The Africa Centre for Population Health

The Africa Centre for Population Health in Somkhele is half of a new major research institute.

B. Gilbert/Wellcome Trust

Research charities help marry two major South African HIV/tuberculosis institutes

As the International AIDS Conference kicked off in Durban, South Africa, today, two of the nation’s most prominent biomedical research institutions announced that they will marry and combine resources to attack the raging coepidemic of tuberculosis (TB) and HIV in the region. 

The new Africa Health Research Institute, backed by the deep-pocketed U.K.-based Wellcome Trust and the equally flush U.S.-based Howard Hughes Medical Institute (HHMI), plans to connect basic research to population-level studies and clinical trials. “This is something very strong,” says Bruce Walker, an immunologist at Massachusetts General Hospital in Boston who is an HHMI investigator.

Many fundamental questions remain about why HIV spreads so fiercely in South Africa, which has more people infected with the AIDS virus than any country in the world. South Africa also has a huge burden of TB, caused by a mycobacterium that thrives in an HIV-compromised immune system, and badly needs both better diagnostics to detect cases and more effective treatments to combat widespread multidrug-resistant TB strains. The Africa Health Research Institute promises to attack these overlapping problems—both of which are at their worst in the province of KwaZulu-Natal where the institute resides—with a unique combination of high-powered basic research and biological samples, such as blood or lung tissue, from tens of thousands of people who have carefully documented health histories. “We’ve got significant funding and significant expertise and it really has a huge potential,” says clinical virologist Deenan Pillay, who will head the new institute. “There’s nothing like it as far as I can see anywhere in the world.”

Deenan Pillay will head the new Africa Health Research Institute.

Deenan Pillay will head the new Africa Health Research Institute.

B. Gilbert/Wellcome Trust

The creation of the Africa Health Research Institute also provides a solid home for two institutions that each have faced uncertain futures. One of the partners in the merger is the KwaZulu-Natal Research Institute for TB-HIV (K-RITH), which HHMI created in 2008 at the suggestion of Walker. The idea was to create a strong basic research institution at the heart of the HIV/TB coepidemic that would bring in world-class researchers and train a new generation of African scientists. HHMI spent $40 million building a state-of-the-art biomedical facility, including a biosafety level 3 lab that can handle dangerous pathogens such as drug-resistant TB and HIV. “In terms of facilities, I don’t think there’s any place that comes close in sub-Saharan Africa,” Walker says.

But K-RITH ran into trouble soon after it opened its doors in 2012. Its first director, William Bishai, a TB investigator from Johns Hopkins School of Medicine in Baltimore, Maryland, ended up resigning a year later after HHMI, which emphasizes “fundamental research,” told him not to pursue clinical trials. HHMI feared that this would veer from its mission and also could make the philanthropy vulnerable to lawsuits, says developmental geneticist Dennis McKearin, an HHMI administrator in Durban who ran K-RITH after Bishai left. 

Several others familiar with the episode told ScienceInsider, and Bishai confirms, that HHMI also had concerns that he inappropriately used its funds to pursue clinically related projects. Bishai insists he did nothing wrong and is “very proud” of how he ran K-RITH. “Why put in $100 million to study TB and HIV and put the right hand in a sling and prevent it from reaching out to the patients?” he asks.

Science

Barry Bloom, a TB researcher at Harvard T.H. Chan School of Public Health in Boston, who led the search committee that selected Bishai for the job, says HHMI did not have a policy about clinical research when K-RITH opened, but it was clear to him that the philanthropy blanched at the idea from the outset. “Howard Hughes said they would not have anything to do with patients,” Bloom says. “What Bill didn’t understand is they were serious. I told him 100 times over. He was a bull in a china shop.”

“When Bill left it had an enormous negative backlash on K-RITH,” notes Kristina Wallengren, an epidemiologist and molecular biologist who was clinical adviser at the institute but formally tied to Johns Hopkins. “It was enormously damaging to the scientists.” (Wallengren now heads a nonprofit in Durban, the TB & HIV Investigative Network, that stages clinical trials.)

The other partner in this new union, the Africa Centre for Population Health, embraces clinical research, but it too has gone through upheavals. Established by the Wellcome Trust in 1996 in Somkhele, about 235 kilometers north of Durban, it has focused on observational studies that track HIV’s spread through entire communities, creating elegant spatial epidemiological maps. All told, the institute says it has “detailed population data” on more than 100,000 people. It also has led clinical studies of mother-to-child transmission of HIV and the impact antiretroviral treatment has on AIDS prevention.

But in 2013, the Wellcome Trust brought in Pillay, a clinical virologist from University College London, to head the center, a leadership change that signaled a desire to conduct more research that directly helped the local community. “One of the reasons I became director of the Africa Centre in 2013 was the wish of the Wellcome Trust as the main funder to see a very different scientific agenda,” Pillay says. “There’s been increasing pressure and need for the Africa Centre not just to observe the epidemic but to do something about it. How long can you be producing bloody maps?”

Pillay says Bloom effectively rescued the Africa Centre. “The sense I got from Deenan and others is that if he didn’t take the job, Wellcome would have shut the place down,” he says. Bloom, a former HHMI investigator who for a time chaired the scientific advisory board for K-RITH, is optimistic Pillay will also be successful in his new challenge. “Deenan has the insight and the enthusiasm to pull together the basic research and the clinical studies.”

The Wellcome Trust, which, unlike HHMI, strongly supports clinical trials, has promised the new institution $50 million over the next 5 years in a renewable grant. HHMI, for its part, plans to give a total of $80 million to the Africa Health Research Institute (in addition to the building) by 2018, after which it plans to cut back its contribution, McKearin says.

This is the first time the two organizations have collaborated on a global health institution. “Bringing together HHMI and the Wellcome Trust into funding this unified institution is a great match,” McKearin says. “It would be very difficult to even imagine a better outcome.”