EAGLES flies in to link Europe and researchers in developing countries

SUMMARY: An enthusiastic new group of successful scientists met in Alexandria last month to begin bridging the gap between developing country researchers and those in richer countries, especially in Europe – where a USS$63 billion seven-year research fund is about to be carved up. Diabetes was their test case.

(May 06)

European Research Commissioner Janez Potoènik enthused to delegates at the BioVision conference at the New Library of Alexandria last month that a brand new, independent initiative of leading life scientists to link up with partners in developing countries – EAGLES – was about to play a very important role for Europe.

Thus the European Action on Global Life Sciences (EAGLES), whose full steering committee met in Alexandria for the first time on 29 April, is beginning full of hope and ambition.

In Alexandria, EAGLES held parallel meetings on desertification, and the growing global challenge of diabetes, clarifying underlying issues and seeking to identify top-level research partnerships with the South. These could be funded by the Commission – and perhaps other partners.

EAGLES plans meetings in September in Ougadougou on HIV/AIDS, and later on TB and malaria, and will publish ten position papers on the challenge and opportunities for North-South research collaboration to improve life in developing countries.

Chaired by Ismail Serageldin, Director, New Library of Alexandria, its Executive Director is Danish science journalist and broadcaster Jens Degett. “We felt huge interest in our programme, not only from Europe, but also developing countries, the US and Japan” Degett told RealHealthNews.

“The strong supportive statement for EAGLES from Commissioner Potoènik indicates that the European Commission is eager to improve the collaboration between European researchers and researchers in the developing world” said Degett. “I believe that EAGLES is the institution that will make this possible.”

A bridge between the Commission and developing countries, to identify and encourage developing country participants and programmes to join in – and influence – Commission research, is desperately needed. The Commission’s next major R&D period and plan, the US$63 billion Framework Seven (2007-2014), is described in 300 pages of densely worded text, and even Europeans are beginning to pay for special seminars to understand its intricacies.

EAGLES, though currently tiny, with a small panel of committed scientists and a handful of staff, promises to be the first stone in the creation of a bridge between this European mammoth, and the South, for the life sciences.

EAGLES will focus mostly on health sciences but will also cover agriculture and nutrition. “We want to encourage collaborations and partnerships with developing countries in which the researchers are on equal terms” said Degett. “And we want to push the Commission to spend not its current 3% of its research funds on developing countries, but 5%.”

The concept of EAGLES emerged from a series of discussions about European policies for cooperation with developing countries in biotechnology, initiated by the President of the European Federation of Biotechnology, Børge Diderichsen and the Director of the Beijing Genome Centre, Huanming Yang.

Diderichsen is Vice-President, Corporate Research Affairs, of the Danish pharmaceutical company Novo Nordisk, which has a reputation for a strong commitment to social responsibility through its “triple bottom line”, adding responsibility and the environment to profitability. The result is trust, said Diderichsen, which makes good business sense. Novo Nordisk fund the World Diabetes Foundation (WDF), which supported the two-day EAGLES diabetes meeting in Alexandria.

So what did EAGLES conclude in this meeting? Basically, the measure of the problem – which appears to be grossly neglected by the Commission – and guidelines for practical research collaborations with the South. With further rounds of consultation – including with the Commission itself – these will be transformed into a position document from EAGLES to the Commission, aiming to influence research policy and open new lines of North-South research collaboration.

Thus EAGLES heard that diabetes is a chronic disease leading to nerve damage, circulatory disorders, blindness and amputations – and predisposes sufferers to infectious diseases. WHO predicts the global diabetes population will grow to more than 200 million in 2010 and 330 million in 2025, with developing countries bearing the brunt of this epidemic.

Obesity and sedentary lifestyles are important risk factors, the meeting heard. According to WHO, more than 75% of women over the age of 30 are now overweight in countries as diverse as Egypt, Mexico, South Africa and Turkey. Estimates are similar for men, with over 75% now overweight in Argentina, India, China, Kuwait and Greece.

In Tanzania, a massive 28% of MPs were diabetic, Kaushik Ramaiya of the International Diabetes Federation (IDF) told EAGLES – but only 1-3.5% of people in rural areas. But the urban rate is 3-7.7%, he said, and urbanization is growing at 6% a year.

Deaths were mostly metabolic and renal failure, he said, and average direct costs US$489/year/case, threatening a growing burden on over-pressed health systems, in which the poor will suffer at the expense of the rich. In China, there were some 40 million cases of diabetes, with another 40 million in an early pre-diabetic condition, the meeting heard. Diabetes mortality had risen five-fold in China from 1975-95. And an estimated 60-70% of cases went undiagnosed.

“Yet one of the big barriers we face at WDF is that when we meet development agencies, they always say chronic diseases are not important in the developing world!” Anil Kapur, WDF Managing Director, told RealHealthNews.

“I can confirm that” said Diderichsen: “When EAGLES asked the European Commission to support this meeting, we were told they wouldn’t – as they thought diabetes was not a problem in the developing world! And they claimed it was not poverty-oriented.”

But EAGLES is intended to focus on research, so what research collaborations were recommended? WDF was keen to emphasise that solutions to diabetes were at hand – such as healthy lifestyles – and initially Kapur seemed inimical to recommending more science.

“You can do a lot of research, and spend money very easily” he said. “But if it’s research that translates into action….”

According to WDF’s Jamal Butt “An increasing focus is needed on R&D in developing countries and how the EU can support that.

“We should focus on three or four issues like socioeconomic factors – it can’t be hard-core genomic research that you support in these countries but work for example related to prevention, understanding the disease prevalence, understanding the epidemic itself,” he said. “We haven’t got a complete handle on what is going wrong, to create these epidemics. Then there’s practical research to stop the epidemic – finding specific solutions.”

Also, according to one participant “if you increase the knowledge base, you get greater power to deal with the politicians to change the situation.”

“In a lot of countries there’s no data,” agreed another. “There are 36 countries in Africa, but we’ve only got solid data in 3-4! In other countries, no one knows what is happening…. And a politician will only listen to data from his or her own country, or the lack of it will be an excuse to do nothing.”

Another possibility was implementation research, recommended a delegate from Tanzania. “A few years ago there was an EU grant for a project known as AfroImplement. They took six countries in sub-Saharan Africa and trained them in research methodology, studying healthcare systems – and above all, how to operationalize their findings. As a result, most of these countries are now running useful rural health projects.”

But the research must be practical, emphasized another. “Enough pilot work has been done in the regions. We need to expand where there are gaps, and translate results into affirmative action so people with diabetes actually benefit, rather than just scientists benefiting by writing papers.”

“What kind of research would move the political system in a country to take action?” the meeting was asked.

“It’s not only epidemiology,” said one expert. “I think it’s also important to understand what is happening to the level and quality of care. That would actually help that care to be improved.”

“So [the research] should actually be at three levels,” said Butt: first, primary prevention, where you are looking at who has diabetes, what are the risk factors, and can we do something to prevent it; second, what’s the quality of care at primary and district level; and third what is the level of care for people with complications, at tertiary level, like laser treatment for retinopathy. For example there may not be a single foot clinic in the country. This is not basic research, but knowledge on these things would be so useful!”

Another issue worth investigating in developing countries was how to improve information, education and communication – essential in making the lifestyle changes that could control the epidemic.

“So how do you address specific issues in specific nations?” asked Anil Kapur. “How do you modify nutrition? How do you change misconceptions? There are lots of things that can be done at that level to understand the dynamics of the epidemic.”

Another issue was to translate success stories in one part of the world into another country. “It usually needs a study,” said one participant. “You take the tool, and test it out, looking at cultural factors, adapting, and getting politicians to take notice in that country.”

“An example was the Diabcare-Asia study,” said Kapur “which was done in 12 countries. It was basic data collection, on a single sheet of paper and doing one test. Data was collected on 25 000 cases – and that became a basis for addressing policy-makers, and saying ‘this is what’s happening to care’. And asking ‘can we do something about it?’ and leading on to guidelines.

“So one idea I have is that several countries should have a study like this, produce guidelines, and identify people who would start implementing these guidelines; then after a year they should go back and repeat the same study, and see what has changed.

“My belief is that a lot of the issues are in doctors’ behaviour as well as in patients’ behaviour; and that when a doctor becomes a subject of study, his or her behaviour will change. So [as a result of a study] you’ll see more people being measured for blood pressure, more eyes being examined.”

On the genetics of diabetes, several initiatives already exist, the meeting heard. But there were intriguing issues in why some communities seemed at greater risk of type 2 diabetes than others, even after correction for weight, diet and exercise – with ethnic Indians in Tanzania, for example, having about double the risk of Africans.

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