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African-European Tuberculosis Consortium: Interview with Prof. Dr. Gerhard Walzl
Prof. Dr. Gerhard Walzl of the Department for Biomedical Sciences at Stellenbosch University/South Africa is coordinator of the consortium AE-TBC (African-European Tuberculosis Consortium). As part of the European and Developing Countries Clinical Trials Partnership (EDCTP) the consortium receives funding by the German Federal Ministry of Education and Research. There are seven African and five European institutions involved in the project entitled „The evaluation of Mycobacterium tuberculosis specific host cytokine signatures in whole blood culture supernatants as diagnostic biomarkers for active TB infection“, which runs since June 2010. The objective of the project is to develop innovative methods for diagnosing tuberculosis (TB).
1. You coordinate the „African-European Tuberculosis Consortium“ (AE-TBC). What makes this international research group special and what is the relevance of the cooperation?
The consortium was formed with a selection of partners who had previously worked together in another consortium, whose funding had come to an end. That group was led by Prof Stefan Kaufmann from the Max-Planck Institute for Infection Biology, Berlin, Germany, and was funded by the Bill and Melinda Gates Foundation. The group had been together for five years and therefore the relationships that had developed between partners, the trust that had been established over several years and the communication channels were all ongoing and the group did not have to go through a long growth phase. Two partners were added: the University of Namibia, brand-new in the field of medical research with a medical school that had just been founded, and a professional grant management company, Eurice, from Saarbruecken. What makes this consortium unusual is that African partners lead the project, with equitable participation of all partners, regardless whether African or European. Apart from a strong focus on the scientific aims of the project, research capacity development in Africa and improved networking of all partners with the scientific community are additional focus areas for the group.
2. If you had two sentences to describe your project „The evaluation of Mycobacterium tuberculosis specific host cytokine signatures in whole blood culture supernatants as diagnostic biomarkers for active TB infection“ – what would you say?
The project utilizes advanced clinical research capabilities together with cutting edge basic science expertise and advanced biotechnological capabilities of the consortium members to address an important clinical need: the development of a field-friendly, rapid, but accurate diagnostic test for active tuberculosis. We also use the project as a vehicle for research capacity development in Africa and as an opportunity to expand networks and to facilitate our combined ability to generate future research funding for all participating members.
3. What is fascinating for you when it comes to your area of research?
Tuberculosis is caused by a bacterium and is spread via inhalation of infectious droplets. It has plagued mankind for thousands of years. Although the causative agent was discovered in 1882, we still use diagnostic methods that are more than 100 years old and use drugs that are at least half a century old and have to be given for at least six months. Only very recently have we started testing new vaccine candidates to replace BCG, a vaccine that was introduced decades ago, and which has insufficient efficacy. TB is one of the big killers in the developing world, like it was in Europe at the beginning of the 19th century, yet we collectively have neglected to use moderns approaches to stamp out this disease. It causes 8.8 million cases each year and claims 1.4 million lives. TB is a indicator of social inequality and we have major challenges on scientific, political, social and advocacy fronts.
4. Tuberculosis is considered one of the most aggressive bacterial infectious diseases on a global scale, and South Africa is especially affected. The aim of your project is to develop innovative methods for diagnosing tuberculosis. What could these look like?
One of the problems with TB is that it affects people who are stricken by poverty, often in resource-poor settings. Apart from a lack of easily accessible diagnostic and treatment centres, health seeking behaviour is also affected by poverty. As TB diagnosis mostly requires multiple visits before the diagnosis is confirmed and as test results are mostly not available immediately, many people who initially seek medical attention for their TB symptoms are lost to follow-up and are either never started on treatment or only after long delays, which promotes further spread of the disease. As it is often difficult to demonstrate the presence of bacteria or their products in patient samples we hypothesize that bio signatures that consist of several human inflammatory markers may provide promising alternative diagnostics. After all, the human immune system has sensitive detection mechanisms in place. Such bio signatures may be measurable with simple and cost-effective strip tests, similar to pregnancy tests or glucose test strips and may be measurable on blood, saliva or urine.
5. The WHO has proclaimed the goal to reduce the number of new cases of tuberculosis as well as the number of deaths caused by this disease by 50 percent until 2015. Until 2050 tuberculosis bacteria are hoped to be completely wiped out. These are ambitious goals – what do you think?
All of the WHO’s six regions are on track to achieve the Millennium Development Goal target that TB incidence rates should be falling by 2015. TB mortality rates have fallen by just over a third since 1990, and five of six WHO regions (the exception being the African Region) are on track to achieve the target of halving 1990 mortality rates by 2015. The target of halving TB prevalence rates by 2015 compared with 1990 is unlikely to be achieved globally, although the target has already been reached in the Region of the Americas with the Western Pacific Region very close to reaching this target too. Eradication of TB by 2050 is very unlikely and the rising occurrence of drug resistant TB and the continued dangerous interplay between TB and HIV make it imperative that the TB field and all its players work together innovatively and forcefully to deal with the problems effectively. How can we justify that there were almost ten million orphans in the world due to TB in 2009? That is more than the population size of Austria, or Baden-Wuerttemberg, and just fever than Bavaria. We also have to remember that the hard-fought gains in TB control can be very quickly wiped out by economic downturns, as we are experiencing currently.
6. The German-South African Year of Science 2012/2013 promotes joint research projects in both countries. What advice can you give the project partners based on your experience with bilateral scientific and technical cooperation?
I have had extremely fulfilling German-South African research partnerships over the past ten years. The partnerships were never based on unhealthy dependency of one partner on another (neither financially nor with regard to human research material) but rather built on complementary capabilities and strengths, and a common research focus. Partnerships can only work if all partners truly benefit from the relationship and if both grow through the collaboration. Mutual respect and a willingness to accept country- and culture-specific differences are essential on both sides.