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Innovation for health

Research that makes a difference

TDR annual report | 2009


Innovation for health

Research that makes a difference

TDR annual report | 2009


WHO Library Cataloguing-in-Publication Data

Innovation for health: research that makes a difference: TDR annual report 2009.

1.Tropical medicine. 2.Research. 3.Program evaluation. 4.Strategic planning. 5.Annual

reports. I.UNICEF/UNDP/World Bank/WHO Special Programme for Research

and Training in Tropical Diseases.

ISBN 978 92 4 159970 2 (NLM classification: WC 680)

Copyright © World Health Organization on behalf of the Special Programme

for Research and Training in Tropical Diseases 2010

All rights reserved.

The use of content from this health information product for all non-commercial

education, training and information purposes is encouraged, including translation,

quotation and reproduction, in any medium, but the content must not be

changed and full acknowledgement of the source must be clearly stated. A copy

of any resulting product with such content should be sent to TDR, World Health

Organization, Avenue Appia, 1211 Geneva 27, Switzerland. TDR is a World Health

Organization (WHO) executed UNICEF/UNDP/World Bank/World Health Organization

Special Programme for Research and Training in Tropical Diseases.

This information product is not for sale. The use of any information or content whatsoever

from it for publicity or advertising, or for any commercial or income-generating

purpose, is strictly prohibited. No elements of this information product, in part

or in whole, may be used to promote any specific individual, entity or product, in

any manner whatsoever.

The designations employed and the presentation of material in this health information

product, including maps and other illustrative materials, do not imply the expression

of any opinion whatsoever on the part of WHO, including TDR, the authors

or any parties cooperating in the production, concerning the legal status of any

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Mention or depiction of any specific product or commercial enterprise does not

imply endorsement or recommendation by WHO, including TDR, the authors or any

parties cooperating in the production, in preference to others of a similar nature

not mentioned or depicted.

Printed in Switzerland.

Compiled and edited by Julie N Reza

Design and layout: Lisa Schwarb – Bruno Duret

Cover Photo: WHO/TDR/Craggs

This report represents the combined efforts of many TDR staff, all of whom are

thanked for their invaluable input, comments and support.


Contents

PART I

Foreword by Dr Tim Evans, TDR Special Programme Coordinator and Assistant Director-General –

Information, Evidence and Research, World Health Organization .................................................................... 7

Message from Dr Jorge Motta, Chair of the TDR Joint Coordinating Board .................................................... 9

About TDR ................................................................................................................................................................. 11

Key achievements during 2009 ...................................................................................................................... 12

PART II

Introduction by Dr Robert Ridley, TDR Director ............................................................................................... 17

Research for delivery, policy and access ..................................................................................................... 20

Research for discovery and development of tools and products for neglected diseases ..... 26

Empowerment – Promoting equity and fostering ownership and research leadership ........................ 32

Stewardship – Knowledge for decision-making and advocacy for research for health ......................... 38

References .................................................................................................................................................................. 43

PART III

Key publications and resources .............................................................................................................................. 47

TDR governance and management ........................................................................................................................ 49

STAC membership ..................................................................................................................................................... 52

Leadership at TDR ..................................................................................................................................................... 60

TDR partnerships ....................................................................................................................................................... 65

TDR financial review for the biennium 2008–2009 ............................................................................................ 68

TDR annual report | 2009

3


PART I

TDR annual report | 2009

5


6


Health for all remains a basic condition of human development

and the TDR partnership remains crucial in helping to achieve this goal. ”


PART I PART I

Foreword by Dr Tim Evans

TDR Special Programme Coordinator and Assistant Director-General –

Information, Evidence and Research, World Health Organization

TDR, the Special Programme for Research and Training

in Tropical Diseases, provides critical tools and evidence

for scaling-up health interventions to improve global

health and to achieve the Millennium Development

Goals. It focuses on infectious diseases of the most

vulnerable, poorest and marginalized populations who

have limited access to health care, with the goal of

developing sustainable solutions to meet their critical

needs. The health conditions of poor and marginalized

communities tend to be hidden below the ‘radar screens’

of health service providers and politicians. Yet these

communities form the group that needs the most help.

This annual report pays testimony to the determination

with which TDR and its many partners are directing

their attention to this important group. It outlines

progress to advocate for these needs, to develop leadership

and research capability in the countries where these

diseases occur, and to provide critical new evidence that

will contribute towards eliminating diseases such as

visceral leishmaniasis.

each other’s strengths to do what we could not do

alone. TDR staff – many of them highly experienced

scientists in their own right – bring this all together.

Although they do not conduct the research, they help

make it happen through management support under

the guidance of global experts – always with the goal

in mind to have people and affected communities in

disease endemic countries play a pivotal role in the

choice, design and subsequent development of effective

and affordable health solutions.

WHO’s engagement with TDR stems from our conviction

that TDR helps to bring about more efficient

approaches in the combat against diseases of poverty. As

a major TDR co-sponsor, WHO is pleased to pledge its

continued support to the Special Programme and wish

TDR ongoing success. Health for all remains a basic

condition of human development and the TDR partnership

remains crucial in helping to achieve this goal.

WHO is the executing organization of TDR and is one

of the four co-sponsoring organizations – the others

are the United Nations Children’s Fund (UNICEF), the

United Nations Development Programme (UNDP) and

the World Bank. Our agencies work together, leveraging

TDR annual report | 2009

7


8


TDR’s emphasis on equity and access for all, ownership and

sustainability, and decision-making at the local level, all provide

the groundwork for its many achievements. ”


PART I

Message from Dr Jorge Motta

Chair of the TDR Joint Coordinating Board (JCB) * *TDR’s top level governing body. For more details, see section on TDR governance

It is my privilege and pleasure to be serving as the Chair

of the TDR Joint Coordinating Board (JCB) for 2009

2011. TDR has successfully advanced into a new strategy

that places emphasis on facilitation and coordination

to achieve high-level impact. The JCB remains strongly

committed to supporting TDR’s work and applauds TDR’s

ability to identify new and innovative solutions in the

combat of diseases of poverty.

Health and development are closely linked, and research

for health is essential to achieve sustainable development.

TDR’s emphasis on equity and access for all, ownership

and sustainability, and decision-making at the local level,

all provide the groundwork for its many achievements.

This model is shared by many new organizations that

have arisen since TDR’s establishment in 1975.

Over its history, the Programme has contributed evidence

to significantly improve communicable disease control

and protect vulnerable populations. The list of achievements

includes: leprosy multidrug therapy, which has

formed the basis of leprosy elimination strategies; drugs

and strategies for onchocerciasis control; interruption

of Chagas disease vectorial transmission in South and

Central America; strategies to improve malaria treatment

access and effectiveness through home-management

approaches, special drug packaging, evaluation of drug

combination therapy; and the validation of several

marketed diagnostic tests. TDR has strengthened the

ability of institutions and researchers – in countries where

infectious diseases create the highest burden – to carry

out research to international standards. It has also helped

build local, national and international research networks

and partnerships.

Since 2008, TDR has strengthened and reshaped its

empowerment and stewardship role in order to better

meet the needs of policy-makers, researchers and research

institutions in developing countries, and to enable them

to play a pivotal role in tackling the diseases that affect

them and to contribute to shaping the health research

agenda. For example, TDR is helping to initiate an African

Network for Drugs and Diagnostics Innovation (ANDI) to

increase research partnerships and networks in Africa.

As we all look ahead to 2015, the target date for achievement

of the Millennium Development Goals, we see that

many challenges remain. Advances in global health are

inexorably linked to poverty. The current global economic

environment shows signs of its devastating effects on

the lives and livelihoods of the poor. Countries where

resources are already stretched are finding it harder to

meet the challenges of providing health care, and research

is often considered an unaffordable luxury. History has

shown this view to be a mistake. When challenged by

difficult problems, investment in appropriately-directed

research becomes even more important.

Another challenge is to better understand, anticipate

and counter the effect that climate and environmental

change may have on the emergence, resurgence and

spread of infectious diseases, especially vector-borne

diseases. TDR is positioning itself to effectively address

this challenge. For example, a new thematic reference

group on environment, agriculture and infectious diseases

will help improve research into how climate change may

affect health.

In reviewing and approving TDR’s strategies and activities

at its 32nd session in June 2009, the JCB was keen to

ensure a harmonious balance between all aspects of the

Special Programme. It also examined how TDR governance

could be further enhanced, notably by including

representatives of nongovernmental institutions that are

collaborating with TDR. The JCB also considered the key

role that TDR is planning to play in the implementation

of some elements of the Global Strategy and Plan of Action

for Public Health, Innovation and Intellectual Property.

Because of TDR’s focused agenda and diversified partnerships

and networks, the JCB is confident that the Special

Programme is well positioned to continue to harness the

power of health research

in ways that help

alleviate the suffering of

poor and disadvantaged

communities.

and management in part III.

TDR annual report | 2009

9



TDR – the Special Programme for Research and Training

in Tropical Diseases – is the leading UN-based organization

dedicated to research on infectious diseases of poverty. ”

10


PART I

About TDR

TDR – the Special Programme for Research and

Training in Tropical Diseases – is the leading United

Nations (UN)-based organization dedicated to research

on infectious diseases of poverty.

It operates within a broad framework of intergovernmental

and interagency cooperation and participation.

Since being established at the World Health Organization

(WHO) in 1975, TDR has helped stimulate

research and development (R&D) into new drugs,

diagnostics and implementation strategies. In 2008

TDR began a new 10-year strategy that places greater

emphasis on ensuring that disease endemic countries

(DECs) play a pivotal role in research and priority

setting.

Through its three strategic arms (research on neglected

priority needs, empowerment and stewardship) TDR

continues to identify research gaps and, by working

together with a huge network of collaborating organizations

and individuals throughout the world, facilitate

ways to address these.

TDR has identified several core principals that

influence its work; these are currently being fed into a

monitoring and evaluation system that will help assess

the performance of the programme. Our core values

include:

Ensuring that disease endemic countries play

a pivotal role in shaping the research agenda

and carrying out research.

Promoting equity, including gender balance,

in research.

Promoting partnership.

Promoting sustainability of research and its impact

where the diseases occur, with the fruits of research

and capacity building taken forward under local

ownership.

TDR focuses on how new products and strategies can

best be developed and applied for the communities

where they are most needed. For example, for malaria,

this has meant the generation of evidence on how

bednets and pre-packaged artemisinin-based combination

therapies (ACTs) can be used at the community

level. TDR has contributed to the tools and strategies

being utilized for global disease elimination campaigns

for Chagas disease, leprosy, lymphatic filariasis, and

onchocerciasis; current research is helping the regional

elimination campaign against visceral leishmaniasis

(VL) in the Indian subcontinent.

TDR has also helped develop many networks and

partnerships that have advanced R&D on infectious

disease, and TDR has continued to foster the training

of thousands of developing-country researchers and to

strengthen hundreds of developing-country research

institutions.

TDR has an annual budget of approximately US$

50 million and a staff of around 100; its unique

position derives from the breadth of consensus through

which it operates in partnership with hundreds of

scientists, institutions and networks all over the world,

and by the manner in which it is governed – by its four

co-sponsoring organizations as well as an independent

governing board comprising equal representation of

developed and developing countries.

TDR annual report | 2009

11


Key achievements during 2009

TDR achievements fall into four broad categories:

Research for delivery, policy and access

Research for discovery and development of tools and products for neglected diseases

Empowerment – promoting equity and fostering ownership and research leadership

Stewardship – knowledge for decision-making and advocacy for research for health

Among the highlights in 2009 for research for

delivery, policy and access were the following:

Dengue: A TDR–European Union jointly funded

and coordinated multicentre study in seven

countries has led to the development of a revised

model for the clinical classification of dengue.

This was shown to be user-friendly and practical

for case management in a subsequent study in

18 countries. TDR-supported research has also

shaped the new edition of the WHO Global

Dengue Guidelines (published with TDR input in

December 2009). The new dengue case classification

system and guidelines should greatly enhance

case management in dengue-endemic regions.

Onchocerciasis: TDR-coordinated clinical trials in

Mali and Senegal have provided evidence that annual

treatment with the drug ivermectin, continuously

applied over 15 years with widespread coverage in

regions at community level, can eliminate the disease

in those regions. This could lead to more concerted

regional elimination campaigns.

Malaria: A paper describing a TDR-coordinated

clinical trial on the use of artesunate suppositories

(rectal artesunate) for the treatment of malaria,

which was mentioned in the 2007–2008 TDR

programme report, won the prestigious British

Medical Journal (BMJ) award of ‘2009 clinical

research paper of the year’. The paper provided

the first evidence of how rectal artesunate can be

used to manage severe malaria and save the lives of

young children in remote community settings. This

evidence is feeding into other community-based

initiatives.

Within research for discovery and development

of tools and products for neglected

diseases there have also been three major breakthroughs

during 2009:

Malaria: For the first time, there is a guide profiling

which rapid diagnostic tests work best under

different field conditions. The accuracy and efficacy

of 41 rapid diagnostic tests for malaria have been

evaluated in a study co-funded and coordinated

by TDR with several partners; a publication based

on the study points out the weaknesses of several

tests and identifies those that are most suitable for

field use. Findings should help inform diagnostics

procurement processes and will be of particular value

in resource-poor settings. The report has become one

of TDR’s most popular publications of 2009.

Tuberculosis: A TDR-commissioned trial evaluating

the performance of light-emitting diode (LED)

adaptors for the microscopic analysis of tuberculosis

12


PART I

(TB) samples has shown that these low-cost adaptors

simplify diagnosis. This work should enhance

the diagnosis of TB, particularly in resource-poor

settings, and has been incorporated into WHO’s Stop

TB policy guidelines.

Chagas disease: Thanks to a TDR-coordinated

collaboration, diagnosis of Chagas disease can be

improved through a standardized protocol using

a technique called the polymerase chain reaction

(PCR). Such a commonly accepted standardized

diagnostic protocol has the potential to help interpretation

for both research and case management.

During the past year, as part of its objective to enhance

empowerment to foster ownership and

research leadership in developing countries, TDR

has supported the following:

The 5 th Multilateral Initiative on Malaria (MIM)

Pan-African Malaria Conference in Kenya. The MIM

conference is held every three years in Africa; this

year the conference brought together over 1200

scientists and major stakeholders in malaria research

and control to discuss current and future issues

pertinent to their work. TDR played a significant

role in supporting the organization of the conference,

which was overseen by a secretariat hosted

at the African Malaria Network Trust (AMANET)

in the United Republic of Tanzania. The largest

global malaria conference of its kind, it generated

new collaborations and has played a major role in

helping inform malaria research.

Grants, networks and training activities that will

help ensure that disease endemic country scientists

play a pivotal role in leading research and shaping

the research agenda. The creation of several TDRsponsored

research training centres was initiated,

which will better allow disease endemic countries

to lead research capacity-building efforts in their

regions, with a train-the-trainer approach ensuring

sustainability.

Development of an Action Framework for Research

Partnerships on Neglected Diseases of Poverty

through a large stakeholders’ meeting in Berlin,

jointly co-sponsored by TDR with the German

government. The framework recommends ways in

which governments, research institutions, funders

and others can help to ensure more equitable

research partnerships on neglected diseases of

poverty.

In taking forward its role of Stewardship

to harmonize, identify and align research needs to

country needs, TDR has undertaken three key activities

over the year:

The creation of a think-tank of 100 international

experts organized into 10 disease-specific and

thematic reference groups that will help to identify

the top priorities for research on infectious diseases

of poverty. Their work will feed into the production

of the first global report on research into infectious

diseases of poverty, which will be published in

2011.

Establishment of a new initiative, Enhancing

Support for Strengthening the Effectiveness of

National Capacity Efforts (ESSENCE), to help increase

coordination among donors in aligning their

support of research in developing countries with

country needs.

The further development of the web-based global

knowledge platform on tropical disease research,

TropIKA.net, which has seen a significant increase

in overall use, including the successful creation

of web-based discussion spaces for a number of

stakeholder-driven, partnered initiatives.

The support of WHO’s Department of Control of

Neglected Tropical Diseases in the publication of

guidelines on the diagnosis, treatment, prevention

and control of dengue (see page 12).

TDR annual report | 2009

13


PART II

TDR annual report | 2009

15


16


Over the last 30 years, TDR has been at the forefront of research,

capacity building and global institutional development. ”


PART II

Introduction by Dr Robert Ridley

TDR Director

TDR’s work and achievements reflected in this annual

report are closely linked with several important

long-term and medium-term developments that

occupy the thoughts of policy-makers and stakeholders

in health research. These include: (i) the Millennium

Development Goals; (ii) the Paris Declaration on Aid

Effectiveness; (iii) climate change and the environment;

(iv) the promotion of science, technology and innovation

for development; (v) health systems strengthening.

Millennium Development Goals: In September 2010

the UN General Assembly will take stock of where the

world stands in relation to the Millennium Development

Goals (MDGs) targeted for achievement in 2015.

Three of these goals (MDGs 4 to 6) relate directly to

health, namely to child mortality; maternal health; and

HIV/AIDS, malaria and other diseases. Ultimately, the

work of TDR relates to all the MDGs, including the

eradication of extreme poverty and hunger (MDG 1)

which can only be achieved by breaking the vicious

cycle of disease and poverty.

Over the last 30 years, TDR has been at the forefront

of research, capacity building and global institutional

development, such as through the creation of product

development partnerships, to address these issues. The

manner in which TDR supports research is founded in

principles of equity that underlie the MDG concept.

In this report there are specific examples of recently

concluded and ongoing research, notably in the fields

of onchocerciasis and visceral leishmaniasis (VL), that

continue to support the goals of eliminating diseases of

poverty.

The ‘big three’ diseases of HIV/AIDS, TB and malaria

remain a global problem of major proportions, but due

to sustained global efforts the scale of their burden is

stabilizing and, in the case of malaria, may even be

declining. One disease that is on the rise, however,

is dengue. TDR has long played a role in stimulating

innovative malaria research initiatives and has applied

itself to dengue research over the last 10 years.

This report highlights TDR malaria research on the

development and application of rectal artesunate for

the community-based management of severe malaria

in children, which in March 2010 lead to an award by

the prestigious British Medical Journal award of ‘best

clinical research paper of the year’. The citation noted

the paper’s ‘significant contribution to improvements

in health and health care’. The report highlights

innovative diagnostics research to support malaria and

TB control. It also highlights recent TDR-sponsored

research that has led to new guidelines for the classification

of dengue that is leading to improved case

management of this increasingly important disease.

Paris Declaration on Aid Effectiveness: The principles

of the Paris Declaration can be summarized as

promoting leadership, ownership of, and responsibility

for, development within developing countries and

ensuring coherence and harmonization of donor

support. TDR has long supported research capacity

building that has helped develop leaders who can

take an evidence-based approach to decision making.

This has been further strategically developed through

TDR’s new Stewardship and Empowerment functions,

as highlighted in this report. Many of the ideals of the

Paris Declaration require the development of equitable

partnerships between northern and southern partners,

through which true leadership and ownership can

be exercised by developing country institutions. A

framework for action for the development of equitable

partnerships was developed at a meeting of international

stakeholders in Berlin 2009 that was convened

by TDR. Donor coherence is also being explored

through an initiative (ESSENCE*), based at TDR,

that brings together major development agencies and

research funders.

Climate change and environment: Climate and environmental

change is increasingly recognized as one of

the major challenges of our age. Its impact on health,

especially through vector-borne diseases such as those

* Enhancing Support for Strengthening the Effectiveness of National Capacity Effort.

TDR annual report | 2009

17


Introduction

covered by TDR, could be immense. TDR is working

with others in WHO to incorporate environmental

issues into its research and into its strategic view

of poverty-associated disease. Results from recent

innovative research linking ecology and community

response to mosquito control for dengue are being

analysed and will be covered in future reports. TDR is

also preparing its first ever global report on the status

and priority needs of research on infectious diseases

of poverty. Based on expert analysis, review and

stakeholder consultation, this report will focus on three

major elements driving health research in the future.

The first and foremost of these will be climate and

environmental change. The other two foci of the report

will be on science, technology and innovation, and on

health systems.

Science, technology and innovation: The impact of

technology on human development and on health can

be seen everywhere in our daily lives. However, it is

only recently, that developing countries have collectively

started to explicitly espouse and develop science,

technology and innovation strategies as a prerequisite

for their own development. The African Union (AU)

target that 1% of gross domestic product (GDP) should

be spent in this area is testament to the significance

of science, technology and innovation strategies and

it is anticipated that a significant proportion of this

expenditure will be on health research. WHO member

states have recently agreed on a Global Strategy and Plan

of Action for Public Health, Innovation and Intellectual

Property to address diseases that disproportionately

affect developing countries. TDR plays an integral

part in the WHO effort. Historically, it has supported

research capacity development in scientific disciplines

central to technical innovation. It is currently devoting

a major effort to promoting regional networks for

innovation, the most advanced of which is the African

Network for Drugs and Diagnostics Innovation

(ANDI).

Health systems: Appropriate tools to treat and prevent

disease, and policies that address development,

inequity, environment and health, are of little use if

there is not a functioning system in countries through

which to implement policies and deliver on health

care. Increasingly, research needs to be taken from

discovery through to delivery within the systems

context, and with the leadership and ownership of

countries and communities. TDR’s collective work

aims at adding value and sustainability to the entirety

of national health and research systems. For this to

happen research towards the delivery of specific interventions

must be undertaken by keeping in mind the

needs of the entirety of health systems and not just the

needs of any one specific intervention or disease. These

and related issues increasingly underpin TDR’s research

and form the basis of TDR’s support, under the leadership

of WHO, for the first ever symposium on health

systems research planned for November 2010.

As you read this report we hope that you find interest

and value in the work that has been undertaken and

that you find it fits with the broader strategic issues

and imperatives alluded to above.

18


PART II


In this report there are specific

examples of recently concluded and

ongoing research, notably in the

fields of onchocerciasis and visceral

leishmaniasis, that continue to support

the goals of eliminating diseases

of poverty. ”

TDR annual report | 2009 19


Research

for delivery,

policy and access

TDR’s delivery and access research focuses on how to improve the uptake and use of new

or improved tools and products in low- and middle-income countries that have high

infectious disease burdens, particularly in remote, rural areas where they are needed

most. Where possible, TDR research is embedded within national control programmes

so that evidence-based interventions are integrated into existing systems. Outcomes

of TDR research often contribute to shaping local, national and international public

health policies.

20


PART II

Key delivery and access highlights

A revised classification model has been

developed for dengue following a TDR

European Union co-funded and coordinated

multicentre study in seven countries. The

new model is simpler for clinicians to use

in primary healthcare settings, and will

help ensure that patients get appropriate

treatment. This, together with other TDR

research, has shaped the new global WHO

dengue guidelines.

A paper describing a TDR-coordinated

clinical trial on the use of rectal artesunate

for the treatment of malaria (mentioned in

the 2007–2008 TDR programme report) was

awarded the 2009 British Medical Journal

(BMJ) clinical paper of the year award. The

study highlighted the life-saving potential of

rectal artesunate, given as a suppository to

malaria patients in rural areas of Bangladesh,

Ghana and the United Republic of Tanzania.

TDR-coordinated studies from Mali and

Senegal have provided the first evidence

that in certain regions the drug ivermectin,

when continuously applied over 15 years with

widespread coverage, could help eliminate

the debilitating disease onchocerciasis (also

known as river blindness because of the loss

of sight it can cause in some patients).

TDR annual report | 2009

21


Research for delivery, policy and access

At TDR we focus on low- and middle-income

countries that bear the highest burden of infectious

disease. Most people living in these countries

have limited access to electricity, running water

and professional healthcare workers. Because

access to treatment is often limited, diagnostic

tools that work in these difficult conditions are

critical. They can help identify the best treatment

sooner, resulting in fewer complications and

lowering the overall cost of care. Early treatment

also reduces the chances of disease transmission.

Our work includes research to improve case

diagnosis and classification and studies on how

to scale up delivery of drugs, diagnosis and

other services. We are also investigating the best

ways to control diseases and possibly eliminate

them. Improvements in classification and control

methods often have socioeconomic and ethical

implications, so TDR frequently works with

partners to develop best practice guidelines for

the use of these methods.

criteria and a change in country guidelines. The new classification

into levels of severity has been complemented by

clear treatment instructions for the three groups of patients

and has been shown to be of great assistance in case

management and for disease surveillance in a subsequent

study in 18 countries. It is currently incorporated into

a new edition of global guidelines for the diagnosis,

treatment, prevention and control of dengue 3 (described in

more detail on page 41), which is expected to improve case

management and disease surveillance.

Onchocerciasis – evidence

for the feasibility of elimination

Achievement details

Dengue – revised case classification

Dengue is the world’s most rapidly spreading vector-borne

disease, with an estimated 50 million infections occurring

annually. Its spread beyond Latin America and South-East

Asia is of great concern; the identification of dengue

viruses in West Africa is causing particular alarm. A 2006

TDR review 1 of 37 published papers suggested that the

previous WHO classification scheme was impractical,

particularly in primary healthcare settings, with around

40% of dengue cases being unclassifiable. Case classification

is important as it determines case management

and onward referral. A new system – dividing patients

into those with dengue, with or without warning signs,

and those with severe dengue – follows the largest

ever prospective study on dengue carried out in Brazil,

Malaysia, Nicaragua, Philippines, Thailand, Venezuela and

Viet Nam 2 . Termed the ‘DENCO’ study, it was co-funded

with the European Union. Studies using this new classification

system have so far been overwhelmingly positive.

The revised classification has been used in dengue

outbreak situations in Argentina, Bolivia, Cape Verde and

Paraguay, where it led to changes in hospital admission

A TDR multicountry study 4 co-funded with the Bill &

Melinda Gates Foundation* has provided the first evidence

that onchocerciasis can be eliminated. About half a

million people in 30 African countries are blind or visually

impaired due to onchocerciasis. The drug ivermectin has

been incredibly successful in stopping disease progression

by attacking the parasitic worms that cause the debilitating

itching and blindness. But this control has required annual

mass drug treatments, and it was unknown how long the

drug would have to be given to entire communities before

disease transmission was broken and the disease died out.

Studies carried out in 126 villages in three regions of Mali

and Senegal where ivermectin treatment had been given for

over 15 years, as part of mass treatment in order to control

onchocerciasis, showed that few infections remained in

humans and transmission levels were below the threshold

for elimination. Treatment was then stopped in test areas

in each region, and follow-up evaluations carried out after

16–22 months. These showed no signs of infection or

transmission, which led to the conclusion that elimination

* The Foundation also supported research on community-directed interventions and

supports our clinical research capacity building fellowships.

22


PART II

of onchocerciasis is possible in some endemic regions

in Africa. Further studies are needed to find out if the

findings can be extrapolated to other endemic areas in

Africa.

Malaria – British Medical Journal

clinical paper of the year

A TDR-coordinated study was identified by the British

Medical Journal (BMJ) as the best clinical research paper

in 2009 that “contributed significantly to improvements

in health and healthcare”. The Lancet article 5 was originally

reported in the 2007–2008 TDR Programme Report. It

covered a large randomized clinical trial of over 12 000

malaria patients in Bangladesh, Ghana and the United

Republic of Tanzania and led to the conclusion that one

rectal artesunate suppository, administered before referral

to the hospital, substantially reduced the risk of death

or disability in patients in rural villages, who could not

be given oral treatment and who were unable to get to a

facility for further treatment for several hours. An expert

panel of judges announced their decision to award the

prize in March, 2010.

Dengue – targeting productive

breeding places for vector control

A series of 2009 publications have further demonstrated

the value of targeted vector control for dengue. A TDRcoordinated

trial 6 carried out in Kenya, Mexico, Myanmar,

Peru, Philippines, Thailand, Venezuela and Viet Nam,

showed that targeting only the most productive water

container types (i.e. those that led to most mosquito

pupae – roughly half of all water-holding container types)

was as effective (and had lower implementation costs)

than targeting all water-holding containers. Dengue is

transmitted by mosquitoes, so the study has implications

for control policies/strategies that address breeding habits

of the vector.

Systematic reviews are also helping to guide dengue

control measures. One review indicates that spraying

peridomestic areas (areas near the household) with

insecticides to kill mosquitoes is ineffective against dengue

transmission if used on its own. 7 TDR-funded studies also

show that due to limited capacity, vector control services

in many countries are not adapting to new interventions,

suggesting a need for monitoring and evaluation to follow

the uptake of such interventions. 8

Ongoing activities

Dengue control –

an environmental approach

The International Development Research Centre (IDRC)

in Canada is in part funding ‘eco-bio-social’ research in

relation to dengue in Asia. The aim is to improve the

understanding of ecological, biological and social variables

that interact to affect the vectors that carry disease. The

IDRC has also funded research to improve dengue and

Chagas disease control through innovative ecosystem

management.

Malaria and other fevers – home-based

management could save lives

Home-based management of malaria (HMM) has the

potential to save many millions of lives, because it helps

patients get access to healthcare and treatment they would

not have otherwise. TDR research has already shown that

artemisinin-combination therapies (ACTs) can be used

successfully for HMM. 9,10 TDR studies have continued

to focus on the integrated management of fevers (due to

malaria, pneumonia and diarrhoea); these studies, which

will be conducted in Burkina Faso, Malawi, Nigeria and

Uganda, should be completed by 2012.

Malaria – making rectal artesunate

available to severely ill children

in ‘real-life’ conditions through

community health workers

TDR studies have demonstrated that rectal artesunate

suppositories buy much-needed time to stabilize seriously

ill infants and young children so they can be taken to

hospital for care. The next step has been a multicountry

study in Ghana, Guinea Bissau, Uganda, and the United

TDR annual report | 2009

23


Research for delivery, policy and access

Republic of Tanzania to assess whether mother-coordinators

can make rectal artesunate available in community

settings. The trial was set up to answer questions such

as: What is the coverage achieved by different dispensers

providing near-home rectal artesunate treatment in the

real-life setting? How should community personnel be

trained and supported to make the drug available and to

ensure that available drugs are used appropriately? Will

patients and guardians feel that hospital referral can be

deferred after their child has received a suppository or will

they adhere to the recommendation to go immediately

to the hospital? The trial has concluded and data are

currently being analysed. A publication with the results

from this study is planned for 2010.

Malaria – understanding vector

resistance to insecticides to help

control efforts

the cotton-growing regions is resistant to all four classes

of insecticide currently available for vector control. The

study highlights the urgent need to monitor the impact of

resistance, and should be of great interest to control efforts.

Malaria and dengue – MosqGuide,

providing guidance for the use of

genetic vector control

MosqGuide 12 is a TDR-funded project bringing laboratorybased

researchers to work together with field experts to

develop guidance on the assessment and potential deployment

of different types of genetically modified mosquitoes

to tackle malaria and dengue. Commissioned in 2008,

the project will be responsible for the development of

best practice documents on a variety of issues, including

arthropod biology, vector control and environmental

risk assessment. These will be of value to those making

decisions on a national, regional and international level

about the safety, ethics and sociocultural aspects of using

genetically modified vectors for disease control. A number

of modules are in development and these will be published

on the MosqGuide website: http://www.mosqguide.org.uk

TB/HIV – providing antiretrovirals

earlier to patients

The use of insecticides to control malaria is growing

in Africa. However, control specialists are increasingly

concerned by insecticide resistance seen in mosquitoes

such as Anopheles gambiae. This is particularly alarming

because few insecticides are available for control efforts.

A TDR-funded multicentre study 11 is being carried out

over 3 years in Burkina Faso, Benin, Chad, Sudan, and

South Africa to establish the magnitude of vector resistance

to insecticides, characterize resistance mechanisms and

assess the implications for control interventions. The first

year involved Burkina Faso, Chad and Sudan, and has

shown how resistance is very heterogeneous, with large

differences in mosquito mortality rates being observed

even in the same study sites during the course of the

malaria transmission season. All Burkina Faso and Chad

mosquito populations, and some Sudan populations, were

classed as permethrin and/or deltamethrin resistant. Some

areas of all three countries also showed high frequency of

DDT* resistance. A source of major concern is the finding

that, in Burkina Faso, the vector population in one of

With one in three people a carrier, TB is one of the world’s

most widespread infections. Moreover, increasing drug

resistance and problems associated with TB in HIV-positive

individuals make TB a growing public health concern.

A TDR-supported trial** aims at providing evidence

for the treatment of HIV-infected TB patients utilizing

concomitant anti-TB chemotherapy and highly active

retroviral therapy (HAART) through a CD4 T cell range

of 220–500 cells/mm 3 . It is expected that the information

generated from this study will complement the current

global guidelines for management of these categories of

patients.

When completed, the trial will be the largest of its kind,

with 1800 patients spread over four countries (South Africa,

the United Republic of Tanzania, Uganda and Zambia).

* Dichlorodiphenyltrichloroethane.

** During 2009 Merck and GlaxoSmithKline (GSK) have jointly provided in-kind support

worth about US$ 2.8 million of their antiretroviral drugs, Stocrin (Efavirenz) and Combivir

(AZT and 3TC), for clinical trials on the treatment of HIV/AIDS in TB patients in the United

Republic of Tanzania, Uganda, Zambia and South Africa (the TB-HAART studies). GSK,

in addition to its contribution of AZT (US$ 1.3 million) towards the end of 2009, added

Combivir placebo, estimated at about US$ 50 000, to the study.

24


PART II

Syphilis – rapid diagnostic tests

studied for introduction into

control programmes

programme co-funded with the German development

agency GTZ has been implemented. The effect of the

standardized training and application of the M&E Toolkit

on programme performance is now being assessed.

Visceral leishmaniasis – an improved

way of managing case detection

Six effective rapid syphilis tests previously evaluated

by TDR are currently available through WHO’s Bulk

Procurement Scheme. TDR is now working with seven

countries in Africa, Asia and the Americas (Brazil, China,

Haiti, Peru, the United Republic of Tanzania, Uganda and

Zambia) on how to introduce validated rapid syphilis tests

into national control programmes, and how to ensure the

quality of tests and testing when used in remote settings.

Visceral leishmaniasis - vector

control critical to elimination

Visceral leishmaniasis (VL) can cause fever, anaemia,

enlargement of the spleen and severe wasting. It is

potentially fatal if untreated, and has an estimated incidence

of 500 000 cases per year; 60% of cases occur in three

countries of the Indian subcontinent – Bangladesh, India

and Nepal. But an elimination campaign is underway to

stop this disease, in part because of the tools developed

through TDR research. A TDR-supported study 13 has

shown that control of the sandfly vector (that carries the VL

parasite) could make an important contribution to efforts

to eliminate VL. Such control is most effectively done by

indoor residual spraying (IRS) with insecticides and, to a

lesser extent, by the use of long-lasting insecticide treated

bednets (LLIN) and through the traditional practice of

plastering walls of homes with lime. The authors concluded

that IRS should be strengthened in India and Nepal, and

initiated in Bangladesh, for the best potential to rapidly

reduce disease transmission. However, analysis of national

IRS programmes in India and Nepal has identified severe

performance and outcome issues (paper under revision).

Based on these findings a Monitoring and Evaluation

(M&E) Toolkit for IRS has been developed, and a training

Results from TDR-funded studies show that although the

incidence of VL has decreased since 2008 in endemic

districts of India, Nepal and Bangladesh, levels are still

19 times higher than the elimination target for 2015.

Interim data on case detection suggest that a three-tiered

approach could reduce the incidence of the disease. In

highly endemic areas, a ‘camp approach’ where mobile

teams visit endemic villages is most cost-effective and

feasible. In districts with lower endemicity levels an ‘index

case approach’ is appropriate, where mobile teams do

house-to-house screening around index cases reported

through passive surveillance. Passive surveillance should

be used in middle-low endemicity areas that already have

a well established surveillance system. These findings

are currently being made available to the national health

services through documents and training activities. 14


We are also investigating the

best ways to control diseases and

possibly eliminate them. ”

TDR annual report | 2009

25


Research for

discovery and

development of tools

and products for

neglected diseases

WHO’s Global Strategy and Plan of Action (GSPOA) on Public Health, Innovation and

Intellectual Property calls for building and improving innovative capacity for research

in developing countries and for improving, promoting and accelerating transfer of

technology between developed and developing countries, as well as among developing

countries. TDR’s role and contribution to this is to build networks and foster ‘southsouth’

collaborations in which scientists from developing countries play a leading role.

This section focuses on some of the tools and products that have resulted from these

partnerships.

26


PART II

Key tools and products highlights

Evaluation of 41 rapid diagnostic tests for

malaria has been carried out in a study

co-funded and coordinated by TDR with

several partners. Much variability in the

performance of tests was found, with several

tests identified that are suitable for field use.

The report of this study should help countries

decide which tests to purchase, and also spur

manufacturers into further improving the

quality of their products.

A TDR-commissioned trial evaluating the

performance of light emitting diode (LED)

adaptors for the microscopic examination

of TB samples has shown that these low-cost

adaptors make the examination process

faster and easier. Such a simplified method

for diagnosis is likely to have a positive impact

in the field and has been included in WHO

Stop TB guidelines.

A TDR-coordinated collaboration has

helped develop a standardized protocol

for diagnostic testing of Chagas disease by

a technique called the polymerase chain

reaction (PCR). It is anticipated that such

standardization will help both clinical

diagnosis and research.

TDR annual report | 2009

27


Discovery and development of tools and products

New tools and products – such as diagnostics and

treatments – are desperately needed to tackle

infectious diseases of poverty. Treatment for

many diseases still relies on drugs developed

decades ago, so it is crucial to get more drugs into

the R&D* pipeline. In the absence of commercial

incentives, R&D companies remain reluctant to

invest in developing drugs that predominantly

affect the poor. At TDR we complement the

work of other organizations such as product

development partnerships working in this field,

seeking to fill gaps in research and better engage

and support developing country institutions in

these endeavours. We focus on producing results

as fast as possible and on a larger scale than

research that can be carried out by individuals or

institutions alone. We work collaboratively, using

the convening power of our WHO co-sponsor to

bring together multiple partners and develop

new approaches to R&D.

Two G-Finder reports also highlight some of

the issues relating to research into new tools

and products for infectious diseases of poverty.

The first 15 shows that while tuberculosis, HIV/

AIDS and malaria are now receiving attention

globally, neglected tropical diseases are inadequately

covered. The second 16 highlights the

fact that developing countries have the capacity

for innovation for research and that this should

be better utilized. Both papers support TDR’s

strategic approach to promote and build capacity

for innovation on a range of infectious diseases

of poverty, seeking to strengthen leadership

and improve ownership of health research by

developing countries.

* R&D: Research and development.

** The evaluation was co-sponsored by TDR, the WHO Regional Office for the Western

Pacific (WPRO) and the Foundation for Innovative New Diagnostics (FIND). Testing

was performed at the US Centers for Disease Control and Prevention (CDC) and

was done on samples from patients that had been quality assured and validated at

numerous institutions in malaria endemic countries.

Achievement details

Malaria – evaluation of rapid

diagnostic tests to improve detection

In April 2009, the day before World Malaria Day, the

results from the largest ever independent, laboratorybased

blinded evaluation of 41 currently available rapid

diagnostic tests (RDTs) for malaria were published. 17

The study, funded by TDR and other partners,** found

that there was great variability in the performance of tests

at tropical temperatures, at which many tests are likely

to be carried out, with some tests showing much greater

sensitivity than others. It also found that testing varied

between lots, suggesting that each lot should be tested

post purchase and prior to use in the field. Several RDTs

were found with high detection and low false-positive

rates that are stable at room temperature and easy to use,

so suitable for field use. RDTs are an invaluable way of

quickly diagnosing disease in countries with high disease

burdens, and the findings should help countries make

informed choices about the RDTs they purchase – this is

particularly important when public health resources are

limited. To ensure transparency, the reports are published

openly, thereby providing an impetus for manufacturers to

ensure and improve upon the quality of the tests that they

produce. The publication on malaria RDTs has been highly

popular, largely because it points out the weaknesses of

several tests and identifies tests that are suitable for field

use.

This latest evaluation is part of a growing series of diagnostics

evaluations that TDR has undertaken – including

evaluation of tests for syphilis, 18 leishmaniasis, 19 tuberculosis

20 and dengue. 21 A further evaluation of rapid tests for

visceral leishmaniasis is currently under way, as is a second

round of dengue tests. Results from a second round of

evaluations on a further 29 malaria diagnostic products

will be published in 2010.

28


PART II

Tuberculosis – a better way of

analysing samples by microscopy

been used for the diagnosis and assessment of T. cruzi

infection for several years, but up until this collaboration

the protocols used varied widely, making data comparison

between research groups difficult. T. cruzi causes Chagas

disease, and a standard operating procedure for the use of

PCR to detect T. cruzi DNA will greatly aid Chagas disease

diagnosis and research. The results of a TDR-sponsored

multicountry process of validating the use of PCR for

Chagas disease studies were presented in October 2009

at the XXI Congresso Brasileriro de Parasitologia and II

Encontro de Parasitologia do Mercosul in Foz do Iguazú,

Brazil, and will be published in 2010.

TB is notoriously difficult to diagnose by microscopy, but it

is often the only feasible method in resource-poor settings.

Based on trials commissioned by TDR 22 and others, the

Scientific and Technical Advisory Group of WHO’s STOP

TB Department recommended that conventional high-cost

fluorescence microscopy could be replaced by low-cost

light emitting diode (LED) microscopy in all settings where

fluorescence microscopy is now used, and that fluorescence

LED microscopy be phased in as an alternative for

conventional Ziehl-Neelsen microscopy in both high- and

low volume laboratories. 23 The LEDs make bacteria ‘glow’

in specially stained smears; results so far indicate that LED

fluorescence microscopy makes diagnosis faster and easier,

and therefore more suitable for the field. The potential for

a rapid TB blood test is also being investigated by TDR

such a test could replace TB smear tests, which are costly

and time consuming to carry out. A diagnostics test based

on a new combination of TB antigens for use in such tests

will be evaluated by TDR during 2010.

Chagas disease – a standardized

protocol for the polymerase chain

reaction

A TDR-coordinated collaboration has led to the assessment

of, and agreement on, a standardized protocol for

polymerase chain reaction (PCR)-based detection of DNA

from Trypanosoma cruzi, the parasitic organisms that

cause Chagas disease. Biomedical researchers and medical

practitioners from 14 countries (mainly Latin America,

where Chagas disease remains endemic) participated

in a workshop and symposium (sponsored by TDR,

INGEBI-Conicet UBA and the United Nations University’s

BIOLAC programme) that led to the agreement. PCR has

Ongoing activities

Tuberculosis – clinical trials

improving treatment options

A TDR-funded study focuses on a novel gatifloxacincontaining

drug combination to assess if this can cut TB

treatment time from six to four months. Shorter treatment

times are more convenient for the patient, require fewer

resources, and are more likely to ensure patients complete

the course of medicines – particularly important in

reducing the rise of drug resistance. A multicentre phase 3

trial conducted in five African countries with national

TB control programmes (in Benin and Senegal) and local

institutions (in Guinea, Kenya and South Africa) has

completed the enrollment and treatment phases (approximately

1840 patients) and is now following patients for

relapses. If the shortened regimen proves effective and safe,

this will be the pivotal trial in a regulatory submission.

Toxicology and phase 1 and 2 clinical studies have already

been completed.

Safety and efficacy trials are also being carried out on a

single-dose pill for TB that combines multiple drugs that

would otherwise have to be taken as a loose combination.

A single-blinded randomized trial of 1000 patients in

Ethiopia and Nigeria should be completed in 2011 to

assess the safety and efficacy of fixed-dose combinations

over single formulation of the same drug, among a

mixed group of HIV-infected and uninfected TB patients.

The study was designed by TDR not just to provide the

evidence base for the use of fixed-dose combinations in

improving treatment adherence among TB patients, but

also to develop the capacity within national programmes

and associated national research institutions to conduct

TDR annual report | 2009

29


Discovery and development of tools and products

such studies. The tremendous contribution of this study,

to research capacity development and institutional

strengthening, has just been highlighted at the recently

held 40th anniversary (17–19 March 2010) of the

Armauer Hansen Research institute, Addis Ababa,

Ethiopia, one of the collaborating sites.

Onchocerciasis – start of phase 3

clinical trials for moxidectin

Over 100 million people are at risk of infection with

onchocerciasis in Africa alone, with others at risk in

some regions of the Americas and Yemen. Moxidectin

could dramatically speed up elimination of disease across

Africa if it can be shown that, unlike ivermectin which

is currently used to control the disease, it sterilizes or

kills the adult worms responsible for the long-lived

nature of the infection, as well as kills the larvae. The

TDR-supported clinical trial* is currently investigating

moxidectin’s potential for tackling this devastating illness.

To be carried out over two and a half years, the trial will

take place in three African countries where onchocerciasis

is endemic – 1500 people at four sites in the Democratic

Republic of the Congo (DRC), Ghana and Liberia will be

enrolled. A clinical research centre was built in Liberia,

and in DRC; these centres have been fully equipped

while the research teams have received training on how

to conduct the trial according to international standards.

Such activities highlight TDR’s efforts to strengthen the

research capacity of fragile states such as Liberia and DRC.

Visceral leishmaniasis –

a new drug combination may help

elimination efforts

The oral drug milfetosine (brought to registration by

TDR and its partners in India) has changed the face

of visceral leishmaniasis (VL) treatment in recent years.

For nearly a century the standard treatment for VL (or

kala azar) has been a painful 30-day course of intramuscular

injections with sodium stibogluconate. A further

innovation may soon be available. Preliminary results

from a recent clinical trial sponsored by TDR

and led by Banaras Hindu University and Rajendra

Memorial Research Institute of Medical Sciences in

India suggest that a single injection of AmBisome ®

(a drug also developed with TDR support) followed

by 14 days of oral miltefosine, shows promise as an

alternative VL treatment. AmBisome ® was obtained

at low cost following negotiation with WHO ‘s Department

of Control of Neglected Tropical Diseases (NTD)

department, which has allowed this combination to be

considered in the future as a cost-effective alternative.

The shorter treatment should increase compliance which

will be beneficial to patients and healthcare providers.

The combination will also decrease the likelihood of

drug resistance, making it acceptable for a region-wide

elimination programme. Preliminary results showed

a cure rate efficacy of the combination regimen above

97%. Final results are due to be published in 2010.

Visceral leishmaniasis – improved

treatment for post-kala azar dermal

leishmaniasis

A TDR-supported clinical trial is addressing the value of

a 12-week course of the oral drug miltefosine compared

to an 8-week course for treating post-kala azar dermal

leishmaniasis (PKDL), a sequel of visceral leishmaniasis

and a reservoir of the parasite for continued transmission

of the disease. In Bangladesh where there are almost

as many PKDL patients as VL patients, this is particularly

important. The current PKDL treatment standard

is a six-month course of treatment with pentavalent

antimony, making treatment compliance difficult. Prior

to this study, evidence on the efficacy of PKDL treatment

with drugs other than with antimony has been scarce.

* Pfizer (formerly Wyeth) has agreed to provide over US$ 6 million over three years to

support the development of the drug moxidectin for onchocerciasis treatment. Pfizer

and African Programme on Onchocerciasis Control (APOC) have also contributed

operationally to the trial, which is being carried out in collaboration with Pfizer and

African investigators and institutions.

30


PART II

Human African trypanosomiasis

treatment – investigating new

treatment regimens

Human African trypanosomiasis (HAT) is a devastating

disease that threatens millions of people in sub-Saharan

Africa. An ongoing TDR-funded study on stage 1 HAT

is comparing the safety and efficacy of a three-day

pentamidine regimen against the standard seven-day

regimen. Shortened treatment should reduce side

effects and costs of case management and improve the

operational feasibility of HAT control. Partnering with

other organizations is being actively pursued to speed

up and finalize patient recruitment for clinical trials by

the end of 2010.

Meanwhile, the combination of nifurtimox and

eflornithine (NECT) is being studied in Uganda in a

clinical trial of stage 2 HAT (a stage of the disease which

is fatal if untreated). This study was jointly designed

with the Drugs for Neglected Diseases initiative (DNDi)

to feed into a strategy for inclusion of the combination

in the WHO Essential Medicines List. The data from

the study will complement the information provided by

DNDi which supported the inclusion of the NECT in the

WHO Essential Medicines List in 2009.

Republic of Tanzania. Focusing on factors that enhance

tsetse fly trap performance should lead to ‘best traps’

for six vector species that play a significant role in HAT

transmission. Results from studies such as this will help

develop an algorithm to help support decision-making

and greatly improve HAT vector control.

Chagas disease – factors hindering

elimination

TDR is funding a multicountry study on prevention of

triatomine bug re-infestation in Argentina, Bolivia, Brazil

and Paraguay – including characterization and improvement

of knowledge about the status of resistance to

insecticides of Chagas disease vectors (triatomine bugs).

Preliminary results highlight two problems that could

hinder vector elimination: (i) inadequate spraying with

insecticides and development of resistance; and (ii)

triatome insects that travel from areas outside those

that have been sprayed. Final results should be in by

the end of 2010.

Human African trypanosomiasis –

completing the gene sequence

for the tsetse fly

By March 2010 a TDR-supported international genomics

effort (the International Glossina Genomics Initiative,

IGGI) should achieve complete sequencing of Glossina

morsitans morsitans, the species of tsetse fly that acts as a

vector of HAT. Understanding more about the tsetse fly

may help researchers to develop ways to control disease

transmission by this vector.

Human African trypanosomiasis –

research on tsetse fly trap efficacy

Preliminary findings from a TDR-funded study on the

optimization of tsetse fly traps and baits have identified

key physical and chemical features that limit their efficiency.

As tsetse fly traps are an important element in the

control of tsetse flies, the identification of features that

affect trap efficiency may help to improve their design.

Phase 1 field trials using a range of fabrics procured

from Africa, Europe, USA and Asia started in April 2009

in Burkina Faso, Côte d’Ivoire, Malawi and The United

Drug discovery

During 2009 two new lead compounds deserving

further medicinal chemistry have been declared for

malaria through work with Pfizer and Merck Serono.

As part of a collaboration between TDR, NovoNordisk

and the National Center for Drug Screening (NCDS)

Shanghai, the first high throughput screening (i.e. rapid

screening) for a TB drug target has been completed at

the NCDS. Meanwhile there is continued progress with

TDR compounds in medicinal chemistry centres at the

University of Cape Town (South Africa), and the University

of Sao Paulo (Brazil). TDR’s targets database (www.

tdrtargets.org), which is a global open-source resource

for drug targets, continues to improve and be used by

increasing numbers of scientists worldwide.

TDR annual report | 2009

31


Empowerment –

promoting equity

and fostering

ownership and

research leadership

Over the years, TDR has played a central role in building research capacity for infectious

diseases of poverty, an activity that comes under TDR’s new ‘Empowerment’ strategic

function. In line with the 2005 Paris Declaration, our vision is to ensure that researchers

from countries bearing the highest burden of infectious diseases are able to fully

participate in research and its governance. Specific empowerment support activities

in TDR are coordinated by an Empowerment team, but empowerment principles and

activities are carried out across the entire spectrum of TDR’s programmes.

32


PART II

Empowerment highlights

The 5th Multilateral Initiative on Malaria

Pan-African Malaria Conference in Kenya

this year, coordinated by a secretariat at the

AMANET trust in Tanzania and co-sponsored

by TDR, was a highly dynamic and well

attended meeting that brought together a

range of stakeholders in malaria research

and control to discuss scientifically technical

topics such as insecticide and drug resistance

and genetic modification of vectors for

disease control, and strategic issues relating

to the potential to eliminate malaria from

countries where the disease is currently

endemic. Bridging these themes into a

common research approach to address

malaria is likely to have growing importance

over the coming years.

Grants, networks and training activities have

continued to be provided through TDR in

2009. These build on TDR’s traditional research

capacity-building role, and will evolve over

the coming years to ensure that developing

country scientists and institutions play a

greater role in leading research and shaping

national and international research agendas.

The creation of several TDR-sponsored

research training centres was initiated, which

will better allow disease endemic countries

to lead research capacity-building efforts in

their regions, with a train-the-trainer approach

ensuring sustainability.

An Action Framework for Research Partnerships

on Neglected Diseases of Poverty was

developed following a TDR-backed meeting

of stakeholders from Africa, the Middle East,

Asia, Latin America, North America and

Europe. Participants discussed south–south

and north–south partnerships, outlining

the ways in which governments, research

institutions, funders and others can help

ensure equitable partnerships on neglected

diseases of poverty.

TDR annual report | 2009

33


Empowerment – fostering ownership and research leadership

Low- and middle-income countries can

only play a pivotal role in research if their

research is strengthened at institutional

and national levels, which means moving

beyond the traditional capacity-building

model of building individual research

excellence. TDR, through its Empowerment

function and other empowerment

activities, takes a concerted and systematic

approach to addressing inequities in health

research that exist between countries,

within countries and in the content and

conduct of research. We aim to build a more

equitable environment, by developing the

range and breadth of researchers and allied

health professionals, nurturing research

careers and helping to develop new leaders,

promoting networks and strengthening

national systems.

Our activities have different effects

at different levels

National level systems: strengthened

through network/partnership

development and technical

support.

Institutions: improved access to

research grants.

Individuals: improved access to

research grants, training courses

and scholarships, mentorship and

leadership/career development

fellowships. Box 1 highlights the

research excellence of some of our

former grantees.

BOX 1 – Research excellence

of former TDR grantees

In 2009 several former TDR grantees received recognition

for their research excellence.

In 2009, in Addis Ababa, Ethiopia, Ethiopia last

year, Sanaa Botros, Professor of Pharmacology

at Egypt’s Ministry of Higher Education and

Scientific Research and one of the world’s

leading researchers studying the treatment of

schistosomiasis and other tropical diseases,

received an African Union Women Scientists

Regional Award – Earth and Life Sciences Prize

in recognition of her scientific achievements. Gaining her PhD in the

1980s Botros went on to win a number of awards and honoraries,

including the Arab Women Organization Award for Science and

Technology in Biological Sciences in 2008 and the Country State Award

in Medical Sciences from the Egyptian Academy of Scientific Research

and Technology in 1997. Early in her career Botros showed that locally

produced drugs for schistosomiasis were as effective as imported drugs

which had, at that time, been the only available drug for schistosomiasis.

The local drug went on to be used widely, saving Egypt much

unnecessary expenditure. She has also shown the ineffectiveness of other

drugs which, as a result, are no longer distributed in Egypt. She currently

sits on the Task Force for the African Network for Drugs and Diagnostics

Innovation (ANDI).

Abdoulaye Djimdé, Head of the Molecular

Epidemiology and Drug Resistance Unit of the

Malaria Research and Training Center at Mali’s

University of Bamako, was named Best Pharmacist

in the Francophone World by the National

Academy of Pharmacy of France. Presented during

the 62nd World Health Assembly in Geneva in May

2009, the award recognized Djimdé’s outstanding

contributions to antimalarial therapeutics development. Djimdé began

his career by researching the herbal medicines that traditional healers

used to treat jaundice in his native Mali. Several years later, he served as

principal investigator on a Multilateral Initiative on Malaria (MIM)/TDR

Antimalarial Drug Resistance Network in Mali. Now one of the world’s

leading experts on the molecular characterization of malaria parasite

resistance to antimalarial drugs, Djimdé has published 45 peer-reviewed

articles and oversees a team of 19 scientists at the University of Bamako.

He works closely with the National Malaria Control Programme of Mali

and currently serves as chairperson of the MIM/TDR Task Force on Malaria

Research Capability Strengthening in Africa. He is also an Associate

Professor of Microbiology and Immunology at the Faculty of Medicine,

Pharmacy and Odonto-Stomatology, University of Bamako.

34


PART II

Tunisian scientist Ikram Guizani, also a

former TDR grantee, was awarded a prize

for Best Female Scientific Researcher by

the President of the Republic of Tunisia

in recognition of her contributions to

leishmaniasis control. As head of the

Laboratory of Epidemiology and Ecology

of Parasitic Disease at the Pasteur Institute

of Tunisia, Guizani has made significant contributions to the

understanding of the pathogenesis and population genetics of

leishmaniasis at the molecular level. Taking a ‘gene-to-patient’

approach, her research has resulted in several milestones:

the development of a bioinformatic tool kit for in silico

characterization of potential targets; validation of an antigenic

leishmania target, LeIF protein; and development of a prototype

diagnosis kit based on DNA chips using targets identified

by comparative genomics. Over her 20-year career, Guizani

has received several TDR grants, served on TDR’s Research

Strengthening Committee and published more than

30 peer-reviewed articles. She is a founding member of the

Tunisian Women and Science Association and a founder and

African coordinator of the TDR-sponsored South–South Initiative

for Tropical Disease Research.

Lizette Koekemoer, currently Head of the

Vector Control Reference Unit at the National

Institute for Communicable Diseases of

the National Health Laboratory Service in

Johannesburg, was awarded the Southern

African Association for the Advancement

of Science (S2A3) British Association Medal

(Silver) for 2009, one of the highest awards

for original scientific research in South Africa. Koekemoer was

recognized for her ‘high-quality science, with a sound background

and straightforward analytical methodology’. Over the course of

her career Koekemoer was involved in the discovery of two species

of Anopheles mosquito and introduced new technology to vector

research, including a multiplex PCR assay to identify five members

of the An. funestus group of mosquitoes in Africa. The assay is now

the standard method for identification of this group of mosquitoes

worldwide. Another major research focus for Koekemoer has been

the molecular basis of insecticide resistance in mosquitoes, which

she and her colleagues have shown has a metabolic mechanism. She

has published 40 peer-reviewed articles, almost all in international

journals. On several occasions she has served as temporary adviser

to WHO/TDR in the area of research capability strengthening, and is

currently a member of the TDR Research Strengthening Group (RSG)

committee.

Achievement details

The Multilateral Initiative on Malaria

in Africa (MIM)

This initiative was created to strengthen the capacity

of malaria-endemic countries in Africa to carry out

research to improve malaria control. Together with

a number of other bodies led by a secretariat hosted

by The African Malaria Network Trust (AMANET)

TDR co-sponsored the 5th Multilateral Initiative on

Malaria (MIM) Pan-African Malaria Conference, held

in Nairobi, Kenya between 2–6 November. TDR had

a significant role in organizing the event. Over 2000

people registered for the conference, making it one

of the largest malaria meetings in the world. Various

disciplines were represented by researchers, control

experts, science administrators, healthcare workers,

members of the media and representatives of

private foundations, governments and international

organizations from across the world. Key themes

addressed at the conference included: the need to

combat resistance to antimalarial drugs; mosquito

resistance to insecticides; genetic modification for

vector control; and strengthening African research.

One of the challenges that TDR will try to address,

building on its experience of community-based

care, is improving access to artemisinin combination

therapies to treat malaria. Discussions led by the

malERA initiative to address research issues identified

with malaria elimination were of strategic interest.

Bridging the technical research agenda to broader

political and strategic control objectives is likely to

grow in importance over the coming years. The MIM

meeting was supported by the TropIKA.net team,

which provided online background and updates

about discussions, allowing participation in debates

by scientists unable to attend in person.

Research grants

TDR continues to fund research strengthening grants

and re-entry grants for a range of infectious diseases

of poverty. Most of TDR’s resources go to the two

poorest regions of the world – Africa and South-

East Asia, although we fund activities throughout

the world. Total ongoing activities included 33

collaborative research grants on malaria in Africa,

36 re-entry grants and 5 institutional strengthening

TDR annual report | 2009

35


Empowerment – fostering ownership and research leadership

grants globally. Small grants have been funded through

almost all of the WHO regional offices and more than

25 networks are engaged by and supported by TDR,

mostly operated by health researchers in low- and middleincome

countries.

TDR has also helped train hundreds of scientists through

a number of capacity strengthening professional development

short courses (see Fig. 1). We have increased the

number of short training courses and are increasing the

number of candidates receiving Leadership Training

Grants (LTGs) and Leadership Development Fellowships

(LDFs). LTGs adopt an innovative approach to providing

training grants at the PhD level. While focused mainly on

the training and development of the individual grantee,

they also help support the grantee’s home institution to

improve research practices, which has an impact regionwide.

LDFs are three-year postdoctoral fellowships for

experienced DECs researchers to become health research

leaders by pursuing their professional development in a

multidisciplinary and partnership manner. In addition,

Figure 1. Relative

numbers of investigators

and staff

undergoing capacity

strengthening

supported by TDR

from different WHO

regions

Figure 2. Relative

numbers of ongoing

MSc/PhD grants

going to different WHO

regions

Participating WHO regions

AFR:

AMR:

EMR:

SEAR:

WPR:

Africa

Americas

Eastern Mediterranean

South-East Asia

Western Pacific

PhD and Masters students were funded in 24 countries

(mainly in Africa – see Fig. 2), a third of which were

female researchers. Over the next four years 30 scientists

will receive Career Development Fellowships in the area

of clinical research (amounting to a total of around

US$ 3 million) in partnership with the pharmaceutical

industry and the Bill & Melinda Gates Foundation.

Berlin stakeholders’ meeting -

strengthening research partnerships for

neglected diseases of poverty

An Action Framework for Research Partnerships on Neglected

Diseases of Poverty was formulated in Berlin in March

2009 24 following a meeting of stakeholders (including

representatives from ministries of health, ministries of

science and technology, development agencies, research

funding agencies and leaders from technical research

institutions).This was a follow-up to recommendations

coming out of the Bamako Global Ministerial Forum on

Research for Health in November 2008 which called for,

among other things, the development of more equitable

partnerships. The participants discussed south–south and

south-north partnerships and developed the framework,

which includes recommendations for:

Governments – to adopt national policies for health

and encourage collaboration across government to

support research for health.

National research institutions – to develop research

partnerships consistent with the national public health

priorities established by governments and support the

development of local scientific leadership and up-todate

research and development skills; to establish, at

the start of projects, equitable agreements between

partners to cover issues of ownership, management

and dissemination of data, research tools and publications,

and where appropriate intellectual property and

benefit sharing.

Health research funders/donors – to align their

support with national and research agendas and

provide adequate core support to cover the true cost

of research in low-income settings.

Private sector and civil society – to be open to

working with governments and research institutions

and, for civil society, to follow up on a call for civil

society engagement in research that was provided as

input to the Bamako forum on research for health.

36


PART II

Some 120 participants from Africa, the Middle East, Asia,

Latin America, North America and Europe came together

for the meeting, convened by TDR and the German Federal

Ministry for Economic Cooperation and Development.

The framework should lead to more equitable partnerships

where the agenda is driven increasingly by institutions in

developing countries.

Ongoing activities

ANDI and regional networks for innovation

The concept of regional innovation networks was created

to promote new thinking on innovation and access to

medicines. The African Network for Drugs and Diagnostics

Innovation (ANDI) is one such initiative that TDR is

fostering towards this goal. Recently boosted with a grant of

5 million euros from the European Union, ANDI is being

set up to partner, fund and coordinate research through

collaborative project networks and partnerships, and is

seeking to establish support platforms to help manage

pharmaceutical research throughout Africa. ANDI held its

second stakeholder meeting in 2009. A sustainable fund is

being sought that can yield around US$ 30 million a year.

This will fund a portfolio of innovative products within

Africa and provide knowledge management and database/

technical support for the projects. ANDI will operate under

an African-led governance and management structure

through a central office with subregional hubs. Further

information can be obtained from: www.who.int/tdr/svc/

partnerships/initiatives/andi

The concept behind the initiative has proved so popular

that it has already spurred on the development of other

regional networks. A Chinese network held its first

meeting in 2009 and is under further development to link

into a broader Asian network. It is anticipated that, once

established, these networks will more broadly support

south–south collaboration for innovation.

Other networks – working together to

enhance health research and its impact

TDR currently hosts the secretariat for ISHReCA (the

Initiative to Strengthen Health Research Capacity in

Africa). Created in response to needs expressed by African

researchers, ISHReCA is working to secure donor support

to run medium-term programmes that will attract young

minds to health research and raise the profile of health

researchers on the continent (http://ishreca.tropika.net/).

ISHReCA is set up to provide the much needed forum to

express researchers’ needs more powerfully vis-à-vis funders

and African governments. Efforts are underway to establish

the secretariat at a host institution in Africa and develop its

future strategy. TDR has also helped develop and host the

secretariat for ESSENCE (Enhancing Support for Strengthening

the Effectiveness of National Capacity Efforts) – a

new initiative set up by funding agencies to harmonize the

activities of funders and so improve the way that funders

work together to increase research capacity in Africa.

TDR continues to support other networks by providing

advice and guidance. This includes the Partnership for

Social Sciences in Infectious Diseases of Poverty (PSSiDP)

and the Forum for African Medical Editors (FAME). TDR

supported a meeting in Geneva to assist PSSiDP to develop

a new five-year business plan, including a revision of its

strategic approach and a resource mobilization plan. TDR

will continue to part-fund this network over the next two

years. TDR also helped initiate the South-South Initiative

(SSI) for tropical disease research (www.ssi-tdr.net/), which

has successfully promoted research partnerships between

scientific groups across Africa, Latin America and Asia. SSI’s

mission is to foster scientific leadership in disease endemic

countries promoting high quality collaborative research and

increased competitiveness in the field of diseases of poverty.

Training activities

TDR continues to develop health research leadership in

low- and middle-income countries at all levels. As well as

increasing knowledge, skills and competencies through

funding PhDs and MScs, TDR is developing short courses

in research methodology and project management, and

providing guidance on writing research proposals. TDR also

funds and facilitates research strengthening, professional

development and career development. A new mentorship

initiative will provide incentives to support the link between

young and established researchers.

The creation of four new regional training centres in 2010

in Indonesia, Kazakhstan, Columbia and Rwanda will

further allow the transfer of ownership of these courses to

disease endemic countries. Several specific training activities

have been handed over to institutional or regional training

centres to help build self-sustainability. Regional training

centres in biosafety for human health and the environment

have already been set up in Colombia (for Latin America),

India (for Asia) and Mali (for Africa).

TDR annual report | 2009

37


Stewardship –

knowledge for

decision making

and advocacy for

research for health

TDR’s Stewardship function forms the third arm of TDR’s new strategy. It focuses on

collating knowledge to make informed decisions on research policies and priorities,

and on advocacy for research needed to decrease the burden of diseases of poverty.

TDR’s Stewardship team is specifically dedicated to neglected diseases knowledge

management, knowledge sharing and priority setting in the global health arena.

However, stewardship activities are carried out across the entire spectrum of TDR’s

programmes as an element integral to disease-related research, capacity-building

and other activities.

38


PART II

Stewardship highlights

A think-tank of 100 international experts

has been created to develop and analyse

reports from 10 disease-specific and thematic

reference groups and so identify the top

priorities for research on infectious diseases of

poverty. Their findings will help shape a global

report on research into infectious diseases of

poverty, to come out in 2011.

The web-based global knowledge platform on

tropical disease research, TropIKA.net, has seen

a significant increase in use in 2009. Four developing

countries were among the top ten users

of the platform. The first TropIKA.net Career

Development Fellowship, which provides

post-doctoral scientists with hands-on

experience translating research outputs and

outcomes to reach a wider audience, has also

been awarded.

Development of dengue guidelines (in collaboration

with WHO’s Department of Control of

Neglected Tropical Diseases), which will help

improve the diagnosis, treatment, prevention

and control of dengue.

TDR annual report | 2009

39


Stewardship – knowledge for decision making and advocacy...

Infectious diseases of poverty are a formidable

stumbling block to human development and realization

of the MDGs in most low-income countries.

Despite increased funding globally for health and

health research, the impact on human health has

been less than optimal – partly because research

efforts have been uncoordinated, fragmented and

sometimes not well focused, with inequitable input

from the developing world. At TDR we are trying

to redress this situation.

Through its Stewardship function, TDR

will work with experts and a broad array

of stakeholders to:

Help identify priority research needs

and major research gaps

Provide a strategic overview of infectious

disease research

Provide a global knowledge platform

on health research

Provide a neutral discussion platform

for stakeholders

Advocate for support of health

research and the use of its results

tive

research initiatives

Achievements

Creation of a think-tank – identifying the

top priorities for research on infectious

diseases of poverty

In 2011 TDR will publish the first in a periodic set of

global reports on research into infectious diseases of

poverty. This is intended to be a major international

reference that will accelerate research efforts to meet the

public health challenges of infectious diseases of poverty

(see ongoing activities in this section). Primarily aimed

at research funders, policymakers and the research

community, especially in developing countries, the

report will highlight major issues and priorities for

action on research for infectious diseases of poverty that

could create a real shift in the health research landscape.

It will promote effective use of research results for

policies and agendas on infectious diseases of poverty

in the coming decade and beyond. Through providing

a common resource, the report should result in greater

health impact from the collective global health research

effort, with those countries most afflicted by infectious

diseases of poverty playing an integral and pivotal

role. Top priorities for research on infectious diseases

of poverty to feed into this report are being developed

by a major ‘think-tank’ of 100 international experts.

These experts are organized into 10 disease-specific and

thematic reference groups (DRGs and TRGs respectively,

see Box 2). Each of these reference groups will produce a

report that will develop the top priorities to be discussed

in the global report.


Infectious diseases of poverty

remain a formidable stumbling

block to human development

and the attainment of the healthrelated

Millennium Development

Goals in most low-income

countries ”

TropIKA.net – reaching an increased

audience with latest news and information

on research for health

When TropIKA.net was launched in 2007 as a

web-based, global knowledge management platform

(www.tropIKA.net), the goal was that it would eventually

become a ‘one-stop-shop’ for research on infectious

diseases of poverty. Since then, TropIKA.net’s reach has

increased substantially and the content has been greatly

enhanced. The platform is gaining recognition as a

place for stakeholders in infectious disease research to

improve knowledge of the area and enhance dialogue

with others. Knowledge hubs have been implemented

40


PART II

at five key scientific forums, including the second ANDI

stakeholder meeting and the 5th MIM Pan-African

Malaria Conference. The first TropIKA.net Career

Development Fellowship has also been awarded to a

scientist from China – the goal of these fellowships

being to provide postdoctoral, hands-on experience in

translating research output and outcomes so that these

can be accessed by a greater audience. Other highlights

from TropIKA.net are provided in Box 3.

BOX 2 – Disease-specific and

thematic reference groups

Dengue - new guidelines for diagnosis,

treatment, prevention and control

Dengue is the world’s most rapidly spreading vector-borne

disease and is of growing concern to those involved in the

field of public health. Over the years, the epidemiology of

dengue has changed, and the 1997 WHO guidelines on

diagnosis, treatment, prevention and control of dengue

are out of date. In late 2009, TDR supported WHO’s

Department of Control of Neglected Tropical Diseases to

publish new guidelines for diagnosis, treatment, prevention

and control of dengue. 25 These guidelines, which

are the culmination of several years’ collaborative work

that started with the report from the Dengue Scientific

Working Group in 2006 and subsequent systematic

literature reviews, 26 as well as multicentre studies covering

all dengue endemic regions, have already been taken up

and put into action by dengue-endemic countries such as

Argentina, Bolivia, Nicaragua, and Paraguay.

Ongoing activities

Preparation of a global report on research

for infectious diseases of poverty

Publication is planned for the second quarter of 2011,

with subsequent reports published every 3–4 years.

The first stage is the completion of the disease-specific

and thematic reference group reports, which will then

be synthesized into a global report that will have key

chapters on: (i) the environment and health; (ii) health

systems and universal coverage; and (iii) innovation

and biotechnology.

Distribution of host countries & co-chairs of disease specific and thematic reference groups

Disease-specific reference groups (DRGs)

DRG 1 Malaria

DRG 2 Tuberculosis

DRG 3 Chagas disease, human African trypanosomiasis

and leishmaniasis

DRG 4 Helminth diseases (including onchocerciasis, filariasis,

schistosomiasis and soil-transmitted helminths)

DRG 5 Dengue and other emerging viral diseases of public

health importance

DRG 6 Other infectious diseases, including zoonoses

Thematic reference groups (TRGs)

TRG 1 Social science research and gender

TRG 2 Innovation and biotechnology platforms for health

interventions

TRG 3 Implementation research and health systems research

TRG 4 Environment, agriculture and human health

Examples of critical issues identified by the DRGs:

DRG 3 Accurate estimates of the diseases’ burden, prevalence

and incidence, and strategies for sustainable and

integrated surveillance systems.

DRG 5 Processes of case management at all levels, including

training and identification of essential components of a

dengue ward and how to respond to a sudden surge in

case load.

TRG 1 Processes leading to marginalization of people and

linkages with infectious diseases of poverty.

TRG 4 Trends and forecasts in environmental conditions and

agricultural systems, and implications for infectious

diseases of poverty.

TDR annual report | 2009

41


Stewardship – knowledge for decision making and advocacy...

BOX 3 – TropIKA.net highlights

During 2009 TropIKA.net has had:

a substantial increase in the number of visitors from developing

countries. Four developing countries (Brazil, India, Philippines and

South Africa) were among the top ten users of the platform.

The platform has received over 7500 visits per month from users

in 175 countries (September 2009)

over 640 new items added to the website, including interviews with

leading figures involved in action against infectious diseases.

Knowledge hubs have been implemented at five key scientific

forums including:

ESSENCE (Enhancing Support for Strengthening the Effectiveness

of National Capacity Effort) Workshop on Capacity Development in

Health Research (United Republic of Tanzania, March 2009)

Second meeting of the African Network for Drugs and Diagnostics

Innovation (ANDI; South Africa, October 2009)

5th MIM Pan-African Malaria Conference (Kenya, November 2009)

Annual meeting of the Global Forum for Health Research (Cuba,

November 2009)

American Society of Tropical Medicine & Hygiene 58th Annual

Meeting (USA, November 2009)

Collaborative workspaces have also been used by the following

major global health initiatives:

ESSENCE (http://essence.tropika.net)

ANDI (http://andi.tropika.net)

malERA (Malaria Eradication Research Agenda)

(http://malera.tropika.net)

ISHReCA (Initiative to Strengthen Health Research Capacity in

Africa) (http://ishreca.tropika.net)

Research Partnerships for Neglected Diseases

(http://berlin.tropika.net)

TDR’s disease and thematic reference groups

First Global Symposium on Health Systems

Research

Awareness is growing among politicians, policy-makers,

health service providers and researchers that the evidence

base to improve the performance of health systems is

not strong enough. Under WHO leadership and with

other partners, TDR, through its Stewardship function,

is hosting a secretariat responsible for organizing the first

Global Symposium on Health Systems Research – Science

to Accelerate Universal Health Coverage, which will be

held in Montreux, Switzerland (16–19 November 2010).

The aim of the symposium is to share evidence, identify

significant knowledge gaps and set a research agenda to

help to accelerate universal health coverage, especially in

low- and middle income countries.

The four-day event will focus on two main streams.

The first stream – state of the art research – will include

themes: political economy of universal health coverage,

health system financing, scaling-up of health services,

monitoring and evaluation, and knowledge translation.

The second stream – state of the science – will address

foundational issues in health systems research (HSR)

such as the need for a common terminologies and

frameworks; an inventory of methodologies and their

strengths; and capacity-building opportunities for HSR. In

both of these streams of the Symposium, TDR operations

research related to scaling up proven interventions as

well its guidelines for operations research will be part of

the programme. More generally, expected outputs of the

symposium include the publication of background papers

on the above-mentioned themes and development of a

global agenda for health systems research. More importantly,

this initiative is expected to build and strengthen the

scientific community of HSR and improve the use of this

research for health policy development.

Genetically modified mosquitoes –

building a framework for testing disease

control

Together with WHO and the USA Foundation for the

National Institutes of Health (FNIH), TDR convened

a group of scientists and specialists from 13 countries

for brainstorming about the current status and future

development of genetically-modified mosquitoes (GMM)

for malaria and dengue control. The participants recommended

developing a framework that would help guide

the testing of GMM as a method of controlling disease

through reduced transmission. This work will include

recommendations for assessing efficacy and safety, and

include regulatory, ethical, legal and social issues around

the development and release of these mosquitoes – helping

countries prepare for GMM testing. The first consultative

meeting was held earlier this year and a report is now

available online. 27

42


PART II

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Pagnoni F. Home management of malaria. the Lancet, 2009, 374:288-289.

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Siddhivinayak Hirve, SP et al. Effectiveness and feasibility of active and passive case

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spending? USA, The George Institute for International Health, 2009.

TDR annual report | 2009

17 Malaria Rapid Diagnostic Test Performance - results of WHO product testing of malaria

RDTs: Round 1, Geneva, WHO/TDR, 2008 (http://www.who.int/tdr/publications/

tdr-research-publications/rdt-performance/pdf/full-report-malaria-RDTs.pdf,

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Diagnostics evaluation series no.1 - Laboratory-based evaluation of rapid syphilis

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(http://www.who.int/tdr/publications/tdr-research-publications/vl-rdts/pdf/VL-

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20 Diagnostics evaluation series no. 2 - Laboratory-based evaluation of 19 commercially

available rapid diagnostic tests for tuberculosis, Geneva, WHO/TDR, 2008 (http://

www.who.int/tdr/svc/publications/tdr-research-publications/diagnosticsevaluation-2,

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Diagnostics evaluation series no. 3 - Evaluation of commercially available anti-dengue

virus immunoglobulin M tests, Geneva, WHO/TDR, 2009 (http://www.who.int/tdr/svc/

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stewardship/pdf/Berlin_Mtg_Report_Final.pdf, accessed 18 May 2009).

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43


PART III

TDR annual report | 2009

45


TDR is a partnership

programme, bringing people

and groups together to identify

research gaps, advocate for

46


TDR’s unique position

derives...from the breadth of

the consensus through which

it operates in partnership

with hundreds of scientists,

institutions and networks all over

the world, and by the manner in

which it is governed. ”


PART III

Key publications and resources

TDR-funded research led to

169 articles being published in peerreviewed

scientific journals during

2009. The percentage of first authors

from disease endemic countries was

71.5%. We also published 11 TDR

scientific publications (see below),

which are available free of charge in

print or via the TDR website (www.

who.int/tdr).

Over the year we have also published

three issues of TDRnews, which

provides deep, journalistic coverage

of key research projects, as well as

news of TDR-funded researchers,

meetings and initiatives. These are

all available in the publications and

resources section of the TDR website.

Our redesigned website has experienced

steady growth of about 5% a

year, with over 40 000 content pages

accessed by over 1 million visits

from government, academia and

the health care sector. Key features

include news about TDR-funded

work and researchers, and a vast

publications and resources section

with free downloads of all research

and guideline publications, accessible

at www.who.int/tdr/svc/publications

or in print. During 2009 alone

our handbook on good laboratory

practice, for example, had nearly

10 000 downloads.

Published in 2009

A human rights-based approach to

neglected tropical diseases

A WHO information sheet, developed

jointly with TDR and WHO’s Department

of Health, Ethics and Trade,

that aims to improve understanding

about neglected tropical diseases.

This document is also available in

French and Spanish.

Dengue – Guidelines for diagnosis,

treatment, prevention and control

A new edition of guidelines

that provide updated practical

information on diagnosis, treatment,

prevention and control of dengue.

Evaluation of commercially

available anti-dengue virus

immunoglobulin M tests.

Diagnostics evaluation series No. 3

A report describing the results of a

WHO/TDR/PDVI (Pediatric Dengue

Vaccine Initiative) evaluation of nine

commercially available anti-dengue

virus IgM tests.

TDR annual report | 2009

47


Key publications and resources

Good clinical laboratory

practice (GCLP)

A guide on how to carry out good

clinical laboratory practice.

Web only.

Good laboratory practice training

manual: Trainer (2nd edition)

A manual on good laboratory

practice (GLP) aimed at trainers

of GLP.

Good laboratory practice training

manual: Trainee (2nd edition)

A manual on good laboratory

practice (GLP) aimed at trainees of

GLP.

Handbook: Good laboratory

practice (2nd edition)

A handbook that provides

laboratories and trainers in disease

endemic countries with technical

information needed to implement

GLP programmes.

Malaria rapid diagnostic test

performance – results of WHO

product testing of malaria RDTs:

Round 1 (2008)

A report outlining the results of a

WHO/TDR/FIND (Foundation for Innovative

New Diagnostics) sponsored

evaluation of laboratory-based rapid

diagnostic tests (RDTs) for malaria.

Operational research in support of

antiretroviral therapy scale-up

A meeting report summarizing the

findings from country operational

research projects following a lessons

learnt workshop and product development

team meeting in 2008.

Pathways to better diagnostics for

tuberculosis

A blueprint for the development of

tuberculosis diagnostics, developed

by the New Diagnostics Working

Group of the Stop TB Partnership,

which intends to help tuberculosis

diagnostics researchers work more

effectively with academics, officials

and industry professionals.

Strategic and business plan for

the African Network for Drugs and

Diagnostics Innovation (ANDI)

A publication (developed in collaboration

with several stakeholders,

notably African research institutions,

the African Development Bank and

the European Union) outlining how

ANDI will lead to the creation of a

sustainable platform for R&D innovation

in Africa.

48


PART III

TDR governance and management

TDR is a joint undertaking of four global organizations:

UNICEF, UNDP, the World Bank and WHO. WHO acts

as the executing agency of the programme. The joint

co-sponsorship is reflected in the Memorandum of

Understanding among the agencies, which originates

from 1978 and was last amended in 2008. The

Memorandum of Understanding provides the basic

framework within which the programme operates.

TDR’s top governing body is its Joint Coordinating

Board (JCB), which includes a mix of representatives

from developed and developing countries. The JCB

meets once a year.

In addition, a Standing Committee composed of

representatives from the four co-sponsoring agencies

meets twice a year to provide guidance and oversight

on an ongoing basis. Programmatic technical review

and advice comes from a Scientific and Technical

Advisory Committee (STAC), while individual

Strategic and Scientific Advisory Committees

(SACs) are in place for each of the programme’s

11 major activity areas. A WHO-based secretariat in

Geneva, made up of nearly 100 staff from all over

the world with extensive academic, public health,

and industry experience, led by a director and senior

management team, is responsible for day-to-day operations

(see Figure 3 below).

Figure 3. The TDR governing bodies

Joint Coordinating Board (JCB)

Standing Committee

(UNICEF, UNDP, World Bank, WHO)

Scientific & Technical

Advisory Committee (STAC)

Executing Agency (WHO)

TDR Organization

TDR annual report | 2009

49


Governance

Joint Coordinating Board (JCB)

The JCB reviews all TDR activities, decides on its

budget, evaluates its progress and considers its

long-term plans. The board is composed of 34

members: 12 members selected by the resource

contributors to the programme, 12 government

representatives chosen by the six regional committees

of WHO, six members, representing other cooparating

parties, selected by the JCB itself, and the four co-sponsoring

agencies (see Figure 4 below). The composition

of the JCB has been subject to further discussions in

2009. A notable development was the formation of

constituencies among the resource contributors to the

programme in a drive to broaden representation.

The JCB held its 32nd annual session in Geneva

in June 2009. The board commended TDR on its

scientific and technical progress and expressed

satisfaction with its management. The JCB elected

Dr Jorge Motta, member of the National Directing

Council of the National Research System, Panama,

as Chair of the JCB for 2009 and 2010 and expressed

its gratitude to Professor Rolf Korte, Senior Health

Policy Advisor, German Agency for Technical Cooperation,

for his commendable work as the chair of the JCB

in the period from June 2007 to June 2009.

The JCB recognized the importance of TDR taking a

holistic, multisectoral approach to research on diseases

of poverty, with links to poverty alleviation strategies,

Figure 4. Membership of the TDR Joint Coordinating Board (as of 1 January 2010)

WHO regions (regional offices)

AFR: Africa

AMR: Americas

EMR: Eastern Mediterranean

EUR: Europe

SEAR: South-East Asia

WPR: Western Pacific

50


PART III

the MDGs and the need for political will to apply the

products of research for the control and elimination

of disease. The JCB welcomed TDR’s exploration of

opportunities to leverage bilateral support to countries

for research and encouraged TDR to take on a leadership

role in global health research for diseases of

poverty. The JCB also approved a Programme budget

for the 2010–2011 biennium of US$ 121 million.

If met, this would represent a 35% increase on the

2008–2009 expenditure*.

The Standing Committee

The Standing Committee, composed of senior representatives

of the four co-sponsoring agencies, with

ex-officio attendance from the chair and vice-chair of

the JCB and the chair of STAC, met twice during 2009

under the chairmanship of UNDP, first in March and

then in November. Both meetings were held in New

York.

At its March 2009 session the Standing Committee

recognized the value of TDR’s work related to community-based

interventions for the strengthening of health

systems and encouraged TDR to publish rapidly its

work in this field in peer-reviewed scientific journals.

The Standing Committee also welcomed TDR’s move

towards more multisectoral collaborations, including

with ministries of science and technology.

Scientific and Technical Advisory

Committee (STAC)

TDR’s senior scientific body is the Scientific and

Technical Advisory Committee (STAC), composed of

21 leading health research scientists. The STAC reviews

and evaluates all scientific and technical activities and

makes recommendations on programme activities,

including the distribution of funds. The STAC thus acts

as advisor to the JCB as well as to the TDR Director.

At its annual session in February 2009, the STAC

pointed out the need to think ahead and take into

account the rapidly evolving landscape for research.

The STAC stressed the need for TDR activities to be

fully integrated within developing countries’ health and

research systems and to operate coherently with their

policies and priorities for research.

The following pages provide brief biographies of STAC

members fors 2009 and 2010.

The November 2009 session focussed on a number

of strategic issues as well as operational and financial

matters. The Standing Committee encouraged

further strengthening of TDR’s cooperation with its

co-sponsors beyond WHO and recommended that

TDR explore potential areas of operational collaboration,

including the broad framework of ‘innovation for

development’.

* Expenditure in 2008-2009 was US$ 88.1 million (audited financial statement).

TDR annual report | 2009

51


Governance

STAC membership*

Professor Peter Martins Ndumbe, Chair, MD, MSc, PhD, FIBiol, CBiol

Professor Ndumbe is Dean of the Faculty of

Health Sciences at the University of Buea,

Cameroon; previously he was Dean of the

2009 STAC

member

Faculty of Medicine and Biomedical Sciences, University of

Yaoundé. Professor Ndumbe is currently Chair and Member

of the AFRO/WHO Task Force on Immunization and Chair of

the WHO IVR Advisory Committee (IVAC). He has previously

served on the AFRO Regional Committee and as a member

of the EPI Global Advisory Group and the Children’s Vaccine

2010 STAC

member

Initiative Strategic Planning Task Force. His

consultancy activities have included working

with WHO AFRO in the Programme for Health

Development and for WHO-EPI in Rwanda. Professor Ndumbe’s

areas of professional interest span HIV/AIDS, vaccines, malaria,

filariasis and schistosomiasis. He has published over 90 journal

articles, monographs and books in the area of AIDS, vaccines,

malaria, hepatitis B , onchocerciasis and health systems.

Professor Hannah Akuffo, BSc, MSc, PhD

Professor Akuffo is Head of Team for Policy

and Method Development, The Secretariat for

Research Cooperation, Swedish International

2009 STAC

member

Development Agency (Sida); she is an Adjunct Professor of

Parasitology at the Department Of Microbiology and Tumor

and Cell Biology (MTC) at the Karolinska Institutet. Professor

Akuffo has served on the Steering Committee on Vaccines for

Leishmaniasis, and been a chair and member of TDR’s Research

2010 STAC

member

Strengthening Group and the Steering

Committee for Vaccine Research. Her areas

of professional activity include immunology

of leishmaniasis, immunology of mycobacterial infections, and

diseases affecting low-income populations. She has more than

60 publications in the area of leishmaniasis, mycobacterial

infections including leprosy and TB, onchocerciasis and other

diseases affecting low-income populations.

Professor Maged Moustafa Al-Sherbiny, BSc, MSc, PhD

Professor Al-Sherbiny is Assistant Minister for Scientific

Research in the Ministry of Higher Education and

Scientific Research in Egypt and Secretary General

of the Supreme Council of Research Institutes. He is also a

Professor of Biotechnology and Immunology in the Zoology

Department at the Faculty of Science at Cairo University and

was recently elected president of the Egyptian Academy

2010 STAC

member

of Scientific Research and Technology. He has held

several TDR project grants in the past. Professor

Al-Sherbiny’s main areas of professional interest lie

in parasitology (especially schistosomiasis), immunology

and diagnostics, and innovation systems and science and

technology. He has several patents and over 40 peer-reviewed

publications.

* Note that Dr Andrew Kitua served as a STAC member in 2009 but is now a member of TDR staff.

52


PART III

Professor Pascale Allotey, PhD, MMedSci, PGDip Intl Health,

BA (Hons), HonFRSPH, RN, PHN, SCM

Professor Allotey was appointed Professor

of Public Health and Associate Director of

Monash Global Health at Monash University

2009 STAC

member

Sunway Campus, Malaysia, in September 2009. Prior to that

she was Co-director of the Centre for Public Health Research,

the Chair of Race, Diversity and Professional Practice in Public

Health at the School of Health Sciences and Social Care and

Director of the Professional Doctorate in Public Health (DrPH)

programme at the Brunel University Graduate School. Her

research areas span the disciplines of medical anthropology

and epidemiology, focusing on the health of populations

marginalized by conflict, gender, ethnicity, disability and

disease. She has published extensively on gender and tropical

2010 STAC

member

diseases, disability, sexual and reproductive

health and rights and the health of refugees

and asylum seekers. Recent work has focused

on research capacity development in lower- and middleincome

countries and the integration of research and policy

for emerging public health challenges. She has served as

a temporary adviser for the TDR Task Force on Gender and

as a short-term consultant for the WHO Regional Office

for the Western Pacific (WPRO), and currently sits on the

Board of Trustees for the nongovernmental organization

Reproductive Health Matters International. She has over

70 peer-reviewed publications.

Professor Fatima Alvarez Castillo, BA, MA

Professor Alvarez Castillo is Professor at the

University of the Philippines and Assistant

to the Dean for Research, College of Arts &

2009 STAC

member

Sciences, also at the University of the Philippines. Professor

Alvarez Castillo was previously Visiting Professor at the Institute

for Social and Health Sciences and Centre for Peace Action

at the University of South Africa. She has acted as principal

2010 STAC

member

investigator for a five-country TDR study

on the resilience of community and health

systems in conflict situations. Her professional

activities lie within the areas of anthropology, politics,

gender, qualitative research, community-based research,

action research and research ethics. She has published over

30 monographs, book chapters and journal articles.

Professor Myriam Arevalo-Herrera, BSc, PhD

Professor Arevalo-Herrera is Professor at the School

of Health, Universidad del Valle in Colombia and

Scientific Director at the Malaria Vaccine & Drug

Development Center-MVDC in Colombia. She is a Member

of the WHO Advisory Committee on Malaria Vaccines and

her areas of professional activity include malaria vaccines

2010 STAC

member

and good practices in laboratory and clinical research.

She has over 40 publications in laboratory and clinical

research with a major emphasis on malaria vaccine

research, and she has made significant contributions to

publications and guidelines on good practice.

TDR annual report | 2009

53


Governance

Dr Vicente Y Belizario, Jr, AB, MD, MTM&H

Dr Belizario is Deputy Director of the National

Institutes of Health and Professor in the

Department of Parasitology at the University

2009 STAC

member

of the Philippines Manila. Previously, Dr Belizario was Assistant

to the Dean for Academic Affairs at the College of Public

Health at the University of the Philippines Manila. He has

served as a member of TDR’s Research Strengthening Group

and as a temporary adviser for the Conference on Control of

Food-Borne Trematode Infections, World Health Organization,

2010 STAC

member

in Viet Nam. His professional activities span

clinical and epidemiology studies on a wide

range of infectious diseases (with a focus on

helminths and malaria among tropical diseases). He is also

interested in the interface between research and policy. Dr

Belizario has over 40 publications on malaria, TB, filariasis,

schistosomiasis, parasitic infections, intestinal parasites and

other infectious diseases.

Dr Sujit Kumar Bhattacharya, MBBS, MD

Dr Bhattacharya is Medical Officer at the WHO

His professional interests lie in infectious diseases,

2009 STAC

Regional Office for South-East Asia and was formerly member especially clinical, epidemiological and microbiological

aspects that can be used to diagnose new

the Additional Director General of the Indian Council

of Medical Research. He has served as a member of WHO/ infections and overall control of any infection. He is a fellow of

SEARO’s Regional Technical Advisory Group on Kala Azar three national academies in India. He has published over 320

and SEARO’s Regional Technical Advisory Group (RTAG) for papers and has contributed to several books and book reviews.

the Elimination of Kala Azar from the Indian subcontinent.

Professor Fred N Binka, MB ChB, MPH, PhD

Professor Binka is Dean of the School of Public

Health at the College of Health Sciences,

University of Ghana. Previously Professor

2009 STAC

member

Binka was Executive Director of the Indepth-Network. He is

a member of the Technical and Research Advisory Committee

(TRAC) of the Global Malaria Programme. In the past he has

served as chairman of the WHO AFRO Advisory Committee of

Experts on Malaria, chairperson of the WHO Tropical Disease

Research Task force on Malaria and Health Sector Reform

2010 STAC

member

and chairperson of the MIM/TDR Task Force.

He was also a member of the WHO Advisory

Committee on Health Research (ACHR), the

WHO Expert Advisory Panel on Health Science and Technology

Policy, the Board of Trustees for the Alliance for Health Policy

and Systems Research, and a variety of TDR committees. His

areas of professional activities include malaria, epidemiology

and public health. He has published six chapters in books and

over 75 peer-reviewed publications.

54


PART III

Dr Yves Champey, MD

Dr Champey is a consultant working since

1998 with the Genopole Director General

in building a biotechnology cluster in Paris,

2009 STAC

member

France. He is a physician with over 40 years’ experience in

the pharmaceutical industry. Dr Champey coordinated the

creation of Drugs for Neglected Diseases initiative (DNDi)

and served as DNDi’s founding Chairman from 2003-2007.

He presently chairs the Strategic Committee on Development

and Ecosystem for Health Biotech Medicen Paris Region.

2010 STAC

member

Dr Champey is a former Board Member

at Rhône-Poulenc Pharma R&D, General

Secretary and then President of the French

Association of Pharmaceutical Physicians, Founder and

President of the Rhône-Poulenc Rorer Foundation and a

member of the Inter-Ministerial Mission on Public Research

and Drug. Dr Champey’s main areas of professional interest

are new drug development and biotechnology.

Professor Jie Chen, MPH, MD

Professor Chen is Director of the WHO

Collaborating Centre for Health Technology

Assessment & Management and also Director

2009 STAC

member

of the Key Laboratory of Health Technology Assessment (Fudan

University) at the Ministry of Health, Shanghai, China. She has

served as a member of the WHO Expert Committee on Health

Information and the Joint Research Management Committee

for the World Bank Loan Project on Schistosomiasis and

2010 STAC

member

Tuberculosis Control in China. Her professional

activities centre on social medicine, health

administration, clinical epidemiology, hospital

management and health economics. Professor Chen has

published over 70 articles and books on social medicine, health

administration, clinical epidemiology, hospital management

and health economics. Furthermore, she has been a tutor for

more than forty students on their Master’s or PhD programmes.

Dr Carol A Dahl, BA, MSc, PhD

Dr Carol Dahl, Director of Staff, Global Health

Program at the Bill & Melinda Gates Foundation,

works as a partner to the President,

2009 STAC

member

Global Health in facilitating progress and performance

against Global Health priorities and serving as a liaison for

the Program to fields of science and technology. Dr Dahl was

previously Director, Global Health Discovery. Prior to joining

the Foundation in 2003, Dr Dahl served as Vice President

for Strategic Partnerships at Biospect Inc. (now Pathworks

Diagnostics). From 1990 to 2001, Dr Dahl worked at the US

National Institutes of Health in several capacities, including

2010 STAC

member

founding director of the Office of Technology

and Industrial Relations at the National Cancer

Institute (NCI) and Program Director at the

National Center for Human Genome Research. Dr Dahl’s areas

of professional activity include science and technology-based

solutions delivered for impact on the health priorities of the

world’s poorest populations, innovative supporting technologies,

and science and research administration. She has had

multiple publications on scientific and technology priorities

for global health and biomedical research innovation.

TDR annual report | 2009

55


Governance

Professor Asma I Elsony, BSc, MD, PhD

Professor Elsony is currently Director of the Epidemiology

Laboratory for Research and Public Health in member Office for the Eastern Mediterranean. Her areas of

Malaria and a WHO expert for Geneva and the Regional

2010 STAC

Sudan. She is the former President of the International

professional activity include tuberculosis/HIV, lung

Union Against Tuberculosis and Lung Disease (UNION) in disease, epidemiology, and public health. She has published

Paris. Professor Elsony is a technical expert for several global several manuals on TB control and lung health, several book

organizations and currently a member of the Technical Review chapters, and more than 30 peer-reviewed publications. She

Panel (TRP) for the Global Fund to Fight AIDS, Tuberculosis and is also a reviewer for a number of journals.

Professor Alan H Fairlamb, CBE, BSc, MB ChB, PhD, FLS, FRSE, FMedSci

Professor Fairlamb is currently a Wellcome

Principal Research Fellow and Head of the

Division of Biological Chemistry & Drug

2009 STAC

member

Discovery at the College of Life Sciences, Wellcome Trust

Biocentre, University of Dundee, UK. Over the past 25 years, he

has served on various steering and scientific advisory committees

for WHO/TDR as well as for many other organizations.

2010 STAC

member

Professor Fairlamb’s major research interests

include: the functional roles of trypanothione;

mode of drug action and resistance mechanisms;

and post-genomics and drug discovery for parasitic

diseases. He has published over 200 original scientific articles

and reviews on these subjects.

Professor Bernhard Fleischer, PhD

Professor Fleischer is the Director of the Bernhard-

the University of Mainz, Germany. He has worked with

2009 STAC

Nocht-Institute for Tropical Medicine, Germany; Head member WHO on the immune response to parasitic infections,

of the National Reference Center for Tropical Diseases,

animal models of protozoal and helminth infections,

Germany; Professor for Tropical Medicine, Medical Faculty at novel strategies of vaccination and immunomodulation, and

the University of Hamburg, Germany; Director of the Institute molecular diagnostics of parasitic infections. His main areas of

of Immunology at the University Hospital, Germany; and professional activity remain microbiology and immunology,

Chairman of the Departments of Medical Microbiology and and he has had many papers published in these areas.

Immunology at the Bernhard-Nocht-Institute. Previously he

was an Associate Professor in the Department of Medicine at

56


PART III

Professor Nouzha Guessous-Idrissi, PhD

Professor Guessous-Idrissi is currently an

independent researcher and consultant in

Bioethics and Human Rights. She is also an

2009 STAC

member

2010 STAC

member

Emeritus Professor at the University Hassan II of Casablanca,

in charge of the promotion of Human Rights and Ethics

Education. Until 2005 she was the Head of the Parasitology

Department of the Faculty of Medicine and the University

Hospital Ibn Rochd of Casablanca, Morocco. She has served

as a member of the TDR Steering Committee on Pathogenesis

and Applied Genomics and is a former member of the International

Boioethics Committee of UNESCO

(2000-2007) that she chaired (2005-2007). Her

areas of professional activity include ecology

and epidemiology of leishmaniasis; the burden of parasites

and fungi, and their impact on human health; and the monitoring

and surveillance of opportunistic parasites and fungi

in immunocompromised patients. She has approximately 50

publications in the areas of leishmaniasis, parasites and the

environment, toxoplasmosis and mycology.

Professor Maria G Guzmán, MD, PhD, DrSc

Professor Guzmán is the Head of the Virology Department

at the Institute of Tropical Medicine in Cuba and member WHO’s Vaccine Committee on Dengue and TDR’s

Evaluation Commission for Research Proposals,

2009 STAC

Director of the PAHO/WHO Collaborating Center for

Scientific Working Group Meeting on Setting Priorities

for Dengue Research. Her work has contributed to the

the Study of Dengue and its Vector. At present she is a member

of the technical group on dengue at PAHO, Co-chair of the knowledge of the pathogenesis, the clinical features, and

dengue reference group at TDR and coordinator of the net of the epidemiology of dengue and dengue hemorrhagic fever

labs (RELDA) in the Americas organized by PAHO. Previously (DHF). Professor Guzmán is the author of more than 200 papers

she was Director of the PAHO/WHO Collaborating Center for and short communications, including several books, and is

Viral Diseases. Her past memberships have included being also the author of three patents.

a member of TDR’s Research Strengthening Group, PAHO’s

Professor Peter J Hotez, MD, PhD

Professor Hotez is Distinguished Research

Professor and Walter G. Ross Chair, Department

of Microbiology, Immunology, and

2009 STAC

member

Tropical Medicine, George Washington University, USA.

He is also President of the Sabin Vaccine Institute, where

he serves as Director and Principal Scientist of the Human

Hookworm Vaccine Initiative, and Editor-in-Chief for PLoS

Neglected Tropical Diseases. Previously he was on the faculty

at Yale and a paediatric resident of the Massachusetts General

2010 STAC

member

Hospital. He obtained his PhD and MD from

the Rockefeller University and Weil Cornell

Medical College in New York. Professor

Hotez’s areas of professional activity and interest include

vaccinology, molecular parasitology, tropical pediatrics,

advocacy for neglected diseases and open-source publishing.

He has co-authored more than 200 peer-reviewed scientific

articles and is the author or editor of 10 books including

Forgotten People, Forgotten Diseases.

TDR annual report | 2009

57


Governance

Professor Pirom Kamolratanakul, MSc, MD, BSc

Professor Kamolratanakul is President of

Chulalongkorn University, Thailand. Previously

he was Dean of the Faculty of Medicine

2009 STAC

member

at Chulalongkorn University. He has served as a member

of WHO’s Programme Implementation Coordinating Teams

(PICTs) and his areas of professional activity span research on

evaluation of health care, health care financing, technology

2010 STAC

member

assessment, national policy study, health

insurance, and essential health packages. He

has over 117 publications on topics including

primary health care, food-borne diseases, health surveillance

and health education, infections and malnutrition, malaria,

TB, clinical economics, health economics and vector control.

Dr Vishwa Mohan Katoch, MD, FNASc, FAMS, FASc, FNA

Dr Katoch is the Founder Secretary of the Department

been a member of WHO’s Regional Technical Advisory

2010 STAC

of Health Research (DHR) at the Ministry of Health and member Group (RTAG) for Leprosy Elimination for South-East

Family Welfare (MOH FW) in India and the Director

Asia and of WHO’s Working Group on Leprosy. Dr

General of the Indian Council of Medical Research (ICMR) in Katoch’s areas of professional interest include the microbiology

New Delhi. He is the Former Director of the National JALMA and molecular biology of mycobacterial diseases. He has

Institute for Leprosy & other Mycobacterial Diseases. He has contributed to 247 research papers.

Professor Christos (Kitsos) Louis, MD, PhD

Professor Louis is a Professor of Genetics at

the Department of Biology of the University

of Crete, and Research Staff at the Institute

2009 STAC

member

of Molecular Biology and Biotechnology of the Foundation

of Research and Technology-Hellas (FORTH). He is also the

Chairman of his department as well as the Associate Director

of the University of Crete Graduate Programme on Bioethics.

He was a member of the TDR Committee on Molecular Entomology

(BCV) from 1996 till 2005, and an elected member of

2010 STAC

member

the European Molecular Biology Organization

(EMBO). Finally, he is a former Associate

Member of the Hellenic Research Advisory

Council. His areas of research include the genomics and

molecular genetics of the malaria vector Anopheles gambiae,

as well as bioinformatics and bio-ontologies. Professor Louis

has published more than 130 scientific publications, book

chapters and books.

58


PART III

Professor Anne J Mills, PhD, MA, DHSA

Professor Mills is Head of the Department

of Public Health and Policy at the London

School of Hygiene & Tropical Medicine

2009 STAC

member

(LSHTM), UK, Professor of Health Economics and Policy, and

Head of the Health Economics and Financing Programme at

LSHTM. Until recently she was chair of the Board of the Alliance

for Health Policy and Systems Research; previously she has

been Co-chair of the Working Group of the Task Force on

Innovative International Financing for Health Systems, served

as a member on the Commission on Macroeconomics and

Health and TDR’s Applied Field Research Steering Committee,

2010 STAC

member

as Chair of the Health Financing Task Force

of this Committee, and as a member of the

Consultative Committee on Primary Health

Care Development. Her areas of professional activity include:

the financing and organization of health systems in developing

countries; the economics of tropical disease control, especially

malaria; improving policy-making, implementation and

management; and supporting the development of analytical

capacity. Professor Mills has published 17 books, 44 book

chapters, 34 monographs and over 160 peer-reviewed articles.

Professor Mario H Rodriguez-Lopez, MD, PhD

Professor Mario H Rodriguez-Lopez is Director

of the National Institute of Public Health,

Ministry of Health at Cuernavaca, Morelos,

2009 STAC

member

Mexico. Formerly he was Director of the Center for Research

on Infectious Diseases at the National Institute of Public

Health, Ministry of Health in Mexico. He served as a member

of TDR’s Steering Committee on Molecular Entomology, the

2010 STAC

member

Expert Advisory Panel on Vector Biology and

Control and TDR’s Steering Committee on

Malaria Field Research. His areas of professional

activity include malaria, vector biology, epidemiology

and public health. He has published over 140 peer-reviewed

publications and 20 chapters in books.

Professor Dyann Wirth, BA, PhD

Professor Wirth is Professor of Immunology

and Infectious Diseases and Director of the

Harvard Malaria Initiative at the Department

2009 STAC

member

of Immunology and Infectious Diseases at Harvard School of

Public Health, USA. Formerly she was Associate Professor at the

Department of Tropical Public Health, Harvard School of Public

Health. She is a member of TDR’s Pathogenesis and Functional

Genomics Committee, and has served as Chair of the WHO

Steering Committee on Strategic Research and TDR’s Research

Group on Chemotherapy of Malaria. She has also been a

member of TDR’s Parasite Genome Committee, the WHO

2010 STAC

member

Steering Committee on Strategic Research,

TDR’s Research Strengthening Group, TDR’s

Strategic Research Planning Committee and

TDR’s Research Group on Chemotherapy of Malaria. She is

an expert in molecular microbiology and development of

molecular genetic tools used in the investigation of malaria

and leishmania. She is particularly interested in new drugs

for multidrug-resistant parasites and the application of

genomics to drug and vaccine development. Professor Wirth

has published over 130 publications in genome research of

malaria and leishmaniasis.

TDR annual report | 2009

59


Leadership at TDR

TDR senior management*

Director

Robert Ridley

Programme Management

Alan White

External Relations

& Governance

Meinrad Studer

Communications

Jamie Guth

Strategic Alliances

Jane Kengeya-Kayondo

Portfolio Policy &

Development

Fabio Zicker

Stewardship

Ayoade Oduola

Empowerment

Glenn Laverack

Research on

Neglected Priority

Needs

Soumya

Swaminathan

Lead Discovery

for Drugs

Solomon

Nwaka

Innovation

for products

in DECs

Vector

Control

Interventions

Yeya

Toure

Drug

Development for

Helminths/NTDs

Piero

Olliaro

Quality-

Assured

Diagnostics

Francis

Moussy

Evidence

for Treatment

of TB/HIV

Philip

Onyebujoh

Antimalarial

Policy/

Access

Andrew

Kitua

Visceral

Leishmaniasis

Elimination

Greg

Matlashewski

Communitybased

Interventions

Johannes

Sommerfeld

* TDR employs a staff of approximately 100. The organigram above is complemented by brief biographies of our senior management on the following pages.

60


PART III

Robert Ridley, PhD

Director

Robert Ridley has a long affiliation with TDR and associated

organizations. Before becoming TDR’s Director in 2004. Dr

Ridley served as TDR’s Coordinator of Product R&D, as Chief

Scientific Officer for the Medicines for Malaria Venture (MMV),

and as the Manager for Drug Discovery at TDR. Dr Ridley

originally gained his PhD in bio-organic chemistry and in

the 1980s served as a lecturer at the University of Malawi.

Following research fellowships at McMaster University, Canada,

and Edinburgh University, UK, Dr Ridley became Vice-Director

for Infectious Diseases Drug Discovery at F. Hoffmann-La

Roche AG, Switzerland, where he had overall responsibility for

malaria projects and several antibacterial projects. Dr Ridley

is currently a member of the Board of the Global Forum for

Health Research. He has also served on several other scientific

committees and editorial boards and has contributed to over

100 publications on tropical diseases, innovation and public

health.

Alan White, MSc (Econ), FCCA,

ACMA, CIA, MCT

Programme Manager,

Programme management

Alan White has been TDR Programme Manager since June

2009. He has more than 25 years of international financial

management and operations consulting experience, gained

with Procter & Gamble in Geneva and as an independent

consultant working with organizations across Europe. He has

experience in a broad range of industries in the private sector

as well as in the not-for-profit sector. Mr White has a Master’s

degree in Economics from the London School of Economics

and holds professional qualifications as a Chartered Certified

Accountant, a Chartered Management Accountant, a Certified

Internal Auditor and a Corporate Treasurer. He is a former Vice

Chairman, Treasurer and Member of the Board of the Chartered

Institute of Management Accountants in Switzerland.

Jamie Guth, BS, MALS

Manager, Communications

Jamie Guth joined TDR as Manager of Communications in

2005. Prior to joining TDR she was Director of Public Affairs/

Marketing for the Dartmouth-Hitchcock Medical Center, an

academic medical centre in New Hampshire, USA where she

was responsible for marketing, media relations, publications,

web development and media services. She has also held a

variety of positions at a CBS affiliate in Michigan, USA, ranging

from reporter to producer of a monthly magazine programme.

Ms Guth has been a reviewer of National Institutes of Health

multimedia grants, given presentations on writing for television,

web site development, branding and marketing, and

been a board member and president of the Health Sciences

Communications Association, USA.

Meinrad Studer, MBA

Manager, External relations

and governing bodies

Meinrad Studer has a vast experience in humanitarian and

multilateral affairs. He served in different capacities the International

Committee of the Red Cross (ICRC) in the field in South

and South-East Asia, the Middle East and Southern Africa,

before working as Diplomatic Advisor at the ICRC headquarters

in Geneva. He later joined the Swiss Agency for Development

and Cooperation in the capacity of Senior Advisor. He joined

TDR in March 2009. As Manager for External Relations and

Governing Bodies, he is in charge of coordinating the relations

with the Joint Coordinating Board and Standing Committee

as well as TDR’s donor relations and resource mobilization

activities.

Jane Kengeya Kayondo, MBChB, MSc

coordinator, strategic alliances

Jane Kengeya Kayondo is a medical doctor with specialization

in public health and epidemiology. Before joining TDR she

was a leading researcher on HIV/AIDS at the Uganda Virus

Research Institute, where she was the national team leader

for the British Medical Research Council Programme on HIV/

AIDS. Before taking on her present role in TDR she has served

in several capacities including: Manager of the Task Force on

Malaria Home Management, Coordinator of Implementation

Research, and Coordinator of MIM/TDR. As Coordinator of

Strategic Alliances at TDR, she is responsible for identifying,

nurturing and implementing alliances and partnerships.

TDR annual report | 2009

61


Leadership

Glenn Laverack, BSc (hons), MSc, PhD

Coordinator, Empowerment

Glenn Laverack has worked in public health, social development

and research in developing countries, including Africa,

Asia, and the Pacific regions, for more than 25 years. He was

formerly the Director of Health Promotion at Auckland University,

New Zealand. His interest in community empowerment

is longstanding – during his PhD he investigated community

empowerment within top-down health programming in rural

Fijian communities. Dr Laverack is committed to empowerment

strategies and has a wide range of publications regarding

empowerment, public health and community capacity

building in international settings.

Fabio Zicker, MD, PhD

Coordinator, Portfolio policy and

development

Fabio Zicker originally trained as a clinical cardiologist and

infectious disease epidemiologist. He joined TDR in 1997,

following seven years as regional advisor in communicable

disease at the Pan American Health Organization (PAHO) and

a professorship in epidemiology at the Federal University of

Goias, Brazil. He was involved in early therapeutical clinical

trials on Chagas disease and schistosomiasis and on vaccine

trials on malaria and leishmania candidate vaccines. Dr Zicker

led TDR’s research capability strengthening programme and

established the MIM/TDR malaria research initiative.

Ayoade Oduola, PhD

Coordinator, Stewardship

Ayoade Oduola has over 20 years’ experience of pivotal

research in tropical parasitic diseases. Since his doctoral

training in pathology from the Medical University of South

Carolina, USA, he has made major contributions to antimalarial

drug discovery and development and to the understanding

of drug resistance by malarial parasites. Dr Oduola has been

rewarded with several international patents, awards, honours

and grants. He has served on many international scientific and

advisory committees and he has also acted as Chair of the

Task Force for Capacity Building for Malaria Research in Africa

under the Multilateral Initiative on Malaria in Africa (MIM).

Soumya Swaminathan, MD

Coordinator, REsearch on neglected

Priority Needs, Former acting leader,

Integrated community-based

interventions

Andrew Kitua, MD, PhD

Leader, Evidence for antimalarial

policy and access

Andrew Kitua graduated in medicine from the Universita Statale

di Milano, Italy and gained a master’s degree in epidemiology

from the London School of Tropical Medicine & Hygiene, UK. He

later attained a PhD in clinical epidemiology at Basel University

in Switzerland. He became the first Tanzanian and African

Director of the Ifakara Health Research and Development

Centre in the United Republic of Tanzania in 1993. Dr Kitua

also served as the Director General of the National Institute

for Medical Research, the United Republic of Tanzania. His

former activities include being a member of the Foundation

Board of the Global Forum for Health Research, a member of

TDR’s Scientific and Technical Advisory Committee (STAC),

and Chairman of the Developing Countries Coordinating

Committee (DCCC) of the European & Developing Countries

Clinical Trials Partnership (EDCTP).

Soumya Swaminathan is a paediatrician by training. She

completed her medical education in India, followed by a

fellowship in paediatric pulmonology at the Children’s Hospital

of Los Angeles, USA. She has spent 17 years at the Tuberculosis

Research Centre in Chennai, India, where she was involved in

clinical trials for TB and HIV treatment and prevention in adults

and children. She set up the Division of HIV/AIDS at the centre

and was principal investigator of the NIH intramurally funded

“International Centre for Excellence in Research” in Chennai.

She has also worked with several Fogarty programmes in the

US towards capacity-building activities.

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PART III

Greg Matlashewski, PhD

Leader, Research to support the

elimination of visceral leishmaniasis

Greg Matlashewski joined TDR from McGill University in

Montreal, Canada, where he was a Professor and Chairman

of the Department of Microbiology in Immunology. Prior

to joining McGill, Dr Matlashewski conducted research on

cancer-causing viruses at the Imperial Cancer Research Fund

Laboratories in England. His research at McGill focused on

leishmaniasis and human papillomavirus infections; he was

also the principal investigator of a DNDi-supported clinical

trial in Peru on topical treatment for cutaneous leishmaniasis.

Dr Matlashewski has over 90 peer-review publications and has

served as an advisor to organizations including WHO, NIH,

FDA, DNDi, the US military and the Canadian parliamentary

House of Commons.

Francis Moussy, PhD

Leader, Accessible quality-assured

diagnostics

Francis Moussy joined TDR in March 2009, having previously

held the post of Professor and Deputy Director at the Brunel

Institute for Bioengineering, Brunel University, UK. Dr Moussy

originally gained his PhD in Biomedical Engineering. After

fellowships at the Universities of Toronto and Alberta in

Canada, Dr Moussy went on to become Assistant Professor

at the Universities of Maryland and Connecticut, USA and

Associate Professor at the University of South Florida, USA.

Dr Moussy has 20 years’ experience developing biosensors/

diagnostics and drug delivery devices. His research has been

funded by several US federal grants including a US$ 2.2 million

grant from the NIH National Institute of Biomedical Imaging

and Bioengineering (NIBIB).

Solomon Nwaka, PhD

Leader, Lead discovery for infectious

tropical diseases and for Innovation

for product development in disease

endemic countries

Solomon Nwaka has considerable scientific and management

experience in both public, private and international organizations,

in countries including the USA, Japan, Canada, Germany

and Nigeria. Prior to joining TDR, he was the Director of Drug

Discovery at the Medicines for Malaria Venture (MMV) in

Geneva, Switzerland; he also had a senior role in a Canadian

biopharmaceutical company. He holds a PhD with emphasis

in molecular biology and has worked at the University of

Kentucky (USA), the National Institute for Bioscience and

Human Technology (Japan), the University of Freiburg

(Germany), the International Center for Genetic Engineering

and Biotechnology (Italy) and the Catholic University of

Leuven (Belgium). Dr Nwaka has received several international

fellowships and serves on a number of international scientific

editorial boards as well as technical advisory committees of

global health initiatives. He has a major interest in capacity

building for product R&D and biotechnology in developing

countries and has published broadly in these areas.

Piero Olliaro, MD, PhD

Leader, Drug development and

evaluation for helminths and other

neglected tropical diseases

Piero Olliaro carried out his early postgraduate research

studies in infectious diseases in Italy and France. Before joining

TDR he worked both in academia and in the private sector

(where he developed rifabutin as a drug for tuberculosis and

other mycobacterial diseases and started the development

of paromomycin as a treatment for cutaneous and visceral

leishmaniasis). He is a member of the French Académie

Nationale de Médecine and invited professor at the University

of Oxford, UK.

TDR annual report | 2009

63


Leadership

Philip Onyebujoh, MBBS, MSc, DTM&H

(RCP), PhD, FASSaf, FRCP (Lond)

Leader, Evidence for treatment policy

for HIV-infected TB patients

Philip Onyebujoh qualified in medicine from the Ahmadu

Bello University Teaching Hospital in Nigeria. He later went

to the UK to study clinical tropical medicine (at the London

School of Hygiene & Tropical Medicine) and public health

(at the Royal College of Physicians, London); his PhD was on

mycobacterial diseases. In 2000 he became a fellow of the

South African Academy of Sciences and later a fellow of the

Revered College of Physicians. Dr Onyebujoh joined WHO in

2001, working within the strategy and operations unit of the

WHO Stop TB department. Prior to joining WHO, he was the

Chief Specialist and Director at the Clinical and Biomedical

TB/HIV Research Unit, South African Medical Research Council

from 1998 to 2001.

Johannes Sommerfeld, DPhil, MPH

Leader, Integrated community-based

interventions*

Yeya Tiemoko Touré, PhD

Leader, Innovative vector control

interventions

Yeya Touré joined TDR in 2001 following 20 years as researcher

in medical entomology and professor of cell biology and

genetics in the Faculty of Medicine and Pharmacy (FMPOS),

Bamako, Mali; director general of the National Research

Council (CNRST) of Mali; and head of the Malaria Research

and Training Center (MRTC), FMPOS. His PhD, from Université

de Droit, d’Economie et des Sciences d’Aix-Marseille III, France,

was on vector population ecological genetics. His research

focused on malaria and lymphatic filariasis epidemiology

and transmission; vector biology, ecology, genetics; and

resistance to insecticides and control. His honours include:

“Etoile d’argent du Mérite National du Mali avec effigie Abeille”.

He was a member of several WHO/TDR steering committees,

the WHO Expert Committee for Vector Biology and Control

and several scientific and technical advisory committees of

research institutes in Mali and West Africa. He is a member of

the Academy of Sciences for the Developing World (TWAS).

Johannes Sommerfeld is a health social scientist who, since

2000, has been overseeing at TDR social science and public

health research in relation to infectious diseases and their

control. With a master’s degree and doctorate in cultural

and medical anthropology from the University of Hamburg,

Germany, and a MPH degree in epidemiology from the

University of South Florida, USA, Dr Sommerfeld has previously

held research associate appointments with Heidelberg

University Medical School, Germany, and the Harvard Institute

for International Development, USA. As well as recently taking

on the role of leader of integrated community-based interventions

at TDR, Dr Sommerfeld is project leader of the TDR/IDRC

research initiatives on eco-bio-social research on dengue in

Asia and Latin America.

* Dr Boakye Boatin served as leader until October 2009.

64


PART III

TDR partnerships

A key strength of TDR is the way we work in partnership,

collaboration or alliance with other agencies,

organizations, institutions and people. With these

partners, we leverage the resources we receive from

our donors, the skills of our staff and the expertise of a

network of advisers and investigators to develop effective

solutions. Together we:


research necessary to fill the most neglected needs;


mitigation of socioeconomic impacts of disease, and

the strengthening of health and research systems;


and use;


leadership in low- and middle-income countries.

Since being established in 1975 our collaborations have

led to a number of multiple-partnered activities and

new organizations related to global health research –

notably the Medicines for Malaria Venture (MMV), the

Foundation for Innovative New Diagnostics (FIND),

the Drugs for Neglected Diseases initiative (DNDi), the

Global Forum for Health Research (GFHR) and the

Multilateral Initiative on Malaria (MIM). We continue to

develop new partnerships and are currently investigating

partnering regional networks for innovation and an

implementation research platform.

We work in partnership with hundreds of experts each

year (through our different committees and expert

groups) to shape our key research activities. Working

through partners means we have access to an increased

number of people ‘on the ground’ who are able to help

with our work; our experience is extensive in coordinating

and/or managing large collaborative projects.

Currently we have over 500 institutional partners.

We refer to all of our research funding and grants as

‘collaborative research grants’ because we see ourselves

as working in partnership with our grant recipients; we

proactively follow and work with our research grantees

as needed.

What does TDR look for in partners?

When building partnerships we look for shared values

or goals and complementary skills and/or resources.

Our partners are in both disease endemic countries and

among stakeholder groups with access to and a focus

on these countries. Our partners carry out the research,

give our work political support, may provide funding

or in-kind support, or have operational capacity that

enhances the way in which we can work and advance

our ability to react to a changing environment. While

some of our partners provide financial resources, others

provide in-kind support in the form of infrastructure,

access to technology and tools (e.g. research drugs), and

expertise that helps us carry out our work.

What does TDR provide to partners?

In turn, depending on the nature of the partnership,

we provide funding for research capacity building and

other activities, and access to a wealth of knowledge and

research expertise. We make available detailed reports

on research priorities identified by a broad range of

stakeholders, and provide links to our co-sponsoring

organizations’ country and regional offices and their

staff. Based in WHO, we engage with policy-makers and

control experts to inform research and its translation to

policy. We also bring to partnerships our country-based

knowledge and research networks, and our project

management and skills training for researchers at all

levels.

Historically we have worked with research institutions,

universities, governments, industry, donors/funders,

control programmes and with many other organizations

that work in health research and delivery of health

interventions. While sustaining these partnerships,

over the last year we have increased the number and

types of alliance that we build. A newly formed strategic

alliance advisory group (SAAG) is providing advice on

how we can further build partnerships that will help us

to increase the effectiveness of our activities and work

towards our specific goals.

TDR annual report | 2009

65


Partnership

We cannot attempt to list all the many institutions,

groups and organizations that we work with in this

report, but instead we provide insight below into how

some of our interactions with partners increase our

combined potency and leverage.

Technical partnerships

In our work on developing research evidence for the

treatment of HIV/AIDS in tuberculosis patients with

HAART (highly active anti-retroviral treatment), for

instance, we worked closely with national control

programmes in the United Republic of Tanzania,

Uganda, Zambia and South Africa that have helped

oversee research work that is carried out in collaboration

with national research institutions. National control

programmes officers were engaged in workshops on

the development of the research protocols and, with

input from WHO’s Stop TB department, national control

programmes with the highest disease burden were

selected following these workshops. Involving national

control programmes in this way means that the research,

in effect, is being overseen by policy-makers – in turn

this means that they are able to translate evidence into

policy sooner than may happen via other routes. In

general, using local resources and infrastructure to carry

out our research studies helps ensure that our activities

are directed towards those diseases and people most

affected.

Research quality assurance partnerships

We work with partners in different ways to ensure

research quality. For instance, we are working in

partnership with the Foundation for the National

Institutes of Health (FNIH) to develop a framework

for best practice in the laboratory and field testing of

genetically modified mosquitoes (GMM) for the control

of disease. The collaboration extends to co-funding

expert consultation meetings on GMM and publishing/

disseminating relevant reports. The collaboration is

strengthened by the fact that FNIH also funds projects to

develop control methods and has ties to policy-makers

in several countries – meaning that implementation is

likely to be speedier. We are also partnering with the

Forum for Ethical Review Committees in Asia & the

Western Pacific (FERCAP) to develop a framework

for best practice in ethical review and to disseminate

good-quality ethical review standards and procedures.

The impact of this partnership is the establishment

of high-quality ethical review locally – to date, there

are 50 committees that have been certified as meeting

international ethical review standards. We have also

trained more than 50 clinical monitors worldwide and

we organize an annual meeting to strengthen their

networking and exchange of experience and information.

TDR is also building local capacity for clinical

monitoring, in partnership with regional Clinical Coordination

and Training Centers in Thailand and Ethiopia.

Such activities increase local awareness on international

scientific and ethical requirements for clinical research;

in the long term our partnership should help these

centres and local monitors to become independent.

Advisory partnerships

TDR staff members do not set research priorities.

Instead, we bring together experts from around the

globe to analyse, debate and recommend what needs to

be done, and experts then monitor the progress of any

activities that TDR funds. We depend on hundreds of

people a year to donate their time generously, bringing

their expertise and the support of their institutions for

the greater cause we all share. We have 11 strategic

and scientific advisory committees and a database of

over 20 000 people who have worked with TDR over

the years – either as an investigator or as a committee

member. Many have provided guidance on our strategy,

grant selection and implementation. An example of such

an advisory committee is our Diagnostics Evaluation

Expert Panel (DEEP), which was assembled by TDR to

make recommendations on best practice in diagnostics

trials. The work from this panel has resulted in Nature

Reviews Microbiology supplements on how to evaluate

diagnostics for sexually transmitted infections, malaria,

visceral leishmaniasis and CD4,* with one on dengue

being prepared.

Capacity-building partnerships

Part of our mission is building research capacity and

leadership in the countries where the diseases create the

greatest burden. Recently, we helped develop the African

Network for Drugs and Diagnostics Innovation (ANDI),

which brings together the African Development Bank

and research organizations across Africa to improve

the ability of African countries to bring forward new

medicines and diagnostics. This has already led to

symposia on innovative product development activities

* A laboratory marker used to assess immunodeficiency and progression

of HIV-1 infection.

66


PART III

which are unique in Africa. For more than 12 years,

TDR has also hosted the research and capacity building

funding arm of the Multilateral Initiative on Malaria

(MIM), which provides support to core African research

groups for the development of malaria control tools.

These grants are awarded and reviewed by a MIM/TDR

Task Force on Malaria Research Capability Strengthening

in Africa. These MIM grants encourage partnerships,

including North-South partnerships, but our grants are

always provided to the southern partner as the lead and

principal investigator.

We are also partnering with research organizations to

build regional training centres for long-term sustainability

beyond initial donor support.

Knowledge management and

information partnerships

Access to knowledge and information is key to building

scientific research capacity; TDR therefore works in

partnership to improve such access. For instance, the

management and development of TropIKA.net, the

global web-based knowledge management portal, has

involved collaboration with BIREME, a Brazil-based

Pan American Health Organization (PAHO)-specialized

centre with the mission to contribute to the development

of health in Latin America and the Caribbean by

promotion of the use of scientific and technical health

information. Both the editorial team and technical

platform for TropIKA.net are hosted by BIREME. TDR

has also actively promoted HINARI (The Programme for

Access to Health Research) to research institutions from

low-income countries as a means of assessing scientific

literature free of charge.

TDR annual report | 2009

67


TDR financial review for

the biennium 2008–2009

TDR follows the two-year budget cycle of WHO, its

executing agency. This section provides a brief overview

of TDR’s financial performance in the 2008–2009

biennium.

Income

TDR’s income is derived almost entirely from voluntary

contributions. Its donors can be grouped into three

categories: (i) governments and intergovernmental

organizations; (ii) philanthropic foundations and nongovernmental

organizations; and (iii) the private sector.

Total income received in 2008–2009 was US$

77.4 million. Of this, US$ 27.2 million (35%) was

designated funding for specific activities and US$

50.2 million (65%) was undesignated funding.

Including carryover from 2006–2007 of US$

19.4 million, the total funding available in 2008–2009

was US$ 96.8 million. This represented 80% of the

Programme’s funding requirement for the 2008–2009

biennium expenditure budget of US$ 121 million. The

2008–2009 funding gap was therefore US$ 24.2 million.

This funding gap required TDR to reduce its initially

projected level of expenditure.

Table 1. Key financial results (US$ million)

2006–2007 2008–2009

Opening balance 18.8 19.4

Income 74.3 77.4

Funding available 93.1 96.8

Expenditure 73.7 88.0

Closing balance 19.4 8.8

Implementation rate 79% 91%

TDR continued to receive the support of its traditional

donor base, which includes twelve governments that

provided contributions of at least US$ 1 million per year.

Major new donors in 2008–2009 were the European

Commission and the International Federation of

Pharmaceutical Manufacturers & Associations (IFPMA).

We were also pleased to receive contributions from a

number of developing countries.

Expenditure

Total expenditure in 2008–2009 was US$ 88.0 million.

This is up 20% from US$ 73.7 million in 2006–2007.

Table 2 compares 2008–2009 expenditure with

2006–2007 expenditure.

Table 2. Expenditure by main category (US$ million)

2006–2007 2008–2009

US$ million % US$ million %

Operations 44.6 61 48.3 55

Programme-related

7.0 9 8.8 10

support

Personnel* 22.1 30 30.9 35

Total 73.7 100 88.0 100

*The increase in personnel costs in both dollar and percentage terms is due to

the combination of approved new recruitment to meet the challenges of the

new TDR strategy with lower than forecast funds available in the context of the

global financial crisis.

Figure 5 (on next page) provides detail of 2008–2009

operations expenditure by type of operational activity.

68


PART III

Figure 5. Detail of 2008–2009 expenditure by type of operation

Community-based

interventions

US$ 0.6 M (1%)

Visceral leishmaniasis

elimination

US$ 1.6 M (3%)

Antimalarial

policy/access

US$ 5.8 M (12%)

Other neglected

priorities research

US$ 5.8 M (12%)

Stewardship US$ 2.7 M (6%)

Empowerment

US$ 5.7 M (11%)

Lead discovery for drugs

US$ 4.3 M (10%)

Innovation for products in

disease endemic countries

US$ 0.6 M (1%)

Evidence for

treatment of TB/HIV

US$ 6.7 M (14%)

Quality-assured diagnostics

US$ 4.6 M (10%)

Vector control interventions

US$ 3.9 M (8%)

Drug development for

helminths /NTDs US$ 6 M (12%)

Implementation

Table 1 (previous page) shows that the overall

implementation rate in 2008–2009 was 91%, up from

79% in 2006–2007. Moreover, almost all of the US$ 8.8

million closing balance was already firmly committed for

expenditures on specific activities in 2010–2011.

In 2008–2009 TDR demonstrated its ability both to

manage a very tight liquidity situation and to make

good use of those limited funds that were available. We

will undoubtedly face further financial challenges in

2010–2011, but are confident that with a new resource

mobilization strategy in place and a renewed emphasis

on cost containment by improving the efficiency and

effectiveness of our work processes, we will emerge as an

even stronger organization.

TDR annual report | 2009

69


Finances

TDR financial contributions 2008-2009 in US dollars (US$)

CONTRIBUTOR 2008 2009 TOTAL 2008-2009

Belgium 1 464 129 1 756 954 3 221 083

Brazil 7 500 7 500

China 55 000 55 000 110 000

Commission of the European Communities (CEC) -- 1 181 918 1 181 918

Cuba 5 000 5 000 10 000

Denmark 2 109 705 1 873 360 3 983 065

Germany 1 230 529 1 307 443 2 537 972

Ghana -- 15 000 15 000

India 25 000 25 000 50 000

Iran (Islamic Republic of) 10 719 -- 10 719

Ireland 314 465 -- 314 465

Italy 3 573 746 -- 3 573 746

Japan 400 000 400 000 800 000

Luxembourg 1 891 074 1 700 680 3 591 754

Malaysia 25 000 25 000 50 000

Mexico 10 000 -- 10 000

Netherlands 1 173 770 1 173 770 2 347 540

Nigeria 101 865 -- 101 865

Norway 3 565 368 3 565 367 7 130 735

Panama 7 000 7 000 14 000

Spain -- 104 589 104 589

Sweden 3 140 704 3 140 703 6 281 407

Switzerland 1 962 661 1 443 465 3 406 126

Thailand 23 607 21 234 44 841

Turkey 5 000 5 000 10 000

United Kingdom of Great Britain and Northern Ireland 1 988 072 7 528 046 9 516 118

United States of America 2 481 250 2 307 915 4 789 165

African Programme for Onchocerciasis Control (APOC) 700 000 700 000 1 400 000

Bill & Melinda Gates Foundation (USA) 1 173 209 1 412 597 2 585 806

ExxonMobil Foundation 500 000 500 000 1 000 000

Foundation for Innovative New Diagnostics (FIND) -- 418 510 418 510

Global Forum for Health Research -- 29 425 29 425

Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) 292 000 -- 292 000

International Development Research Centre (CAN) 765 938 1 281 020 2 046 958

International Federation of Pharmaceutical

Manufacturers & Associations (IFPMA)

1 000 000 -- 1 000 000

International Vaccine Institute, Republic of Korea 100 000 -- 100 000

Liverpool School of Tropical Medicine -- 79 243 79 243

Medicines for Malaria Venture (MMV) 174 434 -- 174 434

Miscellaneous -- 957 173 957 173

Oswaldo Cruz Foundation (Brazil) -- 74 980 74 980

Population Services International (PSI) -- 1 038 000 1 038 000

Rockefeller Foundation -- 750 000 750 000

United Nations Development Programme (UNDP) -- 120 000 120 000

University of Heidelberg (funds from CEC), Germany 27 095 -- 27 095

World Bank 1 900 000 3 800 000 5 700 000

World Health Organization 1 789 000 1 061 479 2 850 479

Wyeth Pharmaceuticals Division 3 600 000 -- 3 600 000

TOTAL CONTRIBUTIONS FOR TDR 37 585 340 39 872 371 77 457 711

70


Picture credits: pages 4, 10, 14, 21, 23, 25, 27, 30, 33, 39, WHO/TDR/Craggs; 6, Paul Hahn; 8, 44, WHO/TDR/Schwarb;

16, 60, David Quattrocchi; 22, 29, 31, WHO/TDR/Crump; 24, WHO/TDR/Stammers; 25, WHO/TDR/ Matlashewski; 28, FIND.


DOI 10.2471/TDR.10. 978-924-1599702

TDR/World Health Organization

20, Avenue Appia

1211 Geneva 27

Switzerland

Fax: (+41) 22 791-4854

tdr@who.int

www.who.int/tdr

ISBN 978 92 4 159970 2

The Special Programme for Research and Training in Tropical

Diseases (TDR) is a global programme of scientific collaboration

established in 1975. Its focus is research into neglected diseases

of the poor, with the goal of improving existing approaches and

developing new ways to prevent, diagnose, treat and control

these diseases. TDR is sponsored by the following organizations:

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