Speech by His Excellency Paul KAGAME, President of the Republic of Rwanda, on “Building viable medical research communities in Africa: Policy Challenges” at the University of Cambridge

I am delighted to be here at the University of Cambridge – permit me to begin by thanking you very much, Professor Richard for your kind invitation to deliver the Dr. S.T. Lee Public Policy Lecture. I appreciate the opportunity to share views on what I consider to be one of Africa’s and Rwanda’s critical challenges – building viable scientific and research capabilities to address our health and medical priorities, as well enable us to significantly participate in this vital and vast global industry. It is fitting that this discussion takes place at Cambridge – we recognize and appreciate the distinguished history of collaborative work between this University and African institutions in various fields, including the health and medical domain. We look forward to even richer and more innovative partnership that is mutually beneficial. The importance and role of the health and medical sector and associated industries in socioeconomic development cannot be overstated: First, discoveries, inventions, and innovations from health and medical research allow individuals to live longer and more productive lives thereby contributing to healthier populations and improved national productivity. Second, the health and medical industry is a leading wealth creator – the pharmaceutical and biotech markets run into over six hundred billion US Dollars annually, while global health care expenditures amount to trillions. Third, the sector provides enormous employment opportunities globally. Besides medical professionals and workforce, this industry continuously creates demand for thousands of scientists and researchers, clinical technicians, ICT professionals, sales and marketing staff as well as health insurance providers – among many other categories. Robust advancements in ICT have accelerated innovation by permitting, for instance, critical medical data to be processed and transferred quickly over long distances for analysis and delivery of treatment. However, much of this industry, as well as its benefits, impact Africa only in a marginal sense – our continent remains trapped in a dependency syndrome in which we “consume” research agenda, outcomes, as well as bio-products, from the outside world. This passivity is unacceptable and demands urgent reversal – which is beginning to happen, but we need to do much more, as I will illustrate. The background to Africa ’s health and medical challenges include colonial and post-colonial historical factors that are generally well-known – suffice to note that much of the past five decades up to the mid-1990s were characterized by instability, conflict, weak institutions, and dismal economic performance. This was the context in which the health and medical challenges we are talking about today emerged for much of our continent. One example of the grave consequences of this legacy is the fact that Sub-Saharan Africa accounts for eleven percent of the global population, but bears twenty four percent of the world’s disease burden – while we command less than one percent of global health expenditure. The “lost decades” also led to severe shortage of scientists, researchers and trained medical personnel – Sub-Saharan Africa is said to have only three percent of the world’s health workers, which excludes the bigger portion of African professionals that continuously leave the continent in the form of “brain drain”. It is therefore no wonder that the level of research and development is extremely low in Africa – in the range of 0.05 percent of global output, while medical research and authorship of scientific scholarly work is almost as negligible. Meanwhile, entrepreneurship required to transform Africa ’s health sector into a dynamic investment domain for producing goods and services is still in its infancy. These factors ultimately explain the vicious cycle of disease burden, poverty, and low life expectancy in our countries, which, for the most part, remain commodity based and non-value adding economies. The good news is that the situation on our continent has been changing – Africa has been moving in the right direction, with the broader consolidation of peace and stability paying good socioeconomic dividends. Several indicators reflect this new path – these include growth rates of above six percent annually for most African countries in the past several years; bigger and improved roles of the private sector in wealth creation; and the rise of large scale domestic firms, some of which are participating in trans-border transactions, especially in the ICT and telecom sectors. These positive developments have not bypassed the health and medical sector entirely – research communities are growing, although from a low base. Medical research initiatives are to be found in many parts of our continent, but need to be reinforced and accelerated especially in the following three areas. First, we have to design and own Africa’s medical research agenda – currently most of the ongoing research is externally-designed, driven and funded with very limited capacity for retaining the findings let alone integrating the outcomes into domestic solutions. Second, we need to build greater capacities by training and retaining more scientists through investment in first-rate medical research infrastructure and creation of an environment that appreciates scientific work generally. I am concerned that the debate on African scientists and other professionals that leave our continent is shifting towards the financial resources they send to their home countries that now run into over six billion dollars annually. In my view, the more critical question is the role of African professionals in building effective institutions to address our health priorities – and to contribute to the development of medical industries that would generate far more significant wealth than remittances. I am very pleased to note that African scientists practicing on the continent are taking the lead in advocating greater scientific research and development. Take for example the case of the various national science academies that were previously honorific associations for recognizing individual scientific contributions among peers. In the past several years, these African academies have gradually become authoritative and credible voices for influencing national policy and legislation on science and technology – and to generally offer evidence-based advice to their countries. These African scientific communities need to be acknowledged and encouraged to play their rightful roles in strengthening the triangular relationship between governments, business and academia that is fundamental to innovation and development. Third, we in Africa should recognize the potential for health and medical fields to create business and employment opportunities. Here we can borrow from bold and strategic policy lessons in countries such as Singapore. When Singapore was faced with growing competition from its neighbors in shipping and electronics, it established a biotechnology industry, notwithstanding the country’s relatively limited pool of scientists, compared to the developed world. As we now know, Singapore resolved this challenge with borrowed human capital – drawing scientists from countries such as the United Kingdom by providing them, among other things, a vibrant atmosphere to use their talents, which have since produced desired results. The African Development Bank, our continent’s premier development institution, is aware of the opportunities in this field – it earlier this year established an equity vehicle for providing risk capital to investors in health service provision, health insurance, pharmaceutical production and distribution and health education. This is an important development that brings us closer to good practices. The availability of venture capital and equity vehicles are key for encouraging start-ups from which successful health and medical companies are launched, as has been powerfully illustrated by experiences in the United States. It is also vital that African efforts be supported by consistent policymaking that recognizes and fosters prosperity creation. All doing business indicators should improve even faster, this includes intellectual property legislation in order to attract bigger and more innovative investment generally, and in the health and medical sectors in particular. We in Rwanda have embarked on a process of overcoming the noted challenges with multiple strategies, beginning with our broader vision of a knowledge-based economy. To realize this vision, research has been given particular attention, beginning with the creation of the Ministry of Science, Technology and Scientific Research dedicated to policy leadership in this field. In the health sector itself, research protocols and guidelines are being developed and adopted – for example, an Ethics Committee for clinical research has been established, and is now operational. Another key pillar in building a viable health and medical research community in our country is the National Center for Clinical Research. The Center’s main objective is to become a platform for clinical research in Rwanda and in our region, by among other things, attracting international firms and institutions that seek to reduce costs of doing business, or to move their medical innovations agenda to the African population. Significant progress is being realized in this regard – GlaxoSmithKline and Harvard Medical School are our partners on this, while discussion with several other companies and institutions is gathering momentum. The establishment of the Center is not sufficient – in this respect, Rwanda is determined to invest in nurturing a critical mass of scientists and researchers. For the first time in our history, in-country training of PhDs in medical sciences has started, in addition to training abroad, while partnerships are being built with global research institutions to strengthen our research base. I should highlight here, two related recent developments aimed at encouraging a culture of research and sharing of outcomes, in the Rwandan health and medical community. The Rwandan Medical Journal has been re-launched to provide a vehicle for sharing discoveries and new ideas. The Aimée Niyikiza Memorial Award that recognizes excellence in research and publication was established earlier this year. This annual prize awards the top Rwandan researcher, as well a winning young Rwandan researcher that submits original research. Finally, there is the Rwanda National Reference Laboratory, whose principle purposes include national supervision, surveillance, and quality assurance for improving health and medical outcomes. These various efforts in Rwanda are already bearing fruit in terms of policy ownership, direction and outcomes, as the in case of malaria – where we realized a sixty six percent decline in malaria deaths in children under five years old between 2005 and 2007. Part of this success is the widely acknowledged research on drug resistance that led to the changing of our malaria treatment policy to better treatments, as well as improved responsiveness to ensure proper use of medication and mosquito nets. Let me conclude by re-emphasizing the urgent need to strengthen Africa ’s health and medical research capabilities. To achieve this goal, African government and business leaders, scientists, researchers and professionals have to commit ourselves to the development of dynamic medical sectors that provide health care, create prosperity, and employment opportunities. The noted modest progress in building viable research communities in Africa and in Rwanda shows what can be achieved if we dedicate ourselves to this endeavor. We appreciate very much the contributions our partners have made in this regard. We look forward to continued innovative relations – the University of Cambridge , as noted earlier, has a rich history in collaborative work, and I am certain you will continue to provide invaluable support to Rwandan and African institutions. I once again thank you for your invitation to this policy forum – and appreciate your kind attention this evening. Ends