Pre-eclampsia; African Women’s Neglected Disease

By Esther Nakkazi

Twenty-two year old Lorriane Akampurira thought she had minor problems with her pregnancy. Her feet were swollen. Later her whole body too. It was her first pregnancy.

“People started saying that it was because I was carrying twins. Others said the baby was big,” said Akampurira. When she started feeling real sick she went to hospital. At that point her whole body was swollen like ‘there was water in it and it could burst anytime.’

Lorraine's husband was deeply affected.  They are a young couple, newly married and with no experience. “My wife could not sleep at night but people kept on saying the swelling was normal. She was in pain all night. I kept on asking myself about this normal swelling?,” said Mr. Akampurira.

When Lorraine arrived at the hospital, one look at her from the doctor was enough. The baby had to be removed immediately in order to save the life of mother and baby. Akampurira was diagnosed with Pre-eclampsia.

Pre-eclampsia and eclampsia remain ‘neglected diseases’ among African women.

On 22nd May, Akampulira and her husband joined the rest of the world to commemorate the inaugural world Pre-eclampsia day. In Uganda, the event was organised by the Health Systems Advocacy Partnership (HSAP) project under the theme; ‘Take the Pre-eclampsia Pledge; know the symptoms. Spread the word.’

Pre-eclampsia is a common pregnancy complication that is characterised by new-onset of hypertension. Studies show that women in the developing world are 300 times more at risk of dying from pre-eclampsia.

In Uganda, 368 women die from pregnancy and childbirth-related causes per 100,000 live births and hypertensive disorder, or pre-eclampsia and eclampsia is the second most common cause of maternal death after postpartum haemorrhage.

The cause of pre-eclampsia is unclear but it has been observed to run in families suggesting that there is a genetic predisposition to it. It is still an unknown disease, with no local language equivalent and no clinically useful screening test. Health workers can detect pre-eclampsia by persistent hypertension and presence of protein in urine.

Dr Annettee Nakimuli, the head of the gynaecology and obstetrics department at Mulago referral hospital said at least 4 women die per day at Mulago due to pre-eclampsia and it is responsible for 8% of admissions of pregnant women at this hospital.

Nakimuli said the condition presents with signs like swelling of the body but generally there is no pain. Because of this many women suffer ignorantly. On top of this, pre-eclampsia is surrounded by myths; some say it is witchcraft, a pregnancy of twins, a baby girl as well it is labelled as ‘a disease of cheating women.’

Nakimuli said all women are at risk but more so those in the extreme age bracket; below 19 or over 40 years of age as well as those who get pregnant through IVF.

When Akampurira’s baby girl was delivered at six months she was assured that the body swelling would stop but it did not. Even as she attended this world pre-eclampsia day, her legs were still swollen. She also suffered from kidney disease and was on her way to hospital for another check up of her heart which could have been damaged.

Akampurira’s baby lived for only nine days and died. She had breathing problems.

In Uganda, pre-eclampsia is the leading cause of pre-marital birth. The babies are usually born pre-term, they are small for age and their survival is limited.

“Death is the worst. Women with pre-eclampsia get complications and remain sick forever,” said Nakimuli. Complications include stroke, breathing problems, kidney failure, cardiovascular disease and others.

At Mulago, the gynaecology and obstetrics Unit remits the biggest number of patients to the dialysis. “The urologists are always complaining to us because we send them the most patients,” said Nakimuli. 

Efforts to end pre-eclampsia in Uganda;

On 22nd May, the Health Systems Advocacy Partnership (HSAP), a project seeking to bring stronger health systems so people in Sub-Saharan Africa, particularly Uganda gain better access to sexual and reproductive health services joined the world to bring attention to pre-eclampsia and other hypertensive disorders.

“Hypertensive disorders are not rare complications of pregnancy,” said Denis Kibira the executive director of HEPS-Uganda. Kibira said the government needs to expand access to proven under utilised interventions and commodities for prevention as well as avail early detection and treatment of pre-eclampsia and eclampsia.

Luckily, Uganda knows what to do with pre-eclampsia but there are still some hurdles along the way.

Dr. Jessica Nsungwa Sabiiti, the commissioner in charge of Reproductive Health at the Ministry of Health said Uganda has a policy that recommends the use of Magnesium Sulphate, for use for women suffering from pre-eclampsia.

Magnesium Sulphate, a cheap drug, is one of the 13 UN Lifesaving Commodities for women and children on the Uganda national essential medicine list. Its overall availability in Uganda health facilities is 77 percent.

Unfortunately, health workers especially nurses and midwives, who are the first contact for mothers with pre-eclampsia are not prescribing the drug, said Nsungwa. “They fear the toxicity so their lack of confidence prevents them from prescribing it.”

As a result of fear to prescribe, the nurses wait for the doctors at the detriment of the mother’s health and yet there are just a few of these in primary health care.

But with the awareness growing and government committed to train health workers there is some light at the end of the tunnel. Let alone the condition getting world recognition.

“I was so excited that there is at last world pre-eclampsia day. It will create awareness. We are on our way to success,” said Nakimuli.

After the event, Akampurira and her husband said they were on their way to pick the ‘heart-health’ results from the hospital. Hopefully, the young couple will have the next baby survive.

ends.

40 years after the first Ebola outbreak are we able to handle the next epidemic?

By Esther Nakkazi

(An edited version of this piece was published in The EastAfrican newspaper (no link) in September 2016. I wrote it when I was a resident Journalist at the Institute of Tropical Medicine. Just uploaded it in light of the recent Ebola outbreak in DRC)

Driven by discoveries over the last 40 years since the first Ebola outbreak, scientists are optimistic that the new tools and data at hand will limit the damage for the next epidemic.

Since September, 1976, in Yambuku, Zaire - now the Democratic Republic of Congo, when the first outbreak of the disease was reported, 25 Ebola outbreaks have happened but the 2014 West African outbreak was unprecedented.

In nearly two years in three countries there were 11,000 deaths. Over Ebola’s existence of 40 years, 30,900 cumulative cases have occurred with12,800 deaths at an annual average death of 322. 

At the 8th International Symposium on Filoviruses in Antwerp, Belgium, hosted by the Antwerp Institute of Tropical Medicine, on 12-15 September 2016, which reviewed global progress against Ebola, scientists said they have enough Ebola arsenal; vaccines, diagnostics, clinical data and therapeutics ready for the next epidemic.

For the academia and researchers, so much has been discovered over the past 40 years. As Micheal Kurilla, the director biodefence research at the National Institute of Allergy and Infectious Diseases said at the symposium, ‘the once one pager on hemorrhagic fever in text books is now being constantly rewritten and updated.’

“The silver lining of the epidemic is that there has been some solid research from epidemiological, social, anthropological, therapeutic and vaccine research,” said Peter Piot the director of the London School of Hygiene and Tropical Medicine, UK.

Three microbiologists, Professors Peter Piot, Guido van der Groen and Jean-Jacques Muyembe are no strangers to Ebola. The two Belgians received the first ‘unknown’ virus at the Antwerp Institute of Tropical Medicine from the former who sent it from Kisansha and they discovered Ebola.

Top insights on research:

Ebola is not all the time killing it can also save some lives. ITM spearheaded the use of blood and plasma from recovered patients to cure victims although it was not very successful and has since developed diagnostics.

“We have moved relatively quickly, gained a lot of time and learned a lot of things on how to do things better,” said Prof. Dr. Johan Van Griensven who heads the HIV and Neglected Tropical Diseases Unit at ITM.

There is also a general desire to progress Ebola R&D faster through initiatives like the coalition for epidemic preparedness innovations which is creating partnerships and giving incentives to develop vaccines, therapeutics and diagnostics where there is no market to contain outbreaks of emerging infectious diseases. This is at the back drop of limited epidemic R&D market incentives.

There are also efforts to share data and not duplicate funding. What happened in the West African outbreak was terrible. Chinese came in just to pick samples, institutions owned data and refused to share it.

Now efforts have been made to share data and to encourage players to play into each other’s comparative advantage, said Dr. Barbara Kerstiens, the deputy Head Fighting Infectious Diseases and Advancing Public Health Unit, DG for Research and Innovation at the European Commission.

Overall, the WHO has also made harmonised clinical trials a blue print plan for action.

Various pharmaceutical companies have also gone ahead to develop vaccines. On 12 September, Johnson & Johnson, announced that its subsidiary Janssen Vaccines & Prevention B.V had submitted its investigational preventive Ebola prime-boost vaccine regimen to the World Health Organisation (WHO) to be used in emergencies.

“If listed for emergency use, the investigational Janssen vaccine regimen could be a vital prevention tool for rapid outbreak response,” said Johan Van Hoof, Global Therapeutic Area Head, Infectious Diseases and Vaccines, Janssen Pharmaceutical Companies.

It would particularly be available for health workers and vulnerable communities on the front-lines who suffer the most in Ebola outbreaks. It has already been tested and passed in animal models and for safety.

Many other vaccines have passed the test for animal models - which do not necessarily represent the pathogenesis - that occurs in humans. For many Ebola vaccines and treatments when scientists caused disease in rodent species they would be mildly affected although it was deadly in humans. Scientists therefore did not know which animal models would be predictive and this limited advancing.

When the outbreak happened in West Africa everything changed. It was a windfall. The unexpected opportunity to test the animal models under real life conditions was presented.

“It gave us an opportunity to advance and focus on the most appropriate animal models so that the future counter measures will have a much higher probability of success in the next outbreak” said Kurilla. “We got a lot of ‘proof of concept’ for interventions although at some point it was less than ideal to move forward.”

Furthermore, there are new lessons to learn from long studies. For instance, 40 years ago it was unknown that the Ebola virus is spread sexually and that it survives in survivors bodies for a long time 

And a lot to learn from research that did not work like the ITM convalescent plasma treatment that had held a lot of hope. “Data should not be undervalued because showing that something does not work is equally as important and has enormous value,” said Kurilla.

It is also new research that age and viral load where key determinants for the survival against Ebola, not necessarily solely supportive care as many thought.

The WestAfrican Ebola outbreak flipped to the usual; a humanitarian emergency having outbreaks to an outbreak becoming a humanitarian emergency. There were also unnecessary delays and a reluctance both government and international community levels to consider it a humanitarian crisis and not just another health problem until gears shifted.

Thus, institutions like World Health Organisation have made reforms. With no historical formal mechanism in countries for managing outbreaks but a clear architecture in the way humanitarian crisis are managed for conflict and natural disasters changes are underway.

“Previously, the humanitarian and outbreak departments were separate but they are now merged,” said Dr. Rick Brennan the Director, Emergency Risk Management and Humanitarian Response at WHO.

WHO is also working to create a system with standard procedures to support a more predictable mechanism with better leadership and coordination especially working to leverage that capacity to manage large scale outbreaks, said Brennan.

“We need more experience of the humanitarian sector, which is dominated by logistics, organisation, coordination that could be more boring and bureaucratic but I believe we need more of that in the first place,” said Piot.

WHO has also linked up with the World Bank for a ‘unified framework for preparedness’ . This will strengthen preparedness at the country level not just for outbreaks but for emergencies.

The reasoning is that every country is prone to emergencies and its capacity to respond to them needs a baseline study to understand the average patterns faced and how they can prepare.

“We have done this because regardless of the event there are some basics that you always need,” said Brennan. These include good medicine management, information capacity, communication capacities, strong logistic.

WHO has also put in place a special procedure to fast track R&D the WHO Emergency Use Assessment and Listing (EUAL) that can be implemented when there is an outbreak with high rates of morbidity and mortality and a lack of treatment or prevention options.

Janssen Vaccines & Prevention B.V has submitted its investigational preventive Ebola prime-boost vaccine regimen for it.

“If the WHO grants an emergency use listing, this will accelerate the availability of Janssen’s investigational vaccine regimen to the international community in the event another Ebola crisis occurs,” said Paul Stoffels, the Chief Scientific Officer, Johnson & Johnson.

The DRC which has recorded seven outbreaks, the highest ever in a single country, also has lessons. At the epic of the West Africa outbreak it had its own.

“The first thing is to detect, report and test. We now have a good surveillance system and we have trained some health workers,” said Prof Muyembe.

Muyembe who leads the national coordinating committee on Ebola in the country and is the director general of the National Institute of Biomedical Research (INRB) said these are key ingredients to control the virus.

In addition, there is strong community engagement and ownership to implement, control and prevent Ebola. For them dialogue is important and only negotiated solutions are implemented. Ebola survivors are used to disseminate information.

“Many people can now identify Ebola. If the outbreak happened right now they would know exactly what to do,” said Muyembe.

“I think that indirectly DRC demonstrates that you can control this epidemic in the absence of a fantastic health system. A strong leadership, experience and an equipped laboratory were able to bring the epidemic under control,” said Piot.

But the environment was also very different. Currently, the urgency has waned. Unless something is done it is back to business as usual.

In 1977, Piot a young doctor, attended his first WHO meeting after visiting Yambuku. At the WHO meeting strong statements were made like ‘we shall invest in epidemic preparedness, support to build health systems and primary health care’ and believed it.

In 2015 Piot travelled with Muyembe back to Yambuku to see what had come of all the promises.

“We arrived at the mission and what we saw was very sad. A nurse survivor who had survived Ebola in 1976 was there. He runs the hospital laboratory of the hospital. He has a decent microscope and some reagents and that is it. No one pays him.”

Except for tonnes of plumpy’nut which is not required in this region that hardly suffers from malnutrition, there were no anti-HIV and malaria drugs.

“We owe it to the people who died in this epidemics to do much better. When the headlines have gone we should continue with the work,” said Piot.

ends

(An edited version of this piece was published in The EastAfrican newspaper in September 2016. I wrote it when I was a resident Journalist at the Institute of Tropical Medicine. Just uploaded it in light of the recent Ebola outbreak in DRC) 

Building Capacity for REDD+ among Academia in East Africa

By Esther Nakkazi

Reducing Emissions from Deforestation and forest Degradation (REDD) is a complex subject and so is having academia research about it.

But a project to build capacity for higher education and research on climate change for improved ecosystem health through reduced greenhouse gas emissions and sustainable livelihoods has managed to do just that in East Africa.

The REDD-EA project is a five year project (2014 - 2018) that supports masters, PhD and post graduate studies at Makerere University in Uganda and the University of Dar-es-Salaam (UDS) in Tanzania with short stays at Norwegian University of Life Sciences.

Funded to the tune of $3m by the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED), the project has largely remained on track- meaning they have so far achieved their target.

Prof John Tabuti at the department of Environment Management Makerere University said the first batch of fellowships is on track at both universities. In total, Uganda will build capacity for 34 and Tanzania 15 students.

But like all REDD+ projects, which remains a complex subject, implementers still think that like any other such to have an impact even the academia need to focus on one issue - community engagement.

Officials say that without doubt, community understanding is at the heart of REDD+ projects to be successful. Why? Most of the projects work with communities. Since REDD+ is defined as a multilateral policy that is meant to reward actions that conserve forests, communities are at the core of their success.

The REDD+EA project overall aims to strengthen scientific and institutional capacity of academic institutions to deliver quality research on REDD+ and to generate evidence based results for policy, said Tabuti also the principal investigator of the REDD-EA project.

So far Uganda has trained 7 PhDs and 24 masters, while the University of Dar-es-Salaam is training 6 PhDs and 6 masters. More students will be recruited this academic year said Tabuti.

In Tanzania, ‘Students are already at various stages of their research and dissertation writing. They are expected to translate their theses into scientific papers as a way of wider dissemination of their findings,’ said Dr Edmund Mabhuye a faculty member center for climate change studies at the University of Dar-es-Salaam.

The trained students will also ensure that functional and specialized training programs on REDD+ are created within universities, according to the REDD-EA project aims.

Kellen Aganyira a PhD student at Makerere university on the REDD-EA project fellowship said the opportunity for research and capacity building in higher education for REDD+ can only be got from such projects.

“Building our capacity as researchers is important. If we go down there and find out what is happening on the ground we inform policy makers,” said Aganyira.

“Training researchers is one way of reaching many practitioners since one researcher can disseminate knowledge to stakeholders across scales and levels,” said Mabhuye by email.

Doing it differently;

REDD+ is defined as a multilateral policy meant to reward actions that conserve forests. It involves payment through carbon credits. Since it is communities that should conserve forests, their participation and understanding is key for them to consent and protect forests if the projects have to succeed.

But it is a difficult concept to understand. For instance researchers report farmers asking them how they should pack carbon in order to sell it. Aganyira whose PhD is focussed on community participation in carbon projects agrees that it is a difficult sell.

“Communities do not seem to understand how they arrive at the amounts paid to them,” she said.
And that is not all. The carbon money delays so much that communities loose interest and land policies do not make it any easier. While payments require legal documents of ownership of land most forest land is communally owned.

It was therefore imperative for the REDD-EA project to focus on a deeper understanding of one topic - community engagement. Instead most REDD-EA fellowships students focussed on a wide rage of topics ranging from land tenure, community understanding, carbon in wetlands, carbon credits, REDD+ law, economics and a wide range of other topics.

“The challenge was that we went into many directions. I am a bit unhappy because we have not gone so deep,” said Tabuti. “It should have been narrowed down so that all PhDs focus on one theme to deepen our understanding.”

At Makerere University the next intake promises to be focused. “If I had to do this again I would go for community engagement. At the community you want them to understand and make informed choices,” said Tabuti.

ends

From Russia With Love; Uganda Nuclear Power Plant

By Esther Nakkazi

On April 19th, the leading Uganda daily newspaper, The New Vision carried on its front page a story ‘Russia to build Nuclear plant for Uganda’. The story went ahead to state that talks about the project are in the final stages.

When I read the story I did not react much but an expat in energy and infrastructure from Holland hung onto the story and was perplexed. He asked me about the Chernobyl disaster and I knew nothing about it but later found time to read about it.

The Chernobyl disaster occurred in April 1986 and is recorded as the most disastrous nuclear plant accident in history. It spilled over the whole of Europe and was costly in terms of cash and casualties. And its still consuming money and causing damage to humans and wildlife.

We could say that the Russians learnt a lot since then and they are the best country to teach us on how to avoid a similar scenario, read- ‘everlasting disaster’ but there are some issues that are so ‘Ugandan’ I do not know that my country can handle nuclear technology, which requires the highest level of safety.

If you travel on Ugandan roads you would be sorry with the level of careless accidents, safety does not exist! If you watch our construction industry you will be alarmed at how buildings collapse half way and kill workers. So you clearly understand that safety is not an issue in Uganda. For the Chernobyl disaster to happen there was among other things an overlap in safety.

If Uganda has to go ahead with this project there some key questions; who will own the nuclear plant? Is it Uganda or Russia?. If it is Uganda do we have the money to sustain it for hundreds of years after the Russians leave? We must be aware that it continues to eat money even when it is generating no money at all. 

The plant will generate radio active waste, which is harmful to people and the environment. Do we have the capacity to handle such waste which causes cancer if it is not well managed?

Where will the it be built? It has to be built near water because it operates with pressurised water, generates steam and needs water for cooling. So I suppose it will be on Lake Victoria or River Nile, all water bodies shared with partner States. The politics of that will be interesting to watch.

Nuclear energy is good so don’t get me wrong. It is the cheapest form of energy and is carbon-dioxide free during production. You can also use its radiation to treat cancer.

But it is also high end technology, requires discipline and I repeat 'maximum level of safety', which at this point I am afraid to say Uganda does not have. So hopefully the Uganda Ministry of Energy officials who are okaying this project have the capacity to question some of these issues and others that I may not mention here before the project takes off.

Stellenbosch University Software Donation troubles Makerere

By Esther Nakkazi

Makerere University will upgrade or all togather overhaul its system responsible for storage of administration, finance and student data, officials said.

The International Tertiary System (ITS) that integrates finance, human resource and academic data was brought in to Makerere from Stellenbosch University about ten years ago. It was a donation costing about $700,000.

However, Makerere University officials say their staff in the academic Registrar’s department who have already been arrested, allegedly tampered with the system which, caused a delay in issuance of transcripts to students who graduated in February this year. But some sources say this is not the case.

The staff also allegedly altered students’s marks and listed some 58 students into the 67th graduation booklet. Makerere administration has been apologising to the affected students and promised quick action.

Now the University wants to upgrade the ITS, which is unique and was tailor-made for Stellenbosch university, and has also since become obsolete.

“We have been operating a system purchased from South Africa but it is now obsolete that is why some unscrupulous staff managed to beat it. So we shall either upgrade it in the medium term or buy a new system,” said Prof Barnabas Nawangwe, the deputy vice chancellor in charge of finance.

Prof Nawangwe explained that either decision would rely on the cost but only if they failed to agree on upgrading the ITS with a new version would they buy a new system.

When Makerere administration realised that there were anomalies on the 67th graduation list, they halted the issuance of transcripts which affected over 14,895 students.

Prof John Ssentamu Ddumba, Makerere University vice chancellor, instructed the IT team to clean up the system and ensure that it is not tampered with again.

In mid March, Mr. Alfred Masikye, the academic registrar wrote to all university stakeholders alerting them on a temporary shut down in processing transcripts which alarmed the recently graduated students who wanted their transcripts for either further studies or to apply for jobs.

According to Masikye’s communication the university management had discovered that names of 58 students had their marks altered and henceforth withdrew them pending further investigations.

Press reports show that as early as 2015, Makerere withheld about 14,000 students’ transcripts until they verified their results. Prior to that incident, in 2008 a meeting had noted that the ITS was insecure and ill functioning.

A source who did not want to be named told this reporter that since inception, the ITS has always had major flaws and was incompatible with Makerere University.

One of the reasons is that the ITS was never configured to Makerere’s requirements but implemented the way it was working at Stellenbosch University, the source said. “It was like do it here as you did it there. It was also a donation and the administrators could not refuse it.”

Stellenbosch University and Makerere University have major variables. As a software that was tailor-made to Stellenbosch, its failures or repairs meant calling someone from South Africa, which was costly, the source said.

She said the two universities with major differences could not be aligned to fit the ITS at Makerere. For instance while the ITS was using the calendar year in Stellenbosch, Makerere uses an academic year so data inout and storage was a challenge.

Makerere university, as its legacy, has always registered students using registration numbers but the ITS system uses a ten-digit student number. When this anomaly was realised the Makerere administration started issuing student numbers on top of the registration numbers to fit the system.

Users at the administration level complained and they requested that one of numbers be dropped but Makerere had to keep its legacy of registration number so both of them were maintained causing more chaos.

The other issue is that the ITS would allow students to register online only after paying at least 60 percent of the tuition fees. The way the ITS was modelled is that it would automate registration with that data input from finance and enable the student to register.

Since Stellenbosch University is a state-subsided most of its students would have no problem with that requirement but Makerere has been in running battles with students to pay their school fees on time. 

However, another source who also preferred anonymity says the students results management system responsible for input, storage and administration of student marks and production of transcripts was locally designed.

He said Makerere is just not saying the truth about the problem and not effectively managing issuing of transcripts to graduated students on time.

Makerere University officials, however said the two were aligned so the locally made system, which was tampered with by its staff was aligned to the ITS and students records would be imported into it. But the matter would soon be resolved.

Ends.  

Ebola Vaccine induced longest reported immune response

By Esther Nakkazi

An investigational “prime-boost” Ebola vaccine regimen, induced a durable immune response in 100% of healthy volunteers over one year, the longest duration follow-up reported researchers said.

The data was reported in The Journal of the American Medical Association (JAMA) on 14th March. The Phase 1 study is the longest duration follow-up reported for any heterologous prime-boost Ebola vaccine regimen.

This follows recent evidence of the persistence of Ebola virus in bodily fluids and the potential for sexual transmission among Ebola survivors, which reinforce the urgent need for a robust and durable vaccine for the disease.

“The world needs a vaccine to help prevent or mitigate future Ebola outbreaks, and ideally it should provide sustained protection for at-risk populations,” said Paul Stoffels, M.D., Chief Scientific Officer, Johnson & Johnson in a press release.

Janssen’s investigational Ebola vaccine regimen was developed in collaboration with the National Institutes of Health (NIH). The regimen is based on Janssen’s AdVac® technology and MVA-BN®technology from Bavarian Nordic A/S. Johnson & Johnson’s partners in the Ebola program also include Europe’s Innovative Medicines Initiative, the London School of Hygiene & Tropical Medicine, Inserm, and BARDA.

In the Phase 1 study, led by the Oxford Vaccine Group at the University of Oxford, UK, healthy volunteers were given one vaccine dose to prime their immune system and the alternative vaccine to boost their immune response.

The Phase 1 study enrolled healthy participants aged 18 to 50 years. Of 75 active vaccine recipients, 64 attended follow-up at day 360, the latest time point analyzed. No vaccine-associated serious adverse events were observed from day 240 to day 360. All of the active vaccine recipients maintained Ebola virus-specific antibody (immunoglobulin G) responses from the first post-vaccination analysis conducted through to day 360. 

Dr Matthew Snape, Chief Investigator of the study reported that this is the longest duration follow-up for any heterologous prime-boost Ebola vaccine regimen yet published. 

Phase 1, 2 and 3 studies are ongoing to confirm these findings.

A total of 10 clinical studies are being conducted on a parallel track across the U.S., Europe and Africa in support of potential eventual registration for the Ebola vaccine regimen. The first study of the vaccine regimen in a West African country affected by the recent Ebola outbreak began in Sierra Leone in October 2015.

In September 2016, Janssen completed a submission to the World Health Organization (WHO) for Emergency Use Assessment and Listing (EUAL) for the investigational preventive Ebola prime-boost vaccine regimen. 

Janssen in partnership with Bavarian Nordic rapidly scaled up production of the vaccine regimen and now has approximately 1,800,000 regimens available, with the capacity to produce several million regimens if needed.

ends

EU funding to combat illegal fishing on Lake Victoria

Fisheries Managers from Uganda, Kenya and Tanzania

By Esther Nakkazi
The European Union (EU) will contribute 100,000 Euros to improve monitoring, control and surveillance of Lake Victoria to combat illegal, unreported and unregulated fishing. More funds are expected from partner states.

The EU funds to be available for eight months from April to November 2017, will be managed by the Lake Victoria Fisheries Organisation (LFVO) and given to SmartFish one of the largest regional Programmes for fisheries in Africa.

At a regional consultative meeting held in Entebbe (28-29th March), fisheries managers from three partner states that share Lake Victoria of Uganda, Kenya and Tanzania agreed on a joint action plan.

The fisheries managers agreed to carry out joint patrol activities, registration of fishers, enforcement and support to comply with licensing, marking licensed fishing boats as well as to create awareness and encourage voluntary surrender of illegal fishing gears.

“Pooling of assets, information and knowledge between different countries enables countries to share surveillance and control of fishing,” said Fanjanirina Jérômine, IOC-SmartFish monitoring, control and surveillance (MCS) Assistant.

Patrick Kimani the Kenya regional representative IOC-SmartFish said there is need to sustain MCS activities being undertaken although inspite of these illegal fishing on Lake Victoria persists.

Paul Okware the acting assistant commissioner in charge of regulation and control at the Uganda Ministry of Agriculture, Animal industry and Fisheries commented on how illegal users are increasingly using strange illegal methods and gears.

And while these have also increased catching and trading in immature fish,  harmonising all agencies in enforcement for all partner states has become a nightmare, he said.

Fisheries situation in Uganda:

Lake Victoria partner states currently have different standards. This is true especially after Uganda in November 2015, suspended all operations of Fisheries Officers, Beach Management Units (BMUs) and police - these are pending reforms.

But prior to this there was harmony as fisheries management in Uganda, Kenya and Tanzania was on a single spine command as by 2004, co-management, BMUs and other institutions were in place and harmonised.

However, in Uganda, with time these did not function well as parallel and uncoordinated enforcement systems and officers emerged who pushed the technical officers and BMUs to the side lines thus causing a gap for fisheries illegalities to escalate.

In 2015, Uganda's suspension of BMUs was announced by President Yoweri Museveni who also issued a directive requiring fisheries to form a Fish Protection Unit (FPU) led by an officer from the Presidents office. To that effect a Memorandum of Understanding (MoU) was prepared and in the long run the Fish Bill incorporating reforms will be passed.

BMUs helped to; improve sanitation to meet Fish Quality Assurance and safety requirements, maintain and update registers of BMUs and vet fishers to be licensed, provide fisheries catch and marketing data, implement fisheries regulations and management measures at landing sites as well as develop local fisheries management plans.

Museveni also directed that special courts for fisheries be introduced. He abolished importation of fishing gears and announced imprisonment of 7 years for fisheries offenders. According to Okware, after Museveni's announcement over 300 illegal gears were impounded in 2015/2016.

In the meantime, only 0.3% vessels are licensed in Uganda waters, however, if all vessels were licensed and a formidable enforcement was in place, Uganda would collect Ushs 5 billion annually.

Godfrey Monor, the executive secretary LVFO said it was awkward that only 0.3 vessels are licensed by Uganda because it creates a situation of ‘free for all’ which is not healthy for an ecosystem.

But the meeting heard that licensing in Uganda is also used as a management tool, more like, the less the licensing the more the fish stocks will grow.

Uganda has also introduced a mobile licensing system and TradeMark East Africa will soon train fisheries people on e-licensing system.

Kenya and Tanzania Monitoring, Control and Surveillance status report;

In the Kenya waters, according to the 2016 frame survey, gill-nets increased by 2% from 188,984 in 2014 to 192,987 in 2016 of these about 40% are undersize or illegal; monofilaments increased from 58 in 2004 to 20,842 in 2016; beach seines increased by 24% from 724 in 2014 to 901 in 2016.

The number of fishers increased by 9% from 40,133 in 2014 to 43,799 in 2016; boats increased by 7% from 13,402 in 2014 to 14365 in 2016. Over 300 illegal gears were impounded in 2015/2016 and Kenya fisheries are in the process of boat registration to give specific identities to crafts for licensing to commence.

This comes at the backdrop that Kenya since the inception of the devolved system of governance no meaningful MCS has been done as well there is little information exchange between counties and national governments.

Meanwhile, Tanzania has the highest MCS activities compared to Uganda and Kenya on Lake Victoria. For instance for the period January 2016 to March 2017, Tanzania patrols resulted into confiscation of 19,250 beach seines, 3,171 undersize gill-nets, 9,459 monofilaments, 44 dagaa nets, 84,140 kgs of immature fish and apprehension of 777 culprits.

In Tanzania, fishing vessel licensing is done by a competent authority in collaboration with BMUs. According to the frame survey report 2016, the total number of fishing crafts operating in Tanzanian waters were 31,773.

A total of 18,452 or 58.07% of the total Fishing Crafts are registered and licensed, the highest number on Lake Victoria.

Way forward for MCS on Lake Victoria;

The meeting heard that inspite of all activities including joint regional patrols by partners states on Lake Victoria there is increased illegal fishing as well as catching and trading in immature fish.

Susan Imende deputy Director at Ministry of Fisheries Development Kenya said fisheries managers have to think ‘outside the box’ as illegal users are ahead of them, which is pushing down fish stocks and while joint regional patrols could be effective and are a normal procedure the arrested fishers say they are being harassed.

Samson Abura the LVFO Communication Director said this time it should be ‘ business unusual’ and suggested a data base for MCS operations and IUUs to be set up as well as a good plan to show partner governments what is being done.

However, Monor from LVFO was skeptical about sustainability and if suggested activities would create any change. “We have done many activities but get the same results. We shall first increase the appetite of illegal fisheries but what happens after November?,” he asked after the EU funds are used up.

“This is like a ‘knee jack reaction’ because the funds are available. Will it be sustainable and have effective outcomes?” wondered Monor.

ends