Conversations on Country Ownership in Malaria Research

With Kamija Phiri, Rebecca Pwalia and Yaw Bediako

My good-humoured African colleague recently shared a thought-provoking observation, “We all know malaria as the enemy, but we tend to overlook the fact that this disease was arguably the most powerful force persistently impeding the progress of the colonial project.”

The desperate pursuit of the “empires” to defeat this formidable foe, profoundly shaped malaria research, leaving a stain on its history and continuing to influence the pathways for decision-making for malaria control and elimination. 

An open letter published in 2021 highlighted a startling finding: locally-led, in-country research institutions in Africa, that play a crucial role in advancing malaria research, received only 1% of the total funding allocated to malaria aid in 2017. This letter, along with other seminal publications such as Abdisalan Noor’s article ‘Country ownership in global health’ have helped gain momentum for the much-needed conversation on ‘country ownership’. 

To enrich the global discourse and amplify the voices of our peers, MESA has initiated a series of interviews featuring varied profiles from the malaria community and highlighting their take on country ownership, including perspectives on concrete ways to support the end goal of countries charting their unique malaria elimination journeys.

In this first edition, we bring forward a dialogue with three inspiring African researchers: Kamija Phiri (KP), Rebecca Pwalia (RP), and Yaw Bediako (YB).

What does ‘country ownership’ mean to you?

KP: Research questions should be driven by the country, to solve local problems and meet local needs. Country ownership is also ownership of the research processes. This is not limited to just the conduct of the research but also the intellectual property, the results, and the data. If there are biological samples, how and where are they being processed and who is in charge of them, all of this has to be well-articulated and always owned by the country.

RP: Country ownership involves countries taking charge of their malaria control strategies by involving leaders and relevant stakeholders. It also means taking ownership to develop policies and outlining their goals and visions in their local context to eliminate malaria.

YB: Country ownership means that the endemic countries take the lead in deciding what kind of control programs they need and what kind of research they think should be done. We are in an era where there is recognition that there is still a need for external funding, but that should not undermine the sovereignty of the individual countries in determining their local agenda.

What are some unique challenges that malaria researchers in Africa face?

KP: The biggest challenge that I can think of is actually having female researchers leading malaria projects. There are not a lot of researchers in Africa in general, but of the few, most of them are male. It is time that we really invest in capacity and ensure that there are more female researchers. The other challenge I believe is that sometimes we are not as proactive and hungry to apply for grants. I have sat on a lot of panels to award grants and I see very few proposals come in from African countries. Perhaps we think that we are not good enough and question ourselves and in the end, we let opportunities pass us by. 

RP: Lack of mentorship is the number one challenge. You can spend your whole life going to school and end up not knowing where you are headed because you don't have anyone to guide you. If we had such guidance, especially in the field of science, we would have a lot more African scientists, especially women scientists. I was lucky to identify opportunities and receive guidance from senior research fellows and line managers. So in my lab, I also try my best to guide and mentor young members of the team. Funding is the other challenge. Due to the lack of funding, we are often unable to attend meetings and conferences, missing out on important knowledge and opportunities to network and collaborate.

YB: Funding is our biggest challenge. Since there is little local funding for our work, most of us are funded by grants from external sources, usually based in Europe or North America. This places us in a rather vulnerable position where we have to balance a desire to chase ideas that we find interesting with a need to align our interests with what is considered a priority by the funding agencies. Another challenge is the logistics of doing science. The cost of getting an antibody to my lab in Accra may be five times the cost if the lab was based in London. 

The cost of getting an antibody to my lab in Accra may be five times the cost if the lab was based in London.

What are some promising developments in the African research landscape?

KP: Over the last couple of years, there have been some really good achievements such as the malaria vaccine. Something a little bit closer to my heart is my group’s research on the new innovative strategy for preventing malaria in severely anemic children. We have shown that if you do cover these children with an antimalarial for the first three months post-discharge, you can drastically reduce their risk of dying by close to 90% and the risk of hospital readmission by close to 70%. This has been recommended by the World Health Organization and I am really proud of my team for achieving this. 

RP: We are seeing increased collaboration within the country for evidence-based decision-making. For instance, the medical entomology research group at my institute collaborates with the National Malaria Elimination Program in Ghana to collect data on insecticide resistance in malaria-causing mosquitoes to inform policies. Moreover, a lot of scientists trained abroad have come back with networks and expertise which has further resulted in increased capacity in Africa to conduct research that was previously not possible, such as advanced genomics research. 

YB: The most promising development over the last decade has been the realization, especially by funders and partners overseas of the need for country ownership. We need African homegrown solutions for African problems. Now there is more focus on supporting African leaders in science and young investigators like myself are empowered to chase our ideas. In my area of work, we are seeing the emergence of bio-entrepreneurship in Africa and we are starting to view science as more than an academic pursuit and we are gradually starting to develop an Africa-led scientific ecosystem.

A lot of scientists trained abroad have come back with networks and expertise which has further resulted in increased capacity in Africa to conduct research that was previously not possible.

How can African malaria researchers contribute to the priority-setting processes for malaria elimination efforts?

KP: We researchers need to step into the next phase of engaging policymakers with our results so that they can be taken up as policy. I am currently working with the Ministry of Health in the Malawi government, trying to ensure the uptake of the post-discharge malaria chemoprevention strategy. This has included hours of monthly meetings, presenting to various committees, and being available to provide information and advice. This is a lot of work that researchers are not used to doing, but if we do not engage with policymakers, we will not be able to influence the malaria elimination plans.

RP: In addition to conducting research, researchers should engage with community leaders, governments, and national malaria programs. We should also explore opportunities for local funding to conduct research on alternative solutions by exploring the nature-based ways in which our forefathers protected themselves from diseases like malaria. But most importantly, our governments should recognize the importance of work such as vector control and incentivize African scientists to advance their research.

YB: I use the analogy of our fight for independence. Independence is not given to you, you have to take it. As African scientists, we need to begin (maybe I won't call it a fight) to be collaborative, really step up and demonstrate quality. We need to demonstrate that we are capable of doing science at an internationally competitive level and that we have the leadership skills to propose solutions. There is a lot that Africa can teach the world about affordable healthcare and we need to make our work visible and demonstrate the value that Africa brings to the global discourse.

If we do not engage with policymakers, we will not be able to influence the malaria elimination plans.

This series of interviews by MESA is an attempt to unpack ‘country ownership’ to explore how malaria-endemic countries are taking charge of their own narrative. 

Kamija Phiri is a Professor at the Kamuzu University of Health Sciences. He is also the founder of the Training and Research Unit of Excellence (TRUE), a Malawi-based independent research organisation. He sits on the Malawi National Malaria Advisory Board which advises the Ministry of Health on all matters related to malaria control and is a recipient of several awards, including the 2012 Merle A. Sandee Health Leadership Award in Africa.

Rebecca Pwalia is the Chief Research Assistant at the Vestergaard-Noguchi Memorial Institute for Medical Research Vector Labs in Ghana where she is leading a team of 12 research scientists for the development of vector control tools. She is passionate about advancing women in science and actively works to promote opportunities for women in the field of vector control.

Yaw Bediako is an immunologist and CEO of Accra-based start-up, Yemaachi Biotech. He is also a research fellow at the West African Centre for Cell Biology of Infectious Pathogens at the University of Ghana. Bediako was selected as a Calsestous Juma Science Leadership Fellow by the Bill and Melinda Gates Foundation and is an Affiliate member of the African Academy of Sciences.