A case for the adoption of Phage therapy in Africa

By emmannaemeka @ 2022-12-07T01:38 (+12)

Background

Antimicrobial resistance(AMR) is one of the greatest threats we face as a global community. An essential global public health objective is lowering the burden of infection-related mortality. Previous research has calculated the number of fatalities brought on by drug-resistant infections and sepsis and discovered that infections continue to be the world's leading cause of mortality. The WHO has predicted that by 2030 (https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis),  antimicrobial resistance could force up to 24 million people into extreme poverty.According to the UK Government-commissioned Review on Antimicrobial Resistance, AMR might result in the yearly death of 10 million people by 2050. It is predicted that 90% of these deaths will occur in Africa and Asia.

According to a recent report published in the Lancet, which estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen–drug combinations in 204 countries and territories in 2019.  The study predicted that in 2019, there were an estimated 4·95 million (3·62–6·57) deaths associated with bacterial AMR  including 1·27 million (95% UI 0·911–1·71) deaths attributable to bacterial AMR.  Six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000–1 270 000) deaths attributable to AMR and 3·57 million (2·62–4·78) deaths associated with AMR in 2019. The full report can be found here.

A case for sub-Saharan Africa

Based on the report, analysis based on regions of the world, Western sub-Saharan Africa had the highest burden, with 27·3 deaths per 100 000 (20·9–35·3) attributable to AMR and 114·8 deaths per 100 000 (90·4–145·3) associated with AMR, while Australasia had the lowest AMR burden in 2019, with 6·5 deaths per 100 000 (95% UI 4·3–9·4) attributable to AMR and 28·0 deaths per 100 000 (18·8–39·9) associated with AMR in 2019.  In Nigeria, communicable diseases accounted for 66% of morbidity in 2015 There is an urgent need to address this problem in Sub-Saharan Africa. 

Phages as an alternative to antibiotics

Phages have been proposed as an alternative to drug resistance. While phages have been used successfully in Europe, Australia and the USA. No report on phage therapy use in Africa. Phage research is neglected in Africa. A recent survey of phage scientists under the Africa phage forum showed that funding, lack of skill sets and infrastructure are the major setbacks preventing success in phage research in Africa. 

To stimulate phage research as an alternative to antibiotics in Africa, I propose coordinated and strategic support. This support should focus on:

  1. Influencing policies that will allow for the adoption and use of phage therapy in Africa. No country within Africa has a framework for the adoption of phage therapy
  2. Address the infrastructure problem. This can be done by setting up phage banks in regions of Africa. In Nigeria, I am currently building a phage bank that can isolate, characterize and purify phages for use as phage therapy against the WHO priority pathogens. We can encourage this kind of phage banks across Africa. Funding has been a major challenge even for the phage bank in Nigeria. 
  3. Training, Phages for global health have supported the training of phage researchers in Africa. They can be encouraged to do more
NickLaing @ 2022-12-07T05:51 (+3)

Thanks so much for this (I'm in Uganda). Love hearing from Africans on the EA forum nice one!

I love the idea of phages, and I hope they can become a useful antimicrobial agent in time.  Unfortunately though I'm not sure it's worth focusing on things like phage banks, until phages are proven to be useful as an antimicrobial agent in the general population.

Also tragic as it is, I sadly don't have confidence that investing in phage research within Africa will yield fruit. I could be wrong about this, but north of South Africa there have been very few meaningful biomedical innovations come out of any country. I can't think of any vaccine, medication or test which has been innovated  This may be due to a range of factors like poor education systems, poor infrastructure and most importantly I think horrendous beauracracies which stifle talent like yours and have no agility. 

In saying that, if something was going to work it would more likely be a smaller "cottage" type project like yours. I think that's why Tech innovators in Africa have so many amazing achievements, because they can innovate alone and in small groups, without needing the infrastructure and beuracratic support needed by biomedical researches. 

Anyway I love the idea, nice one!

emmannaemeka @ 2022-12-07T21:07 (+1)

Thanks, NickLaing for your kind words. 

I have a different view about the success of phage therapy in Africa. It may interest you to know that this has gained traction lately. In 2020, along with other phage researchers in Kenya and Uganda, we formed the Africa Phage forum (APF). APF has done considerably well in driving phage research in Africa, you can find our latest pre-print here. 

 

Are phages worth researching in Africa? Are Phage banks worth the investment? Will it yield fruit? 

During the COVID-19 pandemic, we waited for the west to spare us some vaccines.   The narrative has to change, we need to prepare for pandemics, and we need to have the capacity to tackle our problems. Antimicrobial resistance is a huge problem in Africa and Africa must lead in her own battle. APF has been systematic, currently, Nigeria and Kenya are working towards formulating a framework for Phage therapy adoption. In a sense its yields fruit. Hopefully, with the right funding and support, Nigeria will treat her first patient with Phages next year(I am working hard to get this done. Clinicians in Nigeria are being sensitized to adopt phages.  In Kenya, Phages have been formulated for Salmonellosis in poultry, field trials start next year. 

 

Do we need a phage bank in Africa?

Yes! A phage bank in Africa is not only for Africa. In Australia, they treated a patient with phages from phages isolated and banked in Israel. We need phages across the world. This will guarantee phage effectiveness across the globe. What will a phage bank achieve, aside from storing phages, a phage bank will solve the infrastructure problem associated with research in Africa. A lab that can isolate, characterize, sequence and store phages will surely meet the global standards needed for phage innovation.

 

"I can't think of any vaccine, medication or test which has been innovated  This may be due to a range of factors like poor education systems, poor infrastructure and most importantly I think horrendous beauracracies which stifle talent like yours and have no agility. "

 

Sadly yes, I have been looking for funding for my lab, it's been almost so difficult securing such funds. However, I am hopeful. My long-term goal is to reverse this trend. Get phage therapy to solve common problems. My PhD student currently works on formulating phages for the treatment of Typhoid fever as well as a water treatment solution(Phagebased).  Wish me well to get funded soon.  The infrastructure issue should be taken seriously.