Pregnant women in Africa are exposed to considerable health risks, with parasitic infections being a major threat. Schistosomes, soil-transmitted helminths, and malaria parasites are highly prevalent and polyparasite infections are common. In pregnancy, besides iron deficiency parasites are a key factor causing anaemia associated with an increased risk of maternal and infant morbidity and mortality. More than 50% of the pregnant women are affected by anaemia and an estimated 0.8 million pregnant women globally have severe anaemia. Antenatal care is a health program to regularly deliver health services including preventive measures with the aim of improving maternal and newborn health. In terms of fighting parasitic diseases, WHO recommends to preventively treat soil-transmitted helminths, schistosomes and malaria parasites. In many endemic sub-Saharan African countries, however, these recommendations are often only partially implemented and not consistently applied in daily antenatal care. Reasons are multifactorial but hesitation in administering multiple drugs this vulnerable population and the complexity of integrating the use of multiple drugs into the antenatal care schedule. On the other hand, data is accumulating that outweighs the potential risk of antiparasitic drug intake versus health benefits. The project aims to increase the uptake and integration of presumptive antiparasitic treatment during pregnancy to combat anaemia and improve health outcomes for pregnant women and their babies in sub-Saharan Africa. To this end, a multi-country trial will assess the safety, tolerability and efficacy of co-administered antiparasitic drugs. Pharmacokinetic data, cost-effectiveness analysis and public health stakeholder’s involvement will further strengthen the case for future implementation of co-administered antiparasitic drugs in antenatal care schedules. Training in African scientific leadership will contribute to a critical mass of highly trained professionals.

The ORCHESTRA project provides an innovative approach to learn from the SARS-CoV-2 health crisis and derive recommendations for increasing preparedness for future outbreaks. The main outcome of the project is the creation of a new pan-European cohort built on existing and new large-scale population cohorts in European and non-European countries. Data analysis through a federated learning technique supported by advanced modelling capabilities will allow the integration of epidemiological, clinical, microbiological and genotypic aspects of population-based cohorts with environment and socio-economic features. The ORCHESTRA cohort will include SARS-CoV-2 infected and non-infected individuals of all ages and conditions and thereby enabling a retrospective evaluation of risk factors for the disease acquisition and progression of the disease and prospective follow-up aimed at exploring long term consequences and analysis of vaccination response. To better address these research questions, the ORCHESTRA-cohort will include adequately sampled representatives of general populations, COVID-19 patients and special ‘at risk’ populations of fragile individuals and health-care workers. The project aims also to evaluate how the acquisition of SARS-CoV-2 variants impacts on the severity of disease. ORCHESTRA will specifically assess the immunity function status in vaccinated and not vaccinated health care workers, including assessment in-between the first and the second dosages of any available vaccine and explore differences in level and durability of antibody immune responses and frequency of breakthrough infections (symptomatic and asymptomatic) in fragile population (e.g oncological, transplanted, hematological, HIV-infected and suffering from Parkison disease). The understanding of the evoked immune response by population, variants and type of vaccine are key to better understand how vaccines againstSARS-CoV-2 variants can prevent transmission and severe SARS-CoV-2 infections, why certain variants may be able to escape vaccines, and whether refresher boosters at regular intervals could change any of these outcomes. The participation of non-European and Low-Medium Income Countries and a Global COVID-19 Guidance group of major stakeholders and investigators from successful clinical trials addressing therapeutic approaches to COVID-19, ensures inclusion of all expertise needed and translation of recommendations to different social and economic settings. The project will significantly impact on the responsiveness to SARS-CoV-2 and can be used as a model for responsiveness for new public health threats.

Onchocerciasis is a neglected tropical disease leading to blindness and associated with epilepsy. Most cases are in sub-Saharan Africa. The WHO has proposed that its transmission be interrupted in a third of endemic countries by 2030. The main strategy is annual Community-Directed Treatment with Ivermectin (CDTI). Despite nearly 3 decades of CDTI, transmission persists in several foci. In Phase II & III clinical trials, moxidectin has shown superior efficacy compared to ivermectin, clearing Onchocerca volvulus microfilariae for nearly a year. No large-scale community trials have yet been undertaken to document its effectiveness and safety for mass treatment. A barrier to onchocerciasis elimination is its co-endemicity with loiasis in Central Africa. Individuals with high Loa loa microfilaraemia may develop serious adverse events if treated with ivermectin. EMINENCE will address these challenges through: 1) a Phase IIIb community trial of annual or biannual moxidectin compared to annual ivermectin in Bafia and Monatele, Cameroon, renowned for their high transmission intensity, 2) a Phase II adaptive trial of ascending moxidectin doses on increasing L. loa microfilarial densities, and 3) a social sciences study to assess the acceptability of and adherence to moxidectin. We will evaluate and model the epidemiological impact of annual or biannual moxidectin compared to annual ivermectin through parasitological, serological and entomological surveys, and will attempt to elucidate potential differences between the two drugs regarding their effects on adult worms. We will evaluate the safety, tolerability and efficacy of moxidectin compared to ivermectin in L. loa-infected individuals in the Republic of Congo and Cameroon. Our project will contribute to the evidence-base that moxidectin may be effective and cost-effective to accelerate onchocerciasis elimination in areas where ivermectin has proved insufficient, and will investigate its safety in loiasis co-endemic areas.

The spread of Mpox virus (MPXV) in Sub-Saharan Africa, specifically Democratic Republic of Congo (DRC) and Republic of Congo (RoC) presents an urgent public health concern with global implications. MPXV cases have been reported across 114 countries with 89,752 confirmed reports and >150 deaths. It has the highest prevalence in DRC and has resulted in twice the number of deaths in the African region compared to Europe. RoC, a DRC bordering country, is also experiencing a surge in positive cases, highlighting an urgent need for data-driven efforts to identify transmission routes and implement public health initiatives. MPOX-PROBE is responding to this call for action with an international consortium and activities in three main pillars (1) improving epidemiological surveillance of Mpox with new diagnostics and sampling efforts including high-risk areas and vulnerable populations; (2) capacity building to improve diagnostic and research capacities of researchers and public health workers in DRC and RoC; (3) strengthening public health response by sharing surveillance data and newly developed spatiotemporal risk and transmission models for Mpox. Through MPOX-PROBE, this consortium will create actionable data to uncover MPXV transmission routes and natural reservoirs facilitating development of effective interventional packages. The transmission and risks models will allow prediction of future or emerging outbreaks and develop initiatives to prevent further spread. Together, these efforts will benefit vulnerable populations and general public in sub-Saharan Africa alike while also performing ground-breaking research to understand transmission mechanisms.

The world is facing the silent “pandemic” of antimicrobial resistance (AMR). Central Africa has the highest mortality rate (23.5 deaths/ 100,000) attributable to AMR in the world. Research is desperately needed to better understand the burden of AMR in this region, and it is vital that this work is done by local researchers who will be the future leaders of scientific and clinical research in central Africa. The overall aim of the Central Africa Training Platform for Clinical Research on infectious diseases (CATCR) project is to produce essential, world-class research in central Africa, for central Africa, by central African people. To achieve this, it is crucial that the critical mass of PhD and PostDocs in central Africa is increased. Therefore, the consortium will (1) develop a multifaceted training programme on infectious diseases focusing on AMR for MSc, PhD and healthcare professionals; (2) develop a clinical fellowship programme of recruitment, training, evaluation and retention; (3) research the lack of knowledge on antimicrobial usage trends in patients with parasitic infections; (4) research the causal link between prevalence rates and influencing factors of carbapenemase-producing Enterobacterales (CPE) and occurrence of AMR in humans and livestock; and (5) research to understand the prevalence of tuberculosis (TB) and drug-resistant TB characteristics in Central Africa. Finally, (6) the project will focus on communicating, and disseminating research results. Through CATCR, talented researchers, clinicians and health care professionals working on AMR in central Africa will benefit from access to fully-funded fellowships to complete ground-breaking research. Public and regulatory authorities in Africa will use the research and newly established fellowships to develop vital AMR action plans and to increase the critical mass of researchers in the region will ultimately lead to benefits for patients and citizens of central Africa.