Abstract
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These two conferences highlighted some specific issues that we often address at International Society for Biological and Environmental Repositories (ISBER) meetings and other biobanking conferences, and in articles appearing in Biopreservation and Biobanking. However, there are biobanking challenges and opportunities that are particular to Africa. The chapter on Biosampling and Biobanking in the WHO Handbook for Cancer Research in Africa 2 noted the following: “The global total of new cancer cases is projected to increase by 60% to 21 million annually by 2030, with an estimated 13.1 million deaths from cancer yearly. About half of these cancer deaths will occur in low- and middle-income countries (LMIC) and more than 80% of these in African countries.” Given biobanking's central role in basic, translational, and clinical research, developing workable standards for biospecimen management in African countries is a critical need.
Although all clinical research efforts would benefit from improved biobanking standards in Africa, biobanks in Africa were initially developed due to the need to collect samples during the AIDS epidemic. 3 Much of the early and current biobanking activities in Africa have resulted from the spread of emerging infectious diseases, as well as more long-term issues concerning tuberculosis and malaria. More recently, the Ebola epidemic in western Africa resulted in additional biobanking needs and challenges.
The two conferences in July addressed aspects of these infectious disease outbreaks and related biobanking issues. The Johannesburg meeting was organized by the CDC Maternal and Child health Branch of the Division of Global HIV/AIDS and Tuberculosis. The purpose was to address the issues of management and storage of DBS samples, and possible future use in resource-limited settings. The rapid scale-up of infant virologic HIV testing in sub-Saharan countries has resulted in the collection of thousands of DBS specimens that are processed at specialized laboratories across the subcontinent. There are currently no guidelines or standardized practices to guide the short- or long-term storage of DBS samples for future testing. As a result, leftover DBS specimens are managed by laboratory staffers on an ad hoc basis. Many laboratories periodically discard remnant DBS specimens due to storage and human resource constraints, whereas others may store DBS samples under suboptimal conditions, rendering the samples unsuitable for future use. The Johannesburg conference focused on the need to develop standardized approaches for the maintenance and management of DBS samples and data repositories that reflect regional and national legal, ethical, and programmatic requirements and needs. In addition to a variety of presentations and discussions concerning DBS sample collection, analysis, and biobanking approaches, representatives from seven of the most affected African countries described their programs and discussed strategies to coordinate and harmonize their activities relative to DBS sample collection and analysis. Follow-up discussions are being planned, as the technical and ethical challenges vary for each country and region.
The Lagos conference assessed biobanking, bioinformatics, biosafety, biosecurity, and bioethics concerns in the aftermath of the Ebola outbreak in West Africa. As noted in the conference brochure (available to download 1 ), 28,645 people were infected during the Ebola outbreak in 6 countries in West Africa and 11,324 died, a mortality rate of about 36%. In the aftermath of the Ebola outbreak, a number of serious biobanking and biosecurity issues have come to light, which this conference was convened to discuss. Biobanking was the major topic of several sessions. Pasquale De Blasio and I led a biobanking workshop to discuss best practices, and issues specific to biobanking in Africa, and, for example, handling hazardous biospecimens from the Ebola outbreak.
The broader biosecurity concerns in Africa due to Ebola, AIDS, and other disease outbreaks are outlined in the Dakar and Harare Declarations, which can be found in the conference brochure. 1 These outbreaks have led to serious concerns about infrastructure issues in Africa, including biobanking, but also security concerns due to the potential for dangerous biological samples to be mishandled, or not being securely stored and getting into the wrong hands. In addition to the concerns addressed in the Declarations, a number of international organizations including the WHO and GET, 4 the Global Emerging Pathogens Treatment Consortium, are also involved in finding solutions, and were well represented at the conference.
In addition to these and other conferences, two projects that are addressing issues concerning biobanking and research infrastructure in Africa are H3Africa (Human Hereditary and Health in Africa) 5 and B3Africa (Bridging Biobanking and Biomedical Research across Europe and Africa). 6 The H3Africa program, jointly funded by the Wellcome Trust and the U.S. National Institutes of Health, will study the genomic and environmental determinants of a variety of diseases. The program required the development of a biobanking network among several African countries. A review by Abayomi et al. in the December 2013 issue of the Journal 7 addressed the infrastructure, ethical/regulatory, information systems, governance, and sustainability issues that faced biobanking in Africa as the H3 Africa project was initiated. In general, the lack of biobanking standards and infrastructure in Africa slowed initial progress in developing the H3Africa network.
B3Africa, funded by Biobanks and Biomolecular Resources Research Infrastructure Consortium-European Research Infrastructure Consortium, 6 aims, as noted on its website, “to implement a cooperation platform and technical informatics framework for biobank integration between Africa and Europe. The collaboration harmonizes the ethical and legal framework, biobank data representation and bioinformatics pipelines for sharing data and knowledge among biobanks and allowing access for researchers from both continents.”
Projects such as H3Africa and B3Africa will result in improved conditions for biobanking and biospecimen research in Africa. However, currently the situation in Africa and among LMICs elsewhere is indicative of the challenges faced in such countries. Infrastructure and regulatory issues were already mentioned. In addition, as noted by Fleming, 8 there is also a shortage of trained pathologists in LMICs, which presents a major obstacle to collecting high-quality samples and otherwise developing well-managed biobanks. The problem is particularly acute in sub-Saharan Africa. The shortage of pathology services not only affects the ability to collect samples for biobanking. The quality of patient care is also affected in that tissues are often not collected for diagnostic purposes.
Going forward, African biobanking practices are expected to improve as the public and researchers become more educated in the important role of biobanking in public health and best practices, and biobanking networks are further developed to support multicountry projects in Africa and elsewhere. A number of international organizations have increased their efforts to identify issues and conduct workshops to increase awareness and provide training opportunities. One of the more active organizations is BCNet. 9 BCNet is the LMIC Biobank and Cohort Network and is a cooperative effort among the International Agency for Research on Cancer, the U.S. National Cancer Institute Center for Global Health, and other international partners. BCNet is engaged in a number of training efforts in LMICs and recently partnered with ISBER to provide online training for ISBER's best practices. Other such efforts concerning research practices and needs in Africa are outlined in the WHO book. 2
I appreciated the opportunity to attend the two conferences in July, and learn about biobanking and biosecurity issues in Africa that have not been fully addressed by our Journal. I hope that we can follow-up with additional reviews and original research articles from our African colleagues. I would like to thank the organizers of the CDC meeting for the invitation to the Johannesburg meeting, and a special thanks to Akin Abayomi and Pasquale De Blasio, both members of our Editorial Board, for the invitation to the Lagos conference.