Africa has the greatest variety in human genes anywhere on the planet but the world is failing to capitalise on it, according one of the continent’s leading scientists, Prof Kelly Chibale, a man determined to change that. He believes the birthplace of humanity could hold the scientific key to its future.

About 18% of the global population lives in Africa – a proportion set to rise over the next few decades – and it accounts for 20% of the global disease burden. But only 3% of clinical trials take place on the continent, and most of those in just two countries – South Africa and Egypt.

“I would argue that actually, if you really want to have confidence in a clinical trial, it must start in Africa. Why? If it works in Africa, there’s a good chance it’ll work somewhere else, because there is such huge genetic diversity,” says Chibale, of the University of Cape Town.

Genetic differences affect how drugs are processed by the body. They might pass through more quickly, meaning a standard dose is not enough, or more slowly, risking a toxic overdose. Testing a drug in people with a wider variety of genes, rather than the historic standard of a Caucasian man, means the frequency and amount of a drug given to patients can be better calibrated for everyone before it gets to market. Some global regulators now require genetic diversity in trials before they will approve medicines.

It is an “opportunity”, Chibale says, but will require persuading more African people to volunteer to take part in research, and governments will need to be more open to hosting trials.

He says it is important that encouragement for more Africans to get involved comes from people such as him. There is deep mistrust in many communities because of medical abuses under colonial and apartheid regimes. If calls to participate come from non-African outsiders, people will think “you’re trying to use us as guinea pigs”, he says. “People have been traumatised. But if I say it – because I come from there and I know this is the truth. Who says it, matters.”

The 2023 recipient of the Royal Society’s Africa prize, Chibale was in the UK at the institution earlier this month to give a lecture on tailoring medicines to African populations. He leads the H3D research centre at the University of Cape Town, a unit he founded in 2011, which is working on drugs to fight diseases such as malaria and tuberculosis, and combat antimicrobial resistance – conditions that predominantly affect people in Africa.

“Africans have to take a lead in doing these things, because these are problems that affect us more,” he says. “The status quo is that innovative medicines are discovered and developed largely in the global north. Then, five to 10 years later, those innovative medicines are brought to Africa.”

It means there is no certainty that those drugs will work in African populations, or fit into the way medicine is practised across the continent, Chibale says – offering as an example a greater reliance on traditional remedies as the first option, which can mean patients present to hospitals later than in western countries.

“You have to do the discovery and development near to where the patients are, so you understand how to meet their pressing health needs in their social and physical environment.”

There are big challenges in conducting scientific research on the continent, Chibale concedes, and a need for African governments to bolster public health research infrastructure and smooth legislative and regulatory pathways.

Efforts to increase drug manufacturing on the continent are welcome – it was “almost embarrassing” to have to seek ingredients from China or India for H3D’s own trials, he says. “Every country has a right to prioritise their citizens […] if there are supply chain issues, you will be left behind.”

There are obvious health benefits for Africa if drugs are better tailored to local people, he says, as well as economic benefits. “They create jobs, they create infrastructure.”

And African institutions must step up as partners. “In any kind of partnership, you have to bring something to the table. You cannot just demand. It is not always about money: sometimes [you need] just the right policies, the right climate for business to flourish, the right climate for research.”

Chibale was born in rural Zambia, a 10-hour walk from a bus stop. His father died when he was two months old and he had a nomadic childhood, moving between townships for his mother to find work. He would study at night by the light of a homemade paraffin lamp in the tiny room he shared with his brother.

He had malaria multiple times. “Each time, I would go to the clinic for malaria medicines and get cured. Malaria is fatal if you don’t get treatment. Two, three days – you’re gone. But I took so much for granted.

“It was only much later in life that I realised two things … [about the] malaria medicine that I used to take in the village – number one, someone somewhere invested money, millions in the discovery and development of the medicine. Number two, someone somewhere volunteered to participate in the clinical trial for my benefit.”

New structures such as Africa CDC (Centres for Disease Control and Prevention), and the African Medicines Agency are important, he adds, in addressing one of the obstacles to clinical trials in Africa: a lack of harmonised regulatory environments that can create a big market, such as the EU.

Chibale believes it is down to scientists to make the business case for research. H3D brings in foreign investment from pharmaceutical companies and funders including the Gates Foundation and Medicines for Malaria Venture. And it has grown from an initial staff of five to 75, most of whom have PhDs.

“These people would be either in the UK, or Europe, or the US if we didn’t have that,” he says. “People move because they are looking for opportunities, but if we can create those opportunities where they are, then they won’t make the move.”

Chibale studied chemistry in Zambia, then at Cambridge University in the UK on a scholarship. He and his peers saw education as a way out of poverty, he says. His return to Africa was a decision made “from my spirit”, although he could not work in Zambia. “Like in many countries, there will be no infrastructure to allow me to practise. So it is wasted – it’s throwing money down the drain – because you can train people, but you cannot retain them,” he says.

Today he wants to highlight Africa’s scientific success stories, including his own. H3D took a candidate malaria drug through to phase 2 clinical trials, before safety signals in what, in frustration, he calls “stupid rats” forced them to pause.

They can combat “afro-pessimism”, he believes, or a sense that scientific success is simply not possible on the continent.

“People didn’t believe Africa could be a source of innovation. We’ve shown that we can,” he says.