London School of Hygiene & Tropical Medicine Malaria Centre

Partnering to tackle disease across Africa

Researcher uses microscope MRC Unit The Gambia in Fajara.

Researcher uses microscope MRC Unit The Gambia in Fajara. Credit: MRC Unit The Gambia at LSHTM

23 March 2018
By Jacqui Thornton March 2018

In March 2017, molecular biologist Martin Antonio was sitting at his desk in Fajara on The Gambian coast when he got an urgent call from the World Health Organization’s (WHO) Africa headquarters.

A deadly outbreak of meningitis had started 2,000 miles away in Zamfara State, Nigeria, and it was spreading rapidly. Scientists in the affected region had been unable to identify the pathogen involved and they needed help.

Doctors were able to treat patients, but without knowing which strain they were dealing with, the team couldn’t vaccinate healthy people - who were being struck down in the thousands.

Since December, scientists had been trying to work out the conundrum and finally called the WHO for help – who in turn contacted Prof Antonio, Principal Investigator and Unit Molecular Biologist at the MRC Unit The Gambia at LSHTM, their go-to expert on vaccine surveillance. “The size of the problem was staggering,” he remembers.

In Zamfara state alone, in a month there were more than 1,200 suspected meningitis cases, with 162 related deaths. By May 2017, there were 7,140 suspected meningitis cases and 553 deaths, making it an epidemic, as declared by the Nigerian Center for Disease Control.

Prof Antonio mobilised a rapid response team of six scientists and doctors who arrived five days later and identified the bacteria behind the outbreak - Neisseria meningitidis serogroup C - in just three days.

With the help of the UK government, which donated 820,000 doses of the meningitis C conjugate vaccine, and GAVI, the Vaccine Alliance, which funded a further 500,000, more than 1.3 million people in the two worst affected states of Zamfara and Katsina – or around 15% of the population – were protected.

Prof Antonio, who is the Director of the WHO collaborating Centre for New Vaccines Surveillance, based at the Medical Research Unit The Gambia at the London School of Hygiene & Tropical Medicine (MRC Unit The Gambia at LSHTM), said, “Nigeria had tried very hard, but they did not have the human resources or the laboratories. When we found the pathogen, we had a Eureka moment! It was very satisfying.”

The team had set up a mobile field lab in the back of a specially converted Land Rover to test samples of cerebrospinal fluid (CSF) from suspected patients, which gives a definitive diagnosis of meningitis. This complemented another lab they set up at the Ahmad Sani Yariman Bakura Specialist Hospital in the state capital Gusau, 120 km (75 miles) away. They worked closely with the Nigerian Centre for Disease Control and the Ministry of Health.

To diagnose and treat patients, MRC Unit paediatrician Dr Bernard Ebuke also trained more than 100 local healthcare professionals to perform lumbar punctures to get the CSF and set up a makeshift outdoor hospital.

“We had brought cutting edge science to the bush,” he said. “The Nigerians were very appreciative of our support. It was crucial.”

The team was known across West Africa for its expertise, having been called upon to conduct a similar exercise in Ghana the previous year, when a different strain of pneumococcal meningitis hit the country.

“We have an excellent technical platform, so we can do analysis very quickly and of high quality,” says Prof Umberto D’Alessandro, Director of the MRC Unit The Gambia at LSHTM. “I’m extremely pleased we were able to help.”

Saving lives with research

The expedition to Nigeria is a good example of what the MRC Unit The Gambia at LSHTM, in West Africa, and the Medical Research Council / Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit (MRC/UVRI & LSHTM Uganda Research Unit) in East Africa, aim to do – to improve people’s health and save lives through research. In addition, the Units train local people and build capacity.

Both units have been at the forefront of scientific and medical advances in Africa – in Gambia’s case for 70 years; in Uganda 29 years.

Their core income comes from the Medical Research Council United Kingdom, but such is their expertise and reputation that they win international grants and funds for many projects.

This year the MRC Unit The Gambia at LSHTM has a total budget of >£20 million, and employs 1,200 staff. Uganda has a £9 million budget and 400 staff. Funders include the Wellcome Trust, the Bill & Melinda Gates Foundation, the European & Developing Countries Clinical Trials Partnership (EDCTP) and international governments among others.

Both Units have internationally-accredited laboratories, with The Gambia’s Himsworth Laboratory being home of the World Health Organization Regional Reference Laboratory (WHO RRL), providing diagnostic services to the entire WHO African Region. Activities span from basic research in immunology, microbiology, virology and molecular biology to large epidemiological studies, intervention trials and routine clinical diagnosis.

The MRC Unit The Gambia at LSHTM also houses a biobank, with one million DNA samples, while the Unit in Uganda hosts the national and regional reference laboratory for HIV drug resistance.

And crucially, both Units offer clinical care to local people based around their headquarters and field stations – often in areas with very few health facilities.

A famous malaria experiment

In The Gambia, work began soon after the end of the Second World War, when the country was still a British colony. Food was in short supply and the nutrition needs of its people were paramount. The Unit was based in Fajara in a former military hospital on the coast, located on Atlantic Boulevard.

In 1949 Dr Ian McGregor, later considered by some to be the most eminent malaria expert in the world, joined the Unit to study the relationship between parasitism and nutrition and became its director five years later. 

McGregor established a rural field station in Keneba, several hours’ drive eastward from Fajara, including a ferry crossing, which initially focussed on nutrition science. But within a few years, the focus turned to malaria in the country where the Anopheles gambiae mosquito, responsible for more malaria deaths that any other mosquito, was first described.

Dr McGregor, a parasitologist by background, conducted what is seen by many to be the most famous experiment in malaria control.

At the time, it was not known whether humans could develop immunity against malaria, like other infectious diseases such as measles, known as acquired immunity. He took blood from adults who had previously suffered from malaria and gave it to infected children and showed that this cleared the parasite, proving that antibodies could protect from malaria.

His findings were published in 1964 and were the first real proof that humans can build up an immune-response to the disease -- vital for encouraging vaccine development.

Dr McGregor’s work was taken further by his successor Dr, now Prof Sir, Brian Greenwood, appointed as Director of the MRCG from 1980-1995.

While Dr McGregor was more lab-based, Dr Greenwood was more focused on clinical research, in particular on the prevention and treatment of malaria.

Shortly before his arrival, the MRC Dunn Nutrition Unit based in Uganda was relocated to Keneba and came under the scientific direction of the Dunn Unit in Cambridge. In response, the MRC supported the establishment of two new field stations, one at Basse, at the far end of the country, and the other in Farafenni on the north bank of The Gambia river close to the northern Senegal border, chosen because there were very poor roads and no health services. 

Read the full article on the LSHTM website.