In February, several global biosafety lab experts joined a roundtable organised by Chatham House in Nigeria’s capital, Abuja. They were seeking solutions to a major challenge facing the world today – finding and staying ahead of the viruses and bacteria that challenge human existence. To achieve this, the global scientific community needs to detect these bugs rapidly and then mount an appropriate response. The World Health Organisation (WHO) has just included the risk of a new virulent virus they have termed Disease “X”, as one of the biggest risks facing our world today.
Disease outbreak surveillance and control in Sub-Saharan Africa has become a critical factor in global health security. This became clear during the Ebola Virus Disease (EVD) outbreak that gripped West Africa from 2014 to 2016. The world suddenly woke up to the reality that we are all at risk. Effective disease surveillance needs an effective laboratory system that includes laboratories that can safely detect and handle highly virulent viruses and bacteria. The cost of these labs in terms of infrastructure, manpower and maintenance, especially in resource-limited settings like West Africa, is daunting.
The Ebola outbreak, which primarily affected the three West African countries of Liberia, Sierra Leone and Guinea, with a smaller, famously well-managed cluster of cases in Nigeria, revealed the gaps in disease surveillance in the sub-region. The weakness of the region’s laboratory networks, which struggled to process samples to diagnose the disease in a cost-effective and timely fashion, was laid bare. These gaps have long-term implications for regional and global health security and the challenges have still not been overcome, meaning that West Africa and the region is only a little less vulnerable now than it was then.
Nigeria with the largest population on the continent, also one of the fastest growing and with the highest population densities, is therefore particularly vulnerable to the spread of infectious diseases. Over the past few years, Nigeria has experienced an increasing number of infectious disease outbreaks, including the re-emergence of monkeypox and large outbreaks of meningitis and Lassa fever. This makes the Nigerian context a constant threat to global security especially in light of frequent international travel. An example of this potential threat was seen in the case of the Ebola outbreak, where Nigeria’s Patient zero, Patrick Sawyer, came through an international airport, carrying the virus into Nigeria’s most populous city, Lagos. Thankfully, the country pulled together and protected itself and the world from a much larger outbreak.
Laboratory Systems & Global Health Security
Addressing this challenge in Nigeria and the wider West African region requires an array of networked interventions between global partners and regional institutions. One new key area of focus is laboratory systems and how they can be made more efficient in helping to address disease outbreaks in the region. In June 2017, in the wake of the Ebola Outbreak, the ECOWAS Assembly of Health Ministers signed a resolution, which assigned 11 laboratories in West Africa as regional reference laboratories, in a bid to address the relative sluggishness of Ebola diagnosis during the outbreak and to increase the region’s resilience to future threats.
In many African countries, disease burden and a threat to health security are much greater than the resources to effectively deal with them. The reasons for this include economic constraints, technology and knowledge gaps and insufficient accruable political capital from the investments required. Many Sub-Saharan countries have traditionally relied heavily on donor-funded interventions to improve their diagnostic capacity for infectious diseases. From the building of laboratory infrastructure to the provision of laboratory reagents and capacity building for the staff, not enough thought is given to local circumstances, local resources and local expertise.
Laboratories, especially those that require equipment and expertise for handling the most dangerous, require specialised spare parts, maintenance, and specific skill sets that are not usually readily available in the country. International sourcing is expensive and difficult. Therefore, local solutions are required to keep costs low, while maintaining the levels of biosafety and building local capacity.
At the Chatham House organised roundtable in Abuja, Trevor Smith of Global Affairs Canada’s Weapons of Mass Destruction Threat Reduction Program, said it is important for the sustainability of laboratories to be discussed now. “It’s a critical discussion at this time because I think it’s very honest that we look at the work that has been done by the international community with their African partners and acknowledge that results have not always been what they need to be. This is not to blame anyone,” he said. “The reality is, the technology that was developed to deal with disease in our laboratory environment was developed in countries with high incomes and the ability to maintain and sustain these facilities. They are not always a good fit in countries where budgets are more limited.” Smith explained what he envisions when he speaks of sustainability “A sustainable laboratory does not mean a cheap lab. It does not mean a worse lab. It means a lab that we’ve given more thought to, have pooled the capacities with the resources available to maintain it, so that it will have the longest-term ability to make an impact.”
Can we develop fit-to-serve sustainable laboratory ecosystems in Africa?
Today international development partners and regional bodies in the infectious diseases space are beginning to ask if there could be a better way to design and run effective and sustainable high-end laboratories which take into consideration the context in resource-limited settings. This approach would mean developing laboratories that are appropriately tailored to the resources available, both in the short- and long-term, without compromising biosafety and biosecurity.
This was the goal of the two-day roundtable hosted by Chatham House in Abuja themed “Sustainable Laboratories for High-Consequence Pathogens in Africa: Opportunities, Requirements and Challenges,” which held in in Abuja in February 2018.
The meeting, convened by Chatham House, brought together a group of international and regional development partners, including national public health officials and funding partners in the laboratory space. Participants included public health representatives from Kenya, Ghana, the Caribbean, and partners such as Japan International Cooperation Agency (JICA), The United States Centre for Disease Control (CDC), Walter Reed Army Research Centre, the Nigerian Military Reference Laboratory, the World Organisation for Animal Health (OiE), and Global Affairs Canada.
The roundtable included a visit to the Nigeria Military’s Defence Reference Laboratory. While at this facility, the Director General of the Ministry of Defence Health Implementation Program, Brigadier General Hussaini led the team on a tour of the facility, sharing with the team the biosafety measures in place. The Nigerian Military works in partnership with the United States Army Department of Defence, which through the Walter Reed Army Research Centre has trained 15 bio-medical engineers at the Centre. The team also visited the Nigeria Centre for Disease Control’s National Reference Laboratory on the outskirts of Abuja.
David Harper of Chatham House reflected on the visit to the laboratories. “What particularly impressed me when we went to the Defence Laboratory, was the organisation, the systems that are in place, and particularly, the training, having biomedical engineers on site to help maintain the equipment, to make sure the things necessary to discharge the duties are there,” he said. Of the Gaduwa Reference Lab, he said, “Our colleagues are trying hard to develop a set of laboratory activities that are absolutely essential for Nigeria, and for West Africa and Africa as a whole… these are the sort of things that we are encouraging and we would like to see more of.”
The second day consisted of a think tank like workshop, where attendees got into groups to discuss how laboratories can be made sustainable in Nigeria and the greater West Africa region. At the end of the discussions, the group came to jointly articulate the next action steps that would help guide how donors and countries begin to think about future laboratory ecosystems in West Africa.
Three critical areas to be considered for the future of high biosafety laboratory design and development in Africa emerged from the Roundtable:
- Developing a pre-laboratory screening template: One pertinent question that needs to be asked even before a laboratory is built in any country is whether the country needs a high biosafety laboratory, and what type of laboratory it needs. Until now, most partners would simply assume that the need is there and most countries would accept this assumption without questioning. The roundtable consented that there should be a process in place that would guide how partners and countries should engage in construction of a lab even commences.
- Laboratory Design: Deciding on how laboratories should be designed was a critical component of the Roundtable discussion. Partners highlighted that the goal is not to build “cheaper labs” but to build high-quality functional labs that are tailored to the needs and the resources available in the particular country while still paying attention to the necessary biosafety and biosecurity requirements.
- Long-term Sustainability: One of the core issues that came out of the roundtable discussion as needing to be tackled was that of sustainability. Building a lab is one thing, having the lab continue to operate effectively with the necessary manpower, equipment, and resources is a different challenge altogether. Issues discussed included training for virologists and other laboratory technicians as well as domestic resource mobilisation.
The Chatham House Roundtable ended with an agreement that the group will develop a blueprint for future laboratory installations in Africa. Already the Canadian Government is supporting the development of two new laboratories in the region, one in Lagos and the other in Sierra Leone, and these laboratories could be pilots in the plan to design a customized high-quality biosafety lab in Africa.
The increasing global focus on building sustainable laboratories in Africa is remarkable progress, given that laboratories have been built in Africa for decades mostly without these important discussions. Yet, this is a crucial conversation in light of global health security and the time is ripe to put these measures in place… ahead of the next global health crisis.