Meet the Judges: Prof Hassan Sefrioui, Director and Member of the Executive Board at Moroccan Foundation for Advanced Science, Innovation and Research

AMR is a global public health problem causing severe infections and mortality. Indeed, the emergence of antibiotic-resistant bacteria is rising dangerously worldwide including in North African countries. In Morocco for example, high resistance was noted in pathogens such as pseudomonas aeruginosa, against the two most important antibiotics, ceftazidime and imipenem. In addition, high resistance of streptococcus pneumonia to penicillin and staphylococcus aureus to methicillin has been seen. Other studies have reported multidrug resistance among gram-negative bacteria including E.Coli in isolates from North African patients. 

Hence, regular surveillance and monitoring of AMR are highly recommended in African countries. In addition, the development of novel diagnostic tests targeting early pathogen identification will strongly help the misuse and overuse of antibiotics in all parts of the world, including Africa.

In all African countries, medical diagnostic tests are imported. MAScIR is a research and development (R&D) institution that has been able to develop and manufacture these tests. Indeed, with our 10 years of expertise, trained scientists, and innovative technological platform, we have been able to develop diagnostic tests for several diseases including breast cancer, leukemia, hepatitis C, tuberculosis, and COVID-19. These tests are manufactured by Moldiag, a start-up that emerged from the MAScIR medical biotechnology center.  Moldiag has sold 3 million PCR COVID-19 tests all over Morocco. 

There are several challenges to developing and manufacturing diagnostic tests in Morocco and other African countries. These include investment and financing, clinical validation, regulation, transportation and cold chain, and importation of raw material entering in tests manufacturing. I do believe that political will, an appreciation for R&D and manufacturing activity, as well as an entrepreneurship mindset (including boosting private and public partnerships (PPP)) are strongly needed to move forward the development and manufacture of medical diagnostic tests to save lives all over Africa.

Developing a medical diagnostic test is a challenging task because of the high cost of raw materials, heavy equipment, and labour. Hence, in LMICs, cost-effective tests based on affordable technologies that can overcome transportation and cold chain challenges are preferred. 

Point of care tests (POCT) – which can take the form of different types of devices – are emerging as serious, affordable diagnostic tools that can be easily applied in LMICs. The first generation called rapid diagnostic tests (RDT) use immunological and/or colorimetric technologies and they are very cheap ($1-2 per test). The second-generation devices are based on nucleic acid amplification technology (NAAT) to detect the genetic material of the pathogen. For example, we have developed at MAScIR a POCT portable device based on LAMP method (Loop mediated isothermal amplification: PCR in constant temperature) to detect mycobacterium tuberculosis in patient sputum. Finally, third generation of POCT use mobile technology. They are usually connected to a low-end mobile phone to collect and send data.

I do believe that the novel generation of POCT may be the ideal for accurate and cost-effective diagnostic tests that can be easily used in LMICs to identify multidrug resistant bacteria and support the correct use of antibiotics. 

We have developed several diagnostic tests that are manufactured by our start-up Moldiag and sold in Morocco. Most of these tests are patented internationally and registered in Morocco which may facilitate their sales in other African countries. In this context, Morocco has special agreements with some West African countries. In addition, we are exploring with the Africa Centres for Disease Control and Prevention (Africa CDC), the possibility of bringing our innovative diagnostic tests all over Africa. Ideally, to overcome transportation and cold chain challenges, it will be interesting to identify partners that may support the creation of MAScIR subsidiaries in some African regions to manufacture our diagnostic tests locally over there.

Tropical regions are vulnerable to the spread of infectious diseases because of the specific climate, poor sanitation and inadequate infrastructure for healthcare. Tropical disease programmes are currently facing a number of challenges that require urgent solutions in terms of monitoring and under-performance of existing classical parasitological assays used for routine diagnosis. In response to this alarming situation for tropical diseases, WHO convened a new Diagnostic and Technical Advisory Group (DTAG) that I am a member to assist with efforts to:

• Review and prioritize the diagnostics needs for tropical disease programmes;
• Define the target product profiles (TPPs) for the needed diagnostic tools;
• Link with partners from endemic countries, to support test development and validation;
• Provide WHO with guidance on the utility of new tools to support tropical diseases control and elimination.

No, I think it is improving but more work needs to be done in terms of behaviour change amongst healthcare workers, patients, diagnostic manufacturers, and stakeholders. Indeed, people from various communities and backgrounds need different ways of communication. In LMICs for example, patients underestimate the importance of diagnostics compared to treatment and are concerned about adding to the cost of the treatment. In addition, most diagnostic tests available in LMICs are imported, confirming the lack of political will and investment in these countries for developing diagnostic tests locally. Hence, we need to emphasise the necessity for diagnosis before treatment. Currently, some pharmaceutical companies accompany their specific treatments with the corresponding diagnostic test. 

I think the public mindset and the way we communicate about diagnosis is changing throughout the COVID-19 pandemic. Indeed, people all over the world have learnt a lot about the importance of diagnosis before treatment and how a lot of lives have been saved as a result.