Clinical Research in Liberia: Bridging the Gap Between Clinical Science and Clinical Care

Growing up in Liberia, I always dreamed of becoming a medical doctor. That dream came true in 2011. Upon graduation from the only medical school in Liberia, I completed an internship and was licensed to practice medicine and surgery.  The A. M. Dogliotti College of Medicine didn’t offer any courses related to clinical research, with the focus being on public health instead. Despite this, I managed to launch a career in clinical research during one of the most difficult crises to hit my country: Ebola.

At the height of the 2014 West African Ebola crisis, there was a huge need to accelerate the development of new vaccines and medicines. To address this need, a clinical research partnership, the Partnership for Research on Ebola Virus in Liberia (PREVAIL), was formed. The partnership has gone from strength to strength and PREVAIL is now involved in conducting clinical research into Ebola, HIV, tuberculosis, COVID-19, Malaria, and Lassa Fever.

For me, this new era of clinical research in my country has created great opportunities to contribute to science and healthcare. My work in clinical research at PREVAIL as a General Practitioner has been hugely rewarding, helping train me to diagnose, treat and support patients individually, while my time in the pediatrics and obstetrics and gynecology departments has allowed me to improve the day-to-day care of people.

But the benefits are not just in frontline care. Working in clinical research has also broadened my understanding of ethics and regulatory affairs, respect for persons participating in research, participant recruitment, conducting research according to Good Clinical Practice, multidisciplinary and international collaborations, and publishing results to bridge the knowledge gap, thereby leading to improved health policies. For example, my work with Ebola has included a study in which analysis of the semen of male Ebola survivors over three years showed that the intermittent shedding of the Ebola viral RNA in male Ebola survivors continues up until 40 months following the onset of acute Ebola infection, while all other symptoms (except for uveitis) decline over the follow up period of five years.

My experience so far has also underscored the importance of robust surveillance. For example, a COVID-19 multinational study in the Democratic Republic of Congo, Guinea, Liberia, and Mali found that many vaccine-naïve people receiving the COVID-19 vaccine for the first time with no reported history of SARS-CoV-2 infection likely had previous asymptomatic infections as SARS-CoV-2 antibodies were detected in their blood. This implies the low numbers of COVID-19 cases reported in some countries could be due to inadequate surveillance, limited access to COVID-19 tests kits and healthcare, and asymptomatic infections.

Concerning Lassa fever, the need to develop an effective vaccine cannot be overemphasized. Lassa fever can affect people at any age since the major route of transmission is food and drink contaminated by rodent urine and feces; human-to-human transmission is also possible. The Natal multimammate rat, the natural host of Lassa virus, is common around households in Liberia and often too little is done to control or eliminate these pests. Of the 16 counties in Liberia, Lofa, Nimba, Bong, and Bassa have high burdens of Lassa fever, which is particularly concerning as these counties are considered the “breadbasket" of Liberia.

A multipronged response is crucial. Improved community awareness, largescale training for all health workers to detect Lassa fever early, better point of care testing, and improved sanitation are all essential. The introduction of a safe and effective Lassa vaccine is urgently needed to ensure a comprehensive response, which could greatly reduce the spread of this disease and save many lives.

Knowledge of clinical practice and research are the foundation of medicine. Every new vaccine or therapeutic licensed today is first tested and validated through clinical trials. The LEAP4WA scholarship has given me the opportunity to study clinical trials at the master’s degree level and advance my professional growth in this foundational area. Through this, I’ll be able to contribute to clinical research in Liberia and mentor other young minds passionate about this field. It’s truly exciting to be developing my expertise in clinical research, and I look forward to using my skills to help my people in the future.