The double face of research in low and middle-income countries – facing the pandemic

  • 8 April 2020
  • General
  • Kirsty Le Doare

Despite the fact that I have worked in several African countries over the past 10 years, it still surprises me how much the research agenda is governed by the current zeitgeist. In my case, I work in the deeply untrendy area of maternal and newborn health. This has meant years of banging on (mostly slam-in-your-face-shut) doors seeking funding for projects to answer questions about the continuum of immunity between pregnant women and their infants and how we can harness this power through vaccines.

Now, all of a sudden, this just got harder. All the major funding bodies have channelled millions of dollars into COVID-19 research. But what does that mean for those that get left behind. Diseases other than COVID-19 still kill millions each year, a large proportion in the first 28 days of life, yet historically this has never been a focus for funders or policy makers. TB still kills 1.6 million people annually, HIV kills 770,000 and 2.5 million children died in the first month of life in 2018 (50% from infectious causes). At the time of writing, COVID-19 accounts for 70,000 deaths globally yet over 7000 infants will die today (the day they are born), due to lack of appropriate care and delivery or because of infections.

Why then, is so much of the world’s focus moving to just one bug? There are no estimates of how much funding has gone into COVID-19 research since January 2020, but if cost per life saved were to be used as a measure, COVID-19 research would score poorly against other causes of death.

In the development of the Sustainable Development Goals, which in turn were developed from the unachieved Millenium Development Goals, health of a pregnant woman and her infant were recognised for the first time (although notoriously, stillbirth is still missing). Now, however, it is unclear where pregnancy and childbirth fit into this brave new world. Pregnant women get a brief mention in the WHO COVID-19 roadmap, but reports (of 11 pregnant women and 3 infants) seemingly suggesting that the virus is not transmitted to the fetus and infant mean that they are not priority groups for research.

It might be that COVID-19 is like cytomegalovirus, a herpes virus that affects the fetus in the first trimester of pregnancy and is the leading cause of sensorineural deafness in childhood. Or COVID-19 might be like Zikavirus, a flavivirus that if contracted in the first trimester of pregnancy can result in small heads and problems with brain development. Interestingly, Zikavirus was another virus about which there was widespread panic about a new infection following the babies in Brazil who were born with small heads. However, zikavirus was first discovered in Uganda in 1947 and yet there are no reports of zika virus causing problems with births in Uganda or other African countries where the virus is found. Better surveillance of pregnancy and its outcomes internationally would improve our understanding of whether infections cause such syndromes.

There is a seismic shift in funding towards COVID-19 research projects that are being written for open-then-close-the-next-day funding applications. In the meantime, funding for non-COVID19 related research has been delayed, suspended or cancelled. As the focus shifts towards this virus, where many are infected, but few deaths occur in LMIC, it is important to recognise the double face of research. All non-COVID19 research is suspended. This has implications for staff and participants in LMIC who may not receive the protection or care they should expect from government or research services. The international community should come together to ensure that studies in LMIC can be provided with the support they need to continue. Long after COVID-19 has worked its way through the middle classes, babies will still die of other, potentially preventable infections unless we act now.

Dr Kirsty Le Doare  is a Senior Clinical Lecturer and Honorary Paediatric Infectious Diseases and Immunology Consultant, based within the Paediatric Infectious Diseases Research Group part of the Institute of Infection and Immunity at St George's, University of London and is also a Foundation Future Leader.