Dr. Patrick Dakum is the Chief Executive Officer (CEO) of the Institute of Human Virology, Nigeria (IHVN). In this interview, he speaks on ways to improve the response to the COVID-19 pandemic in the country, the institute’s International Research Centre of Excellence (IRCE), how to tackle other infectious diseases, among others.
Nigeria has recorded 60,266 COVID-19 cases and 1, 115 deaths from the virus since its outbreak in the country. Why do you think the number of cases has not abated?
The first case on February 27 , 2020 was through the borders. We then closed the borders as the cases were going up. By the time we got to May/June, it was clear that the country was witnessing community transmission of COVID-19.
One of the measures instituted was stoppage of large gatherings.
Now, if the cases are going on unabated, the question is, to what extent are the health protocols such as simple hand washing, social distancing and the wearing of face mask being complied with?
The number of cases we are seeing in the country is to a very large extent as a result of lack of compliance. Close to 80 per cent of people may just have zero symptoms or very mild symptoms. So they don’t even know that they have it.
So the cases have continued because of lack of compliance, lack of testing to identify people that are positive. They need to be isolated. The idea is to find, test and treat.
However, let me add that we are witnessing a decline in the number of total cases. When we say that as public health physicians, we say it with caution because we want to compare the total number of tests carried out with the positivity rate.
The case identification rate for us is a better marker compared to the total number of cases. To say we have only one case when you test only 100 people and for another person to say we have 10 cases but we tested 10,000 people is a totally different thing.
If you had tested 10,000 people, you would have probably had 10 cases. Having said that, I think that the ball is in the court of communities and individuals to take responsibility for preventing COVID-19. The reality is that COVID 19 is still here.
The country has tested at least 554,006 samples, what is your assessment of this in comparison to our population?
Definitely, the number of tests we are carrying out is not enough. We had a target to test about two million people within six months. So we are way behind in terms of the target for testing.
A lot of these tests are driven from the state level, meaning that until we have state governments pushing very hard for aggressive testing, we will definitely not have enough testing.
The idea of having every hospital where you can walk in and have a test done has not yet been realised. I recall that the Minister of Health mentioned that every secondary and tertiary health facility should have capacity to provide testing for COVID-19.
It is desirable that every secondary health facility should have a gene Xpert machine that has enough biosafety cabinets to be able to do the tests. However, even if they are unable to do the test themselves, they should be able to collect samples and send them to the appropriate place, get the results back within a short time, then transmit the results to the individuals so that action can be taken, especially on those that are positive.
So in terms of testing, we can do enough by ensuring that every local government has got a sample collection centre. I have been saying this for several weeks and months now.
We are moving in the right direction but we need to move faster now that we are beginning to realise that COVID-19 may not necessarily go away and so have to learn to live with it.
Is there any support you are providing for TB patients to enable them cope better with COVID-19?
We have two projects that are mainly focusing on TB. One is called the Public Private Mix with funding from the Global Fund. The Public Private Mix project focuses on trying to increase case finding for TB in the private sector, the private-for-profit and the private-not-for-profit.
The other one is support to the laboratories. We provide staff that have been trained and are experienced in TB detection within a Bio-Safety Level 3 laboratory.
The staff also participate actively in the laboratory in order to mentor other hospital-based staff. We also provide support for Multi-Drug Resistant TB treatment centres, and expansion of diagnostics through gene Xpert machines.
With our PEPFAR HIV grant from CDC, we also provide support for TB/HIV integration.
The other tuberculosis grant we have is from the United States Agency for International Development to support local organization to carry out TB case finding, and it is mainly in the South West of Nigeria: Lagos, Ogun, Osun and Oyo states.
In testing for COVID-19, one format the Federal Government utilises is the use of Gene Xpert Machines, how is IHVN involved in this?
First of all, the machines use cartridges, it means you can use this same machine, do a test for tuberculosis, change the cartridges and put samples and test for COVID-19.
With the support of Global Fund, we are providing additional Gene Xpert machines in collaboration with the national TB programme.
We created a 24 hour service whereby during the day time, we do the normal HIV viral load testing, then in the night, we do the COVID-19 testing.
Work is at an advanced stage at the IHVN International Research Center of Excellence (IRCE). When are you moving in, and how will it help in addressing public health challenges in the country?
I like to refer to our research center of excellence as a bridge builder that bridges local and international expertise, brings together researchers from different countries, and from the developed community and the resource limited community to carry out new findings to address public health issues globally.
The research center is already in operation with Professor Alash’le Abimiku as the executive director. We are working from our Maina Court facility and a few other scattered sites carrying out collaborative research in a number of areas.
The building itself is going to house a functional research center. So it is not as if when we move into the building, then we start thinking of research, No! Already, we have research in various fields that are ongoing.
This will only be housing and pulling together our laboratories into one place. Now, we have a biorepository. A biorepository is a bunch of freezers that keep samples for a long time.
Currently, we are storing samples from researchers across West Africa.
We should have moved into the building by March 2020 but because of the COVID-19 pandemic, a lot of things couldn’t continue anymore. If you want a specific date of when you will meet me in the office there, I bet I can give you March/April of next year. We are also hoping the laboratories will move in by then.
We will do a formal opening whenever the COVID-19 rules grant us the opportunity to gather but we are very excited about this contribution to Nigeria.
The IHVN research centre is not set up to compete with the research centers in Nigeria, No! Instead, it is set up to collaborate and bring together best brains to carry out research with equipment that can be validated and that are ISO certified. This is our approach when it comes to that.
Is the research institute going to be focused on only HIV?
We will carry out research on HIV, COVID-19, communicable and non-communicable diseases like cancers and basic science research across other disease entities.
Given Nigeria’s poor research culture, how will the institute support the country in providing enabling environment for research?
IHVN’s contribution through its international research center is going to be focused on two areas; one is capacity building and the other is service provision, and with a third leg which is collaborative research. Now in terms of capacity building, already the IRCE building has provided some trainings and is planning to continue to provide training on basic research methodologies, research on bio statistics and epidemiology, among others.
In terms of services, we provide a lot of mentoring opportunities for upcoming researchers. We also provide opportunity for industrial attachment, quite a umber of students come in there.
There is no access road to the IHVN International Research Center of Excellence (IRCE); what are you doing about it?
We are grateful to the FCT administration for providing us land. The Institute is located within a zone that is earmarked for research institutes and universities, etc.
The Chairman of our Board, Professor Emeritus Umaru Shehu, the Chairman of our Committee on the Building, Alhaji Umaru Murtalab, along with other members of the board, have made concerted efforts with management and have been able to get the FCT Minister to visit the site to see the issues for himself. He has promised to get the road done so we are looking forward to it. In the meantime, we are constructing a temporary road along the pathway where the permanent road is going to be.
As a virologist, what is your advice to Nigeria in responding to outbreak of infectious diseases?
My first advice is public hygiene – every school must reenact the hygiene practice.
Personal hygiene within homes and communities will reduce infectious disease a lot. The second thing is that structures of public health response right from primary health care level, to the national level should be sustained.
When there is an outbreak, what should be the response?
The emergency operations centers that have been established in states must not be disbanded. Instead, they must be strengthened and when there are no outbreaks, drills should take place there every quarter. Laboratories that have been established, must be sustained with personnel and reagents because nobody knows when an outbreak may occur.
We are already moving towards technological integration of our response. That should be sustained and fine-tuned.
If we do that, then we will be able to contain diseases at an early stage because when nipped at the bud, it doesn’t become a national or global problem.