© The International Society for Neglected Tropical Diseases 2014
The TDR spans 30 years of experience in research and capacity-building for tropical health and has worked with numerous new partners in this field. Looking forward, how do you see the TDR's role & strategies evolving and which partners would you most like to develop a relationship with?
TDR’s past contribution in product development has now been expanded through a number of new public-private partnerships and much more funding from the international community is available for this purpose. This development is very much needed, considering that during 1975-1999 only 1% of all therapeutic products had been developed for neglected diseases, as reported in a recent Lancet article (The Lancet Global Health, Early Online Publication, 24 October 2013 doi:10.1016/S2214-109X(13)70078).
In its new strategy, TDR (2012-2017) has shifted its focus to increase access to treatments and diagnostics through implementation research and building research capacity building where it’s needed. New modalities of grants and research approaches are now supporting the application of research evidence into practice, and looking at effectiveness of interventions and large scale implementation. Our natural partners are stakeholders committed to finding solutions to bottlenecks in the control and elimination of diseases of poverty. They include international cooperation agencies, global health programmes, the academic sector, the public-private partnerships for product development and public health implementers. As an UN-based programme, TDR has played and will continue to play a major convening role, as a neutral party, bringing together different constituencies to agree to priorities, approaches and investment opportunities. http://www.who.int/tdr/publications/strategic_plan.
What do you consider to be Research & Development priorities for lusophone Africa in terms of NTDs and community health?
Recent reports on research priorities http://www.who.int/tdr/capacity/gap_analysis/en/index.html published by TDR have emphasized the need for innovative tools for diagnostics and treatment, and new control strategies for NTDs, mainly vector borne diseases. Most of the African lusophone countries have the similar epidemiological profile: increasing drug resistance; lack of effective and safety products; need for point-of-care diagnosis; and access to interventions were the highest priorities. Most importantly, the need for research on the better use of available interventions and how to scale them up was highlighted. This includes zoonoses and marginalized infections, helminths, human trypanosomiasis and leishmaniasis.
The working group on environment, agriculture and infectious disease of poverty reinforced the concept of ‘’One World One Health” and integrated approaches in public health with the strong engagement of communities. WHO has an special initiative called eportugues, to support the development of human resources for health in Portuguese-speaking Member States facilitating collaboration among institutions, delivering health information, and promoting capacity building http://www.who.int/eportuguese/en/. The platform has made significant contributions to reduce the language barrier and make technical information accessible. There is a good potential for reinforcing research capacity development, but more information dissemination is needed. In a recent call for TDR short-term capacity building grants, only 6 out of the 540 grants applications came from lusophone Africa (2 from Angola and 4 from Mozambique).
You've worked tirelessly to promote strong North-South collaborations; in which areas would you like to see increased international cooperation and stakeholder investment?
There has been a major increase in North-South and South-South collaboration over the last decade. New sources of funding were established and low- and middle-income countries (LMICs) are more engaged in international research. However, there is still a great need for research leadership, critical analysis of research priorities at the country level, and improvement of research systems. More effort should be dedicated to reduce the distance between research and implementers.
TDR has initiated a programme for operational research training:
SORT-IT brings together researchers and public health officials to design studies to address challenges related to programme implementation. This is an area of high demand in which the international cooperation could invest more to improve the impact of public health activities. In another area, TDR is facilitating a dialogue between funding agencies to work together to harmonize approaches and collaboration with endemic countries, called ESSENCE for health research:
What are the main components to ensure that tropical health research is locally led, sustainable and effective? what do you see as the current and future barriers to this ?
LMICs need to appreciate that research is needed for development and for finding solutions to public health issues. The endemic countries are closer to the problems and solutions. Stronger and proactive research organizations and national systems are needed to steward the process and to better define priorities. Major international players have to engage in addressing the burden of diseases in LMICs.
Sustainability depends on political commitment, strong institutions and leadership. Several initiatives from TDR are designed to contribute to local leadership and sustainability. The impact grant provides support to researchers who already know how to conduct research but have identified a specific area they need to learn to address locally identified public issues; the implementation research tool kit can be used for formulating implementation research projects within the local context; the TDR regional training centres offer local training on a range of research-related disciplines.
The 2013 WHO World Health Report on Research for Universal Coverage stresses the benefit of research for improving public health in a sustainable way. http://www.who.int/whr/en/
What will be the essential steps to ensure strong and locally-driven innovation (whether in vector-control, therapeutics,...) for lusophone Africa? How can we ensure the development of African therapeutic from research to clinic?
Research and innovation are collaborative endeavors involving North-South, South-South partnerships and multi-institutional approaches. African countries need to voice their priorities, select the adequate investments and support regional collaborations aligned with national interest. Countries and organizations need to join efforts, including the public and private sectors, to do and achieve more in a multi-sectoral approach.
Reducing the burden of disease has been proven to increase productivity and the financial economy. These are general principles that apply not only to lusophone countries, but to all sub Saharan countries. The language barrier for international collaboration is a fact and more avenues can be explored with partners in Brazil and Portugal to what is already ongoing.
Fabio Zicker is the Functional Coordinator Research Capability Strengthening at the Special Programme for Research and Training in Tropical Diseases (TDR) - World Health Organisation, Geneva
Dr Fabio Zicker joined TDR in 1997, following three years at the Pan American Health Organization (PAHO) headquarters in Washington (1995-97) as Regional Advisor for Research in Communicable Diseases. Prior to this, Fabio was project leader for Biology and Control of Vector-Borne Diseases at PAHO in Venezuela (1990-95).
Following academic training in Clinical Tropical Medicine and Epidemiology
in Brazil, at MacMaster University, Canada, Universidad Autonoma Metr
opolitana, Xochimilco, in Mexico, Fabio decided to pursue a Ph.D. in
Epidemiology at the London School of Hygiene and Tropical Medicine in London. His thesis focused on risk factors for Chagas disease cardiopathy.
From 1975 to 1985, he worked at the Federal University of Gioás in Brazil and was appointed to the post of Professor and Head of the Department of Preventive Medicine, before joining PAHO/WHO in Venezuela, where he assisted the Ministry of Health and the International School of Malariology in implementing a national programme for the control of endemic diseases - supported by a World Bank loan.
After Fabio moved to PAHO in Washington, his relationship with TDR grew stronger as a result of working closely with staff in the Research Capability Strengthening unit (RCS) and vaccine development.
Fabio’s work with capacity building has been extensive – and has involved
research advisory missions to more than 40 disease-endemic developing countries.
This has included providing epidemiological advice to pioneering field trials involving both malaria and leishmaniasis candidate vaccines.
As manager of the MIM/TDR Task Force, he initiated a major push to promote large North-South collaborative projects aimed at strengthening research leadership in
Africa. As RCS Coordinator, Fabio is responsible for developing the TDR new strategy for research capacity building (RCS Plus), targeting support to research and development priorities, in addition to encouraging developing countries to participate in TDR activities.
Fabio’s research and published articles have covered almost all TDR diseases.