The Mérieux Foundation’s activities have not been spared by the COVID-19 pandemic, which has played havoc with schedules and led to the reorganization of some projects so that the most urgent needs could be addressed. This unprecedented health crisis has highlighted the absolute necessity of creating an infrastructure of reliable testing systems in the field, since these are essential requirements for slowing the spread of epidemics. The crisis has also proved the ability of the Foundation’s teams to adapt. Their strong local presence alongside our partners has enabled them to react rapidly to the crisis. The networks of laboratories affiliated to the Foundation in many countries have contributed, sometimes in a highly significant way, to national efforts to diagnose COVID-19.

An exceptional donation granted by bioMérieux shareholders

In 2020, the bioMérieux board of directors decided to cut its dividend payments for the year in favor of public interest campaigns, with €12 million being paid out to the Mérieux Foundation. A total of 30 projects in 19 countries with limited resources were initiated thanks to this support, with the dual objective of fighting COVID-19 and strengthening health systems in general. These actions cover the construction and renovation of facilities, the supply of laboratory equipment, training, knowledge sharing, and research.

The initiatives include:

• The construction of a BSL3 Rodolphe Mérieuxlaboratory dedicated to tuberculosis at the Institut Pasteur in Morocco;
• The expansion of the Charles Mérieux Center for Infectious Disease in Madagascar;
• The purchase of equipment for laboratories in the GABRIEL network;
• Plans to construct a new Bioforce center in the Middle East;
• The allocation of grants to two Bengali students following a training course at the Erasmus University Rotterdam in the Netherlands.

Boosting local testing capacities

As early as January 2020, the Foundation mobilized its resources to support its partner laboratories with limited testing facilities. In total, almost 90,000 testing kits have been sent out in thirteen countries, accompanied by a program for transferring skills.

The Rodolphe Mérieux Laboratories at the heart of the fight against COVID-19

Designated as national reference laboratories or support laboratories for SARS-CoV-2 testing, several Rodolphe Mérieux Laboratories have played a key role in monitoring the epidemic. In Mali and Madagascar, teams were mobilized as soon as the first warning signs of an epidemic appeared. In Haiti, the Rodolphe Mérieux Laboratory within the GHESKIO centers was quickly requested by the Haitian Ministry of Health to support the National Response Plan and received financial support from the Agence Française de Développement (AFD). Today, it remains one of the most active laboratories in the in the country for the diagnosis of COVID-19. The laboratory in Beirut was commissioned by the Lebanese Ministry of Health to carry out COVID-19 screening alongside the Rafik Hariri University Hospital laboratory. Testing began on 7 March 2020 and the laboratory is now one of five reference facilities appointed by the Ministry of Health.

In Brazil, the Rodolphe Mérieux Laboratory in Rio Branco was the first facility in the state of Acre responsible for COVID-19 testing. The laboratory receives test confirmations for the entire country, as well as tests from border towns in Peru and Bolivia. It now carries out more than 70% of the COVID-19 tests in the state of Acre. In Cambodia, the Rodolphe Mérieux Laboratory has been authorized by the Ministry of Health and the WHO to carry out COVID-19 testing.

In the Democratic Republic of the Congo, the Rodolphe Mérieux Laboratory in Goma has also played a central role in the fight against the Covid-19 epidemic. More than 200 tests are carried out every day as part of surveillance operations for both the local population and travelers (national and international flights).

Supporting health professionals

Despite travel restrictions imposed by the health situation, experts at the Foundation have been able to maintain regular contact with laboratory networks, healthcare managers and partners in the field. A webinar dedicated to COVID-19 diagnosis was organized on 15 September 2020. Led by a professor from the London School of Hygiene & Tropical Medicine, the live webinar had 400 participants.

The Foundation has also adapted a MOOC (Massive Open Online Course) on COVID-19 diagnosis and translated it into French. This project was managed in collaboration with FIND (Foundation for Innovative New Diagnostics), the ASLM (African Society for Laboratory Medicine), and the London School of Hygiene and Tropical Medicine to help improve the skills of laboratory technicians in molecular screening techniques.

Adapting current projects

Several projects already initiated have benefited from additional top-up payments or budget reallocation to respond to the COVID-19 emergency. This adaptability owes a great deal to the mutual trust between the Foundation and its funding partners.

It has meant that the RESAOLAB project (see p.25) in West Africa and the LABOGUI project (see p.23) in Guinea have benefited from additional funding from the Agence Française de Développement (French Development Agency), which was used to set up new molecular biology platforms and to improve biosafety. The APRECIT (see p.34) (Cameroon and Madagascar) and EVAMAD (see p.21) (Madagascar) projects have also benefited from additional support from Expertise France, allowing the Foundation to supply protective equipment, reagents and consumables, and training. In Haiti and Myanmar, issues involving access to molecular diagnosis, improving the resilience of laboratory systems, and decentralizing diagnostic capacities have also led to the initiation of new projects.

Initiating research programs

Several collaborative research programs targeting COVID-19 were launched in 2020, at the forefront of which is a multicentric study aiming to assess the risk of nosocomial transmission of SARS-CoV-2. Initiated in partnership with the Hospices Civils de Lyon, the NOSO-COR study (see p.32) is being carried out in seven countries on four continents (Mali, Senegal, Ivory Coast, Guinea, Madagascar, Burkina Faso, Bangladesh, Brazil, and Lebanon) and benefits from the financial support of the Bill & Melinda Gates Foundation. The Fondation AnBer supports the element of the study being carried out in the Hospices Civils de Lyon.

Two other COVID-19 research programs were launched in 2020: a study targeting migrants in refugee camps in Bangladesh and Kenya, and a serological study on the immunity status of carers exposed to COVID-19 in Madagascar.

Maintaining support for vulnerable populations

As well as undermining even the most robust health systems, the health crisis has also rapidly aggravated the difficulties in accessing healthcare for the most vulnerable groups of people. The Foundation has therefore reinforced its commitment to these groups by adapting its support during the COVID-19 crisis. This includes:

• In Madagascar, having supported the Akamasoa association and OSCAPE in the production and distribution of washable masks, the Foundation has also donated personal protective equipment, small equipment, and consumables to partner associations, to support vulnerable and often deprived groups of people.
• In Iraq, the beneficiaries of the Shekan health and social center for Yazidi women and children have made 20,000 masks, which were then distributed to hospitals, refugee camps and police stations in the region. The profit-making activities at the center, which are usually devoted to making tahini, were converted to the production of soap, allowing hygiene measures to be respected.
• In Lebanon, the health center in the Beqaa Valley (see p.44), which opened its doors at the beginning of the year, has provided the isolated local population, mainly refugees, with access to testing.

Despite the difficulties caused by the health crisis, important progress was made in 2020 in the priority areas supported by the foundation: antimicrobial resistance, tuberculosis, acute respiratory infections, and the human immunodeficiency virus (HIV). These public health priorities carry a particularly heavy burden in countries with limited resources, and the Mérieux Foundation has reasserted its implementation of a transdisciplinary approach to address them. In the field of acute respiratory infections, this year’s programs were mainly aimed at fighting COVID-19.

Fighting tuberculosis

The Foundation’s actions in the field of tuberculosis aim to improve access to diagnosis and to strengthen research capa, with two key objectives: to promote access to high-quality diagnosis and technological innovations adapted to the needs of countries with limited resources, and to assess the medical impact of community intervention programs. These actions support the WHO’s “End TB” initiative, which aims to reduce the number of deaths related to tuberculosis by 95% and the number of new cases by 90% between 2015 and 2035.

The Mérieux Foundation supports operational research projects involving clinicians, biologists, scientists, community agents and government representatives, with the aim of maximizing the impact of projects to benefit vulnerable populations. Significant resources are devoted to the diagnosis of resistant and multi-resistant forms of the disease, which requires level 3 biosafety installations (BSL3 laboratory). In 2020, the SPHaïtiLAB program published the results of a national epidemiological study on the circulation of resistant strains, based on a collaborative study carried out by 15 peripheral laboratories.

Improving access to diagnosis and research capacity

The HINTT project, which was also completed in 2020, led to the identification of a new diagnostic test, which will be subjected to further studies to confirm its benefits in the control of pediatric TB. In Madagascar and Cameroon, the APRECIT project closely combines research activities with a strategy of community intervention, with the aim of improving prevention and care for latent tuberculosis in high-risk groups.

Action plan on antimicrobial resistance (AMR)

The Mérieux Foundation is committed to combating antimicrobial resistance, initially targeting TB and HIV, as well as responding to the alert issued by the WHO in 2015 (Global action plan on antimicrobial resistance). Its initiatives aim to strengthen surveillance by setting up medical biology laboratories capable of carrying out blood culture and antibiotic susceptibility testing.

© Mérieux Foundation

Today, the Mérieux Foundation takes an integrated approach, which goes a step further than simply reinforcing microbiological capacity and surveillance systems and includes all aspects of the fight against AMR: a “One Health” strategy dealing with the interdependence of human, veterinary and environmental aspects, an operational approach linked to improvements in the prescription of antibiotics, as well as campaigns to raise awareness of hygiene practices. The projects carried out in Madagascar are representative of this multi-sector commitment, covering the reinforcement of diagnostic capacity, the rationalization of antibiotic prescription, and prevention campaigns amongst the poorest communities.

Structuring of microbiological surveillance activities

The Foundation supports the RESAMAD network in Madagascar, which collects the majority of the island’s AMR data via the WHO’s Global Antimicrobial Resistance Surveillance System (the GLASS platform). Thanks to financing from the Fleming Fund (a UK Aid program to fight AMR), the Foundation also supports nine laboratories in Laos and Myanmar. In Senegal, the Fellowship Scheme will enable surveillance to be improved thanks to the implementation of a mentoring program (involving experts from the Foundation, the APHP and VetAgro Sup). Another educational project supported by the Fleming Fund is the QWArS program, which aims to develop the ongoing training of laboratory staff and epidemiologists involved in AMR surveillance in 17 countries in Africa and Asia.

One Health approach

The Foundation is involved in the TRICYCLE study, a WHO surveillance program to determine the prevalence of a key resistance indicator (Enterobacteriaceae-producing extended-spectrum beta-lactamases) in the human population, the food chain and the environment. The study began in Madagascar with start-up funding from the Foundation and benefits from the microbiological expertise of the Rodolphe Mérieux Laboratory in Antananarivo. It will be extended to several other countries thanks to European funding (JPI-AMR) obtained in 2020 through the TRIuMPH project.

Reasonable use of antibiotics

In 2020, the Foundation launched the TSARA project in five hospitals in Madagascar. The project aims to use laboratory data to adapt the prescription of antibiotics by clinicians. TSARA has a dual objective: to improve patient care by administrating the appropriate antibiotics, thereby preventing the appearance of new types of resistance. This is an innovative project with a concept that will be rolled out to other countries in which the Foundation operates.

Educational dimension

The Mérieux Foundation takes part in several initiatives to raise awareness of hygiene rules with an impact on antibiotic resistance: campaigns in association with authorities and local networks supporting children and their families with health issues relating to everyday life, such as the distribution of educational kits in Madagascar, or the “La main à la pâte” project in Mali (a hands-on project to design self-teaching tools for teachers in the member countries of the GABRIEL network.

Access to tests and support for people living with HIV

The Mérieux Foundation is committed to the field of HIV viral load quantification, which not only allows patients to be monitored and to have their treatment adapted, but also contributes towards reducing the risk of resistance to antiretroviral treatments and slowing the transmission of the virus. In Laos, Madagascar and Myanmar, the Foundation’s support for programs to improve access to HIV viral load testing contributes towards achieving the UNAIDS 95-95-95 objectives by 2030, particularly the objective of having an undetectable viral load for 95% of people on antiretroviral therapy.

Improving access to viral load testing

In Madagascar, the Foundation has been active in this field since 2015 and launched the EVAMAD project in 2020. Supported by Expertise France, the project aims to increase the coverage of HIV viral load testing, whilst rationalizing the use of the diagnostic tools available in the country. Additional funding has been supplied to help treatment centers ensure continuity of care despite the COVID-19 epidemic, and a study on HIV/COVID-19 co-infection has been set up. In Laos, the Center of Infectiology Lao Christophe Mérieux in Vientiane is the national reference center for HIV screening. Between 2011 and 2020, it provided viral load tests and screening for sensitivity to antiretroviral drugs for all people living with HIV in the country, thanks to a partnership with the National HIV Program and the support of the Global Fund. These tests will be decentralized from 2021.

HIV prevention and screening

At the same time, the Foundation supports projects to improve the diagnosis of infectious diseases in people living with HIV, who are particularly susceptible to opportunistic infections, as well as prevention campaigns and programs offering assistance to those living with HIV. In Madagascar, the Foundation works with the local Akamasoa association and helps to raise awareness of HIV screening (1,800 women tested by the association in 2020) and to introduce educational campaigns on reproductive health and the prevention of sexually transmitted diseases. In Haiti, the Foundation is involved in an initiative supporting the economic integration of women living with HIV, alongside ACME, the Association for Cooperation with Micro-Companies, and GHESKIO, one of the Foundation’s long-term partners. The project is based on the granting of microcredit and support for setting up profitable businesses. In 2020, 576 people benefited from a loan.

Working on infrastructure and staff skills is an essential part of the process when it comes to reinforcing laboratory capacity in countries with limited resources. But it is not enough.

To ensure that financial and human efforts bear fruit in the long term, laboratory services need to be well-organized, with defined roles for each level of the healthcare system. The objective is to optimize the available resources in each geographical area. Drawing on more than 20 years of experience in supporting laboratories, the Mérieux Foundation now systematically supports the governance and structuring of reliable and durable laboratory systems.

The Mérieux Foundation works towards the setting up of reference laboratories of excellence, Rodolphe Mérieux Laboratories, and the development of a network of peripheral laboratories in contact with patients. Rodolphe Mérieux Laboratories offer biological diagnostics and epidemiological surveillance. As expert laboratories, they have technology platforms for molecular biology and are capable of handling the most complex analyses.

In both cases, the Foundation works closely with local health authorities to fulfil requirements in the best possible way and to make decision-makers aware of the importance of structuring laboratory activities and setting up a directorate in charge of laboratory services, since they represent a key component of national healthcare systems.

Supporting national policies for laboratories

In West Africa, with the RESAOLAB program , for example, the Foundation has initiated a regional network for sharing practices and data, key elements when it comes to effective epidemiological surveillance. As part of the third phase of the project launched in 2020, having already reinforced the regional and national governance of laboratory systems by supporting the creation of Laboratory Directorates, the Foundation has set itself the objective of strengthening its advocacy of the importance of countries allocating an adequate operational budget to these management teams, in order to ensure their autonomy.

A new regional surveillance project, SEALAB, was launched in South-East Asia (Laos, Cambodia and Myanmar) in 2020 with the aim of supporting national laboratory policies and coordinating their regional structuring. In Guinea, the Foundation has been supporting the Ministry of Health since 2017 in defining and implementing a National Medical Biology Policy (financed by the Agence Française de Développement). The project relies on the National Laboratory Department and its 34 regional laboratories.

In Madagascar, support for the RESAMAD laboratory network, set up in 2006, was widened in 2020 to include a separate element devoted entirely to developing a network for the surveillance of infectious diseases. Financed by USAID, this involves drawing up a strategic development plan for laboratories, working closely with the Ministry of Public Health.

Coordinating skills and resources

In Laos, the Foundation has supported the creation of a network of laboratories in the province of Bolikhamxay. The BOLi-LAB project covers six district laboratories overseen by a provincial laboratory, itself part of the national network managed by the National Center for Laboratory and Epidemiology, which is heavily involved in the definition of requirements. This level of coordination provides each entity with visibility and offers better capacity for surveillance, planning and response. Its success led in 2020 to the extension of this project by 12 months.

In the Democratic Republic of the Congo, the Rodolphe Mérieux Laboratory in Goma started operating in 2020. Initially opened as an emergency measure to prevent the spread of the Ebola epidemic, it also helps with the diagnosis of SARS-CoV-2 in the east of the country and fulfils its role as an outpost laboratory under the supervision of the National Institute of Biomedical Research in Kinshasa.

There are many more examples, and the projects supported by the Foundation reflect various levels of maturity. They all share the ambition of positioning the laboratory as an essential link in the healthcare chain, which is mobilized and recognized as such.