured. Malaria is fatal if you don’t get treatment. Two, three days – you’re gone. But I took so much for granted.
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“It wasn’t until much later in my life that I realized two things… [about the] malaria medicine I took in town – number one, someone somewhere invested money, millions in the discovery and development of the medicine. Number two, someone somewhere volunteered to participate in the clinical trial for my benefit.”
New structures such as Africa CDC (Centres for Disease Control and Prevention), and the African Medicines Agency are important, he adds, in addressing one of the obstacles to clinical trials in Africa: a lack of harmonized regulatory environments that create a large market can create, such as the EU.
Chibale believes it is the job of scientists to make the business case for research. H3D brings in foreign investment from pharmaceutical companies and funders, including the Gates Foundation and Medicines for Malaria Venture. And it has grown from an initial staff of five to 75, most of whom have PhDs.
“These people would either be in the UK, or Europe, or the US if we didn’t have it,” he says. “People move because they’re looking for opportunities, but if we can create those opportunities where they are, they won’t make the move.”
Chibale studied chemistry in Zambia, then at the University of Cambridge in the United Kingdom on a scholarship. He and his peers saw education as a way out of poverty, he says. His return to Africa was a decision made “from my spirit”, although he could not work in Zambia. “As in many countries, there will be no infrastructure that allows me to train. So it’s wasted – it’s throwing money down the drain – because you can train people, but you can’t keep them,” he says.
Today, he wants to highlight Africa’s scientific success stories, including his own. H3D took a candidate malaria drug to phase 2 clinical trials, before safety signals in what he calls “stupid rats” in frustration forced them to pause.
They can combat “Afro-pessimism”, he believes, or a sense that scientific success is simply not possible on the continent.
“People did not believe that Africa could be a source of innovation. We have shown that we can,” he says.
