Dr Zawadi is affiliated with the Tropical Diseases Research Centre (Centre de Recherche en Maladies Tropicales, or CRMT) in Rethy, in the Ituri province in North-Eastern Democratic Republic of the Congo (DRC), where he was investigator of a Phase III trial to test the efficacy and safety of moxidectin against river blindness.

Dr Zawadi, what do you hope to get out of your TDR fellowship?

My work at the CRMT has given me a taste for research. There are not enough researchers in our region, not enough epidemiologists to alert and advise authorities, even though the needs are immense. I want to identify the health problems in our communities and conduct studies that will provide the epidemiological data needed to inform the authorities so they can act.

‘Because of the tense geopolitical context in my home region, out of fear for their safety, few researchers are able to look into the health problems affecting the populations, who find themselves neglected.’

Dr Jack Zawadi

An ongoing epidemic of plague has been affecting the health districts of Rethy, Linga, Jiba, and Logo since 2020, for example; but the persistent insecurity in the region and the lack of data prevent effective interventions.

This fellowship also represents a crucial opportunity for the tropical diseases research centre I work for. To ensure the sustainability of its activities, the CRMT needs to have experienced and skilled researchers – especially in the procedures required to conduct clinical studies.

That is why I intend to build on my year at DNDi to refine my knowledge of clinical research project management. I hope that this experience will help me to enter the world of research more effectively, which also means improving my command of English and… computer tools!

What is your role in the DNDi team?

I am working on a Phase II clinical trial testing the safety and efficacy of a molecule called emodepside against river blindness. My contribution includes – among many other things – reviewing the protocol, the investigator’s manual and the procedures, to adapt them to the reality of the field and to make it easier for the research teams at the trial sites to understand them.

From a personal perspective, by working alongside DNDi researchers, I will be learning a lot about the management of a clinical trial, including its design, its protocol, the drafting of all necessary documentation, the requirements of regulatory authorities and ethics committees, and partnership contracts.

I also want to master the role and responsibilities of a principal investigator, who acts as the focal point between the sponsor and the authorities. I’ll be learning by doing, and I’m delighted to share this journey together with DNDi.

You talk of the ‘reality of the field’ – can you describe the reality of conducting a clinical trial in a conflict zone?

Before joining the CRMT, I was working as a physician at the Libi referral health centre, in Ituri province. In mid-2019, armed clashes between the rebels and the regular army forced me and my family to leave. During this period, I joined the Ebola response team as a supervisor. I returned to Libi in April 2020, in the context of constant displacements of people fleeing the atrocities of armed groups.

In February 2021, I was recruited by the CMRT as an investigator for a clinical study on river blindness. A week after my departure from Libi, the referral health centre where I was working was looted by armed men who stole the equipment in the operating theatre, the stock of medicines and the mattresses on the patients’ beds. The centre remained closed for almost 18 months.

The CMRT clinical study that I joined was a Phase IIIb trial that was testing the safety and efficacy of one or two annual doses of moxidectin, compared with ivermectin, in the rural health zone of Logo, in the Mahagi territory, near Uganda. The team was fantastic. Our activities were sometimes affected by the raids of armed groups in the villages where the study participants lived, which were provoking population displacements, and disrupting patient recruitment and follow-up activities.

These armed incursions were also a threat for us, the CMRT staff, and our families. My second child was born in the General Reference Hospital in Rethy during a period of regular clashes between armed groups and the loyalist army, and sometimes between rival factions; on the day he was born, I was returning from the field with my team, and we were ambushed and even shot at. Fortunately, we made it back to the CRMT office unharmed.

These are the realities that must be considered when conducting trials in some of endemic regions of the DRC in recent years.

What are your plans after this fellowship?

In the DRC region where I work, all neglected tropical diseases have a strong social and economic impact. Some people affected by NTDs become socially isolated and don’t have access to healthcare. The topography of the region, with its forests and fast-flowing rivers, is well-suited to the spread of river blindness in particular – but also of other diseases that need to be more investigated.

After this fellowship, my plan is to continue working with the CRMT, particularly to carry out prevalence studies of river blindness and other diseases that are neglected because of access difficulties and recurring insecurity problems. I hope that the strong links forged with DNDi will help to advance the work of CRMT’s researchers, and consequently support vulnerable populations who do not have access to the care they need.

Developing new molecules against neglected diseases by conducting clinical trials in the region can play a vital role in these efforts. That’s why this fellowship at DNDi is so important.

Thank you Jack!