Dr. Vuyu Kanda Golakai, Dean of the A.M. Dogliotti College of Medicine, Liberia’s medical school, stunned a gathering of medical professionals in Monrovia on Tuesday when he confronted the gathering with what he described as gaps in the conduct of Ebola vaccine research in Liberia. These gaps, according to him, are a result of deviations from standard scientific research norms and suggest a one-sided agenda on the part of international partners.
At the opening of a workshop earlier this week for the Committee on Clinical Trials of Ebola, which brought together medical doctors and public health professionals from the three affected countries, Guinea, Sierra Leone and Liberia; as well as from the United States and elsewhere, Dr. Golakai said the first gap is a knowledge gap between research partners.
He said although no one can oppose research as a priority, there is the need to review and scrutinize the conduct of research in Liberia and Africa. With specific regard to the EVD outbreak, he highlighted among other issues, gaps in requisite knowledge of emergency situations; lack of an action plan or research protocols to follow; gaps in the equity of the partnership, as well as the question of who benefits or suffers from the use of misuse of research data.
Addressing primarily the western medical experts present, Dr. Golakai saw these and other gaps in the Ebola-related research in Liberia as serious deviations from standard scientific research norms and protocols, especially on the part of the international partners.
When compared with research in other African countries, he said, Liberia gets no equity or equality in the so-called research partnership. Thus, he wondered, whose agenda does said research serve; and whose future does emergency response research serve?
He believes that narrowing the basic information gap requires teamwork. Also, a firm commitment to growth and development of research institutions in the country will benefit all participants. On this note, he drew comparison between the well-established Harvard Research Center in Botswana and abandoned chimpanzees on the islands off Charlesville, Margibi County, Liberia; or the Baylor Center of Excellence for HIV-afflicted children (also in Botswana), versus the temporary Ebola Treatment Units (ETU) in Liberia, for example.
He also emphasized that mutual respect, with justice and fairness will render everyone as winners.
Dr. Golakai argued that the process leading to the post-Ebola research in Liberia was endorsed by “the highest authorities in the land” without the input of the local research board, which he said was not right. “By the time they came to the research Board,” Dr. Golakai lamented, “our hands were tied, our mouths were gagged. We could not embarrass our government. We had to go along. That is not right,” he insisted, adding that “What has to do with scientific studies is organized by scientists and taken to the authority of the state, but the clinical trial came from the Head of State which is not right,” he charged.
Dr. Golakai also questioned the motive of the international partners to test the Z-Mapp vaccine in Liberia, when it had been in existence for five years before the outbreak the sub-region.
“Why try the vaccine here and not in the United States where the Z-Map had been in existence for five years prior to Ebola outbreak in Liberia, Sierra Leone and Guinea,” he questioned.
“We also know that since 1976, with the first outbreak, the efficacy of convalescent serum was known. Why did they not prioritize that? The reason is simple. The Western researchers have never accepted it because that was proven by an African.”
Golakai further argued that PREVAIL’s clinical trials units are established in tertiary education hospitals, while priorities are not set by mutual discussion and consent. He explained that Prevail has taken up two floors of the John F. Kennedy Medical Center, creating a severe shortage of space for patients the hospital should otherwise be serving.
According to him, in the midst of the knowledge gap existing between partners, the gap is still ignored.
Dr. Golakai also observed that it was strange for a bat allegedly carrying the Ebola virus, which was discovered in southern Africa, to mysteriously travel all the way to the three affected countries in the Mano River basin only to infect a little boy in the forest of Guinea, known as “Patient Zero”.
“How long did the bats fly covering thousands of miles to reach here with Ebola from Southern Africa,” he wondered. “As a scientist, I find that very hard to swallow.”
Dr. Golakai said since he observed these gaps in the research setting, he immediately exempted himself from the activities and has always remained neutral.
“In democratic settings, decisions are derived by a majority, but sometimes there is a majority of one, if truth, equity and sincerity are on his side,” he said.
“Research in America and abroad is not the same, and has not been conducted in the same manner as research in Africa. You do not work with us, you do not consult with us, to set the agenda. You bring the agenda and tell us that we must follow. For example, we are talking about prioritization of research, post-Ebola and post-epidemic. Did you consult with us to call this conference? No. You set the agenda, that now we must forget malaria, tuberculosis, HIV and all the other serious epidemics that we have and concentrate on Ebola. Why? Because I suspect it is your agenda, not ours.
“At JFK, two floors have been taken over by PREVAIL. We cannot treat our patients. When this conference is over, we wish to ask PREVAIL to relocate. Otherwise, we shall seek redress outside of the scientific forum. Mutual respect must be there. When you came, you never visited the Medical School. In fact, as far as you are concerned, there may be no medical school; or the medical school is not worthy of your consideration.”
Dr. Golakai is professor, college of Health & Life Sciences at the University of Liberia. Since January 2011, he has served as Vice President for Health Sciences at the University of Liberia and Dean of the A.M. Dogliotti College of Medicine. He has wide international experience in Healthcare System Development
Work Experience and Health Education and Training, both at the undergraduate and post-graduate levels.
Responding to Dr. Golakai’s remarks, Dr. Gerald Keusch, Co-Chair of the Committee on Clinical Trials, said that the Committee’s work is sponsored by the United States Government, although the Committe itself is functionally autonomous. “The sponsors of this study providing the resources for us to spend time to gather information are three components of the U.S. Government,” Dr. Keusch said. “Therefore, our report goes first to the sponsoring agencies. But we are totally independent and autonomous in the way we function.
In fact, since the first time that we met as a committee, and met with the leadership of the sponsoring agencies, the only time that we have engaged with them has been in an open, on the record meeting. All of our deliberations in closed session, exclude them. We are autonomous and able to think about the issues to the clearest extent that we are able.
“The committee has broad expertise; it is from the U.S., from Europe and from several countries in Africa. And our job is to assess what happened, and make sure that the preparation for the next — whatever it is going to be — that we are in a better position to act, particularly in the context of such an urgent and devastating outbreak.”