NIH’s Collins: New opportunities for global health research in Africa

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Francis S. Collins, MD, PhD, is director of the National Institutes of Health (NIH).  In that role he oversees the work of the largest supporter of biomedical research in the world, spanning the spectrum from basic to clinical research. Dr. Collins, a physician-geneticist noted for his landmark discoveries of disease genes and his leadership of the international Human Genome Project, served as director of the National Human Genome Research Institute (NHGRI) at the NIH from 1993-2008. The Human Genome Project culminated in April 2003 with the completion of a finished sequence of the human DNA genome.

Francis S. Collins, MD, PhD, director of the National Institutes of Health.

Last week Dr. Collins returned to the United States after an eight-day trip to South Africa, during which he attended a meeting of the Medical Education Partnership Initiative that drew a large group African researchers and medical educators to Johannesburg; a conference of the African and Southern African Association of Human Genetics in Cape Town; and a trip to the KwaZulu-Natal province to visit a clinical trial site for microbicides for women. John Donnelly interviewed him upon his return.

Did you take your guitar with you to South Africa?
You know I was a little worried about the baggage claim reliability, so I left it behind. In the one place where I knew I wanted to jam, I arranged to use someone else’s guitar. It was at the African Leadership Academy, and the leader of the organization is a former student of mine, and so I was able to play with a bunch of 17- and 18-year-olds from around the continent. They were very tolerant of me.

What impressed you from the visit to the microbicides trial site?
It was memorable. The leaders of the research – Quarraisha and Salim Karim – have put together an amazing team in KwaZulu-Natal, and I was also gratified seeing so many people who were trained as Fogarty fellows out of NIH. The most impressive part of the visit was traveling in the rural part of KwaZulu-Natal to the outpost at Vulindlela, where a lot of the primary results of the research took place and showed the effectiveness of using a Tenofovir gel as a microbicide to prevent HIV infection. I had a chance to talk to two of the women in the trial, and how empowered they felt as women to have a means of protection. Until this time, they felt quite vulnerable.

Quarraisha also talked about how rapidly HIV has made inroads in young women ages 18 to 25 years old. The team she has helped assemble out there in a very rural area is full of smart, dedicated people. They have so much optimism even as this epidemic has devastated their country. They are going to turn this around by distributing antiretroviral drugs but also by really doing something about preventing HIV infection in girls and young women.

Did this trip influence your thoughts about priorities for global health research? Did you see many gaps where more work was needed?
I saw opportunities rather than gaps. For instance, this inaugural meeting of the Africa Medical Education Partnership Initiative in Johannesburg, this was history to have all these medical education leaders in the room. They represented 30 different African institutions, and they made it clear they had never been together. They were talking about building capacity for the training of researchers and medical educators. The sense of electricity in the room was phenomenal. That portrays a real opportunity across the continent that hadn’t been there before. Many had relationships with academic counterparts in the U.S. or U.K., but they didn’t have relationships with each other. 

Moving closer to home, what is happening with a proposed initiative called the National Center for Translational Sciences? Will that impact new technologies for global health?
Absolutely. This is not an attempt to turn NIH into a drug company, but to provide a hub of activities to take projects that otherwise could not get off the ground, and make them attractive for investment. … One example in global health is Schistosomiasis (a parasitic infection that may cause fever, chills, lymph node enlargement, and liver failure.) There has been no new drug for 50 years, and the current drug seems to be developing a resistance problem. There’s a company in Illinois working on this, along with an academic investigator in Illinois, and together with a high-input screening center in Maryland, they’ve identified a component that is promising. They are on path for clinical trials. It’s not a project that a company would have started on its own, as the economic market is not that appealing for a new drug. But now that the compound is looking promising, companies are interested. This is the kind of model we want to do more of.

The House has completely cut from the NIH budget a $300 million earmark for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Why is it important to have that money reinstated?
The Global Fund is a critical contributor to the urgent needs that exist for HIV/AIDS. From my personal perspective, it was very unfortunate to see this means of funding diminished. We would like to see this enterprise continue in a vigorous way considering all the lives that are stake.

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