International Conference On Health Access Beyond COVID-19

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Dr. Obi Adigwe, thank you for the very kind invitation to me on behalf of the governing board of the Institute of the National Institute for Pharmaceutical Research and Development (NIPRD)to be here.

I must also thank the Hon. Ministers of Health for their leadership in supporting this platform and several others enabling the exchange of ideas on our health system.

Thank you very much Prof Fortunak for your most informative lecture.

The Covid-19 pandemic was an eye-opener for me in five different respects.

The first is how some of the wealthiest and most developed economies of the world were tragically unprepared to handle a public health crisis on the scale and uncertainty of Covid 19. Whereas countries with more modest economic profiles, quickly deployed a public health framework that was responsive and effective.

The second eye-opener for me was that people, whether they are educated or uneducated, from developed or developing nations still have to be persuaded to take precautions to prevent them from contracting a deadly disease. So, the farmer in Kebbi State, the bus conductor in Lagos, the lawyer in Abuja, the stockbroker in New York, the teacher in Manchester UK will argue with you that there is no point wearing a mask!

The third eye-opener for me is the danger of conspiracy theories and false information in public health crises. Millions in the US, thousands in the UK, many based on false information, here in Africa insist that vaccines are dangerous and that they are a conspiracy to change your DNA, or put the mark of the beast on you or simply insert a chip into you to track you forever!

The fourth eye-opener is that when there is a global health crisis on the scale of the Covid 19 pandemic, do not expect any or much help from anyone. Every nation is on its own.

The fifth eye-opener is that despite infrastructural weaknesses we have an experienced and robust public health system, peopled by some of the best personnel in the world but more importantly the huge opportunities for becoming a leading nation in healthcare. And I will speak to this aspect of the theme of the conference.

But I think it is worthwhile to mention that these eyeopeners should be a guide as to navigating the pathway to assuring health access and socio-economic development beyond Covid 19.

So first perhaps we should begin by asking how well our health system responded to the pandemic.

Shortly after the first Covid 19 patient in sub-Saharan Africa was identified in Nigeria, a sample of the virus was sent to the African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), at Redeemers University in Ede, Osun State Nigeria. There, a team led by Professor Christian Happi, analyzed the sample and was able within 48 hours to share the very first genome sequence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from Africa with the global science community. Few Knew that we even had that capacity or that the facility existed and had even been recognized internationally.

Second, we were able to scale up on testing and case management capacity quickly activating 120 laboratories nationwide from 5 just before the pandemic – most of them public laboratories. Also, we expanded the footprint of our sovereign public health response capabilities especially at the subnational level and in areas where previously such capabilities did not exist. One reason why we have been able to manage this pandemic better than many expected is that we had existing public health infrastructure to work with. The Ebola outbreak of 2014 and our ongoing battle with Lassa fever and our successes with polio eradication helped us to tighten our epidemic contingency plans, strengthen our emergency coordination and surveillance capacities, and also to invest in public health laboratories.

One of the key lessons we learned from our response to the Ebola outbreak was the need to build systems in ‘peace time’ that can be used during outbreaks. The Nigeria Centre of Disease Control (NCDC) which was founded in 2011 was made an independent government agency in 2018 as we prioritized the strengthening of our public health infrastructure. As it turned out the NCDC’s independence was important in its being able to function unrestrained by bureaucracy when the pandemic struck. With the NCDC’s National Public Health Reference Laboratory in Gaduwa, Abuja, its state-of-the-art equipment, and well-trained scientists, it is evident that the NCDC is one of the best prepared and resourced at least in Africa.

Our COVID- 19 response also witnessed the setting up of the locally and internationally acclaimed Presidential Task Force on COVID-19, an inter-ministerial interagency team led by the SGF, which coordinated the national response, set the rules and briefed the nation daily for months. The task force swiftly issued and enforced Covid protocols for travel and general movement. When the first doses of vaccines came, the task force developed the protocols and the public health system already used to mass vaccination campaigns, deployed across the country in every nook and cranny of Nigeria so that the first eligible vaccine candidates received their vaccinations seamlessly.

So, going forward, what do we need to do?

I think flowing from the eye-opener that every nation is on her own in a global pandemic, and how vaccine rich nations at some point even banned exports in order to meet local needs, it is clear that we must take our destiny into our own hands.

And there is great potential. Last December, the Nigerian Institute of Medical Research (NIMR) launched a new set of COVID-19 test kits that can produce results in 57 minutes. The new kit was designed by Joseph Shaibu, a molecular virologist at NIMR.

By the end of the year, the Africa Centre of Excellence in Osun State which first sequenced the genome of the Severe Acute Respiratory Syndrome (SARS-CoV-2) will inaugurate the biggest genomics research centre in Africa. Earlier this year, the Centre was selected by the Broad Institute of the Massachusetts Institute of Technology (MIT) and Harvard University to be part of a prestigious scientific coalition that will help set up an early warning system to prevent and respond to future outbreaks and pandemics.

In September 2020, the World Health Organization named ACEGID one of two (the other from South Africa) specialized continental reference sequencing research laboratories for emerging pathogens, including SARS-CoV-2. Professor Happi and his team have also produced a groundbreaking rapid test, certified by the Food and Drug Administration, FDA of the US government. It costs around $3, much less than Polymerase Chain Reaction (PCR) tests.

In addition, the test does not require highly equipped laboratories that tend to be too expensive. But more remarkably they are developing a Nigerian anti covid vaccine. The Africa Centre of Excellence for Neglected Tropical Diseases and Forensic Biotechnology (ACENTDFB) led by Professor Y.K Ibrahim, the institute (ACENTDFB) has been performing mass testing. In collaboration with the Kaduna State Government and its University Teaching Hospital, they established a facility where COVID-19 samples are analyzed. The facility is part of the Nigeria CDC national testing centers.

At the onset of the pandemic, our host the Institute swung into action and developed a standardized hand sanitizer and made the formula publicly accessible for mass production.

During the Ebola outbreak in West Africa, between 2014 to 2016, the first case in Nigeria was confirmed and sequenced at ACEGID. The center was also instrumental in containing the epidemic in the sub-region by the development of a 15-minute Rapid Diagnostics.

This method was approved by the World Health Organization and the Food and Drug Administration, FDA of the US government.

Also in 2014, ACEGID has developed a 10-minute Rapid Diagnostics test for Lassa fever, setting in motion the possible development of the next vaccine for the disease.

We must build local capacity. And we are certainly well on the way. At the onset of the pandemic, our host the National Institute for Pharmaceutical Research and Development swung into action and developed a standardized hand sanitizer and made the formula publicly accessible for mass production. The Institute also constituted and convened the National Scientific Advisory Committee (NSAC), which developed and launched the Phytomedicine Verification and Validation Protocol, to determine the safety, effectiveness, and quality of the cure claims by traditional medicine practitioners who came forward with divergent claims of cure for COVID-19. The results from NIPRD testing and verification studies on some of these products guided the world in making informed decisions and prevented the exacerbation of a bad situation. This has helped to identify products with potential properties and has promoted the credibility and international acceptance of pharmaceutical products developed from Nigeria.

The NIPRD has also developed an impressive variety of pharmaceutical products, from indigenous resources. And both the NIPRIMUNE and NIPRIMUNE PLUS have been found to possess reasonable activities against COVID-19. Both products which have been registered by NAFDAC are currently undergoing various levels of clinical studies toward approval for social production for emergency use. The NIPRD DG, Dr. Adigwe, has assured me that by this time next year, the Institute will launch three new products currently under development at his nanomedicine, artificial intelligence and machine learning centres.

It is this proactive approach that we must take to the slow pace of vaccine access in Africa, and of course Nigeria. Although we have received some help from friendly nations and the COVAX alliance less than 4% of our eligible population will have been vaccinated by the end of the year. There is no question that we cannot afford not to have our own vaccine production facilities. Think what could have happened to India, which has reported the most number of infections in the world after the United States, if it did not have the capacity to produce vaccines? Where would it’s 1.3 billion people find the vaccines? Today, India has given at least one dose to 65% of its 944 million adults and the necessary two doses to 22%. They expect overall domestic vaccine production to exceed a billion doses by the end of the year which would be more than enough to meet domestic demand.

Nigeria is in talks with the World Bank’s private lending arm and other lenders to raise about $30 million to help finance a vaccine plant, Biovaccines Nigeria Ltd, Chaired by Prof Oyewale Tomori, 49% of the company owned by the Nigerian government with the balance held by May & Baker Nigeria Plc, plans to begin construction of the plant in the first quarter of next year. The plant in Otta, in the nation’s southwest Ogun State will initially “fill and finish”, which means importing the raw material for the vaccines and then packaging it for distribution. South Africa’s Aspen Pharmacare Holdings Ltd. and the Biovac Institute operate similar facilities.

Full manufacturing is expected to follow. So, it is evident that the way forward is more funding for health care research and for innovators to develop solutions in pharmaceuticals and medical consumables. Our administration established the Healthcare Sector Intervention Fund Facility which has disbursed N76.98 billion (about $185 million) to finance the acquisition and installation of critical medical equipment as well as the expansion of production lines in various pharmaceutical companies across the country. The Central Bank of Nigeria is also supporting a number of research and development initiatives in the health sector. In all, a total of N233 billion ($609 million) in grants has been disbursed. The President in his Independence Day speech asked the question “Should another pandemic arise in the future; our question is simple; will Nigeria be ready?”

He then committed to supporting pharmaceutical and research agencies to develop and manufacture vaccines locally. The President also reiterated his directive to the Ministries of Finance, Budget and National Planning, Health, Education and Science and Technology to work with Nigerian and International pharmaceutical companies and research organizations to enhance Nigeria’s domestic pharmaceutical capacity. He also noted that the Nigerian Sovereign Investment Authority is raising a $200 million fund for this initiative that will complement the Central Bank of Nigeria’s ongoing N85 billion Healthcare Sector Research and Development Intervention Scheme to support local researchers in the development of vaccines and drugs to combat communicable and non-communicable diseases, including COVID-19.

In our Economic Sustainability Plan, designed to mitigate and take advantage of the consequences of the pandemic, one of the cross-cutting issues identified for action was the development of Nigeria’s capacity to become Africa’s hub for the manufacture of generic drugs. Today China and India. A distant second lead in the manufacture of generics.

Both have large populations Nigeria will become the fourth largest nation by population by 2050. There is a strong case for at least being self-sufficient in basic drugs and net exporters to Africa. This will of course be private sector-led with an enabling environment in terms of availability of long-term credit, facilitating intellectual property negotiations with drug patent owners, etc.

As I close, I think it is important to say that the healthcare system of our dreams is ahead of us, we know what we want and what is possible. We have the men and women with the required expertise. What we need is more diligent and focused management. Only recently, the President established the health care reform committee which I have the privilege of chairing. That may well be an important vehicle for some of our dreams. Once more let me commend Dr. Adigwe, DG of NIPRD, and the innovative and hardworking team at the institute for their groundbreaking work despite limited resources, and for this particular initiative.

Well done indeed.

Thank you for listening.