Building Laboratory Capacity in sub-Saharan Africa

Niamé Daffé
Nov 4 · 5 min read

In the last decade, the world has seen the emergence and re-emergence of infectious diseases, including the two largest and deadliest Ebola Virus Disease (EVD) outbreaks in history, both of which were in sub-Saharan Africa, and were declared public health emergencies of international concern by the World Health Organization (WHO). The largest outbreak ravaged the West African countries of Liberia, Sierra Leone, and Guinea from 2014–2016 and left 11,310 people dead, including 513 health care workers. The current outbreak that began on August 1, 2018, continues to devastate the Democratic Republic of Congo over a year later.

Ebola has killed thousands of people and overwhelmed multiple public health systems since it first emerged in a remote village in Congo in 1976. For 43 years, Ebola has been untreatable. Two new drugs are changing this. The promise of a new treatment is exciting and a huge step towards eradicating the disease. But, as the world works towards the development of an Ebola treatment, laboratory capacity and infrastructure also need to be part of the conversation.

Build Health International CEO and Co-Founder, Dr. David Walton (left) in Sierra Leone during the 2014–2016 Ebola outbreak.

Ebola Virus Disease (EVD) is only the most recent example of public health emergencies that ravage health systems and devastate already scarce health infrastructure and personnel. This is particularly devastating in Africa. Socio-economic and cultural contexts are not created in a vacuum; they are born from histories, as well as present realities. The African continent has abundant natural resources, but vestiges of colonialism and other forms of mass-extraction and exploitation have left the continent materially poor. This has subsequently contributed to the health infrastructure landscape we see today across the continent.

The development of laboratory capacity, including investment in national laboratory services, systems and infrastructure, is critical to stemming the tide of infectious disease like Ebola. Laboratories are complex and have different levels of capacity and safety in order to keep lab personnel safe. Scientists who study extremely contagious and deadly pathogens, such as Ebola, need to work in specialized laboratories — termed biosafety laboratories (BSL) — which not only protect them from contamination, but also prevent these contagious materials from entering the environment.

BSLs have four levels with increasing safety and protection measures, including clothing decontamination, and specialized ventilation systems. BSL-3 labs are used to study agents transmitted through the air that can potentially cause lethal infection, while BSL-4 labs are used to study deadly agents that pose a risk of life threatening disease for which no therapy is available. BSL labs are needed to diagnose patients and advance the development of treatments, vaccines, and diagnostic tests, as well as quickly and effectively identify harmful microbes and to prepare for any impending threats of bioterrorism. In emergency response situations, they are vital to detecting infection quickly, and mitigating the spread of disease.

Recently, Build Health International (BHI) conducted a scoping exercise to learn the landscape of biosafety in sub-Saharan Africa to better understand the continent’s laboratory capacity in the face of emerging and re-emerging infectious diseases. As of 2007, the United States had 13 BSL-4 laboratories and 1,356 BSL-3 laboratories registered with the Centers for Disease Control and Prevention (CDC). By comparison, we found that sub-Saharan Africa, with a population of 1.078 billion people (2018), only has two BSL-4 and fewer than 25 BSL-3 laboratories, many of which are modular labs, which are prefabricated and shipped to the desired location. Although modular BSL laboratories have many advantages — they are mobile, rapidly deployable, suitable for resource-limited, remote areas, and are often less expensive than traditional labs — they do not offer a permanent solution to the infrastructure gap that exists on the African continent when it comes to laboratory capacity.

During the most recent Ebola outbreaks, development of laboratory capacity was listed as an urgent priority to prevent further escalation of the disease. According to the WHO, a lack of laboratory capacity means suspected cases are forced to wait several days for test results that should only take a few hours. Since EVD includes common symptoms such as fever and headaches, people with other common infectious diseases such as malaria and dengue fever are often held in Ebola treatment centers as a precautionary measure while being tested for EVD, putting them at high risk of contracting the deadly disease by placing them in the same areas as other potentially infected patients. As a result, new chains of transmissions can often spring up even as the number of cases fall. Were there more diagnostic capacity and BSLs in the affected areas, suspected cases could be diagnosed quickly and spread of Ebola within Ebola treatment centers could be minimized.

Since the first outbreak in 1976, there have been twenty-eight confirmed EVD outbreaks in Africa, ten of which occurred in the Democratic Republic of Congo. And yet, the DRC still lacks adequate laboratory capacity to respond to the disease. Increased laboratory facilities, including permanent BSL-3 and BSL-4 laboratories, would improve the diagnostic capacity of African countries and better allow them to quickly contain outbreaks of Ebola, cholera and other highly-contagious diseases when they occur.

Reference Laboratory at the Hôpital Universitaire de Mirebalais, Haiti. Picture Credit: Kat Kendon

At Build Health International (BHI), we believe that infrastructure plays a critical role in promoting global health equity. In 2016, BHI designed and built the Caribbean’s first fixed BSL-3 laboratory at the Hôpital Universitaire de Mirebalais in Haiti, with technical expertise from Harvard University, Brigham and Women’s Hospital, the Dana Farber Cancer Institute, and the architecture firm Shepley Bulfinch. BHI is currently designing and equipping a fixed BSL-3 laboratory at the Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID) Genomics Center in Nigeria, in partnership with Harvard University and MASS Design. By understanding the current landscape of laboratory capacity in sub-Saharan Africa, our hope is to begin to fill the pervasive gap in laboratory capacity on the continent and beyond.

Build Health International Stories

Global health stories at the intersection of infrastructure and impact. Build Health International is building the foundation for global health equity. Visit our website to learn more and get involved!

Niamé Daffé

Written by

Niamé Daffé is Build Health International’s Global Public Health Specialist on the Research and Clinical Planning team.

Build Health International Stories

Global health stories at the intersection of infrastructure and impact. Build Health International is building the foundation for global health equity. Visit our website to learn more and get involved!

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