By Peter Wamboga-Mugirya, Kampala,Uganda
Uganda has established a modern bone marrow transplant (BMT) facility, that will help reduce numbers of patients seeking transplants abroad where they part with between US$40,000 to $50,000 [about Ug. Shillings 150m-200m] to treat one patient (medical procedure and accommodation during recovery) for at least one month in India, alone. The Ugandan facility, the first-of-the-kind in the nation, has been set up by the State-run Joint Clinical Research Centre (JCRC) at Lubowa, south of Kampala.
Bone marrow transplanting is conducted by a specialized surgeon with a team that includes transplant physicians and hematologists.
Currently, few African countries offer BMTs – Algeria, Egypt, Morocco, Tunisia, South Africa and Tanzania – a quick background online search reveals these four northern and two southern African countries having similar treatments. Medical experts say sickle-cell is an inherited disorder and most cases are found in sub-Saharan Africa.
According to Mayo Clinic, one of the internationally-renowned top cancer hospitals in the United States, bone marrow transplant is a procedure that infuses healthy blood-forming stem-cells into your body to replace bone marrow that’s not producing enough healthy blood-cells. “It [bone marrow] is also called a stem cell transplant… You might need a bone marrow transplant if your bone marrow stops working and does not produce enough healthy blood cells. Bone marrow transplants can benefit people with a variety of both cancerous and non-cancerous diseases,” Mayo Clinic states.
These include: acute leukemia, adrenoleukodystrophy, aplastic anemia, bone marrow failure syndromes, chronic leukemia, hemoglobinopathies, hodgkin’s lymphoma and immune deficiencies.
The others are: in-born errors of metabolism, multiple myeloma, myelodysplastic syndromes, neuro-blastoma, non-hodgkin’s lymphoma, plasma cell disorders, POEMS syndrome and primary amyloidosis.
The bone marrow is a spongy soft tissue located in the bones that helps in the formation of red and white blood cells. It also helps in the formation of blood platelets that help with blood-clotting. The JCRC says transplants are going to be a life-changing treatments for persons suffering from a number of listed diseases [stated above].
The new facility, launched by the President of Uganda, Gen. Yoweri Kaguta T. Museveni Oct. 27, 2023, shall offer cell and gene-therapy. At the launch of the facility, the JCRC that falls under the Uganda Ministry of Health, also marked its 30th-anniversary.
Gene-therapy is altering genes inside one’s body’s cells to treat or stop a disease.
The President said he was convinced after listening to the JCRC team that the bone marrow transplants done in the country, will be cheaper than patients having to go abroad. Gen. Museveni noted: “And we shall also have (okutokora—meaning gene-therapy in local Runyankore language) by editing some of these cells. We had some discussions with our religious people who thought that biotechnology and genetic engineering were destroying the work of God so were trying to persuade them that no we’ve been doing it for a long time.” The president added: “I have been a genetic engineer for a long time all my life because we the cattle keepers, always select the good breeds which will produce more milk, there are some bulls that will produce only females [cows]. We the cattle-keepers are therefore the only people who appreciate females more than anybody else. If your cows are producing male [bulls] then you are very unlucky because what will you do with the bulls, but if they are producing females, they are good because you have a bigger breeding population.”
Ugandans infected with cancer shall access bone marrow transplants in Kampala via the Uganda Cancer Institute (UCI), which is located at the Mulago National Referral Hospital in Kampala City. According to the Uganda Medical Board, more than 20 Ugandans annually travel abroad to countries such as India to seek bone marrow transplants. Most of the patients who need the treatments have either leukemia or sickle cell anaemia.
In her Cancer Country Profile, according to the World Health Organization (WHO), Uganda has a total national population of 44,269,587 people (2019). Out of that cancer cases by 2018, were a total of 32,617, while total cancer deaths were 21,829 (2018). Premature deaths from Non-Communicable Diseases (NCDs) by 2016, were 41,687, says WHO of the United Nations (UN). Cancers are among NCDs, globally.
Cancer as a percentage of the NCDs premature deaths in Uganda by 2016 was at 37.9% (the highest among all NCDs).
Uganda’s Health Minister, Dr. Jane Ruth Aceng recalls that JCRC was started in 1992 to find a scientific solution to HIV, which [then] became a major health problem to the Ugandan population. “……. by 1991, the life expectancy in Uganda was 46 years and one out of 10 children were orphaned to HIV /AIDS, and quite often it was the loss of both parents and by 1992, 56% of admissions to the general hospital in Uganda were due to HIV/AIDS and 52% of deaths were attributed to HIV/AIDS,” she says.
Life expectancy today, she revealed, has improved to 65 years crediting the government for its contribution towards that milestone.
“The annual number of new HIV infections is 53,000 and out of the estimated 1.4m people living with HIV, approximately 95% are on treatment with ARVs and close to 95% of those on treatment have achieved viral suppression which not only improves the life of the individuals but also reduces the transmission of HIV,” says the Minister.
Uganda has one of the youngest populations in the world at an average age of 16.3 years, the Minister adds. Most of the new infections are occurring in the young population which has a lower treatment adherence and lower viral suppression than the older age cohorts.” The JCRC has made a significant contribution on each step towards ending HIV/AIDS and we expect it to make a significant contribution on the last mile on this journey of ending AIDS by 2030, she adds.
JCRC Executive Director, Dr. Cissy Kityo highlighted that JCRC played a vital role in the fight against HIV/AIDS in the region by pioneering the use of HIV drugs in sub-Saharan Africa in 1992 and imported the first generic HIV drugs from India to bring down the costs and subsequently became the case study for the architecture of PEPFAR. “……our researchers have worked and continue to work tirelessly to discover new insights, treatments and solutions to some of the most challenging issues facing our nation and region. JCRC has been part of ground-breaking research that has contributed to Global knowledge and informed change of policy and guidelines and the course of the medicines we are taking,” she said. Dr. Kityo says the centre is now leading the first study in Africa to evaluate new HIV drugs which are given as injections every two months instead of taking pills every day.
“We will continue to push the boundaries, there is no limit to knowledge and strive for excellence in research, our laboratory has pioneered many tests to monitor how HIV drugs are working including CD4 count, viral-load and testing of children as early as 6 weeks, we used to test until at 8 months, now we can test them using molecular tests and determine if they should start treatment,” she said.
According to Dr. Nixon Niyonzima, the Head of Research and Training Directorate at the UCI they want to start with carrying out autologous transplants (self-donating), adding that the transplants will be cheaper than what Ugandans currently spend on abroad. He, however, could not disclose the price, but assured all people even the poor, would be able to access this treatment. Officials say they are not sure of the exact number of Ugandan patients seeking bone marrow transplants because people live and keep their experience.
In addition to carrying out transplants, the centre will also provide after-care services for Ugandans who have travelled abroad for transplants and need to be looked after by the trained staff, on returning home. The first bone marrow transplant shall take place in 2024. Officials say Government has allocated 5bn Uganda Shillings [over US$1.35m] this financial year for training of staff and procurement of equipment for the facility.
The Uganda Radio Network (URN) quotes UCI Executive Director at Mulago National Referral Hospital, Dr. Jackson Orem as saying the transplant facility is one of the things that will make UCI a centre of excellence in cancer care in the region.
“We are moving towards putting in place facilities that will make us the centre of excellence. We want to be able to offer world-class cancer care to patients within the East African Community but also in Africa and the World at a pocket-friendly price. We want people to enter UCI and get all the cancer treatment they need,” Dr. Orem is quoted. Uganda recently enacted the organ transplant law that will save the many flocking to India for stem cell transplants. The new law will enable kidney or liver transplants at Mulago National Referral Hospital which already has facilities, equipment and trained staff.
Development partners like the United States Agency for International Development (USAID), the US Presidential Emergency Plan for AIDS Relief (PEPFAR), the US Centers for Disease Control and Prevention (CDC), are supporting Uganda in this endeavour.
In the East Africa region, Tanzania opened its first bone marrow transplant unit in the capital, Dodoma. The Director Benjamin Mkapa Hospital of Tanzania, says the unit will focus on treating patients with sickle cell. It is a milestone for Tanzania’s health sector, says the hospital Director. The East African nation ranks fourth in the world for the highest rates of sickle cell, with around 11,000 children born with the disease each year, according to Tanzania’s health ministry. WHO estimates 1,000 children are born with sickle cell anemia daily in Africa—making it the most prevalent genetically-acquired ailment in the region. Sickle cell anemia caused by a faulty gene that affects how red blood cells develop and the condition can cause severe pain and organ failure.
