Alash’le Abimiku is a Professor of Medicine at the University of Maryland, United States, and the Executive Director, International Research for Human Virology Nigeria. In this interview with Martins Ifijeh, she said fundamental investment in research, support from citizens, and establishment of health infrastructure can help Nigeria tackle the COVID-19 pandemic. She spoke on how the body has initiated ideas to support government’s efforts against the outbreak, and how long term approach will ensure the country is better equipped for future outbreaks
What factors lead to drug resistant TB and why are cases rising during the COVID-19 pandemic?
We know from long ago; tuberculosis is a bacterium. We know that when you expose bacterium to a drug for a limited period of time it also tries to survive by also building resistance. With resistance, there is a mutation within the bacteria’s gene that makes it now possible for it not to be susceptible to a particular drug. Historically, when a bacterium, in this case, mycobacterium tuberculosis is exposed for a period of time to drugs, it will develop a mechanism to continue to exist despite the drugs, hence, you see the resistance. You start with mono- resistance, resistance to one drug and then you see that as we move through treatment, people are treated with multiple drugs so that if the microorganism is resistant to one, the second would work. It takes some time for those microorganisms to develop resistance to those additional drugs, then you continue to add.
Your second question is about COVID-19 and the fact that the numbers are increasing. Remember that we learn a lot from countries that are experiencing this pandemic. When you have your index case, you identify all those people that have come in contact with the index case to make sure that you limit the spread of the virus.
Unfortunately, unless your prevention method is airtight and every citizen does what they are supposed to do, the virus will escape into the community. The moment it escapes into the community, each person interacts with additional individuals, and then it is expected that the cases will rise. It is not unusual, it happened in China, it happened in Spain, it is still happening in the US and in Italy. So we expect it to rise the moment it gets into the community, and that is why every single prevention method in terms of distancing, using soap and water, using sanitizer and using the face mask is absolutely critical for each and every person to do because our strength really depends on our weakest link. So, if we all, 90 percent of us are doing the right thing and 10 per cent are not doing it, we won’t get rid of COVID-19.
A month ago, you told THISDAY IHVN reached out to the federal government concerning your efforts at COVID-19 researches and other supports. Have you gotten feedback from the government?
No, not really, what we have done is we have submitted about five different proposals addressing different aspects of COVID-19 and one has to do with evaluation of the different devices within our population to see how well it works, how we can identify those who are infected, maybe also be able to identify, those that have built up immune responses and also be able to define the clinical symptoms within our population. We have submitted that. We had that the task force on research is considering one of the proposals that we put in to evaluate the different devices for testing COVID-19, one that you can use within very well established infrastructure and facility like IHVN or tertiary hospitals and those that you can use in rural areas where you don’t have dependable electricity. So, we heard that that is being reviewed, although no word yet whether it has been chosen. We have not also gotten any funding to continue that line of research
Are you of the opinion many Nigerians do not believe there is COVID-19?
I guess it is expected. Actually, people do know a bit about coronavirus in the sense that we have had some other outbreaks before epidemics like this. The SARS and the MERS happened in the Middle East and some in China.
Epidemics mean that it is limited to certain parts of the geographical region. This is the first time we have had a coronavirus that has hit everywhere in the world and that is why it is called a pandemic. So I think the reason why everybody knows about coronavirus now is because it has really hit home and it has hit every single country and there is no day you put on the TV or the papers that you don’t read about it. I mean media outlets like yours have also educated the people.
If you remember HIV, we never knew about it until it hit and started killing people. In a similar vein, that is what has happened with the coronavirus. It belongs to the same corona virus family, this COVID-19 and the only difference is that this one is quite novel so all populations over the world have not seen it so everybody is susceptible, we don’t have any prior immunity to it. That is why all of the populations all over the world were very susceptible to it and you heard about the different routes of transmission that makes all our interactions as human beings a potential for transmitting the virus. So I believe that because of the overwhelming spread of the virus all over the world, because of the way that it has affected our interactions with each other, the way that it has affected our ability to move within homes, to the office, to travel out, it is really a significant media topic.
Is it possible to teach coronavirus and the pandemic in schools, putting into consideration the philosophy of our educational system.
That may be a very good idea. One of the things that we have done as a nation or as a population and we haven’t done a good job with is that we do not anticipate. When we had the pandemic flu, H1M, SARS, and when we had all of those things, it was very clear for the public health individual that this will continue to be a public health challenge, because it wasn’t a matter of if, but when it is going to happen again. So, I think they should be taught in schools. We haven’t done a good job in teaching public health.
Preparedness is the one thing you can do to prevent any virus spread because viruses by nature are not that sensitive to drugs. We have a lot of antibiotics and drugs that you can take but it is mostly against parasites and bacteria. Viruses are really based on our human nature so sometimes when you have a pandemic, it is because it has jumped across species to a new one.
In school, we should focus on public health threats and preparedness. When Ebola came, we were having temporary fix; forgetting that isolation units, protective gear, having the laboratories that can do the tests would also work perfectly for corona but you see, when we do things as if they are temporary fix. If we don’t establish it in school, in our government, in our facilities, then we are never prepared. This is here and would stay with us as long as man lives and continues to interact. We would always have those kinds of outbreaks. It’s not rocket science; it just needs commitment in terms of our policy makers and our educational system to really keep that in the forefront of our response.
Appears the federal government is silent on vaccines and treatment drugs for COVID-19, as it is believed no fund has been released yet for this. Are there other ways we can come up with vaccines and drugs outside getting funding from government?
The point you brought up is a good one. That is why IHVN existence is based on obtaining funds and getting grants to do the work, but that does not exonerate the government from investing in research. If you look at other countries, they prepare for epidemics. These countries work for years in building infrastructures and capacity in this area.
The National Institute for Pharmaceutical Research and Development (NIPRD) was successful some time ago in getting drugs, so the bottom line is there are some fundamental infrastructure and investment that government must make first and foremost whether through the International Monetary Fund (IMF) or through the World Bank, the Dangotes or through Gates. There are fundamental investments they need to do that no one grant can do.
Once they do that fundamental investment in research, build the infrastructure and the machinery and everything that will allow your scientist to do the work; then your scientist can now apply for grants that allows them get the reagents and to follow their ideas. There has to be that prior investment and it has to be long-term.
The second thing I will say quickly is that also, each nation must know its capacity. Don’t go and start competing with the western world on putting together a vaccine. The western world has a lot more infrastructure and has a lot more funding. They’ve been doing it for years. Then, you suddenly wake up one night and think that you are going to compete with vaccines, you will not. Find the areas that you are strong in.
One of the things that we know we have, for sure, are local herbs and different activities that we do, that we know that there may be something that we can contribute to the rest of the world, like Madagascar did. Let’s put our money in there, like NIPRD and other organisations, it’s all collaboration. There is no one institution that can do it. Government has to be very clever in how it uses its limited resources and its limited infrastructure in what is it that is unique that we can go in and compete intelligently with the rest of the world and contribute to the answers.
Can’t Nigeria look towards using local herbs to address this COVID-19, rather than looking out for herbs from Madagascar and other places?
Just quickly to tell you that I know for a fact this is one of the areas being considered. I am member of a scientific advisory committee for NIPRD and in fact, in addition to looking at claims internationally and locally, this is being looked at. Again, my concern is the fact that what are we doing until these things happen? We got institutions that their main goal is really to look at things like that. I don’t want to be all negative because to be quite honest there has been some advances in this area where different herbal concoctions within the country have been better refined and they are available in packets and all of that but I always worry that we are too reactive.