A quiet orderly queue of patients in colourful wraps, headdresses and sandals is forming on the veranda in Balonghuin in rural Burkina Faso, west Africa. A tiny old lady, Conseiga Sibodou, a grandmother from the village, sits in the queue. She says: "I have not been feeling well for a few months. I have fever and am shivering." She thinks she probably has malaria and that she may need some tablets. In her own way she's an expert: she has had malaria many times, especially during this, the rainy season.
But Sibodou has not come to the local hospital. She is visiting a clinical trial site. Here new drugs and vaccines from Europe and the US are tested, and many of the people who have turned up here today are hoping that they will meet the eligibility criteria for a trial of new drug. And even if they do not, doctors here say their ailments will be treated at the site anyway.
This is one of several clinical trial sites that have been built in Burkina Faso. As well as drug trials, seven new malaria vaccines are being tried out throughout the country at sites just like this.
New and revamped trial sites are springing up all over Africa. In the old days there were few sites and even fewer African scientists working at them. Much of the research was done by western scientists who would often take their knowledge – and equipment – home after tours of duty. And although some trials were well done, others took place under the radar of the international community, says Dr Thomas Nyirenda, of the European and Developing Countries Clinical Trials Partnership, which funds trial site improvements and trials throughout the continent.
The emergence of newer diseases such as HIV/Aids, the re-emergence of old ones such as tuberculosis, and greater awareness of infectious diseases that disproportionately affect the poor have sparked the change, and led to more focus on trials to test drugs and vaccines against such diseases.
In Burkina Faso, malaria is the biggest child-killer – responsible for half of all deaths – so finding new ways to combat it is a priority. Dr Sodiomon Bienvenu Sirima, of the national research centre – Centre National De Recherche et de Formation sur le Paludisme, which runs the site and trial, says: "If we had a vaccine, plus new insecticides and drugs, we would be able to control malaria. This site has been built to help contribute to the achievement of that goal. Very quickly we may see a just return."
Importantly, there are far more African scientists doing the research. A Tanzania-based NGO called Amanet, for instance, is upgrading clinical trial sites to international standards throughout Africa – including the Balonghuin site – training staff to run them and sponsoring trials in multiple sites.
Professor Wen Kilama, a retired researcher who is now head of Amanet, says: "When I was doing research in malaria, you would go to a conference there would hardly be an African. Researchers used to do surveys, collect [samples] and send them to the US. Now it is being done in Africa. There has been a sea change."
But increasing the number of clinical trial sites is no trivial matter. Because drugs must be tested on the people who will benefit from them, the sites must be located alongside and often within communities. That usually means rural areas. In Burkina Faso, rural people are bitten by mosquitoes infected with malaria a staggering 300 times a year. Their urban compatriots will receive just 10 infective bites.
Rural areas are vast and have little infrastructure. Balonghuin comprises 79 villages covering 17,000 sq km. These villages lack running water, electricity or telecommunications – all vital components for a clinical site that abides by strict international clinical trial standards. That's why sites such as this must be built with generators, enormous water tanks and satellite dishes.
Because rural communities have little access to health services, trial sites must often double as local clinics too. It would be unethical to bring such clinical expertise into an area without helping those in need, says Dr Mahamadou Soumana Sissoko of the Malaria Research and Training Centre at the University of Bamako, who is leading a vaccine trial across the border in Mali.
Malians, who may be keen to participate in trials, hate signing documents, says Sissoko. "During colonisation, when the chief asked you to sign a paper that was not very good. It meant you may be needed to pay more money for tax," he explains.
Though the trend is laudable, there's still a long way to go. There are not enough clinical trial sites or local scientists. A report last month estimated that just half of the 30 tuberculosis trial sites in Africa could be ready to conduct registration-standard TB drug trials in six months. And because African research institutions are chronically underfunded, many bright students go abroad to study and live.
A few universities are now trying to provide meaningful career paths that attract scientists home. Biologist Aminatour Kone is studying in Sweden but plans to return home to Mali when she graduates. Her course involves regular stints to conduct research in Mali and work is promised at the end of her studies. "It has been well-organised so that people can go [abroad] and come back. There is so much to do here in Mali," she says.