THE STATE OF BIOMEDICAL RESEARCH IN CAMEROON Emmanuel

THE STATE OF BIOMEDICAL RESEARCH IN CAMEROON Emmanuel Acha ASONGALEM Vice Dean, Research and Cooperation, Faculty of Health Sciences University of Buea Email: cpehw@yahoo. com, emmanuel. asongalem@ubuea. net Tel: 237 7554 5718

Objectives q q q Introduction Organisation of research in Cameroon Biomedical Research Centres National biomedical research priorities Percentage distribution of research conducted in Cameroon Types of research Research funding Some ongoing clinical researches going on in Cameroon Some biomedical researches going on in UB Unethical incidence of biomedical research Ethical issues in Cameroon Areas of collaboration Biomedical Conference - Kumasi, 2012

Cameroon Official Name: Republic of Cameroon AREA: 457, 439 Sq Km (183, 568 Sq Mi) July 2010 Population 19 406 100 Official Languages: English and French Biomedical Conference - Kumasi, 2012

Organisation of research in Cameroon �No single National organ is responsible for coordinating research in Cameroon. �Three Ministries are involve in biomedical research: Ministry Higher Education (MINESUP) ▪ Coordinated by Div. Operational Research Ministry of Health (MINSANTE) ▪ Coordinated by Division of Operational Health Research Ministry of Scientific Research (MINRESI) ▪ Coordinated by Div. of Research and Program Policy) Biomedical Conference - Kumasi, 2012

Centers of Biomedical Research � MINISTRY OF SCIENTIFIC RESEARCH � Camdiagnostics Institute of Medical Research and Medicinal Plants Studies (IMPM) National Institute for Agricultural Research (IRAD) MINISTRY OF HIGHER EDUCATION Universities (8 state and >10 private) ▪ ▪ � University of Buea – Malaria, HIV/AIDS, Influenza virus and other emerging infectious diseases University of Yaounde 1 – Malaria, HIV/AIDS, Metabolic syndrome University of Douala – Malaria University of Dschang – Malaria MINISTRY OF HEALTH International Reference Center of Chantal Biya (IRCCB) Institute Pasteur – Medical Services Organization of Coordination for the fight against endemic diseases in Central Africa (OCEAC) – Malaria, HIV/AIDS, infectious diseases PRESICA, Yaounde – HIV/AIDS Investigative Research – Cameroon (IRECAM) – HIV/AIDS Baptist Center, Mutengene – HIV/AIDS National Health Laboratory (Hygiene Mobile) – emerging diseases National Laboratory for quality control of drugs (CENAME) – National Medication Distribution Center. Biomedical Conference - Kumasi, 2012

National Biomedical research priorities • • HIV/AIDS Malaria Tuberculosis Emerging diseases – bird and swine flu, cholera • Onchocerciasis Communicable diseases Biomedical Conference - Kumasi, 2012 • Cardiovascular diseases • Hypertension • Heart diseases • Diabetes • Cancer • Respiratory diseases • Asthma Non Communicable disease • Traditional medicine • Nutrition Others

Percentage distribution of research conducted in Cameroon 78. 5% Communicable diseases 24. 6% O th er s 3. 7% ria & C He pa tit i s B os ul rc be Tu Biomedical Conference - Kumasi, 2012 4. 8% Fi lia 5. 3% is ia ar al M DS AI HI V/ er s th O et es ab s ce r Ca n Di Hy pe rte ns io n 6. 3% s 5. 7% th 7. 8% in 8% 34% 21. 3% He lm Non-Communicable diseases

Distribution of Health Research in Cameroon Operational & Health Systems research 9% Social research 5% Epidemiological research 57% Biomedical Conference - Kumasi, 2012 Biomedical & Fundamental research 15% Applied research 14%

Types of biomedical research in Cameroon Preclinical Research 72% (10. 8%) Clinical research 28% (4. 2%) Biomedical Conference - Kumasi, 2012

Preclinical research Natural products Others • • Identification and isolation of new drug leads Pharmacological screening Toxicological screening Pharmaceutical formulations • • Drug resistance studies HIV, HVB variants Development of diagnosing kits Therapeutic strategies (traditional treatments of HIV/AIDS) Biomedical Conference - Kumasi, 2012

Study types of Clinical Trials 100% 80% 60% 40% 20% 0% Observational Biomedical Conference - Kumasi, 2012 Interventional

Distribution of primary outcomes of clinical trial performed in Cameroon 53% 18% 16% 10% Co m ls ia tr pa Tr ss io na ea t te m u en se t t tr ng en i re Sc of ylit ua Q Biomedical Conference - Kumasi, 2012 0% ria ls ls ia tr fe -li tiv en ev Pr Di ag no st ic e t tr ria ia ls ls 3%

Sources of biomedical research sponsorship Private 3% International 41% Biomedical Conference - Kumasi, 2012 National 59% Government 56%

Budget estimates for research in Cameroon Year National (USD) International (USD)(§) Total (USD) MINESUP(*) MPH (†) MINRESI‡ PRIVATE 2006 >18, 200 000 400 000 600 000 NA 15 858 646 >35 million 2007 >18, 200 000 460 000 615 000 NA 27 857 639 >47 million 2008 >18, 200 000 450 000 600 000 NA 21 916 952 >41 million 2009 >18, 200 000 470 000 710 000 NA 33 032 594 >52 million 2010 >18, 700 000 430 000 686 000 NA 11 999 562 >31 million 2011 >19, 100 000 441 000 605 500 NA 23 079 960 >43 million 2012 >20, 400 000 420 000 599 600 NA 15 497 342 >37 million * Not specifically for biomedical research † subsidises to public medical schools and research institution; excludes money in collaborative centers such CIRCB ‡ allocated for health research. It is mainly given to IMPM NA: data not available § Allocation from Global fund to fight HIV/AIDS, Malaria and TB Biomedical Conference - Kumasi, 2012

Areas of international-sponsored research Helminths 9% Others 8% Malaria 28% Metabolic syndromes 11% TB 4% Biomedical Conference - Kumasi, 2012 HIV/AIDS 40%

Distribution of sponsorship 95 85 15 5 Clinical Trials Preclinical Internationally Sponsored Biomedical Conference - Kumasi, 2012 Clinical Trials Preclinical Nationally Sponsored

Sponsors of Biomedical reseach in Cameroon � International sponsors & Institutions America Centre for Disease Control John Hopkins School of Public Health National Institutes of Health US Army HIV Research project (LEID) USAID France Institut de Recherche pour la Développement (IRD) French National Agency for Research on AIDS and Viral Hepatitis (ANRS, France) Centre de Recherche pour la Santé des Armées (CRESAR) Italy CIRCB Canada Canadian International Development Research Center (IDRC) Biomedical Conference - Kumasi, 2012 International organs WHO (TDR, UNAIDs, Global Fund) European Union (EDCTP project on HIV/AIDS, Malaria, TB, CANTAM) United Nations Family Planning Agency (UNFPA) UNICEF World Bank (Global Fund for the fight against HIV/AIDS/TB/Malaria) GTZ International NGOs Helen Keller International Gates & Melinda Foundation Médecins Sans Frontiére Pharmaceutical companies ▪Pfizer ▪Sanofi Aventis ▪Gilead Science ▪Roche � National institutions Government (Universities, IMPM, CENAME, Hygiene Mobile) Private (very little contributions)

Clinical trials going on in Cameroon Prevalence of cardiovascular risk factors in patients attending general practice clinics in selected countries in the Africa and the Middle East region (49 (6) locations) Yaounde, Deido. Douala, Bafoussam, Mbandjock, Njombe and Soa (Pfizer) Evaluation of three strategies of second-line antiretroviral treatment in Africa (Dakar - Bobo -Dioulasso - Yaoundé) (Gilead Sciences and Janssen Pharmaceutical N. V. , Belgium) Biomedical Conference - Kumasi, 2012

Some biomedical researches going on in UB This project is part of the Malaria. GEN (Malaria Genomics and Epidemiology Consortial 1 project involved recruitment of severe malaria in Buea and collecting blood for genomic variations. Central Africa Network on Tuberculosis, HIV/AIDS and Malaria (CANTAM project) sponsored by European and Developing Countries Clinical Trials Partnership (EDCTP) Work on Infectious diseases like influenza, cholera (LEID), sponsored by John Hopkins - Army Institute. Biomedical Conference - Kumasi, 2012

Unethical incidence of biomedical research Tenofovir (VIREAD) prophylactic or preventive properties against HIV infection Cambodia and West Africa (Cameroon, Ghana & Nigeria) (started July, 2004). Gates Foundation (USA) Family Health International (FHI –USA) Care and Health Programme (CHP) – an NGO. 400 uninfected sex workers (200 test drug + 200 placebo) Visit by Act Up-Paris and REDS (Réseau Ethique Droit et Santé, to Cameroon, protest from sex workers, picked up by France-2 TV, magnified and trial suspended in February 2005. Causes leading to failure Transport of USD 3 Prevention package did not include female condoms 5 social workers to counsel 100 participants Infected HIV participants were not to treated with HIV drugs 6 (palcebo) 4 (Tenofovir) have seroconverted by August 2005. State-of –the-art treatment was ordered by FHI. Biomedical Conference - Kumasi, 2012

Ethical issues in Cameroon • All health research projects must obtain permits from the Div. of Operational Research in MPH. – About 14 ERCs in Cameroon, but only 2 are recognized at the MPH (the national ERC (1987), and the ethics committee of Centre International de Reference Chantal Biya (CIRCB) since 2006) – To date, Administrative Authorization for clinical trials and protocols with international collaboration is only granted for protocols reviewed at the National Ethics Committee – The MPH (in collaboration with the CNEC) is currently proposing a guide to regulate the creation of Institutional Review Boards in Cameroon – Faculty of Health Sciences, University of Buea, has a functional ERB for both students and externally funded projects Biomedical Conference - Kumasi, 2012

Areas of collaboration with University of Buea Biomedical and Fundamental research Applied research COLLABORATION Epidemiological research Biomedical Conference - Kumasi, 2012 Social research

Conclusion Biomedical research in Cameroon constitutes only 15% of all health researches conducted and depends mostly on external collaboration. Biomedical Conference - Kumasi, 2012

References & Information sources National Ethical Committee of Cameroon, Yaounde. Ministry of Health Division of operational Health research ▪ http: //dev. cdnss. dros-minsante-cameroun. org/ Ministry of Higher Education Division of Operational research ▪ http: //www. citi. cm/minesup-recherche/ Ministry of Scientific Research & Innovation Division of Rsearch and Program Policy ▪ http: //www. minresi. net/minresi/ Cadre de dépenses à Moyen Terme Santé by Ministry of Public Health, 2010 Situational Analysis of Health Research in Cameroon by Council on Health Research for Development (COHRED), 1995. Libraries and interviews University of Buea University of Yaounde 1 University of Douala Univesity of Dschang OCEAC library Global fund (www. theglobalfund. org) Biomedical Conference - Kumasi, 2012

YOU THANK FOR YOUR ATTENTION Biomedical Conference - Kumasi, 2012