We need African solutions to African problems
Quarraisha Abdool Karim
Africa is plagued by many epidemics — from tuberculosis and HIV/Aids to malaria and wild polio — but has worked for decades to fight these threats. The key to beating these deadly diseases is turning inward to existing expertise and finding locally driven solutions.
The Covid pandemic has placed public health back in the global spotlight and has also served as a reminder that science is not undertaken in an ivory tower.Science shapes humanity because it takes place among us.
Covid has also showcased that no epidemic takes place in isolation. Through collaboration we can build on the foundations of our knowledge to address health challenges. This is not a new idea. In fact, it is something that we became familiar with during the Aids pandemic. Despair, pain, and loss were rampant during the 1980s and early 1990s, at the beginning of South Africa’s HIV epidemic. Every weekend, white funeral tents in rural KwaZulu-Natal seemed to multiply.
Witnessing this helped catalyse me to undertake one of the earliest population-based studies that looked closely at this emerging health issue. HIV prevalence was low at the time, with less than 1 percent infected.
But lurking within the data was a shocking revelation: young women (15-24 years old) were six times more likely to be infected compared to their male counterparts.
We knew something had to be done. So, we began speaking to women to try and get a better sense of what they were experiencing.
We learned that power dynamics of relationships and sex were disrupting disease prevention. Women didn’t have the ability to protect themselves because of the limited options available to them — options like condoms, that placed the responsibility of reducing risk in the hands of men.
Meanwhile, cases continued to surge in South Africa at an alarming rate. Existing methods to prevent HIV infection weren’t going to cut it. Approaches designed in the global North were never going to be able to fully account for the needs of women in Africa. That’s why new solutions had to be brought forward instead.
We sought to empower women through a gel that contained Tenofovir, an antiretroviral medication. This innovative approach, shown in the CAPRISA 004 trial, enabled HIV-negative women to protect themselves from the virus. CAPRISA’s research on PrEP was recently recognised by the VinFuture Prize as a lifesaving innovation from the global South.
Today, Tenofovir is taken daily as a pill for HIV prevention, a solution also known as pre-exposure prophylaxis. Aids is no longer a fatal condition, instead it is chronic yet manageable. But we still see too many deaths and new HIV infections. Two-thirds of all people living with HIV are in sub–Saharan Africa.
As we turn our focus towards other pandemics, we cannot afford to lose the gains made in HIV. It is a trap we fell into before — when early HIV work overshadowed TB efforts — and it is not one we can afford to be caught in again. Even now, Covid continues to draw on lessons from the decades of work that have been poured into our HIV/Aids response. This includes leveraging existing testing tools to detect Covid, utilising clinical trial infrastructure to expedite vaccine development, community engagement, and relying on scientific expertise to guide governments in their response.
Aids has taught us that scientists, policy-makers, and civil societies cannot work in a vacuum. There must be a unity of purpose that galvanises the steadfast support of global leaders and funding agencies.
Africa has the scientific leadership and intellectual capital to develop new technologies and interventions. If there is a problem, then local research is surely the best path toward finding a solution. Pursuing this path of innovation requires funding that will support and promote the growth and expertise of Africa’s scientists.
Dr Quarraisha Abdool Karim is an infectious diseases epidemiologist.
