When will the COVID-19 pandemic be over? Will life return to how it was before COVID-19 disrupted it? These questions probably run through every person’s mind often even if they are not conscious of it. But the pandemic is far from over, even though the ease of lockdown measures makes it appear as if the danger is past. This has led to public complacency when it comes to adhering to safety protocols and other public health and social measures put in place by the Nigeria Centre for Disease Control (NCDC).
In reality, cases of COVID-19 and even deaths are still being recorded daily as shown in NCDC’s weekly situation report. In other countries such as the USA, cases are still rising while countries like Russia are likely to have another lockdown as cases soar. As local and international flights have resumed in Nigeria and some other parts of the world, this is the time to be vigilant and adhere to all the public health measures advised. This will help protect the public and prevent the spread of the virus until a major milestone is reached in the fight against the virus. This hopefully will be when there is an approved vaccine or therapeutics that has been certified both safe and effective against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19.
Nigeria is actively involved in the race to procure a vaccine to protect people against the virus by leveraging on in-country capacity. The COVID-19 response and by extension, every public health response led by NCDC is driven by evidence because every disease outbreak is unique.
NCDC’s Director General, Dr Chikwe Ihekweazu noted this in one of the daily briefings of the Presidential Task Force on COVID-19 in July 2020. He said the response is developing research evidence in Nigeria to inform the prevention & control of the COVID-19 outbreak. He also announced the launch of the Nigeria COVID-19 Research Consortium, convened by NCDC and the Nigeria Institute of Medical Research (NIMR), in collaboration with the National Universities Commission (NUC) and the Tertiary Education Trust Fund. “By bringing indigenous experts and scientists, we can better guide the Nigerian Government’s response to COVID-19 as it applies to our context,” he said.
Academic institutions drive research and innovation across the globe. The African Centre of Excellence for Genomics of Infectious Diseases (ACEGID) housed inside Redeemer’s University has continued building capacity in genomics in young African Scientists, with the aim of translating research outcomes to products.
A potential solution from an unusual location
Founded in 2014 with support from the World Bank supported Africa Higher Education Centers of Excellence (ACE) Project, ACEGID is located in the quiet town of Ede, off the Gbongan-Osogbo highway in Osun State.
The work going on inside its walls is anything but quiet though. The community hosts an institution that delivers cutting-edge research comparable with what’s obtainable in prestigious institutions outside Nigeria. The centre is feeding into the very basic science for the development of vaccines, diagnostics and therapeutics. And they are still breaking new grounds, says the centre’s Director, Professor Christian Happi. “We went from a simple lab in a small institution to a World Health Organisation (WHO) recognised Reference Laboratory for infectious diseases in Africa and also a reference laboratory for the Africa CDC,” he said. These capacities played important roles once the world started dealing with COVID-19.
ACEGID contributed to the first genomic sequencing of the COVID-19 virus in Africa in collaboration with Lagos State Government, Nigerian Institute Of Medical Research (NIMR) and the Nigeria Centre for Disease Control (NCDC) using samples from Nigeria’s index case. This happened within 48 hours, a speed Prof. Happi describes as “unmatchable”.
Beyond being one of the first to start COVID-19 diagnosis, the centre provided important data around the virus properties, development and spread that helped NCDC in the earlier days of the response, says Prof Happi. With their new role as a continental reference laboratory, the capacity they have built in genomic sequencing will now serve other African countries.
Solutions from next generation scientists
Professor Happi’s strong resolve to build the next generation of molecular biologists is already happening. It is evident in the way he interacts with his students as colleagues and the confidence with which he encourages them to talk about their work which mostly revolves around supporting outbreak response in Nigeria.
After his Masters and PhD at Oxford and Cambridge University, Dr Ugwu returned to Nigeria in 2018 with a research grant to study the immune correlates of protection against the Lassa fever virus. These are the characteristics that helped people who got infected with Lassa fever to survive.
Paul Eniola Oluniyi is a PhD research student at the centre with a focus on bioinformatics. “I help make sense of biological data using computational and mathematical tools. Once we carry out sequencing in the lab and generate huge amounts of data, the next thing is to extract insights from the data to understand what the data is telling us. For example during an outbreak, you want to understand how the virus in Patient A related to that of Patient B or how the virus is spreading,” he said.
Oluniyi said insights generated from the genomic sequencing of Nigeria’s index case helped explain the source of the virus. Also during outbreaks of endemic diseases such as Lassa fever, the computational data generated from genomic sequences helps determine geographic spread of the disease and inform policies and public health guidelines. He said it has been fulfilling contributing to Nigeria’s outbreak response while also getting the opportunity to work with and learn from researchers outside Nigeria.
Jessica Nnenna Uwanibe’s PhD research is focused on genotypic prevalence of typhoid, but she is excited about doing research beyond this because she gets to develop other capacities. She is currently involved with the development of the SARs-CoV-2 testing kit which she describes as innovative because most rapid diagnostic kits obtainable in the market target the antibody produced against the pathogen. But the product she and the team are working on identifies the presence of the SARs-CoV-2 Ribonucleic Acid (RNA) in the sample. It cuts down the test time to barely 30 minutes and doesn’t require heavy sophisticated equipment, making it easy to deploy in resource limited settings. The Africa CDC is currently setting plans in motion to validate the test strips in some African countries, Prof Happi said..
Fehintola Victoria Ajogbasile helped perform the genomic sequencing on Nigeria’s first COVID-19 index case even though her PhD work is focused around understanding the population diversity of malaria.
It’s easy to spot how Prof Happi is helping them take ownership and responsibility of the work happening in the research lab. The laboratory manager for instance, Mrs Philomena Eromon, was once a student in the centre, but now coordinates the research students and fellows working on various issues. He hopes to check two more boxes before his retirement — train another professor of molecular biology to take after him and build a molecular biology campus that will become a melting pot of international research excellence.
Need for support for research
Sustaining efforts that have meaningful impact don’t come cheap. Preparing for disease outbreaks or developing tools to respond also requires resources. Also, investments are needed for building capacities and sustaining human resources.
The work done by the research fellows is somewhat comparable to residency training for medical doctors because they learn and work at the same time. The only difference is the PhD research students don’t get paid for the work they do. Most of them stayed back to work in the lab when they could have gone home. Prof Happi commends the NCDC for providing some support, but said there’s opportunity to do more to show the students that their country appreciates the work they are doing. This makes it more important to support the work of public health institutions like the NCDC, and makes it critical for the government not to remove the 2.5% allocated to NCDC from the Basic Healthcare Provision Fund (BHCPF).
There needs to be more local support for innovation. As Prof Happi opined, investments in vaccine development are very expensive. This Lancet article found the cost of developing a single epidemic infectious disease vaccine from preclinical trials through to end of phase 2a is between US$14–159 million range, assuming no risk of failure. The University of Cambridge for instance received a £1.9million award from the UK Government for its SARS-CoV-2 vaccine development.
While both economies are different, can the Nigerian government commit to doing what is within its power to move the needle around research and development? What is the role of the private sector? Are they developing the research capacity to take the outputs from platforms such as the COVID-19 research consortium to product development?
At the peak of the pandemic five months ago, the Central Bank of Nigeria said that it was developing a framework to help researchers access funds, as a way of supporting the fight against COVID-19. The Governor of the Central Bank of Nigeria, Godwin Emefiele, challenged Nigerian scientists across the world to develop a Nigerian vaccine to check coronavirus. He said via the bank’s Twitter handle that “In order to encourage greater research and development in Nigeria of drugs and vaccines that would help prevent the spread of the virus, the CBN is developing a framework under which grants and long term facilities will be provided to researchers, science institutions and biotechnology firms to develop the Nigerian vaccine”.
While research and innovation is encouraged, it is also important to adhere to laid down scientific processes to ensure products are safe for human use. An example of these processes is the recent protocol endorsed by the World Health Organisation Africa Region (WHOAFRO) for COVID-19 herbal medicine clinical trials.These clinical trials are important to prevent researchers coming out to outrightly declare that they have found cures or vaccines for COVID-19, as these are detrimental to research efforts and strategies to control the pandemic. But efforts like #COVID19Truths, a project dedicated to using insights curated from multiple media platforms to counter COVID-19 misinformation, are helping to ensure that accurate information is being shared instead ahead of misinformation.
Supporting the research for vaccine development
The COVID-19 pandemic presented an opportunity to change the narrative for ACEGID. They adapted their knowledge and work around a trivalent vaccine for Lassa fever to support the research into an eventual COVID-19 vaccine. A trivalent vaccine protects against three diseases. As a DNA-based vaccine, all they did was replace the Lassa fever genetic sequence with the COVID-19 sequence in the vaccine cassette. They sent this to their research collaborators at the University of Cambridge for preclinical trials.
For their part, Prof. Happi said they are hoping to commence the phase one clinical trials, but this is where challenges arise. He said not enough is invested into research and development in Nigeria and commencing clinical trials requires a significant amount of funding. “But you find yourself in a situation where you are asking where are all these people in the private sector in Africa that we want to invest in moving things forward” he said, noting that actions don’t always match words. This is where you realise that it is all noise without motion,” he said. This puts them into the difficult position of turning to the Global North with these innovations.
He said since the news of a potential vaccine coming out of Nigeria is public on international media, people should be knocking on their doors to collaborate. But this isn’t happening and planning clinical trials for vaccine development doesn’t come cheap, because you need infrastructure to ensure volunteers are safe and receive optimal care and attention. Without funds in place, they won’t be able to approach the appropriate regulatory agencies like Nigeria Agency for Food and Drug Administration (NAFDAC) or NIMR.
Despite these challenges, the centre continues to push the boundaries of genomic research especially with the new responsibilities of supporting other African countries as a reference centre. On his part, Prof Happi said he is still committed to building the finest researchers from Africa.
While various efforts are being made to flatten the curve so that our lives can return to normal, this is not a time to let our guard down, so we do not lose out on the gains made. This is the time to be more vigilant and adhere to public health guidelines to ensure there’s no resurgence of the virus in Nigeria, even as our researchers continue to do their best towards developing a vaccine for COVID-19.