Professor Alash’le Abimiku is the Executive Director of the International Research Centre of Excellence (IRCE) of the Institute of Human Virology Nigeria (IHVN). In this interview, Abimiku, who is also executive director, Laboratory Diagnostics and Research at the institute, and a professor at the University of Maryland School of Medicine, speaks on ways Nigeria can prevent a fourth wave of the COVID-19 pandemic, how IHVN’s laboratory network is contributing to the diagnosis of infectious diseases, and the latest research findings on HIV and TB among others.
In what ways can Nigeria prevent a fourth wave of the COVID-19 pandemic in light of rising cases in some countries caused by sub-lineages of the omicron variant?
There are several things that we can learn from all the experiences that we have had during the COVID-19 pandemic. We learned things like keeping social distancing, washing hands, and wearing masks. Even during the harmattan, I told people to wear masks.
It is not just about COVID-19, they help against other infections too. I still do them when I fly on airlines and in crowded spaces. So we need to maintain these public health practices in Nigeria.
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Secondly, we all have the responsibility of getting vaccinated with the available COVID-19 vaccines. It has been scientifically proven that if you get yourself vaccinated, it will reduce the amount of virus you have that you can transmit to other people. You also become better protected against the circulating virus. A lot of the vaccines and boosters are effective against variants that come up.
Thirdly, it has to do with our government and policy. It is important not to disrupt travel and flights, but it is reasonable to require a negative test from individuals who are flying into the country from regions that have a high prevalence of the variant. If we do these three things, we are likely to stay above the difficulties and public health challenges caused by new variants.
How is IHVN’s laboratory network contributing to the diagnosis of infectious diseases in the country?
Since inception, the idea was for us as an institution to support the health mandate of the country, especially the Ministry of Health.
We have been trailblazers from inception, in terms of bringing international standards to the country. A lot of the infrastructure that was built in 2004 has been supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
These facilities support individuals that are HIV infected – accurate diagnosis in adults, children, and pregnant women.
We have also done a lot in terms of supporting the tuberculosis programme with the global fund and making sure that there are laboratory structures that can handle tuberculosis or multi-resistant tuberculosis as you need specialised laboratory and containment for this.
We have set up laboratories at IHVN and we have also built the capacity of the national laboratories.
We have built laboratory infrastructure that allows for additional research activities to go on. For instance, the laboratory network we built can support diseases like COVID-19, Lassa fever, Ebola and other additional infections based on the history of outbreaks and pandemics in the country.
We have supported the work that the Nigeria Centre for Disease Control and Prevention (NCDC) is doing on yellow fever, Lassa fever, Mpox, and others.
As a developing country, we do not have the luxury to create a laboratory for just one pathogen. We create a laboratory network and capabilities that can diagnose several infections.
Apart from the infections, we have laboratory infrastructure that also monitors the treatment and management of patients to make sure that they are doing well and that their regular health signs are appropriate.
We monitor individuals by looking at the state of their blood and chemistry, whether it is the cholesterol level, bilirubin, creatinine, virus suppression, and others.
The third arm is the fact that our laboratory infrastructure also allows us to conduct research about happenings within our health infrastructure that is unknown.
They also enable us to investigate and research diseases that are new to our population. That is where we apply for competing grants. For instance, one of the newer grants that IHVN has gotten is a Canadian grant that allows us to ask different questions about Mpox, which has been a more recent kind of outbreak. Although in Nigeria, it is endemic, there was a rise last year.
In terms of partnerships, we have gotten funding from the US government including the Centers for Disease Control for several years to take care of individuals that are infected with HIV.
The other funding that has been used to build our laboratory infrastructure is the Global Fund. They have funded a lot of the work that we have done on tuberculosis.
Some of the other grants that we have are competitive grants in response to invitations for research proposals from open competitions internationally.
Some of our funders include the US National Institutes of Health. From Europe, we have gotten funding from EDCTP – the European and Developing Countries Clinical Trial Partnership.
For a lot of these grants, before we start implementing, we have to build the capacity of the Nigerians that we are working with.
When you compare a study done in Nigeria to that in the US or in China or in Australia, you are not worried about the results because they are based on internationally approved standards.
How will Nigeria benefit from biorepositories or biobanks?
A biorepository is an important research and health tool that allows a country to go back several years later to ask research questions when there is a pandemic or when they observe something in the health system.
Biorepositories (as it is called in the US) or biobanks as the English call them are important banks of biological samples from different individuals that allow you to characterise diseases, ailments in your population now or five years, 10 years or even 20 years back.
These banks are made up of a number of freezers at different low temperatures. A lot of the freezers are at -20, -40, and -80 degrees Celsius and you also have liquid nitrogen, which is at -196oC. This is the lowest temperature and usually viable cells and organisms can only survive in those low temperatures for long.
The important thing is that for you to understand the evolution of diseases and pathogens, you have to have a system of storing biological specimens from your population over a long period of time.
For instance, one of the questions important to ask when there was COVID-19 is when did it start in our population?
If you have biobanks to store these samples at very low temperatures, you can go back after several years, pick up these samples and be able to analyse them to see if the disease has been there all the time.
They are however expensive to operate and so are few in the country; to keep those low temperatures required for micro-organisms in samples like blood, urine, stool, nasal swaps, etc. after several years.
This means you have to have electricity and backup all the time or you need a plant, to generate liquid nitrogen which IHVN has.
For instance, in Nigeria, IHVN has one biorepository that has been licensed because we have been funded by the US National Institutes of Health to establish one and we have got it running for 12 years.
We have been able to support the Government of Nigeria at NCDC to set up one, which has been running for about four to five years.
Because it is difficult for every facility to set up one, we support investigators or institutions to store their samples at a subsidised price that allows us to make sure that the electricity (at IHVN, we have about three backups – two backup generators and the liquid nitrogen) is available all the time.
What is the latest research you carried out in the IHVN bio-repository?
The most recent research that the biorepositories have supported includes non-communicable diseases like hypertension, stress and diabetes. This is because as people on treatment live longer with HIV, other complications like stress and diabetes also need to be researched.
Our biorepository has supported investigators across West Africa, and we have gotten samples that we have stored, shipped, and can share with scientists across West Africa and the world to do various genomic research.
We carry out some sequencing on COVID-19 at IHVN as well. We are also supporting NCDC on genomic sequencing.
Tell us about the findings from IHVN’s research on HIV and tuberculosis?
There are a lot of findings and publications. The most important one for IHVN is that for our treatment programme, we have designed activities for the community that allows us to reach people that normally will not come for care.
You cannot end HIV if there are pockets of the virus in different places in rural areas with challenges of distance and transportation costs for them to access health facilities in the city.
The other key finding is that our programme and that of the government of Nigeria have made it highly unlikely for a pregnant woman who is HIV positive to pass it on to her infant. This is because we have created an adherence programme that makes sure that these women take their drugs so the virus is so low that it cannot infect their children.
With tuberculosis, we are looking at how to make the treatment for tuberculosis shorter. Usually, the treatment is for about nine months. Now, it is six months, and we are looking at how we can make it shorter. If you make it shorter, maybe three months or six weeks, then it is more likely that people are going to take their drugs and get rid of tuberculosis. So, we are very excited about that.
One of the things that we are testing is a new platform/piece of equipment that allows us to see the bacteria load in tuberculosis-treated people. Before, we had a technique of checking to see whether the treatment is working but it is not very sensitive.
Now, we have a platform where we can take the sputum from somebody on treatment and are able to count the number of bacteria using a very sensitive PCR technique. We see the people responding to treatment and those that have gotten rid of tuberculosis easily.
We also just started a research activity to see the response of HIV-infected persons to COVID-19 vaccines. HIV-positive people may be immuno-compromised so they may not respond to vaccination like HIV-negative people.