Professor Alash’le Abimiku is the Executive Director of the International Research Center of Excellence (IRCE) at the Institute of Human Virology of Nigeria (IHVN). In this interview, Abimiku, who is also Executive Director of Laboratory Diagnostics and Research at the institute and a professor at the University of Maryland School of Medicine, talks about ways Nigeria can prevent a fourth wave of the COVID pandemic. -19, how IHVN’s network of laboratories is contributing to the diagnosis of infectious diseases, and the latest research findings on HIV and tuberculosis, among others.
How can Nigeria prevent a fourth wave of the COVID-19 pandemic in light of rising cases in some countries caused by sublineages of the omicron variant?
There are several things we can learn from all the experiences we have had during the COVID-19 pandemic. We learned things like maintaining social distancing, washing our hands, and wearing masks. Even during harmattan, I told people to wear masks.
It’s not just about COVID-19, they also help against other infections. I still do them when I fly on airlines and in crowded spaces. So we need to maintain these public health practices in Nigeria.
Second, we all have a responsibility to get vaccinated with available COVID-19 vaccines. It has been scientifically proven that if you get vaccinated, you will reduce the amount of virus you have that you can pass on to other people. You will also be better protected against the circulating virus. Many of the vaccines and boosters are effective against the variants that emerge.
Third, it has to do with our government and politics. It is important not to disrupt travel and flights, but it is reasonable to require a negative test for people 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 on top of the hardship and public health challenges caused by new variants.
How is the IHVN laboratory network contributing to the diagnosis of infectious diseases in the country?
From the beginning, the idea was that we as an institution support the health mandate of the country, especially the Ministry of Health.
We have been pioneers from the beginning, in terms of bringing international standards to the country. Much of the infrastructure that was built in 2004 has been supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR).
These facilities provide support to people infected with HIV: accurate diagnosis in adults, children and pregnant women.
We have also done a lot in terms of supporting the TB program with the global fund and making sure that there are laboratory structures that can handle TB or multi-drug resistant TB, as you need a specialized laboratory and containment for this.
We have set up laboratories at IHVN and have also strengthened the capacity of national laboratories.
We have built a laboratory infrastructure that allows further research activities to continue. For example, the network of laboratories we built can admit diseases such as COVID-19, Lassa fever, Ebola and other additional infections depending on the history of outbreaks and pandemics in the country.
We have supported the work being done by the Nigerian Center for Disease Control and Prevention (NCDC) on yellow fever, Lassa fever, Mpox and others.
As a developing country, we cannot afford to create a laboratory for a single pathogen. We create a network of laboratories and capabilities that can diagnose various infections.
Apart from 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 adequate.
We monitor people by looking at the status of their blood and chemistry, be it cholesterol level, bilirubin, creatinine, virus suppression and others.
The third arm is the fact that our laboratory infrastructure also allows us to conduct research on events within our healthcare infrastructure that are unknown.
They also allow us to research and investigate diseases that are new to our population. That’s where we apply for competitive grants. For example, one of the more recent grants that IHVN has received is a Canadian grant that allows us to ask different questions about Mpox, which has been a more recent type of outbreak. Although endemic in Nigeria, there was an increase last year.
In terms of partnerships, we have obtained funding from the US government, including the Centers for Disease Control, for several years to care for people infected with HIV.
The other funding that has been used to build our laboratory infrastructure is the Global Fund. They have funded much of the work we have done on tuberculosis.
Some of the other grants we have are competitive grants in response to invitations for research proposals from international open competitions.
Some of our sponsors include the US National Institutes of Health from Europe, we have obtained funding from EDCTP, the Clinical Trials Association of Europe and Developing Countries.
For many of these grants, before we start to implement, we have to build the capacity of the Nigerians we are working with.
When you compare a study conducted in Nigeria with that of the US, China or Australia, you are not concerned with 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 see something in the health system.
Biorepositories (as they are called in the US) or biobanks as the English call them are important banks of biological samples from different individuals that allow you to characterize diseases, ailments in your population now or five years, 10 years or even ago. 20 years ago.
These banks are made up of a series of freezers at different low temperatures. Many of the freezers are -20, -40 and -80 degrees Celsius and you also have liquid nitrogen, which is -196oC. This is the lowest temperature, and usually cells and viable organisms can only survive at such low temperatures for very long.
The bottom line is that to understand the evolution of diseases and pathogens, you need to have a storage system for biological samples of your population over a long period of time.
For example, one of the important questions 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 come back after several years, collect these samples, and be able to test them to see if the disease has been there all along.
However, they are expensive to operate and are few in the country; to maintain the low temperatures required by microorganisms in samples such as blood, urine, feces, nasal swabs, 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 that has IHVN.
For example, in Nigeria, IHVN has a biorepository that has been licensed because the US National Institutes of Health funded us to establish one and we’ve had it running for 12 years.
We have been able to support the Nigerian Government in NCDC to establish one, which has been running for about four or five years.
Because it is difficult for all facilities to install one, we support researchers or institutions to store their samples at a subsidized price that allows us to make sure electricity (at IHVN, we have about three backups: two backup generators and liquid nitrogen) is available all the time.
What is the latest research you have done in the IHVN biorepository?
The latest research supported by biorepositories includes noncommunicable diseases such as hypertension, stress, and diabetes. This is because as people on treatment are living longer with HIV, other complications such as stress and diabetes also need to be investigated.
Our biorepository has supported researchers in West Africa and we have obtained samples that we have stored, shipped and can share with scientists in West Africa and the world for various genomics research.
We also did some sequencing on COVID-19 at IHVN. We are also supporting NCDC in genomic sequencing.
Tell us about the findings of IHVN’s research on HIV and tuberculosis.
There are many finds and publications. The biggest one for IHVN is that, for our treatment program, we have designed community activities that allow us to reach people who would not normally 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 to access health centers in the city.
The other key finding is that our program and that of the Nigerian government have made it highly unlikely that a pregnant woman who is HIV positive will pass it on to her baby. This is because we have created an adherence program that makes sure that these women take their medications so that the virus is so low that it cannot infect their children.
With tuberculosis, we are looking at how to shorten the treatment of tuberculosis. Treatment usually lasts about nine months. Now, it’s six months, and we’re looking at how we can shorten it. If you make it shorter, maybe three months or six weeks, then people are more likely to take their meds and get rid of TB. So, we’re very excited about that.
One of the things we are testing is a new platform/equipment that allows us to see the bacteria load in people being treated for tuberculosis. Before we had a technique to check if the treatment is working but it is not very sensitive.
Now, we have a platform where we can take sputum from someone undergoing treatment and we can count the number of bacteria using a very sensitive PCR technique. We see people who respond to treatment and those who have easily gotten rid of TB.
We have also just started a research activity to see the response of people infected with HIV to vaccines against COVID-19. HIV-positive people may be immunocompromised, so they may not respond to vaccination like HIV-negative people.