2023
A legacy of progress in clinical pharmacology and social justice; remembering Peter Ian Folb
There are few effective and safe therapeutics for diseases that disproportionally affect impoverished populations, such as malaria and other neglected tropical diseases. But even these few therapeutics would not have been available without a critical mass in clinical pharmacology skills and a strong regulatory environment in the countries where these diseases are most prevalent.
The late Emeritus Professor Peter Ian Folb (1938–2022) was a visionary and a leading authority on the scientific basis of drug development, both as an academic and within medicines regulation. In 1996, he enabled the University of Cape Town Department of Pharmacology to become a World Health Organization (WHO) Collaborating Centre for Drug Policy and Research into Drug Development and Drug Safety, in conjunction with its sister department at the University of the Western Cape. This centre was the first WHO centre of its kind on the African continent and among low- and middle-income countries.
For 18 years, Folb was Chair of the South African Medicines Control Council. He advised on improvements to drug regulation and drug policy in 42 African and three European countries. He investigated and unravelled the apartheid government’s chemical and biological warfare programme for the South African Truth and Reconciliation Commission. Despite considerable political pressure, he led the Medicines Control Council’s principled stand of halting human trials on Virodene, a controversial drug based on a toxic industrial solvent that was claimed to be a treatment for human immunodeficiency virus, but that lacked sufficient evidence of efficacy or safety. He was awarded an honorary Doctor of Science degree by the University of Cape Town in 2016.
Folb was professor and head of the University of Cape Town Department of Clinical Pharmacology and chief specialist in internal medicine at Groote Schuur Hospital, Cape Town (1976–2003). Many of those who were influenced and guided by his vision continue to demonstrate the vital role that clinical pharmacology can play in the development and rational use of essential medicines to improve public health.
Folb played a leading role in developing the national drug regulatory framework and essential drugs programme, which underpins the rational use of quality-assured medicines. He published several books on drug safety, and for many years was co-editor of Meyler’s side effects of drugs – the international encyclopaedia of adverse drug events.
From 1993 onwards, Folb served on several international scientific committees. He was a member of the Drugs for Malaria committee, where he contributed to the scientific and strategic development of new treatments for malaria. He was also Chair of the WHO Special Programme for Research and Training in Tropical Diseases Special Task Force for Research into Severe Malaria. He held meetings with African regulatory authorities and directed the development of rectal artesunate as a pre-referral treatment of life-threatening severe malaria in infants and children in remote malaria-endemic settings where injectable treatment was not promptly available.
From 1997 until his retirement, Folb was director of the South African Medical Research Council Traditional Medicines Research Programme. He led the development of integrated primary health-care guidelines for both traditional and allopathic health-care professionals and received two innovation awards from the Department of Science and Technology for the development of novel medicines from medicinal plants in southern Africa. His boundary-breaking work researching traditional medicines using rigorous scientific standards recognized and rewarded the intellectual property of the communities that identified medicinal plants.
In addition to his 1997–1999 work for the South African Truth and Reconciliation Commission, Folb made other important contributions to promote a more equitable society and redress past injustices. For example, he challenged the South African Medical and Dental Council about the death in police detention of anti-apartheid activist, Steve Biko.
Folb balanced art and science, the personal and the professional. He wrote Haiku poetry, painted and created woodcuts, was a marathon runner, and an inveterate walker and a swimmer. He often said that when one walks fast for over 40 minutes, the brain switches to right-sided dominance. That is the time for solving problems and thinking strategically.
Throughout his life, he exemplified the best that a committed clinician scientist with unwavering integrity can contribute to advancing knowledge, health, and challenging social injustice.
Published article linked here
https://iris.who.int/bitstream/handle/10665/365523/PMC9795387.pdf?sequence=1&isAllowed=y
2022 October
Top Scholars in South Africa Honoured
Twenty-nine of the country’s leading scholars and scientists were inaugurated as Members of the Academy of Science of South Africa (ASSAf) at the annual Awards Ceremony on the 19th October 2022 and Karen Barnes, Professor in Clinical Pharmacology at the University of Cape Town has made the list.
As the official Academy of South Africa, ASSAf has a core function to honour the country’s most outstanding scholars by electing them to Membership of the Academy. ASSAf Members are drawn from the full spectrum of disciplines.
New Members are elected each year by the full existing Membership. Membership of the Academy is a great honour and is in recognition of scholarly achievement. Members are the core asset of the Academy and give of their time and expertise voluntarily in the service of society.
2022 August
Using mathematical modelling to fight malaria
Researchers have created a mathematical model to predict genetic resistance to antimalarial drugs in Africa to manage one of the biggest threats to global malarial control.
Malaria is a life-threatening disease caused by parasites and spread to humans through infected mosquitos. It is preventable and curable, yet resistance to current antimalarial drugs is causing avoidable loss of life. The World Health Organisation estimated there were 241 million cases of malaria worldwide in 2020, with more than 600,000 deaths.
In research published today in PLOS Computational Biology, an international research team used data from the WorldWide Antimalarial Resistance Network (WWARN), a global, scientifically independent collaboration, to map the prevalence of genetic markers that indicate resistance to Plasmodium falciparum – the parasite that causes malaria.
Lead author Associate Professor Jennifer Flegg from the University of Melbourne said malaria has devastating impacts on lower-income countries and effective treatment is key to elimination.
“The antimalarial drug sulfadoxine-pyrimethamine (SP) is commonly used in various preventative malaria treatment programs in Africa, particularly for infants, young children and during pregnancy. But we know its efficacy as a treatment is threatened in areas where resistance to SP is high,” Associate Professor Flegg said.
“The statistical mapping tool we have developed is critical for health organisations to understand the spread of antimalarial resistance. The model takes in the data that is available and fills in the gaps by making continuous predictions in space and time.
“Health agencies can use this tool to understand when and where SP is appropriate to use as part preventive malaria treatments and where other antimalarial methods may need to be explored.”
Professor Karen Barnes, Head of WWARN Pharmacology and Elimination, said there is a rapidly increasing need for malaria chemoprevention (drugs that prevent malaria infections), but there are limited treatment options available.
“This timely evidence of the extent of SP resistance across Africa will help to inform where SP preventive treatment, alone or in combination with other antimalarials, would be most likely to have the greatest impact,” Professor Barnes said.
Professor Feiko ter Kuile, Head of WWARN’s Malaria in Pregnancy Scientific Group, said the updated model of SP resistance in Africa was long overdue.
“A lot of the resistance mapping has understandably focused on the emerging resistance to the artemisinin-based antimalarials used for treating malaria. Increasing resistance of the malaria parasite to sulfadoxine-pyrimethamine in Africa has been a concern for several decades. However, easily accessible resistance data was lacking,” Professor ter Kuile said.
“This study combines all the available SP resistance data from the last two decades in a single model. It allows national malaria control programmes and researchers to get much-needed data on the degree of resistance in a given area in a given year. This allows us to understand better the impact of sulfadoxine-pyrimethamine resistance on the effectiveness of these preventive interventions and determine if and when to consider alternative drugs for chemoprevention.” - This is an extraction from the original Scimex article dated 12th August 2022.
2021
African Union releases embargoed 2021 Malaria Progress Report
On the eve of the 35th Assembly of the African Union, the African Leaders Malaria Alliance (ALMA), the African Union Commission and the RBM Partnership to End Malaria are excited to share with you the embargoed 2021 African Union Malaria Progress Report.
The report, which will be presented to Heads of State and Government during the AU Summit this weekend, provides an update on the status of malaria on the African continent. It highlights activities undertaken, challenges faced, best practices learned by AU Member States and their partners to sustain malaria services and accelerate progress towards the goal of eliminating malaria in Africa by 2030. This report also provides updates on requests and calls to action made by the African Union Assembly.
2020 April
Prof Karen Barnes speaks about the concerns with prescribing unproven medication for COVID-19
Chloroquine was traditionally used to prevent and treat malaria, rising rates of drug-resistant malaria has led to it being replaced by other treatments, explains Karen Barnes - Professor of Clinical Pharmacology at the University of Cape Town.
There is not enough evidence to know whether the drug protects against infection from the new coronavirus, known as SARS-CoV-2. Scientists are trying to ascertain whether it can be used to treat COVID-19. In the coming months, South Africa will join a global trial, spearheaded by the World Health Organisation, to help answer this question. Read full article for more information.
2019
Lifetime achievement award for UCT's Mabuza
His extraordinary contribution to efforts to eliminate Malaria in South Africa has earned Aaron Mabuza, of the University of Cape Town's UCT Collaborating Centre for Optimising Antimalarial Therapy (CCOAT), a 2019 Lifetime Achievement Award from the SA Medical Research Council's (MRC) office of Malaria Research.
The occasion also the saw launch of the Malaria Elimination Strategic Plan for South Africa, to which CCOAT contributed. This article was also published on page 69 of The University of Cape Town's 2019 Alumni Magazine
CLINICAL DRUG TRIALS: Tests of progress. The Financial Mail reported on the launch of the UCT Clinical Research Centre's phase one unit in the article Professor Barnes, discusses the need for close monitoring during phase 1 studies "It is a complex science to move safely and responsibly from animal and test tube studies to studies in people. We start with very low doses in small numbers of healthy people and watch them closely. If that goes well, we give slightly more, gradually building up until we get past the dose that we guess will be effective," Read the full article here
2009
Since the establishment of WWARN in 2009, research partners from over 260 institutions globally have worked with WWARN, and over 120,000 individual patient records have been contributed to the WWARN Data Centre. That equates to around 80% of all the available artemisinin combination therapy trial data. Read more