Raph Hamers: Developing collaborative clinical trials in Indonesia
Indonesia is a very populous country with a huge burden of infectious diseases such as TB, malaria, HIV and CNS infections. Running clinical trials requires high levels of expertise, currently developed and strengthened by institutions such as IOCRL (Universities of Indonesia and Oxford Clinical Research laboratory). Better collaborations will also help great ideas make a bigger impact.
My name is Raph Hamers, I’m a senior clinical scientist at the Eijkman Oxford Clinical Research Unit, I’m based in Jakarta Indonesia and my work is on clinical trials.
The main challenges of doing clinical trials in Indonesia is that clinical trials require a high level of expertise and specific skill sets. I think in Indonesia some institutions have that capacity but in general I would say there’s still a need to invest and develop that capacity. The importance of doing clinical trials is that it can help Indonesians to advance healthcare and advance outcomes for patients.
We’re currently running a phase 3 clinical trial in adult patients with HIV infection that have tuberculosis meningitis. The aim of the trial is to evaluate if the addition of an anti-inflammatory drug, dexamethasone, helps to improve the outcome of patients with tuberculosis meningitis. Tuberculosis meningitis is a complication of tuberculosis and it’s the most severe form; people with that form of meningitis often die and if you survive you usually have severe neurological disabilities.
In Jakarta we recently established a new laboratory, the Universities of Indonesia and Oxford Clinical Research laboratory, denoted IOCRL, and the aim of the new laboratory is to expand the agenda on clinical research. We seek in collaboration with our partners to develop new lines of research in infectious diseases that are important to public health. We train young scientists to develop specific skill sets to do the trials; we will have a laboratory that will serve to do all of the lab testing for clinical trials, and I think that new capacity is important to strengthen clinical research in Indonesia.
The Oxford unit in Jakarta has three themes of research. Historically the focus has been on malaria research; this line of research is led by Professor Kevin Baird and has focused on clinical trials mostly and the treatment and diagnoses of Plasmodium vivax malaria. The second line of research is on geospatial epidemiology led by Dr Iqbal Elyazar; his team are using big data approaches to see how they can map infectious diseases in Indonesia and correlate that to factors that determine the burdens. And the most recent line of research is clinical research under my responsibility. In this line of research we focus on CNS infections (central nervous system); the clinical trial on tuberculosis meningitis is one example, currently our most important project.
I think the strength of our unit is that we work very closely with our local partners: we identify the topics we work on based on their advice and based on our mutual interests; I think that’s a very strong component of our work. There are a lot of good people with great ideas, they are well trained, and they are great professionals to work with. What surprised me is that there seems to be a lack of collaborations. People are working very independently but are not necessarily sharing ideas and sharing efforts of collaborating to the extent they could be. I think there’s a great opportunity there if people can find each other more often, then the projects they do and the ideas they have could have more impact.
Our research is important because of our location, primarily. Indonesia is a very populous country: it’s the 4th most populous country in the world and it has a huge burden of infectious diseases. Every year there are estimates of more than 1 million new TB cases, more than 1 million new malaria cases, HIV epidemic is growing at a fast rate - it was estimated that in 2016 there were 48,000 new infections - and then in addition there are many other infectious diseases that are still very common. There is a lot to do, but nonetheless I think Indonesia is one of those countries that are under-represented in international discussions, the voice of Indonesia is generally not well represented in global health and medical science. I think there’s a great need for investments in research to advance the healthcare situation in the country.
I look at translational medicine as generating scientific data that can be used directly to improve patient care. The model that we use mostly is focused on patient-centred research clinical trials; by generating that kind of information we can dive deeper and use those data to unravel biological mechanisms. By combining that more mechanistic information with clinical data, I think it’s a very powerful model to advance health care; to me that is translational medicine.