Next Generation Disease Detectives: The institutions training future Nigerian leaders to fight epidemics

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The global health community received an important announcement on the 29th October 2019 – the beginning of the first-ever human trial for a possible Lassa fever vaccine. This move was championed by Themis Biomedicals and the Coalition for Epidemic Preparedness Innovations (CEPI), but the process leading up to this achievement started long ago. In January 2019, Dr Richard Hatchett, CEO of CEPI said there were prospects for clinical trials for a Lassa vaccine at the maiden Lassa Fever International Conference, which took placed in Abuja, marking 50 years since the discovery of Lassa fever.

The conference, hosted by the Nigeria Centre for Disease Control (NCDC) had experts from across the globe sharing lessons in the fight against Lassa fever.  The discussion didn’t stop with Lassa, but expanded to other viral haemorrhagic fevers, global health security and the essential role played by national public health institutes. Most significantly, participants were able to network and share how they are rising to the challenge of emerging and re-emerging infectious diseases.

In their presentations, many of the conference speakers alluded to the work done by a new crop of young scientists, researchers and public health practitioners who were helping to keep infectious diseases at bay. They were achieving this by employing state of the art technology that was helping make diagnosis more efficient and improving understanding of how infectious diseases agents are changing over time. Speakers included Professor Oyewale Tomori, Professor Christian Happi, Professor Iruka Okeke and Dr Stephan Günther.

Inspiring a new generation
Sitting in his office at the Africa Centre Of Excellence for Genomics of Infectious Diseases (ACEGID), housed inside Redeemer’s University in Osun State, Professor Christian Happi said that attention shouldn’t be on him anymore, but on the new scientists and research students that are breaking boundaries in molecular science. He happily shares their achievements and research areas as a proud father would. He insisted that Africa has no reason for not being the best globally in science research, especially in the area of tropical infectious diseases research.

Professor Happi says we should be able to diagnose tropical diseases without depending on foreign support. Photo credit: Nigeria Health Watch

“We need to tell their stories to inspire other young Nigerians out there to know that they can work within this country and make a difference from Africa,” he said, adding, “I tell colleagues that I’m proud to own all the viruses and diseases because we have the human resources to address all of them. We as Africans only need to stop looking at them as challenges but as opportunities and stepping stones to learn and teach the world.”

Professor Happi is delighted with the conducive learning environment ACEGID provides. Beyond teaching and mentoring, it has now become his life’s mission to turn the place into a melting pot of talent, drawn from all over the world. He said young Nigerian researchers trained in various prestigious universities continue to show interest in returning home to work at ACEGID.

A few out of many
Walking through the corridors of the research laboratory block, automated machines can be heard humming and performing various tasks they have been programmed to do. Two students are still working and are happy to talk about their exciting work and study at ACEGID.

Uche Judith Oguzie, a PhD student in Molecular Biology and Genomics obtained her first degree in Veterinary Medicine and studied Medical Microbiology for her Masters. Her work at ACEGID now involves characterising fevers of unknown origin, using what she refers to as “next generation sequencing platform” because of its numerous advantages. “With the platform, we don’t need to know what’s in the sample before analysing it to see the profile of every organism present in it,” she said. Their work played a significant role in understanding the drivers of the 2018 Lassa fever surge in Nigeria and diagnosing the 2019 Yellow fever cases in Edo State.

For her PhD research, Oguzie Judith is working on identifying causes of fevers of unknown origin using sophisticated genetic sequencing technologies. Photo credit: Nigeria Health Watch

Oguzie wants to focus more on other causes of fever to reduce the overdiagnosis of malaria and typhoid as these are always the first suspects when patients visit hospitals with complaints of a fever. She is motivated by the opportunity to solve African problems on African soil, to be part of a team that can help detect infectious disease agents and advise public health institutions on strategies to save more lives. She says she hopes a critical mass of young scientists will work together to take ownership of indigenous problems, especially in the fight against infectious diseases.

Fehitola Victoria Ajogbasile is a Molecular Biology and Genomics PhD student in her second year of study. Ajogbasile is studying the population diversity of Plasmodium falciparum, the parasite that causes malaria, a disease that caused an estimated 435,000 deaths globally in 2017. Her work helps researchers better understand the various clones of malaria parasites in the country and why some of them are resistant to the antimalarial drugs used against them. Ajogbasile says her work keys into the National Malaria Elimination Program, as they provide her with samples for analyses. The program is also part of the larger drug efficacy study of malaria in Nigeria.

Ajogbasile Victoria is a PhD student at the Africa Centre of Excellence on Genomics of Infectious Diseases working with samples from the National Malaria Elimination Program to understand drivers of antimalarial resistance from different mosquito populations. Photo credit: Nigeria Health Watch

She obtained her undergraduate and master’s degree from Redeemers University, and her PhD program at ACEGID provides her with a unique opportunity to work with research equipment that is not easily accessible to other scientists in Nigeria. She is also able to interact with and learn from research scientists from across the globe in the facility’s serene learning environment. This has been the hallmark of her journey as a researcher.

Oguzie and Ajogbasile were jointly nominated in the public service category of the 2019 edition of the Future Awards Africa for their contributions in diagnosing the yellow fever outbreak in Edo State. Ajogbasile said the nomination makes her “fulfilled as a Nigerian scientist working in Nigeria to positively impact lives.”

Dr Kolawole Salami’s medical degree from the University of Ilorin didn’t prepare him for what he witnessed during his short stint at the paediatric unit, Federal Medical Centre, Jigawa State. He said, “In 2008 I witnessed a massive measles outbreak in Jigawa State, which led me to change my focus. As I watched all available bed space fill up with children presenting with varying severity of the viral infection with most of them succumbing to the infection, I became angry that so many lives were still being lost to a vaccine-preventable disease”.

Salami said he delved into public health to support the implementation of evidence-based interventions that could reduce the burden of infectious diseases. This quest took him around the globe to obtain skills in public health, health economics, general management and vaccinology and pharmaceutical clinical development. He says he is now narrowing his work to concentrate on vaccinology and clinical development of medical countermeasures for the control of emerging and re-emerging epidemic diseases for which no effective treatment or vaccines currently exist.

Dr Kolawole Salami’s worked extensively as a public health practitioner before focusing on vaccine development for emerging and re-emerging epidemic diseases like Lassa fever. His time at CEPI helped prepare him for his current role in the R&D unit of WHO. Photo credit: Nigeria Health Watch

Part of his fellowship in Siena, Italy involved a six-month fellowship at CEPI which he describes as the hallmark of his public health career. There, he worked to support the advancement of vaccine candidates for re-emerging infectious diseases like Lassa fever. He took part in CEPI’s dialogue with stakeholders in Nigeria and West Africa to ensure the region takes the driving seat in the fight against Lassa fever and other endemic communicable diseases. He also mapped 44 sites in eight Lassa endemic countries by interrogating online clinical trial registries that gather key information on site capability through a structured questionnaire developed around the four main themes of the WHO/TDR competency wheel for clinical research

Salami recently accepted a position at the World Health Organisation headquarters in Geneva. “I will be joining their ‘R&D Blueprint for action to prevent epidemics’ team. Their mandate is to reduce the time between the declaration of a public health emergency and the availability of effective diagnostics, vaccines and treatments,” he said.

Rising to the challenge
An important component of epidemic preparedness and response is the ability to diagnose diseases on time. No time is this more important than now, with international travel becoming easier and faster. A panellist at the 2019 Lassa fever conference in Abuja shared how most tropical diseases are diagnosed in the west, in laboratories that are thousands of miles from where they originated. This is changing, although slowly. Professor Happi said it was a moment of pride when he helped diagnose the index case of Ebola in Nigeria in 2014.

Image credit: Nigeria Health Watch

To continue building this young generation of scientists who will use modern diagnostic tools to better understand infectious disease dynamics will require sustained and adequate funding from the government. Investing more funds in epidemic preparedness may also rub off on the focus for clinical vaccine trials. Salami noted that regions where diseases are most endemic should be prioritised for clinical trials of medical countermeasures. This isn’t the case as Sub-Saharan Africa, especially West Africa, has not been a leading destination for vaccine clinical trials, despite having some of the highest infectious disease burdens. “Over the last six years, approximately 5% of vaccine clinical trials took place in Africa and even fewer were undertaken in West Africa. This obvious imbalance in sponsored vaccine clinical trials investment needs to change”, he said.

Could this be the case of the piper dictating the tune? Are there enough clinical trial centres in Nigeria ready to take up the opportunities when they arise? What were the outcomes of the 2017 Clinical Trial Summit which focused on the role of clinical trials in public health emergencies?

The questions are many but perhaps we can start by ensuring that the Nigerian government commits to investing in building local capacity for epidemic preparedness, investing in the laboratory and diagnostic infrastructure. This way, institutions tasked with protecting the health of Nigerians can deliver on their mandate and in the future, produce more clinical trials for infectious diseases in Nigeria. Some progress has been made in improving the laboratory infrastructure in Nigeria. The Japan International Cooperation Agency (JICA) is supporting in the construction of a P3 laboratory that will have the diagnostic capacity of high risk pathogens, research and surveillance. The laboratory of biosafety level 3 (BSL-3) will be housed within the National Reference Laboratory (NRL) of the NCDC in Abuja.

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