Dr. Samba Sow
2017 Roux Prize Winner
Today, Mali is considered one of the poorest countries in the world. Nearly 44% of the 18 million residents of the country live below the poverty line and 90% of the total population resides in the southern half of the country, where the capital of Bamako lies.
This is where Dr. Samba Sow, 2017 Roux Prize recipient, grew up.
Dr. Sow recalls there were only two neighborhoods in the capital of Bamako where residents could find portable safe drinking water. With his mother, he would make the morning trip between 4 and 7 a.m. and then head to primary school. School, however, did not consist of a classroom but whatever tree he could find to study under.
“I remember I was always the smallest of my classmates. If you have a better rock to sit on, if your neighbor friend or classmate is stronger than you, he will come and kick you and take your stool. So it was not easy and I studied in those conditions.”
Dr. Sow was raised by two poor and hardworking parents; his dad was a driver and his mom was a social healthcare worker. They rented a single room shared among many of Dr. Sow’s family members, including his parents, siblings, grandmother, and aunt.
“My childhood was not easy. Poor neighborhood with all the bad habits that you can imagine, including drugs and tobacco use by children. Kids have to go work very hard in the farm after school and most of the children would stop going to school because parents need them to work,” said Dr. Sow. “When I was a child I never thought that I would be able to study even past Grade 9 at school, but my two parents understood the importance early on and they wanted me to study.”
With hard work and the support of his parents, Dr. Sow graduated from college and then decided to start medical school in Bamako. He became a doctor very early, at the beginning of his sixth year, after which he traveled to train and do research at a French Colon y Leprosy Centre running clinical trials and performing research for the World Health Organization (WHO). At the end of his time here, Dr. Sow received a tropical disease research grant from WHO to study epidemiology at the London School of Hygiene and Tropical Medicine. When he graduated, he decided it was time to return to Mali and reunite with his family. He began teaching epidemiology at the medical school in Bamako.
Meanwhile, the Minister of Health at the time, Dr. Traore Fatumata Nafu, was sitting in on Global Alliance for Vaccines and Immunization (Gavi) meetings along with Professor Myron M. Levine, Director General of the Center for Vaccine Development (CVD) at the University of Maryland, Baltimore. Gavi was planning to introduce new vaccines into countries based on local disease burden.
“And it comes to a question, how about Mali? How about West Africa? Where are the data, there was no data for Gavi to use to introduce those new vaccines,” said Dr. Sow.
Dr. Levine was tasked, along with others, to help generate and build capacity for laboratories that could generate the data Gavi needed. He connected with Dr. Nafu and they sought to hire someone to run this operation in Bamako.
After many interviews, Dr. Sow was selected. He was now responsible for establishing a clinical bacteriology laboratory and performing surveillance to show which pathogens were causing the most deaths in children under 5 years of age. Dr. Sow reassembled his former team working on leprosy and started this operation in Bamako, at CVD-Mali.
When CVD-Mali started its work there at the beginning of the millennium, there was no clinical microbiology laboratory in the country’s largest pediatric hospital, Gabriel Touré, in Bamako. People were dying and nobody knew whether they were dying from bacterial infections, viral infections, or something else.
The lack of resources was further compounded by the lack of training for clinicians. They had no experience analyzing and collecting clinical bacteriology information. Out of the 70% of patients admitted to the hospital with a presumed infection, 24% never left alive.
In conjunction with Dr. Sow, with a grant from the Rockefeller Foundation and a little later with a grant from the Gates Foundation, CVD-Mali set up a clinical laboratory so they could test children who came in with a high fever. They now had the ability to perform blood cultures or spinal fluid cultures and determine whether a child had an invasive bacterial disease.
They quickly realized that high fever in children was being misdiagnosed. Clinicians were unfamiliar with other pathogens, so they were diagnosing malaria as the cause of illness for children in 60% of cases. In reality, only 24% were actual malaria cases.
Dr. Sow’s team was left with one question: If not malaria, then what is killing children?
Within a couple of years, it became evident through the use of disease burden research that there was a major burden of not only pneumococcal infection, but also Haemophilus influenzae type b (Hib) disease, a pathogen that has been almost eliminated from North America. Hib’s major symptom: fever.
“We started with the Minister of Health. We took a couple of slides on paper, couple of tables on paper. We went to see her and we explained to her the results. She was so shocked also. She said what is Hib, what is Haemophilus influenzae type b, what is pneumococcal infection?” said Dr. Sow.
Dr. Traore, former Minister of Health, immediately called the President. Within the same day Dr. Sow and his colleague were on their way to meet him.
“We presented what we did at Gabriel Touré and the Hib disease burden infection and the case fatality rate for both Hib, pneumo and the others,” said Dr. Sow. “The President those days, President Amadou Toumani Touré, he was calling himself the friend of the children. When he saw the results, he was shocked. When we explained to him that there is a possibility to get vaccines and that’s how you do it through Gavi, he said let’s do that now. I’m ready to pay now to stop these killing pathogens.”
Within a couple of months, the vaccines were in the country. The results were astonishing. Coverage with the vaccine rapidly scaled up over three years and children infected with Hib and dying from Hib fell sharply.
There was almost an 80% reduction in deaths from Hib and over 88% reduction in hospitalizations due to Hib over the first three years. With the success of this vaccine, Dr. Sow and his team were able to successfully acquire more grants to continue their work researching and implementing vaccines for other preventable and prominent diseases in Mali, like pneumococcus.
“We have shown clearly in three years that if you do surveillance, you demonstrate a high disease burden, then you maintain surveillance, you introduce vaccine and you improve some knowledge and skills at the clinics so that they can collect right data, you can save lives,” said Dr. Sow.
The surveillance programs Dr. Sow established were pivotal in the response to the Ebola outbreak in West Africa in 2014. Dr. Sow, at the request of the President of Mali, led the country’s Ebola response. Despite introductions of Ebola from neighboring countries, Mali did not experience an outbreak. Dr. Sow was deployed to Sierra Leone and Guinea to assist in control and response efforts in those countries as well.
Recently, the French government has bestowed upon Dr. Sow the designation of Knight of the French Legion of Honor, recognizing his courageous contributions to the fight against Ebola in Mali, along with the important public health contributions he has made to the country.
Due to his achievements, Dr. Sow was appointed Acting Minister of Health this year by the President of Mali, His Excellency Ibrahim Boubacar Keïta. Along with his responsibilities as Minister of Health and head of CVD-Mali, Dr. Sow also contributes to the improvement of health metrics sciences as a member of the Global Burden of Disease collaboration.
“Now that we have opportunities and system like GBD we will have to take that opportunity to strengthen our national system, to question our own data, by looking at other data from other places and multiply CVDs around Africa to generate good data,” said Dr. Sow.
Dr. Sow and his team continue to further this work to learn to prevent illness and death, through projects like the Pneumonia Etiology Research for Child Health (PERCH) project. Led by Johns Hopkins Bloomberg School of Public Health, PERCH is a case-control study aimed at updating our understanding of what causes pneumonia, in order to better treat patients and prioritize more effective interventions, like vaccines, to prevent the illness in the first place. CVD-Mali is also one of the seven sites for the Global Enteric Multicenter Study (GEMS), the largest case-control study of diarrheal disease etiology, treatment, and prevention strategies.
“It is evidence-based, data-based and it’s data not coming from the internet. It’s data coming from the ground locally by Malians with Malians,” said Dr. Sow.
David and Barbara Roux established the Roux Prize in 2013 to award innovation in the application of Global Burden of Disease (GBD) research. The prize recognizes the person who has used burden of disease data in bold ways to make people healthier.
Mr. Roux is a founding board member of IHME and, over the past decade, he championed IHME’s most ambitious project, the updating of the Global Burden of Disease. And he encouraged IHME, as the coordinating center for researchers around the world, to find ways to make the information more useful, so that it would actually have an impact on the ground.
Since the first GBD publication in 1993, GBD data have been used in a wide variety of ways to inform better policymaking at the local and international levels. Mr. Roux wanted to reward that kind of evidence-based innovation and to encourage even bolder attempts to improve population health through better measurement of disease burden.
The Global Burden of Disease (GBD) is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors. In 1993, the original GBD study was funded by the World Bank and featured in its landmark World Development Report 1993: Investing in Health. Co-authored by Dr. Christopher Murray, now Director of IHME, this study included estimates for 107 diseases and injuries and 483 nonfatal health consequences in eight regions and five age groups.
Now an ongoing enterprise with annual updates, GBD is an international, collaborative effort with more than 2,300 researchers in over 130 countries, led by IHME. Results are regularly published in peer-reviewed journals for more than 300 diseases, injuries, and risk factors, by age, gender, and country for 195 countries from 199 to present. For more information about GBD, visit IHME’s website.