A WHITAKER GROUP PUBLICATION
AFRICA HEALTH NEWS
GROUNDBREAKING ADVANCES
WORLD’S LARGEST MALARIA
VACCINE TRIAL LAUNCHED
IN SEVEN AFRICAN NATIONS
Phase III of the largest malaria vaccine trial ever undertaken, involv-
ing up to 16,000 children in seven African countries, is underway and
researchers are cautiously optimistic that the new RTS,S vaccine will
represent a groundbreaking advance in the battle against one of Afri-
ca’s most deadly diseases.
The vaccine, which would complement existing interventions such
as bed nets and effective drug therapies, is the first malaria vaccine can-
didate ever to demonstrate significant efficacy during earlier trials. It
is the leading vaccine candidate in the global effort by PATH Malaria
Vaccine Initiative (MVI) to develop an effective malaria immunization.
The vaccine is the result of a partnership between MVI, biopharma-
ceutical company GlaxoSmithKline Biologicals (GSK Bio), and African
research institutions.
Phase II studies, initiated in 2002 and conducted on more than 2,000
children in Mozambique, showed that RTS,S reduced malaria cases by
53% over an eight-month follow-up period. Other studies, published
in The Lancet in 2004 and 2005, described the vaccine as effective for at
least 18 months, reducing clinical malaria by 35% and severe malaria by
49%. The vaccine was also shown to be safe when used in conjunction
with standard infant immunizations.
“A malaria vaccine could help save countless lives and redefine the
future for Africa’s children,” said Dr. Patricia Njuguna, the vaccine’s
principal investigator and the chair of the Clinical Trials Partnership
Committee. “Communities all across Africa are dedicated to this future
and are participating to ensure that we develop a vaccine with an ac-
ceptable safety and efficacy profile.”
Breadth of Trial
RTS,S is the first vaccine designed specifically for African conditions.
Over 800,000 Africans die each year from malaria, the vast majority of
whom are children under five. By conducting the Phase III trial in sev-
en different sub-Saharan African countries, researchers will be able to
evaluate the efficacy of the vaccine in a variety of settings, with diverse
patterns of malaria transmission. The trial is taking place in Burkina
Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania.
The Phase III trial is the culmination of more than 20 years of re-
search, including 10 years of clinical trials in the United States and Af-
rica. It will evaluate the vaccine’s efficacy in two groups of children. One
group, aged six to 12 weeks, will be immunized as part of their regular
schedule of infant vaccinations; the second group will include children
aged five months to 17 months.
“This is the largest trial ever conducted in Africa of a vaccine specifi-
cally designed for use with African children. We have great apprecia-
tion for the families and children participating,” said Dr. Salim Abdulla,
Director of the Ifakara Health Institute in Tanzania, one of the trial’s
African partner institutions. “Development of RTS,S across Africa has
NOVEMBER/DECEMBER 2009
A baby is immunized with the new RTS,S vaccine during Phase II of
the clinical trials.
strengthened our research capacity, a legacy that will far outlast the tri-
als.”
National governments have been very involved in the trial since the
beginning of the process. Each country hosting a study site has undertak-
en independent reviews to ensure the trial meets national safety, ethical
and legal standards for medical research. In addition, an independent
data and safety monitoring board oversees the entire trial with support
from local safety monitors. The trial has been designed in consultation
with regulatory authorities in Europe, the U.S. and African countries, in
conjunction with the World Health Organization (WHO).
If the vaccine meets the expected outcome, it will be submitted to
regulatory authorities in 2012 together with safety and immunogenic-
ity data. Depending on the final clinical profile of RTS,S and the time-
table of the regulatory review process, the vaccine could be introduced
within three to five years.
In anticipation of the vaccine roll-out, MVI and GSK Bio are already
working with malaria-affected countries and international institutions
to ensure that an effective malaria vaccine will be readily available and
affordable to those who need it most. The two organizations signed a
collaboration agreement in 2001 to pursue a pediatric clinical develop-
ment of RTS,S in Africa. They were joined by African research centers
in five countries, with two additional African countries joining for the
Phase III trial.
Development of the vaccine candidate was made possible by grants
of more than $200 million from the Bill & Melinda Gates Foundation
to the PATH Malaria Vaccine Initiative, a global program established
by the international nonprofit organization PATH to accelerate the de-
velopment of malaria vaccines and ensure its availability in developing
countries.
So far, GSK has invested more than $300 million in the vaccine’s de-
velopment and expects to invest at least another $100 million before the
completion of the project.
PAGE TWO
PROGRESS IN THE FIGHT AGAINST HIV/AIDS
NEW INFECTIONS DECLINING IN SSA AS
PEOPLE LIVING WITH HIV INCREASE
The number of people in Africa who were in-
fected with HIV in 2008 is about 15% lower
than in 2001, according to a new report re-
leased in November by UNAIDS, the um-
brella organization that oversees all United
Nations (U.N.) AIDS programs.
In 2001, when the U.N. Declaration of Com-
mitment on HIV/AIDS was signed, 2.3 mil-
lion people in sub-Saharan Africa (SSA) were
newly infected with HIV. In 2008, the number
has dropped by 400,000 to 1.9 million new in-
fections. About 22.4 million people in Africa
were living with HIV in 2008, the report stat-
ed, compared with 19.7 million in 2001.
“The good news is that we have evidence
that the declines we are seeing are due, at least
in part, to HIV prevention,” said Mr. Michel
Sidibé, Executive Director of UNAIDS. “How-
ever, the findings also show that prevention
programming is often off the mark and that if
we do a better job of getting resources and pro-
grams to where they will make the most im-
pact, quicker progress can be made and more
lives saved.”
The report, which combines the results of
epidemiological studies from around SSA, put
the number of AIDS-related deaths in 2008 at
1.4 million. This represents an 18% decline in
the rate of mortality in the region since 2004.
Women and girls continue to be dispropor-
tionately affected by HIV in SSA, accounting
for 60% of estimated infections. The risk of
becoming infected is especially disproportion-
ate for girls and young women. In Kenya, for
example, women between 15 and 19 years old
are three times more likely to be infected than
their male counterparts, while 20 to 24-year-
old women are 5.5 times more likely to be liv-
ing with HIV than men of the same age.
The report states that rapid scaling up of
antiretroviral (ARV) treatment since 2004 has
generated considerable public health gains. As
of December 2008, 44% of Africans in need
of ARV therapy (nearly three million people)
were receiving it. In 2003, the WHO estimated
that antiretroviral treatment was reaching just
2% of those in need.
Treatment scale-up is having a profound
effect on HIV mortality in many countries,
studies have found. In Uganda, timely initia-
tion of ARV therapy reduced mortality by 95%
and also resulted in a 93% reduction in HIV-
related orphanhood. In Botswana, where ARV
therapy coverage exceeds 80%, AIDS-related
deaths fell by more than 50% between 2003
In 2008, 44% of Africans in need of
antiretroviral treatment received it, compared
with 2% in 2003.
and 2007 while the number of children newly
orphaned by AIDS fell by 40%.
Other findings in the report include:
■ A wide variation exists in the relationship
between HIV and income. In eight African
countries where surveys have been conducted
- Burkina Faso, Cameroon, Ghana, Kenya, Le-
sotho, Malawi, Tanzania and Uganda - HIV
prevalence is higher among adults in the
wealthiest quintile than among those in the
poorest quintile.
■ As the epidemic has evolved in SSA, the
relationship between HIV infection and edu-
cation has shifted. Before 1996, studies found
either no association between educational
level and HIV risk or found that the highest
risk was among the most educated. Data col-
lected after 1996 has tended to show a lower
risk among the most educated people.
■ HIV prevalence tends to be higher in ur-
ban settings than in rural areas. The most pro-
nounced difference in HIV prevalence is in
Ethiopia, where urban dwellers are eight times
more likely to be HIV-infected than people liv-
ing in rural areas.
■ Many countries have greatly stepped up
testing. In 2008, Botswana reported the high-
est proportion of people being tested in Africa
(210 per 1,000).
■ HIV prevention programs may be having
an impact on sexual behaviors in some African
countries, where condom use has risen dra-
matically. In South Africa, the proportion of
adults reporting condom use rose from 31.3%
in 2002 to 64.8% in 2008.
■ Access to services to prevent mother-to-
child HIV transmission has expanded greatly,
with 45% of HIV-infected pregnant women
receiving ARVs in 2008, compared with 9% in
2004.
NEGLECTED TROPICAL DISEASES
NEW PARTNERSHIPS
ADVANCE NTD
TREATMENTS
Distinguished experts at two forums in Wash-
ington in October pointed to public-private
partnerships as key to combating neglected
tropical diseases (NTD) that disproportion-
ately affect the lives and productivity of mil-
lions of Africans.
Dr. Christy Hanson, a senior public health
advisor with the U.S. Agency for International
Development (USAID) spoke at a gathering
co-hosted by Global Health Progress (GHP),
a joint initiative of research-based biopharma-
ceutical companies, and the journal Health Af-
fairs, about how USAID had developed a sus-
tainable platform for delivering critical NTD
treatments by partnering with governments
and the pharmaceutical industry.
In an article in Health Affairs that she co-
authored with Mr. Ken Gustavsen, Director,
Corporate Responsibility and Global Policy
Support at bio-pharmaceutical company Mer-
ck & Co, Dr. Hanson outlined disease-specific
partnerships that nine drug companies have
entered into to provide treatment for lymphat-
ic filariasis, river blindness, schistosomiasis,
parasitic worms, trachoma, leprosy, trypano-
somiasis and Chagas disease.
Dr. Hanson and Mr. Gustavsen also high-
lighted the work of the Partnership for Disease
Control Initiatives, a loose alliance of drug
companies that enables them to closer coor-
dinate mass drug administration and address
human resource burdens on affected commu-
nities and health systems.
At a forum on Capitol Hill, hosted by the
Tufts Center for the Study of Drug Develop-
ment, that brought together experts from ma-
jor research institutions, governments and the
private sector, Deputy Ambassador of Malawi
Mr. Kena Mphonda pointed to the successful
partnerships between the Government of Ma-
lawi and Abbott Laboratories, Family Health
International, GlaxoSmithKline, Merck, Phar-
mAccess, Roche International, Johnson &
Johnson, the Elizabeth Glaser Pediatric AIDS
Foundation and the U.S. Centers for Disease
Control (CDC) that are helping to combat
diseases that are impeding Malawi’s develop-
ment.
Recent studies estimate that 534,000 people
die each year and that 56.6 million DALYs
(disability-adjusted life years) are lost annually
to 13 NTDs.

BUILDING CAPACITY
SAFE BLOOD FOUNDATION SAVES LIVES AFRICAN PRIVATE
Up to 10% of the 22.4 million Africans liv-
ing with HIV contracted the virus after un-
dergoing blood transfusions. And, because
of a severe shortage of safe blood in most
African countries, those needing transfu-
sions such as women in childbirth, acci-
dent victims, or children suffering from
malaria-induced anemia, can be faced
with the choice of foregoing the life-saving
transfusion or risking HIV infection from
unsafe blood.
Ten years ago, New York investment
banker Jeff Busch launched the Safe Blood
for Africa Foundation (SBFA), with fund-
ing from ExxonMobil, Abbott Laborato-
ries, Global Med Technologies, Johnson &
Johnson and Merck & Co., to help African
nations strengthen neglected safe blood ser-
vices and provide the funding and support
needed to make it a health priority.
Since then, SBFA has provided assistance
to national blood services in 35 African
countries, trained over 6,000 health care
technicians in safe blood handling proce-
dures, launched educational programs that
encourage young people to protect them-
selves against HIV infection and donate
blood, and supplied millions of blood-test-
ing kits to health facilities across Africa.
Among its partners is the President’s
Emergency Plan for AIDS Relief (PEPFAR),
which in 2008 provided about $92.4 mil-
lion to support countries as they develop or
strengthen national policies and guidelines
on blood safety that address their own coun-
try specific issues.
The results can be measured by a sharp
increase in the safe blood supply in coun-
tries where SBFA is most active. Since 2002,
when SBFA began working with the Botswa-
na National Blood Transfusion Service, the
country’s safe blood supply has increased by
over 100% and the HIV infection rate from
donated blood has decreased from 9% to
less than 2%.
In Nigeria, SBFA is working in partner-
ship with the Nigerian Ministry of Health,
the U.S. Centers for Disease Control (CDC),
ExxonMobil and the U.S. Agency for Inter-
national Development (USAID) to establish
17 zonal blood centers. Since 2003, it has
trained over 1,000 Nigerian blood service
and health care staff in safe blood handling.
SBFA is also working to help ensure that
there are sufficient supplies of disease-
SBFA encourages young people to maintain
healthy lifestyles and donate blood
free blood in Africa. Making sure there is
enough blood for treatment is as critical as
ensuring that the blood that is collected is
safe. There are significant health crises in
many African nations because of the short-
ages, which are exacerbated in high HIV-
prevalent environments where there are
higher discard rates for tainted blood.
In order to encourage the participation
of unpaid volunteer blood donors who are
known to be of lower risk for transfusion-
transmittable infections, SBFA has sup-
ported and expanded the African Club 25
Society, which combines maintenance of
health lifestyles and HIV prevention with
encouraging the participants, who are be-
tween 16 and 25, to become life-long blood
donors.
Club 25 members pledge to give blood at
least 25 times while maintaining a healthy
HIV-free lifestyle. With the support of
SBFA, Club 25 now has over 62,000 active
youth participants in 15 African countries.
To build blood services capacity in Af-
rica, SBFA supports scholarships and fund-
raising for grants and training programs at
the African Institute for Transfusion Medi-
cine (AITM). The purpose of AITM is to
establish a sustainable and continuing pro-
fessional development program in Africa
for leaders, managers, clinicians and staff
in blood services.
SBFA’s other programs in Africa include
an emergency program in the Democrat-
ic Republic of Congo (DRC); providing
technical assistance, training and HIV test
kits in Equatorial Guinea and supplying
trained donor blood recruiters in Lesotho
and Swaziland.
PAGE THREE
MALARIA AWARENESS
SECTOR CONTRIBUTES
TO GLOBAL FUND
African private sector companies, in part-
nership with the hit reality television show
“Big Brother Africa Revolution,” united be-
ginning in November to raise funds for the
Global Fund to Fight AIDS, Tuberculosis and
Malaria.
The funds are to be raised in an Africa-wide
public awareness campaign and earmarked for
the Global Fund’s United Against Malaria ini-
tiative. It will be the first time the African pri-
vate sector has made a donation to the Global
Fund.
“Big Brother Africa Revolution,” now in
its fourth season, is broadcast in 47 African
countries. In episodes running from Novem-
ber 24 to November 26, the housemates in “Big
Brother Africa Revolution” highlighted the
critical importance of malaria prevention by
installing, mending and sleeping under insec-
ticide-treated bed nets. They also made beaded
bracelets in support of United Against Malaria
as part of a much larger public awareness cam-
paign and fundraising initiative led by African
companies such as South African restaurant
chain Nando’s and the trans-Africa telecom-
munications company MTN.
Fifty percent of the revenue earned by M-
Net, the show’s broadcaster, and its producer,
Endemol South Africa, from SMS messages
sent by Big Brother Africa viewers will be
channeled to the Global Fund. In addition, a
percentage of revenues raised from the sale
of all United Against Malaria bracelets will be
donated to the Fund.
“M-Net believes that this is a vital and nec-
essary initiative and so we are pleased that our
Big Brother Revolution series is able to pro-
vide a continental platform where informa-
tion regarding the prevention of malaria in
Africa can be highlighted,” said M-Net Africa
Director Biola Alabi. “It is clear that fostering
greater education and understanding is a key
part of the process in preventing the spread of
malaria.”
United Against Malaria is a partnership of
prominent leaders, organizations, the private
sector and sports stars that have joined forces
ahead of the World Cup in 2010 in South Af-
rica to end preventable malaria deaths.
The Global Fund estimates that around
2,200 Africans die each day from malaria, 85%
of them children under five years of age.
PAGE FOUR
SUCCESS STORIES FROM AFRICA
NEW REPORT HIGHLIGHTS SUCCESSFUL
COLLABORATIONS IN IMPROVING HEALTH
Partnerships between governments, the pri-
vate sector, research institutions, funders and
civil society are critical to achieving meaning-
ful and lasting progress in addressing global
health challenges, according to a new report
published in November by a group of global
health organizations.
Case Studies for Global Health presents 30 di-
verse examples of health partnerships around
the developing world. It is designed to be used
as a tool for stakeholders seeking to build and
manage partnerships to address global health
challenges. It is the first time that such a broad
array of health partnerships in Africa has been
presented.
The report was published by an alliance
made up of Global Health Progress (GHP), a
joint initiative of research-based biopharma-
ceutical companies; the Bill & Melinda Gates
Foundation; the International AIDS Vaccine
Initiative (IAVI); the Association of Univer-
sity Technology Managers (AUTM); and the
World Health Organization (WHO) program
Tropical Disease Research.
The case studies focus on successful part-
nerships in four categories: access to medicines
and health services, discovery and develop-
ment of new drugs and vaccines, health inter-
vention and prevention programs, and health
systems strengthening and capacity building.
“Although they represent diverse causes,
activities and partnerships, the case studies
share a common theme,” said Mr. Christo-
pher Singer, President International of Phar-
maceutical Research and Manufacturers of
America (PhRMA), a founding member of
GHP. “Successful programs engage partners
and policymakers early, communicate openly
and frequently with relevant stakeholders, and
empower and involve communities.”
Among the case studies included are:
■ Advance Market Commitment (AMC),
which brings together donors, governments
and biopharmaceutical companies to ensure
the development of new vaccines for diseases
prevalent in poorer countries by guaranteeing
a market for the vaccines;
■ The partnership between the Global Al-
liance for TB Drug Development and Bayer
Healthcare to develop a new first-line tubercu-
losis treatment;
■ The Apparel Lesotho Alliance to Fight
AIDS (ALAFA), which brings together U.S.
retailers and garment factories and unions in
Lesotho to provide prevention and HIV test-
PHOTO : VANESSA VICK/CASE STUDIES FOR GLOBAL HEALTH
A laboratory technician examines an HIV
candidate vaccine supported by IAVI.
ing programs;
■ The partnership between the Government
of Tanzania and Abbott Laboratories to build
capacity in the Tanzanian health system by
improving laboratory infrastructure and ser-
vices;
■ The development of vaccine vial moni-
tors by a partnership that included the WHO;
global health NGO PATH; the U.S. Agency
for International Development (USAID); the
Global Alliance for Vaccines and Immuniza-
tion (GAVI); the United Nations Children’s
fund, UNICEF; and the U.S. Centers for Dis-
ease Control (CDC). The monitors indicate if a
vial of vaccine has been exposed to heat.
■ The International Partnership for Micro-
bicides (IPM), which is working to develop
microbicides for women to use to avoid HIV
infection;
■ The development of the RTS,S malaria
vaccine by GlaxoSmithKline in collaboration
with the PATH Malaria Vaccine Initiative (see
story on front page);
■ A collaboration between PATH, USAID,
biopharmaceutical company Boehringer In-
gelheim, the Elizabeth Glaser Pediatric AIDS
Foundation and the Kenyan Ministry of Health
to develop a simple nevirapine delivery system
for newborns. A single dose of nevirapine can
prevent mother-to-child transmission of the
HIV virus;
■ A partnership between the Accordia Glob-
al Health Foundation, ExxonMobil and the
Ugandan Infectious Diseases Initiative (IDI)
to create the Ugandan Malaria Surveillance
Program; and
■ Links for Life, which promotes learning
and advocacy around integrated HIV and food
security programming. With pilot programs in
Ethiopia and Malawi, Links for Life currently
involves about 45 organizations seeking to fos-
ter advocacy at the grassroots level.
PREPARED AND DISTRIBUTED BY THE WHITAKER GROUP
LEADERS IN HEALTH
DR. BENJAMIN KUMBOUR
MINISTER OF HEALTH, GHANA
Dr. Benjamin Kum-
bour, Ghana’s new
Minister of Health,
came into office in
November with an
ambitious goal: to
provide universal
health access to all
Ghanaians by com- Dr. Kumbour
pletely overhauling
the country’s health system.
His priorities include restructuring
the National Health Insurance Scheme to
expand it beyond its current 12.2 million
members, cutting the inefficient use of re-
sources to enable the Ministry to allocate
more to health services for lower income
communities, and slowing the drain of
skilled health professionals from Ghana
by building incentives and greater train-
ing capacity into the health system. He is
also seeking to improve and expand Gha-
na’s health infrastructure, particularly in
poorly-served rural areas.
Previously Deputy Minister of Health,
Dr. Kumbour has already been closely in-
volved in the groundwork for some of the
initiatives he will drive as Minister, and
his prior positions as the Deputy Minister
of Education and as the minority spokes-
person in the Ministry of Finance have
given him invaluable experience in man-
agement and finance.
Dr. Kumbour recently told a gathering
of health professionals in Ghana that the
Ministry of Health will move away from a
disease-centered approach to health care
to a system that will focus on prevention
and promoting health lifestyles.
He said that it was particularly impor-
tant to mobilize local communities and
improve health infrastructure in under-
served areas. Over the next few years, 21
new health centers will be built in rural
areas and four existing ones upgraded to
district hospitals.
Further, Dr. Kumbour said he was
committed to increasing Ghana’s train-
ing capacity for health workers, and has
pledged to increase admissions at health
training institutions, establish further
clinical sites for practical training and
create linkages with foreign health insti-
tutions to improve health education.