Q: Many of our readers may not be aware that there is an Institute of Tropical Medicine based in Antwerp, Belgium, and dedicated to biomedical, clinical and public health research aimed at finding tools, treatments and strategies for tropical diseases. This is very unusual since Belgium is not likely to have any health crisis arising from tropical diseases. How do you explain this?
In fact, the Institute of Tropical Medicine has built up its expertise on tropical diseases and health care in developing countries over the course of more than a century. Our roots lie in the early 20th century. In those days, the Institute trained people who were moving to the Belgian colony Congo -, while it also served as a hospital for those who returned ill. After decolonization in 1960, we became a specialised part of the Belgian system of higher education. We also started setting up research and medical care in developing countries; cooperating with local scientists, institutes and authorities.
Today, ITM is a science-driven institute which advances medical science to solve tropical, poverty-related and global health threats through fundamental and applied research, advanced education and expert services. Each year, hundreds of students, including from Africa, specialise in Antwerp. We run hundreds of research projects with partners all over the world and we do over 35.000 consultations in our clinic.
Today we live in a highly interconnected world, in which millions of people and goods move across the globe every day. This also means that many of the most pressing health issues concern us all. Look at the recent Zika epidemic for example, or at the rise in antibiotic resistance worldwide. Because of our highly specialised expertise and strong links with partner institutes in Africa, Asia and Latin-America, we play a role in identifying answers to some of the most urgent health questions.
Q: ITM was very much at the centre of research on two diseases which have been particularly devastating within Africa: HIV/AIDS and Ebola. Please tell us something about this: how ITM got involved; what it did; any successes; and what remains to be done.
Our efforts against HIV and Ebola have indeed been very visible, but allow me to say that many researchers at ITM do groundbreaking work on less visible issues, such as neglected tropical diseases or access to health care, for example. Certainly, HIV and Ebola are two viruses that have marked Africa, but in different ways.
The start of the 1980s saw the emergence of AIDS cases in homosexual men on the US West coast. Spurred on by Peter Piot, the future head of UNAIDS, ITM researchers immediately began looking into this devastating new immune disease. They were the ones who proved that in Africa, HIV/AIDS was primarily a heterosexual problem affecting poor people. The HIV virus can linger in the body for a long time, during which an HIV-infected person can infect others. This has contributed to the rapid spread and devastating impact of HIV/AIDS. We have built up considerable knowledge about this disease throughout the years.
ITM research has led to key insights in how the virus manages to avoid the immune system and our labs have validated hundreds of rapid tests before their use in the field. Clinical trials run by ITM have tested new medication, while our public health researchers have studied how to best organise HIV care, also in light of the fact that HIV has become a chronic disease, as long as antiretroviral treatment is available. Unfortunately, almost half of the estimated 35 million HIV patients worldwide still has no access to antiretrovirals.
Today we live in a highly interconnected world, in which millions of people and goods move across the globe every day. This also means that many of the most pressing health issues concern us all
Our scientists also do research on what is referred to as functional cure, investigating whether treatment can be interrupted if the virus particles present in the blood are reduced to undetectable levels through antiretroviral medication. Preventive use of antiretrovirals in healthy individuals is another new domain of investigation, which might be an additional prevention tool for people particularly at risk of acquiring HIV. Traditional prevention methods, with the use of condoms as an important cornerstone, have so far not been able to keep new infections in Africa at bay.
Q: OK. And what about Ebola?
Ebola is an entirely different story. The first known outbreak of Ebola occurred in 1976 in the Congolese town of Yambuku. Jean-Jacques Muyembe was the first doctor on site after the news arrived in Kinshasa that many people were dying quickly of an unknown disease, including Belgian nuns running a local hospital. Muyembe, who is head of Congolese research centre INRB and still an ITM partner today, sent blood samples to Antwerp for analysis.
This led ITM researchers Peter Piot and Guido van der Groen, their colleagues of an international research team to co-discover a new virus, which they named after the river Ebola in Congo. Unlike HIV, Ebola kills people quickly. Until 2014 there were only sporadic and small outbreaks, which were rapidly contained. This changed when Ebola arrived in urban areas and crossed borders in the 2014 outbreak in Guinea, Liberia and Sierra Leone. Several of our medically trained colleagues volunteered to join organisations such as Medicines Sans Frontières who were really in the front line against the disease. ITM also rapidly assembled an international group of scientists for an emergency research project.
In a clinical trial in Guinea, we evaluated whether antibodies in the blood of recovered Ebola patients could help others to fight off the disease. Unfortunately, convalescent plasma did not have the desired effect, but the study still was a success. First of all, we finally got some scientific answers to questions about the efficacy of convalescent plasma in a clinical trial according to international research and ethical standards.
All previous outbreaks were too small to do so. Furthermore, the Ebola-Tx study showed that it is feasible to organise such a complex clinical trial during an Ebola outbreak and that the community accepted the intervention. In fact, we closely involved Ebola survivors and the broader community in Conakry in the project.
Q: I believe you also offer advanced studies in medicine? If so, what is your language of instruction and what kind of scholars do you welcome to ITM?
ITM is indeed a specialised institution in the Belgian higher education system, which offers a range of postgraduate programmes in tropical medicine and international health. The course with the longest history is our postgraduate course in tropical medicine and international health for mainly Belgian and European physicians and nurses who wish to pursue a career in international health.
We also organise a renowned Master of Science in Public Health and a Master of Science of Tropical Animal Health. The latter master course is a collaborative degree with the University of Pretoria in South Africa. It is a blended learning programme in which most modules are online-based. We also offer a range of short expert courses and more than 100 PhD students work on their doctoral thesis at ITM. Most courses are taught in English, but some courses are taught in French. The Master of Public Health, for example, alternates between English and French.
We have thousands of alumni in Africa, Asia and Latin America which take up key positions in their health systems. For example, when I was in Guinea during the Ebola crisis, a group of more than 30 Guinean alumni organised a reflection day involving all key stakeholders about how to address the crisis from a health system perspective. Wherever you go, you meet people who have studied in Antwerp and who cherish that experience.
Q: Your area of expertise is communication. Why do you think that so little is known within Africa about ITM’s groundbreaking research?
It depends who you ask, really. Among experts, our work is well known but less so among the general public. This has to do with the fact that we are not literally in the front line. When health crises occur, humanitarian organisations rightfully take the place in the spotlight. Most of our work is long term and rather technical. Another reason is that our institutional partners take the foreground in the countries we work in.
Through a large institutional capacity building programme, financed by the Belgian Development Cooperation, we empower our partner organisations to take charge of research and medical care in their countries. This also means there are no African ITM branches, and when people learn about our work they might associate it with our partner organisations, rather than with ITM.
Q: Of particular interest is an award-winning documentary film, produced at ITM, which you personally led. Please tell us about this documentary.
We made a film in the attempt to show the essence of what might seem abstract and difficult to visualise: how our partner organisations take charge of research and care in the context of the abovementioned capacity building programme. I wanted to do this because our “Switching the Poles” philosophy is at the heart of ITM’s institutional strategy.
We have thousands of alumni in Africa, Asia and Latin America which take up key positions in their health systems
Briefly put, the world is changing and so are international (power) relations. We believe that development cooperation as we know it is finite. Instead, we work towards a situation in which ITM and its partners address scientific and societal challenges at equal footing, and often this is already the case.
Q: Looking forward, what should we expect from ITM?
A relentless effort to make a difference for one thing; in the lab, at the bedside, in the field, and in the classroom. We want to advance the medical sciences and translate this knowledge in practice together with our partner organisations. A recently announced initiative to eliminate sleeping sickness by 2025, supported by Belgium and the Bill & Melinda Gates Foundation, fits this bill. ITM will coordinate this ambitious programme in collaboration with a range of Congolese, Belgian and international partners.
Our Institute has over a century of expertise in the diagnosis, treatment and control of this deadly disease, which mainly affects rural populations in the Democratic Republic of the Congo. Today we have the opportunity to give sleeping sickness the final push, putting into practice all lessons learnt so far and implementing novel tools to diagnose, treat and control the disease. Sleeping sickness might be a neglected tropical disease, but it certainly has our full attention!
Roeland Scholtalbers is the Head of Communications at the Institute of Tropical Medicine (ITM) in Antwerp, Belgium.
Wycliffe Muga is a Kenyan writer and veteran newspaper columnist.