The MRC Unit The Gambia (MRCG) represents a unique concentration of scientific expertise and high quality research platforms in the West African region. For almost 70 years, the MRCG has tackled major infectious diseases of global public health importance in sub‐Saharan Africa and is currently a focused centre for delivering excellent global health research under the strategic aim 3 of the current MRC 10‐year strategic plan, i.e. going global – accelerating progress in international health research. Its research output has informed the implementation of public health interventions that have had (and continue to have) a major impact on childhood mortality and morbidity, not only in The Gambia but also in other sub‐Saharan African countries. The Unit’s investigator‐led research is underpinned by the combination of excellent laboratory facilities and easy access to the field with well‐defined populations that are highly supportive of our research, excellent clinical services, rigorous ethical procedures and ability to deliver GCP‐compliant clinical trials. Its large research portfolio spans basic research to the evaluation of interventions for the control of diseases of public health importance in sub‐Saharan Africa.
The number of scientific publications has steadily increased, to reach 157 publications in 2014‐2015, the highest figure in the last 10 years. A large proportion of these publications had a first and/or last MRCG’s author.
Building on these achievements, for the next 5 years, the MRCG’s scientific vision is to contribute to the post‐2015 sustainable development agenda by producing the evidence base to improve health in West Africa and beyond. More specifically, the MRCG will:
- Contribute to the control/elimination of infectious diseases of public health importance in West Africa and sub‐Saharan Africa;
- Address the unacceptably high burden of maternal and neonatal mortality;
- Design and implement next generation interventions against nutrition‐related diseases through discovery science;
- Strengthen research on NCD associated with infections.
The MRCG is structured into three research themes, a structure that provides important opportunities for inter‐theme synergy.
The Disease Control & Elimination (DCE) theme’s scientific strategy focuses on investigating the interactions between hosts, pathogens and vectors, and evaluating interventions aimed at interrupting transmission and/or reducing the disease burden. Its research portfolio includes diseases of public health importance in West Africa at different stages of control or elimination, e.g. malaria, bacterial diseases, hepatitis B. The Nutrition theme (NUT) aims at understanding the pathophysiology of diet‐disease interactions in order to accelerate the development of more effective next‐generation community and clinical interventions. Examples are the studies on iron regulation and relation with infectious diseases such as malaria and bacterial infections; and those on the peri‐conceptional diet and the epigenetically‐mediated adverse Outcomes.
The Vaccines & Immunity theme (VI) thrives to understand the ontogeny of immunity to inform the design of vaccines and maximise their impact. Through laboratory science and clinical trials, VI aim to contribute to the evidence based development and deployment of vaccines. The VI also undertakes a series of translational and more fundamental immunological studies aiming at understanding the development of the immune system in infancy, particularly in the context of bacterial colonisation and infectious diseases. Its TB research focuses on the identification of correlates of protection in adults and children in order to ultimately inform TB vaccine design.
The research platforms and the clinical cohorts represent the basis on which a large proportion of scientific research funded through competitive grants is conducted. They provide an important competitive advantage when submitting research grants, the opportunity to carry out preliminary, exploratory work and to host PhD and career development students. All MRCG researchers have access to all platforms and cohorts. These include the health demographic surveillance systems in West Kiang, Farafenni and Basse, covering overall a population of about 240,000 people; the West Africa Collaboration on which the MRCG will further develop a stronger engagement in West Africa; the Clinical Research platform, now combining the MRCG clinical services, the Sukuta Health Centre and the paediatric ward of the Edward Francis Small Teaching Hospital (EFSTH) in Banjul, and aimed at increasing and better coordinating clinical research; and the Tuberculosis Case Contact platform that provides the ideal framework to identify correlates of protection and risk in populations who are TB‐exposed, infected or diseased.
Previously structured in seven different sections, research services are now divided into two clusters, namely the research governance and support services (RGSS) and the laboratory services (LAB). The former has been created with the aim of better coordinating activities between its different components (clinical trial support, data management and statistics, research development and project management) and thus providing support to investigators to carry out clinical research at the highest possible standards. LAB includes all laboratory activities carried out at MRCG, plus the biobank and biomedical engineering, and is essential for producing world‐class science. The malaria research platform (Malaria Diagnostic, Entomology, Epidemiology) in the current quinquennial period has been fully integrated in LAB. The clinical lab, the serology and TB labs have successfully achieved full GCLP accreditation and the more stringent ISO 15189 accreditation standards is about to be awarded.
Training and capacity building represents an important proportion of the MRCG’s activities. Between 2010 and 2015, the MRCG supported the training of 203 individuals, with MSc representing 24% and PhD 13% of the overall training. For the next quinquennial period, 2016‐21, we will align our training strategy more closely with MRCG’s skills needs.
The MRCG’s engagement in West Africa will be further pursued by first creating an alliance between the MRCG and University of Cheikh Anta Diop (LBV‐UCAD) in Dakar, Senegal. This will evolve in the next 4‐5 years into a new legal entity, namely a West Africa Institute for Health Research (WAHR). This will focus initially on malaria, HIV and maternal and neonatal health as the main research topics. It will have the ambition to become the regional hub for health research and training, and will establish collaborative links with other research institutions and universities in the region. Overall, The Unit will allocate 17% of its total budget to the implementation of the West African engagement.
In the next 5 years, thanks to the excellent research services and laboratories, research platforms and the particularly enabling environment, the MRCG is well positioned to play an essential role in further advancing international health research and having a significantly positive impact on the health and wellbeing of the populations in sub‐Saharan Africa.