Coronavirus: Didier Raoult the African and chloroquine, from Dakar to Brazzaville

On 24 March, Professor Didier Raoult slammed the door on the circle of researchers who were supposed to advise the French president on the pandemic.

Disagreeing with the containment policy adopted by France, which favours mass screening, the iconoclastic infectiologist has just been disavowed by his peers, who are reluctant to endorse the use of hydroxychloroquine against coronavirus.

On Thursday 9 April, Raoult could measure the progress made when President Emmanuel Macron travelled especially to Marseilles to talk to him in order to “take stock of the question of treatment.”

This was a strong political gesture in favour of Raoult’s theses, whose promotion of the use of hydroxychloroquine to treat coronavirus patients has been the subject of much controversy for several weeks.

READ MORE: Coronavirus: 9 things to know about chloroquine

Pre-COVID-19 era

A specialist in emerging tropical infectious diseases at Marseille’s Faculty of Medical and Paramedical Sciences and at the Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, the long-haired professor with the pepper and salt beard was still largely unknown to the general public at the end of February when his views on a chloroquine-based coronavirus treatment began to be heard.

Since then, the Frenchman has seen his media and digital fame take off. And in the ranks of its most fervent supporters, the African continent is not to be outdone.

Is it because the chemical compound he uses to treat his patients, hydroxychloroquine, is well known on the continent, where it has long been used to treat malaria? In two publications exposing tests carried out on some 20 patients, then on 80, the researcher and his teams conclude that “hydroxychloroquine combined with azithromycin is effective in the treatment of COVID-19”.

This quinine derivative is currently the subject of several studies. Those carried out by Professor Raoult have indeed aroused reservations among many experts, who reproach him for not having respected standard scientific protocols. At the end of March in France, the High Council of Public Health considered that chloroquine could be administered to patients suffering from “serious forms” of the coronavirus.”

READ MORE: To fight coronavirus, Burkina Faso is tempted by chloroquine

Those African countries that opt for chloroquine

At Fann Hospital in Dakar, Professor Moussa Seydi, head of the department of infectious and tropical diseases, has already administered chloroquine alone to the first 100 patients who tested positive for COVID-19. “In Marseille, Dr Didier Raoult published encouraging preliminary results. The combination of hydroxychloroquine and azithromycin should make it possible to shorten the carrying time [of the virus], in order to accelerate the healing of the sick,” Seydi told Jeune Afrique on 19 March. To use this drug, he says he relied on the study co-signed by his French counterpart.

Like Senegal, Burkina Faso, Algeria and Morocco have also opted for chloroquine.

On 23 March, the Ministry of Health of the Cherifian Kingdom thus requisitioned the national stocks and distributed to the directors of CHU the protocol for the prescription of chloroquine and hydroxychloroquine for confirmed cases of COVID-19. A decision inspired by Chinese research on the subject, and studies conducted by the French researcher, according to a member of the Moroccan committee in charge of the fight against the pandemic.

Born and raised in Senegal

If Professor Raoult is well known on the continent, it is also because this specialist in tropical and infectious diseases, in addition to having grown up there, has worked a lot there. It was in Dakar that the Frenchman is said to have caught the research virus.

Born in 1952 in the Senegalese capital, he lives there, in the building of the Research Office for Food and African Nutrition (Orana), created by his father.

This building  sits opposite the Pasteur Institute in Dakar which houses the frontline laboratory in the fight against the epidemic in Senegal, and is where this son of a nurse and a military doctor stationed at the capital’s main hospital, took his first steps.

A childhood marked by happy memories of playing on the beach at Anse Bernard, made the move “complicated” when the young Didier Raoult arrived in Marseille at the age of 9. “Being partly Senegalese, I can’t help but feel concerned by what’s happening in Africa,” he says in a video addressed to the Senegalese group eMédia on 7 April.

In 2008, Raoult established a joint research unit at his IHU in the Senegalese capital dedicated to communicable infectious diseases – one of Raoult’s two African teams with the Algiers team. The latter claims to produce 10% of scientific publications in the country of Teranga. “He wanted to have a lot of field staff: epidemiologists, virologists and bacteriologists,” explains one of his close friends, epidemiologist and biologist Cheikh Sokhna, team leader at the IHU Méditerranée Infection in Marseille.

READ MORE: To fight coronavirus, Burkina Faso is tempted by chloroquine

Research on all fronts

Sokhna, also a Senegalese, is director of research at the Institut de recherche pour le développement (IRD), and regularly exchanges with Professor Raoult. This week, IHU’s Senegalese team of about thirty people was due to submit a research project to the Senegalese Ministry of Health on the protocol of the chloroquine-azithromycin combination.

An encouraging sign, according to Sokhna, is that the prevalence of coronavirus seems to be lower in areas where the use of antimalarial drugs such as chloroquine or mefloquine is frequent.

“This can be seen very crudely. But other factors will have to be taken into account before any definitive conclusions can be drawn,” adds the enthusiastic and cautious researcher, who is usually based in Marseille but is currently on a long-term mission in Dakar.

This mixed research unit is far from being the only innovation driven by Didier Raoult in Africa. In 2012, the French researcher installed a MALDI-TOF at the main hospital in Dakar: a mass spectrometer that can detect bacteria in a few hours, compared to the usual two to three days with traditional methods.

Then, starting in 2015, he set up three small laboratories in Dakar and two villages in the Fatick region (Centre-West), three small laboratories – points of care (POC), in the jargon of the milieu – which allow blood or saliva to be taken and the origin of the disease or fever to be quickly given so that the nurses can propose an effective remedy in good time.

Didier Raoult launches research all over Senegal. On malaria, borreliosis, rickettsiosis, malnutrition, hand washing – “which can reduce diarrhoeal diseases by 50% and respiratory diseases by 30%”. The French doctor was already working with his Senegalese teams on other less severe forms of the coronavirus family that existed in the country, causing colds and pneumopathies.

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“Big African brother”

Every year, since 2008, he comes to spend a week in Dakar, participating in the IRD’s scientific day organized by Cheikh Sokhna, which brings together health actors and NGOs. It was on this occasion that he met two renowned scientists: the parasitologist Oumar Gaye, from the Cheikh-Anta-Diop University of Dakar (Ucad), and the pharmacist-colonel Souleymane Mboup, virologist and bacteriologist. They will join the scientific board of the IHU Méditerranée Infection, where the second will succeed the first.

All these names join the large community of African researchers gathered around the Marseille-based professor, including the Congolese Jean Akiana, from the Marien Ngouabi University in Brazzaville, the Algerian Idir Bitam, from the National Veterinary College in Algiers, and the Malian Ogobara Doumbo (who died in 2018). They all consider their peer as a “big African brother”. Not to mention his former doctoral students, with whom he has plans to create cutting-edge laboratories in Guinea-Conakry.

Described as an anti-conformist in the fight against dogma, familiar with the terrain but resistant to the beaten track, Professor Raoult does not hesitate to travel to the African countryside. “It’s an elephant that likes to come into contact with gorillas,” says Dr. Jean Akiana, director of health technologies at the Ministry of Health and a researcher at the National Public Health Laboratory in Brazzaville.

Interested in the transmission of bacteria from animals to humans, and vice versa, Raoult also went to meet gorillas in the Lésio-Louna reserve, in the Pool region, in south-eastern Congo-Brazzaville, to analyse their microorganisms and compare their residues with human faeces. “Picornavirus of the same family as coronavirus was found in the gorillas’ faeces. If we see Ebola genes, it could be a warning,” says Jean Akiana.

Akiana recently received a credit from Professor Raoult’s laboratory to travel to the Tchimpounga reserve to check whether chimpanzees might be the cause of the wild polio virus that struck Pointe-Noire in 2015. The Marseille-based professor also travelled to several departments such as Likouala, Sangha and the Plateaux to prospect for new micro-organisms with no immediate link to an identified outbreak. Samples that, when examined in Marseille, could help to take the lead when new epidemics occur.

In Algiers, a team made up of 100% Algerian teaching and research staff, is working on the final establishment of a research laboratory. The joint unit based in the Algerian capital is also working on infectious disease surveillance, taking advantage of the facilities of the Marseille-based institute.

Without foreigners, “no science in France”

“Its main objective is to help French-speaking countries, to transfer cutting-edge technology and to train young researchers in these innovative diagnostic tools,” says Sokhna. But Raoult, on the other hand, also knows very well what his country’s science owes to the African continent.

Critical of the restrictions imposed by the French administration in terms of the time it takes to obtain a visa, he believes that today the French scientific community relies above all on the contribution of doctoral students from the Maghreb and sub-Saharan Africa. During Emmanuel Macron’s visit, the Head of State was welcomed by a team of young researchers from Algeria, Morocco, Mali and Burkina Faso.

“In France, 50% of PhD students are foreigners. Without foreigners, there is no French science,” Raoult pointed out at a conference in 2013. At the time, the French researcher praised the work of the émigrés who are part of his team, the “engine of war” in scientific research. “The best, the most intelligent, the most dynamic, those who work on Sundays are only Sub-Saharan Africans and North Africans. That’s it! That’s the way it is.”

READ MORE: Coronavirus: Ending Europe’s colonial approach to medicine in Africa

Free spirit

The theme of the conference? “Disobedience at the heart of the research innovation process”. Raoult is known for not embarrassing himself in manners and freeing himself from doctrine, insulted by some, adulated by others, Raoult is a lasting figure. And he doesn’t seem to care. “I couldn’t imagine [my studies] triggering passions of this nature, I don’t even know where they come from,” he says in a video posted online on 8 April, in which he announces the imminent results of his new study, this time involving 1,000 patients.

According to the French press, the professor would have presented last Thursday to Emmanuel Macron his results, which establish a rate of virological cure of his patients of more than 91%. Accustomed to not being listened to by politicians, who take researchers “for strange birds”, Professor Raoult, says he is “guided by curiosity and exploratory research”.

Will he be able to rally Macron to his cause? In a recent Odoxa barometer, Raoult the iconoclast, appears in any case in second place among the favourite personalities of the French.