The Director-General, Nigerian Institute of Medical Research, Prof Babatunde Salako, speaks with LARA ADEJORO on the challenges stalling research in the medical field and the way forward
How has your work been as the director-general of NIMR since 2016?
It has been a lot of work and challenges at the same time. I believe things have changed significantly because of the support we got from the government and from private sector players who have either donated money or have been kind to us by supporting our research activities and organising one event or the other, which has benefitted Nigerians. When I got to the NIMR in 2016, the institution was run entirely as an appendage of the Federal Ministry of Health; indeed, it is an agency under the supervision and control of the ministry, but the institution is an academic one and should be run like one, especially like the university because of the nature of its function as a quaternary institution, particularly research. Also, the career progression for researchers was not encouraging and many of them were leaving for the universities. Even though they were conducting research and supporting the ministry in one way or the other, there were stumbling blocks in terms of funding and career progression for them. We started by changing the narrative. For example, we made representation to the Head of Service, who opened up more director positions for us, and that was how we ended the stagnation that existed in the system. People began to love their work more because they believe there is a future for them. We started to provide some level of funding for them to conduct research and this was what changed the narrative within the institution. We went further to link them with the universities so that some of the directors, who are worthy of being appointed as professors in Nigerian universities, were attached to the universities and those universities were appointing them as professors based on their academic contribution to science. Again, this brought a lot of excitement. However, recently, we started losing quite a number of them again.
What led to that?
That was because many of them were going abroad and were not coming back. In the last three months we had about three researchers that left and many of them were involved in very sensitive projects. We have not been opportune to replace some of them, especially in the area of vaccine development. This is very disturbing and painful. There are many things that a research institution should have that we had to create because they did not exist before, like legal unit, grant unit, and communications and marketing unit that can deal with research results, patents, discoveries and innovations. We created these units to change the orientation of the staff. At the time I joined, we looked at how we could improve funding and we contacted the then Minister of Health, Prof Isaac Adewole, whom I knew as a senior colleague at the University of Ibadan, so it was easy to walk into his office to say we needed more funding and gladly, he increased the budget envelope for the NIMR. From then on, we were able to create internal grants for researchers, we supported conference attendance and provided pre-doctoral and postdoctoral funding support for those who were running their doctorate degrees.
What should be the collaboration between NIMR and universities?
Part of the functions of NIMR is to fund health research in the universities and other health research institutions to assist the nation in solving peculiar health problems but we were not able to do that effectively. However, from the increased funding, we created funding support for PhD holders. We started with N500,000 per year for three or four years to assist them in the completion of their studies. Now, we are at N1m per year. Between then and now, more than six of them have completed their PhDs and many are about completing theirs. They are all very grateful to the system for doing this. Some of the research projects that we have supported ended up with usable results, a number of them have become policy briefs that were sent to the ministry and some ended up in kits design.
What were the contributions by NIMR in finding solutions during the Covid-19 pandemic?
During the active days of the pandemic, in the early period, I must say that we suffered a lot before we got Covid-19 funding. In fact, we had to beg the Nigeria Centre for Disease Control and Prevention to give us one pick-up van, which they did. It was after that we got funding and were able to equip the departments with field vehicles. Now, we have field research in Ijede, a suburb of Lagos, which serves as our demographic health survey field where we did census and enumeration of all the people living in the area, determining their age, gender and occupation so that we can do surveillance of diseases that are common around the place and be able to get data to inform a future decision on such diseases. Many equipment that we lacked were purchased during Covid-19 because of the increased funding that came from the Federal Government. So, we now have a set of very important equipment in genomics, diagnostics and analysis that are not very common in Nigeria and this has increased the institute’s research capacity and capability. We have also been able to purchase field vehicles for all research departments and relevant non-research departments, and now we can go about doing population studies in communities.
What’s the update on the field research?
We have so far enumerated about 48,000 people and our plan now is to go up to 100,000. We have been told by a potential partner that if we can enumerate about 100,000 individuals, we will be able to turn the place into a clinical trial field where most vaccines and drug trials can take place. This will not just be an advantage to that community because the residents will get first-class and uncommon treatment, the institution will also get money from such trials when they are conducted in the place. There will also be job opportunities for the people of the area as they take part in research. There are not many institutions that have such a health surveillance field in Nigeria, so it is going to be accessible to all researchers who may want to conduct research, especially as it relates to drug/vaccine advancement. One of the most important studies we did during the Covid-19 active waves was a zero epidemiology survey in Lagos, Gombe, Edo and Sokoto states in conjunction with the Nigeria Centre for Disease Control and Prevention and others. The Africa CDCs came together to provide funding support in addition to the funding that we got from our budget, which was used to assess the burden of Covid-19 in Nigeria in those states. The information provided by that study informed certain decisions taken by the NCDC during the lockdown. We were able to establish the first drive-walk through centre in West Africa for Covid-19 testing and we tested for free over 52,000 individuals. If you do the cost at N52,000 per person that private facilities charged per test, you will appreciate how much the government spent through the NIMR during that period. Again, we were supported by the NCDC, which was providing some of the reagents we were using. It was then we designed and developed two Covid-19 diagnostics kits. One of them is what we use till today.
What about the ravaging Lassa fever and yellow fever?
The experience we had has led to the design of the Lassa fever and the yellow fever diagnostic kits. Recently, in the wake of the mpox outbreak, we also developed a mpox kit, which is now being used for an international study sponsored by the Government of Canada in Nigeria. We have sold one of the kits for about N30m as we needed to prove that we could design, develop and take our local products to the market. Currently, we are looking at hepatitis B diagnostic and viral load detection kits, and we are trying to design a point of care test for cholera. These are current research going on in NIMR. There are other researches we are conducting that are sponsored by the National Institute of Health. One is looking at HIV self-testing and the other one is looking at Human Papillomavirus as a cause of cervical cancer and the immunisation against HPV. We are also looking at fractional doses of three Covid-19 vaccines to find out if we can vaccinate people with half a dose of the Covid-19 vaccine, to determine whether both full and half doses of the vaccines can be effective. This is because at that time Nigeria did not have enough funds to purchase vaccines and the research could support rapid vaccination of our populace if it came out positive. We will soon conclude on that research even though Covid-19 seems to be slowing down.
Are there other interventions NIMR is doing to solve local health issues, because going by the name of your institution, expectations are understandably high, especially from people who understand your mandate?
We are also looking at reducing under-five mortality in Nigeria and we are currently being supported by the Bill & Melinda Gates Foundation to look at antimicrobial resistance on the effect of mass administration of azithromycin. Azithromycin has been seen as an antibiotic that reduces certain diseases in children, and it kills a lot of children, leading to high under-five mortality. This drug has been recommended by the World Health Organisation for use in countries with under-five mortality greater than 60/100,000. For us to be able to use that in Nigeria, we need to be on the field trying to assess the effectiveness of the drug in reducing under-five mortality and to see if we give mass administration of azithromycin to this group of children we will not be making worse the antimicrobial resistance within the community such that it will not be a case of gain one and lose one. These are studies that when we come up with a positive report, they will affect our policies on vaccine doses and prevention of deaths in under-five children in Nigeria. Beyond research, we also had significant infrastructural development. We have bought so many equipment and we have a servicing agreement with those who supplied them. We also built and renovated laboratories. We built a new clinical research centre because clinical trials require a boost in Nigeria as we were not able to participate in the clinical trials of many vaccines and drugs that were being used in Nigeria during the pandemic.
Why was that?
We thought that one of the reasons might be that we do not have enough infrastructural support to show the people because we had two or three groups that came to our centre to assess what we had and see where we could be involved in doing some of these trials. So, the clinical trial centre that we built is where we are running the Covid-19 and azithromycin trials. We are also equipping a new building to serve as our biobank where we will have a repository of data and samples collected on the field by researchers, which may be used in the future. Sometimes, many of the questions we want to answer may not be ready now, but when we eventually come up with new questions, we can easily fall back on these samples and data. Then, others can come to have a secondary look at the data and samples to help answer other research questions. However, this requires 24-hour power supply to keep the samples frozen. It is also useful in drug development. Pharmaceutical companies can approach the bank if they need to use some of the samples. We have made a lot of giant strides and if you visit the institution now, you will notice the ambiance of a research/academic environment.
Medical researchers have been talking about paucity of funds in carrying out research, will you say this has improved or nothing has changed?
There has been an improvement, but we are not where we are supposed to be. We can do better; one of the reasons we created the NIMR Research Foundation, which is a public-private partnership to support research and training, especially PhD and MDs. We are very lucky to get the former governor of Lagos State, Babatunde Fashola, to chair the foundation’s Board of Trustees and the 14th Emir of Kano, Muhammadu Sanusi; Prof Oye Gureje; Prof Oni Idigbe; and Mrs Moji Makanjuola as members. These very distinguished individuals have helped a lot in projecting the NIMR foundation and trying to get the public to donate towards its functions and activities. At the last count, we should have raked in over N300m for the foundation and the foundation has started training researchers. We do not have enough yet to start asking for training needs of PhDs in the universities. We plan to raise about N10bn and put it in a financial outfit that can manage the fund and we can use whatever we gain from that investment to run the foundation, but we are not able to get as much. However, we continue to engage the private sector; perhaps we need to do research evangelism coined by Babatunde Fashola to show the business community that research indeed is a business and that it is not just about donation, but it is about investment. Unfortunately, the return on the investment in research cannot come the next day; it may take years but we can let them know what they stand to gain if they invest in research. Research often leads to discovery, drug development and ideas that can lead to economic prosperity for whoever supports it. The foundation has trained the first set of its researchers and they are being followed up and assessed to see the progress they are making on what they learnt during the training.
Earlier in the year, you mentioned the need for a NIMR council, what is the essence of that?
The essence is to fund health research, because in most successful nations, they have research funding agencies to provide continuous funding support to health research. The United States has the National Institute of Health, the United Kingdom has the Medical Research Council of the UK, and South Africa has the SA Medical Research Council. But we don’t have that currently in Nigeria. We do have Tertiary Education Trust Fund funding research generally, but it is not enough. If we take a cue from what has happened in places like the US and UK and we create a medical research council, then we will be able to challenge our researchers to come up with ideas that can solve many of the problems that we have. For instance, nobody will come and solve the Lassa fever problem for us, even meningitis, cancer and many others. These are issues we need to approach through research and if we want to do that comfortably, then we need a funding agency that the government will support, not by foreign donors. It will still not be enough though, but it will be there and Nigerian researchers can find a place to go and sell their ideas for funding.
Nigeria is highly burdened with malaria, what is the institute doing to ensure that it has a vaccine or a product to cure the disease?
What we are doing with the health ministry is the entomology survey. It has to do with vectors transmitting malaria and we are looking at insecticide resistance, and how effective some of these insecticides that are being used to impregnate the nets have been. We have discovered that in the southern parts of the country, those nets are not effective and the mosquitoes have developed resistance to the net. What it means is that the government needs to find another insecticide to be used to impregnate the nets and that has to be discussed with the manufacturers and researchers to find a better and effective one. We have suggested that the insecticide should be changed. Now, we are also looking at the genetics of the mosquitoes and why they can develop resistance to the impregnated nets because this will help to give insight into how to stop the mutation or improve the kind of insecticide that should be used. It was in the process of doing this that we discovered a new malaria vector hitherto not found in the West Africa sub-region, the anopheles stephensi, which is an urban malaria vector. So, we thought the best thing to do is to map the country and find out if the vector is found in other parts of the country and to gather epidemiology data supporting the existence of the vector in Nigeria. It is an opportunity for us to try to see the kind of insecticide the mosquito is sensitive to and we think that this may be one of the reasons why the malaria eradication process is slow in Nigeria. We are currently working and trying to find funding to map the country for A. stephensi as we speak.
Recently, the National Agency for Food and Drug Administration and Control approved the R21 malaria vaccine, does the country have what it takes to store the vaccine when it is available?
The Covid-19 pandemic did one thing, beyond just killing or making people sick; it re-energised the government to realise the need to build capacity in the nation’s health system. A lot of storage issues have been solved by the National Primary Health Care Development Agency. I don’t think we have the issue of storage when it comes to the malaria vaccine. I believe the issues we may have will be cold-chain maintenance while transporting it from one point to another, especially the difficult-to-reach areas; and that may affect the potency of the vaccines. The vaccine, which is believed to be about 70 per cent effective, could be better with more research and design, but we are not doing malaria vaccine research. What we are doing is malaria parasite culture and sensitivity tests to antimalarial agents.
Nigeria is battling multiple diseases, how can this be addressed?
Government must fund research for those specific diseases that are ravaging. If they don’t put money into research, then we may not be able to generate new knowledge, new drugs, new vaccines and determine new approaches to treatment and prevention. If there is no funding, the door will be closed to all of these. People have talked about monitoring and evaluating the funding that is being given presently, which is in the purview of the institution and the government, so they don’t just put money, they also follow it up and assess how it is spent. This is what countries like the US have done. In the very early 1940s and 1950s, the US had a higher mortality rate from cardiovascular diseases, but because they funded the NIH and its 27 research institutes, the narrative has changed for the better. Today, funding from the NIH has contributed to a lot of Nobel prizes because of scientific discoveries. Many drugs that have been developed that we are using now are as a result of funding from the NIH. So, we have an example to show that if we fund and monitor it to get the return on investments, in the next 10 to 15 years, we will see improvements in our health indices. It will also lead to improved life expectancy and economic prosperity for the country.
There has always been the issue of funding for research. Why has this challenge remained under successive governments?
We need to approach the funders and those who appropriate money. We need to let them know the gain of research, which is not about making people well or preventing people from dying alone, but to also let them know that research is capable of improving the economic prosperity of a nation. When you discover new drugs, a new company may come out of it; the company will employ people, produce drugs, sell them and the owner/country will make gain from it. Our research can solve unemployment, it will also create jobs and make the economy get better. Imagine if we have a cure for HIV today in Nigeria, people all over the world will have to come with their dollars to pick the drug from Nigeria.
Some people believe the problem is the misuse of what is being released, what is the true situation of things?
That is why we talk about monitoring; the institution that releases funds has to monitor its usage. If we have a research council that is dishing out funds, then they will monitor it on behalf of the government, but if the government is the one doing it on its own, it doesn’t have effective structure to monitor it and that is why you need a coordinated body to monitor it so that the little the government is giving can be put into good use. Of course, funds will be given to the institution and not individuals. I agree that we need to monitor to ensure that the little the government provides can be accounted for.
Nigeria seems to have been left behind in major innovations in the health sector in recent times, like the Covid-19 and malaria vaccines, does it bother you that the country does not have any substantial input despite the many professionals and agencies?
It is one of the reasons we are poor as a country and why we have poor health indices. We do have researchers in the country and Nigerian researchers abroad who can be part of the world’s first-class group of researchers, but we need to back them up with appropriate infrastructure. For example, there is no 24-hour electricity and we are talking about storing samples. To keep a biobank, we will be spending a lot of money to keep it working, because there may be no regular power, so you need alternative energy. Several months ago, when we had a collapse of the national grid, we lost reagents running into millions of naira because we could not even back up with diesel, it was out of our reach. The small inverter we had could not do enough for all the freezers, so we lost reagents, we lost samples that would have been useful for us in the future and we had to start all over again. These are major challenges that only the government can solve. Despite that, we are still able to do certain things. We are still working on vaccine development, but all of these don’t have to do with funding support alone but also infrastructural support. When we get appropriate funding and spend appropriately and come up with the expected output, then we will be able to partake in global experience in drugs and vaccines development. The NIMR’s electricity bill per month is an average of N12m; other institutions’ bills are much more. Most practically find it difficult to pay and sometimes power cuts are inevitable.
What happened to about three Covid-19 solutions submitted to the government in the heat of the pandemic, have they been abandoned or work is ongoing on them?
This is one area I think we need the government’s support. We need our regulatory agencies to support registration of home-grown solutions, not necessarily to reduce standards but to encourage those products by whatever means they need to bring them up to standard and register them. The government also, having found that this is comparable to what is gold standard, should make a policy to support their use in Nigeria. When China and India developed their vaccines, they were giving them to their people, they did not go to seek approval from anyone for as long as their regulatory agencies were happy with the vaccines. If we do not protect our inventions, we will continue to produce things and they will not be useful to the country. We must learn to use our things rather than looking for dollars to buy from abroad. That is the only way research products in Nigeria can be used. We have to wake up and know that anything we produce in Nigeria needs the government’s backing to support its use here. Nobody will buy it from us if they don’t see that there is a market in it for them.
Under the new government, what must be done to ensure that Nigeria has self-sufficiency in technology deployment in the health sector?
Research leads to technology development and most of the technology that we have is not being developed by us, so we are still back to square one. We should fund research and monitor the funds, monitor impact so that the money does not go down the drain. We should continue to train our future researchers, who will continue to replace those who are retiring so that we can ensure sustainability for research skills in Nigeria. Perhaps, the thing to do is to look at what is now called digital health. There are many forms of technology and digital issues, people may not necessarily leave their homes before they access a doctor, at least to give them preliminary instructions on whatever is happening to them and what to do. Digital health will help to improve access to health. The challenge will remain how to regulate digital health practice in a country like ours.
