Overview
The MRC Unit in The Gambia is the UK’s single largest investment in medical research in a developing country and is internationally recognised for its track record of research into tropical infectious diseases. Its success is based on innovative laboratory based research, excellent clinical studies and field-oriented science and the translation of research into clinical and public health practice. Notable achievements have included:
- pioneering demonstration of the impact of insecticide treated bed nets as a preventive measure against malaria, an intervention that is now the cornerstone of malaria control activities worldwide;
- establishing the efficacy of Haemophilus influenzae type b vaccine in The Gambia for the prevention of both meningitis and pneumonia, with subsequent studies showing the near elimination of Hib disease following the introduction of the vaccine into the national programme of immunisation;
- landmark work confirming the impact of conjugate pneumococcal vaccines on pneumonia and demonstrating that the vaccine has a significant impact on child mortality;
- the demonstration of a dramatic and long-lasting reduction in the carriage of Hepatitis B virus in The Gambia following the phased national introduction of infant Hepatitis B vaccination accompanied by a 40-year study to establish the duration of protection and the impact on the incidence of liver cancer.
The Unit continues to implement its vision ‘to lead scientific research to save lives and improve health across the developing world’ and aims to further this through major research themes and the development of new networking and funding opportunities. The close proximity of the International Nutrition Unit in The Gambia provides the opportunity to further enhance investigations of the important role of nutrition in each of our research themes.
Research of regional priority
Research at the MRC Unit in The Gambia remains focused on the health priorities of The Gambia and neighbouring countries in the West African sub-region. Building on the excellent laboratory and clinical facilities and the long experience of community-based studies, our focus will continue to be on tackling key health priorities through excellence in science that can be done especially well in The Gambia and for which the Unit has a clear competitive advantage.
In addition to maintaining and strengthening our strong collaborative links with Northern Partners, the Unit is developing new research partnerships with institutions in neighbouring countries. MRC Unit, The Gambia has a leading role in the regional HIV-2 network and the PneumoWAR invasive bacterial disease network. The secondment of a senior MRC scientist to Cheikh Anta Diop University (Senegal) embodies this new scientific and capacity building strategy.
An enabling framework
The Unit’s Business Plan, (2010/11- 2014/5) approved by MRC Council, provides core funding for the “Research Platform” which comprises one of the strongest concentrations of international research in a developing country including 300 clinical, scientific, technical and administrative staff in The Gambia, Senegal and Guinea Bissau. The Research Platform is an innovative model, which embraces a range of activities (infrastructure, clinical services, IT, transport and well equipped laboratories) to support internationally competitive, externally-funded research that is organised into three themes: Child Survival; Vaccinology; and Disease Control & Elimination.
Building on the Unit’s core resources, research under the themes aim to address national and global health needs; to strengthen further sub-regional and international links; and to tackle key UN Millennium Development Goals, particularly the goal of reducing childhood mortality by two thirds by the year 2015 with the objective of surpassing this target. These thematic areas allow the Unit to focus on internationally competitive science of public health relevance and to respond to new international funding opportunities. 
Child Survival
Child and infant mortality rates remain high in Sub-Saharan Africa and West Africa remains the epicentre of child mortality in the world. Advancement of child survival has been at the heart of much of the Unit’s work, from vaccine trials to bed nets. MRC Unit, The Gambia is very well-placed to build on this track record to pursue the strategic priorities that currently have the highest potential for impact. These include establishing the current determinants of mortality in the community including the priority challenge of neonatal mortality: documenting trends in child survival from two geographically different surveillance sites in Basse and Farafenni: developing strategies for specific and combined interventions to improve child survival including nutritional, environmental, and social measures and interventions to improve access to care; pursuing vaccine field and modelling studies: and research on diagnosis and treatment of the sick child, including care in a hospital setting and first- level health facility.
Vaccinology
The evaluation of novel vaccines in all phases of development has played a very important part in the scientific tradition of the MRC Unit in The Gambia. New tools, such as sophisticated flow cytometry and PCR-based technologies that are now available to immunologists and molecular biologists enable us to explore further the basic mechanisms that underpin success or failure of vaccines currently in use or under development. We are able to study host-pathogen interactions, not only in vitro but also in the natural environment where infectious diseases continue to represent a major challenge to the health particularly to young children. We are ideally placed to conduct cutting-edge studies of the evolving immune response in healthy African children of all ages, which underpin rational vaccine design. In addition, we address disease-specific research questions in selected study groups in hospital as well as in community settings.
Disease Control & Elimination
The Disease Control & Elimination theme aims to conduct cutting-edge, multidisciplinary research to develop approaches to curb the burden of diseases of public health importance. The inclusion of the word “elimination” in the theme definition encompasses the research portfolio that includes trachoma, a disease that has almost been eliminated in The Gambia, and malaria, for which pre-elimination level should be achieved by 2015. The research on hepatitis B within the theme provides a link between the control of communicable and non-communicable diseases, i.e. hepatitis B infection and hepatocellular carcinoma. The Disease Control & Elimination theme will exploit the availability of excellent laboratory facilities and the scope to carry out population studies to elucidate complex and heterogeneous host-pathogen/parasite-vector interactions. Understanding such interactions in areas under intensified disease control is critical for the development of scientifically-based control/elimination plans for the whole African continent. Indepth analysis of the human behavioural factors including migration that affect disease risk is an essential component of the theme’s methodological approach. Joint research projects with institutions located in other West African countries allows a wider view of specific public health problems and provides the opportunity to compare the impact of new interventions in settings with different disease endemicities.
Promoting synergistic thinking
There are obvious overlaps between the three themes. These will facilitate synergy in the research and among the research scientists who are encouraged to form “working groups“ covering specific cross-cutting disciplines such as molecular diagnostics, immunology and epidemiology e.g. malaria and pneumococcal disease.
Strategic aims
The Unit’s new direction will allow the pursuit of three strategic aims with renewed vigour:
- Getting Research into Practice through the support and development of relevant, competitive research on the major causes of morbidity and mortality in The Gambia and the Sub-Region, conducted at the highest level of international scientific and ethical standards.
- Enhancing the quality of our scientists through the development of a cadre of independent African and other international scientists and research leaders capable of winning major international grants.
- Influencing and leading global networks capable of conducting large-scale multi-centre clinical trials and research studies, and able to provide rapid responses to major West African and global public health questions.
Getting Research into Practice
The leveraging of our research to ensure a public health impact is uppermost in MRC Unit, The Gambia’s thinking and plans. A great strength of the Unit’s child survival work is that so much of it is, and will remain close to or at the translational end of the research process spectrum. The development and roll-out of preventive interventions such as vaccines and nutritional, environmental and social measures, along with practical treatment-focused measures such as bedside diagnostics, IMCI, oxygen treatment, and other measures with immediate as well as longterm benefit is at the forefront of the child survival strategy.
Research on improved diagnostic technologies for the accurate and speedy identification of pathogens is required to develop appropriate treatment and prevention strategies, Our work is also uniquely placed to examine changes in both pathogen or host responses following the introduction of novel vaccines, such as pneumococcal vaccines. In addition, relevant clinical trials conducted by the Unit under GCP conditions will inform vaccine policy decisions in our own and wider communities.
Our research is carried out in close collaboration with national public health authorities. Our participation in several control programmes based at the Ministry of Health of The Gambia ensures that research projects are developed in response to specific questions posed by the control programmes. Each project is discussed from its conception with the relevant local authorities so that, where possible results can be rapidly translated into specific interventions. Networking with other institutions in neighbouring countries where the same approach is adopted makes it more likely that research results are taken up by the relevant health authorities in the Region.
Enhancing the quality of our scientists
The continuous training and career development of scientists working at the Unit at all levels is mandatory in order to achieve independent funding within the competitive environment of Global Health. The Unit in The Gambia aims to compete for international funding by developing all its areas, from basic science to clinical trials capacity within the region. This goal is only achievable by identifying and retaining our most talented scientists and providing them with individual mentorship and career development opportunities in both laboratory-based and field science. Our collaborations with international partners represent an additional strength in this endeavour, since it allows our scientists access to cutting-edge technologies which might not be available on site, but which can be applied to the unique samples we are able to obtain in our own settings. Such collaborations are of mutual benefit, if they involve career development opportunities, and will be actively sought.
Influencing and leading global networks
The Unit in The Gambia is uniquely poised to lead proof-of-principle and pivotal studies built on the framework of the Unit’s growing regional networks such as the HIV and PneumoWAR networks already highlighted. Our scientific publications will continue to make the Unit visible to the world’s scientific community whilst enhancing our ability to influence and lead international networks. These will continue to provide relevant data to policy networks such as WHO, GAVI and EPI. Our regional collaborations will further develop Child Survival, Vaccinology and Disease Control and Elimination as key themes within West Africa; such networks will have the power to identify regional synergies and facilitate the progression from research into policy and practice. The themes aim to attract leading internationally active research groups and to create a unique network of collaborating institutions able to respond optimally to fill critical knowledge gaps. To see our science flourish in the international context is a long-term goal, which is nurtured by a focus on quality.
Measures of success
MRC UK’s Strategic Plan and dialogue with Unit scientists have helped to define the following as measures of the Unit’s new development and research programme:
- Publications in high impact and relevant journals
- Research informing and influencing health policy in West Africa and beyond
- The development of a critical mass of West African scientists of international repute
- Influencing and leading international networks and collaborations
- Meeting set targets for external grants and sponsors
- Significantly contributing to international forums in science
The Unit welcomes the opportunity to adapt, grow and change while continuing to undertake research on the key public health issues of relevance to The Gambia and the developing world.
