Oyewale Tomori is a professor of virology, educational administrator and former vice chancellor. He is a fellow of the Academy of Science of Nigeria, fellow of the College of Veterinary Surgeons of Nigeria and fellow of the Royal College of Pathologists of the United Kingdom.
Mr Tomori is currently the Chairman of Biovaccine Board, the company commissioned by the federal government for local production of vaccines in Nigeria, and a board member of the Global Alliance for Vaccine and Immunisation (GAVI). He led the development of the Africa Regional Polio Laboratory Network and has been an active researcher on Lassa fever in Nigeria for the past 49.
In this interview with Ayodamola Owoseye and Nike Adebowale of PREMIUM TIMES, Mr Tomori speaks on the challenges in tackling diseases such as polio, yellow fever and viral diseases in the country. He also talked about the challenges Nigerian scholars face in the course of their works.
PREMIUM TIMES: You have been an active participant in Lassa fever case management in Nigeria for the last 49 years. What is the country still not getting right in the management of the disease?
Tomori: Once the foundation, the basic things are not there, good governance, it affects everything we do. It is not just about Lassa fever, it affects education. It affects the normal way of life. I wouldn’t have gone to school if not for a governor that introduced great things for the people. In Awolowo days was the time when there was no oil. We only had groundnut in the North, cocoa in the South and palm oil in the East. But the little they had, they managed the money well. I am not saying they were not stealing but they managed our money well. And that is why the whole Western Region then, could end up having free primary education which encouraged everyone to attend school.
So, the number one thing is good governance and that is why it is affecting everything we have done, including this Lassa fever disease we are talking about. Lassa fever came in 1969, which is going to be 50 years next year and there is going to be a conference tagged “50 years of Lassa fever in Nigeria” January, next year.
Before then, we were managing and taking good care because the hospitals were good, disease surveillance were okay. But somewhere along the line, just after the civil war, everything went crazy. I guess there was too much money that came to us too suddenly and too fast and then we lost respect for the good things. We abandoned those days of integrity that we had and so that is why it has affected everything that we have done from Lassa fever to even the roads, to building somethings we have around us. So that is what has happened.
PREMIUM TIMES: This year’s outbreak was the largest so far. What measures should be put in place to effectively curb the spread of the disease in the nearest future?
Tomori: I’m glad you said largest so far because we do not know what next year is going to bring. It may even be larger than this because we have not put in place the things to prevent what we are talking about. The good thing about Lassa fever is that, it is a disease we know occurs every year. If you check the record of the ministry, we have about 10 to 20 cases every month reported from different parts of the country. And then, in the dry season we have this big upsurge which will start around October, November and go on till about March before the rain starts.
Being the largest, it had been coming on us gradually and we were not taking note of it. In the early days when Lassa fever started, just in about three or four states where it was occurring, like places we call the old North-east. But then in the last 10 years or so, we have had more occurrence in more states than we had before. Now the average is between 20 and 25 states report Lassa fever every year.
A lot of people are thinking, is the virus changing or whatever? But I do not think it is. If you know the epidemiology of Lassa fever, it is a rodent borne disease. The rodent which are associated with Lassa fever are actually found in farms, especially in the North. If you have been to the North, you will find that their houses and storage silos for corn are built almost side by side. During the wet season, the rodents have enough food out there to eat. As we burn the bush, and store the grains inside they come in to invade the houses and it increases the contacts.
This in turn contaminates foods if they are not properly stored. But now, we are speculating that the population of rodents have increased particularly when you look at the environmental condition in the country. In those days, everybody cleans their house on a daily basis but now, we wait on a monthly basis. While waiting for the monthly environmental, you pile up refuse which attracts more rodents. Invariably, a lot of the cases starts in the rural areas and then, occasional cases comes into the hospital. So things are involved now.
First, our surveillance is not that sensitive enough to know when we reach our threshold. And then, we are not making use of our data. Over the years, we have gathered enough data to be able to say, very likely Lassa fever is going to start in October. I would have expected that as part of the national day celebration of October 1st, one of the things we do is to get ready for Lassa fever. Alert the people about the coming of the disease, so they need to prepare. Tell them what to do to prevent the disease, like taking care of their environment and making sure there are no contamination with rodents.
Doctors are wary because when these fever cases come in from the rural areas, especially at the beginning of the dry season, there should be no thinking of ‘could this be Lassa?’ But usually, you do not get that one. At Ebonyi and some few other states, doctors died from Lassa fever because they don’t know what is coming in. They operated on these people, thereby getting exposed in the process. They do not practice infection control well, which is a normal thing. Before you touch any patient, put your gloves on, wear your face mask; but the government will not provide all these.
In 1999, we had the most horrific situation in a place called Abombisi. There was a case in Aba and the doctors there closed the place. Some of the doctors were brought to Owerri, one of the patients named Peace Mba was ill and went to her place called Abombisi. There was a young doctor, who set up a private clinic in the town so anybody that is sick visits the hospital. So Peace came in with Lassa but because of the poor system of medical practice, the disease spread and even the doctor got infected. I think they lost about 19 people over a period of three to four weeks. So the hospital had to be closed down.
Yet, doctors have not learnt their lesson of simple wash your hands. We were doing that during Ebola but why are we stopping it? I think it is because we lost respect for Lassa fever. Until we improve the people’s awareness and put other things in place, we will continue to have Lassa fever.
PREMIUM TIMES: You once said there was meant to be three Lassa fever management hospitals in Nigeria before this year, but only Irrua specialist seems to be functional. What happened to the others? And is the one in Irrua really functional?
Tomori: You cannot find a better hospital or more dedicated group of people than those at Irua. Everybody takes their case to Irrua for diagnosis. Those guys are there working day and night. One of the reasons you know they are doing a good job is, if you read about doctors dying from Lassa, it’s either from Ebonyi but you will not hear anybody died from Irrua and they treat about 40 to 50 cases at a time. There is no time you go in and will not find a Lassa fever patient.
That is the kind of team we are to have in Maiduguri. The idea was to have one laboratory in Maiduguri and the other, Irrua. Lassa fever came from Borno State, so there was this idea of putting it at that location. But they don’t have much cases anymore compared to that of Ekpoma, Irrua. There was a building which the government was supposed to expand in Irrua because of the large number that comes there but that building has been abandoned for the past 10 years. With so many cases coming in this year, they had to convert an incomplete building to create more hospital beds. Again these are some of the issues about the government. Irrua is the only competent place for diagnosis in this country. That is a cool spot for the country.
We could have done it in any of our places here in Abuja, because if someone has Lassa fever in Gombe, why take a sample all the way to Irrua? If we can get one more hospital in Abuja and one more in the north, then the access is easier than everybody going all the way to Irrua for diagnosis. So if we have had same establishment in Maiduguri, more people would have a chance to survive.
PREMIUM TIMES: Nigeria has of recent relied majorly on international partners and western experts in coordinating disease control. Is it that we don’t have enough specialised personnel to handle disease management in the country?
Tomori: We have more than enough capacity, human resources to deal with disease epidemic in the country. It is just that a lot of Nigerians are going outside. We were dealing with disease epidemic before. Each of the states had its own disease surveillance department, epidemiology. So problems were sorted before it became federal. Federal were only to provide support after they are not able to handle it. So now, all the states abandoned their responsibility and it became a federal thing and then, the federal was overwhelmed.
Nigeria turns our experts into novices because we don’t give them the resources and environment for them to function. You can bring a doctor from Harvard into my village but his degrees from the university will not make him perform any miracle, because he requires certain things to be able to do the work. So we have abandoned basic essentials, we have not provided the basic infrastructure for proper practice. Even though we have the experts, they cannot function.
There was a problem about laboratories in the country, and of course, typically my country calls WHO. WHO sent somebody who came in about five years after I joined the organisation and worked with me. I advised other African countries about laboratories and now my country is calling somebody from outside to do it. This is what I am saying. We have people who have the experience but if we don’t have the resources. But when he goes from WHO, he will be given everything he requires. He will be given cars to go around and also provided with reagents. But we don’t give that to our people and yet, they say we are not competent. We have no respect for our own experts, we don’t provide resources for them to function and that is why we are where we were.
Look at the issue of GAVI funding, how much are we asking for? We shouldn’t be with GAVI. We should be the one giving GAVI money, if we spend our money well. Even the money GAVI gives to us, we misuse it. How much is GAVI putting in for the 10 years? About $1 billion. But Nigeria is putting $2 billion and nobody is talking about that. This shows we have no respect for ourselves. I tell people that, if the donor can do the work without you, they won’t call you. They will do everything without you. You have to also recognise the expertise.
Many of us forgets our contribution and focus on donor money. But when you break it down, again what is donor money? They give a billion and will use $800 million for vaccines. They produce these vaccines from their country. This tells that we also go to improve their industry, which is what we never think about. All the consultants that come to the country stay in Transcorp Hotel. Most consultants don’t even know anything about what they do and then you put them in hotels. The payment for each day they spend is all part of the $1 billion they are giving us. GAVI has been boasting that they gave us $800 million over a period of 10 years.
That was during my first meeting GAVI. The amount is nothing compared to Dasuki’s $2.3 billion (amount for arms procurement former National Security Adviser allegedly mismanaged). So what are they boasting about? Add up all Magu has recovered, it’s more than what the donors are giving us. Because we have misspent our money, out of our $2 billion Nigeria will be borrowing money from World Bank and few other people to put up. So we don’t need donor money, we can do all this with our money if we spend well.
In those days, we had good education standard. Now instead of looking at creating 180 universities in 10 years, we could have concentrated on the ones we have. Some of the private universities in the country have not had more than 200 students in the entire school but we don’t think.
PREMIUM TIMES: We were saying that the state used to take care of their epidemiological challenges some years back. Is it that they don’t have enough resources to channel into that anymore? Maybe that is why they are leaving it for the federal government.
Tomori: In those days, in real time of federalism when we had Western Region and Eastern Region, they were a little of autonomy but over the years, things have changed. Lagos State doesn’t really need anybody’s money because they do their taxes well and also their resources. Many of the states are not enterprising enough, they can raise enough money within for their legitimate needs. Each of the states can raise enough money within their states through taxing and other legit means. When a governor goes to put up the statue of Zuma in his state and in Zuma country, he is being prosecuted for fraud. And this same governor will not pay his workers salary. Yet he puts up the statue of a thief!
So people say states do not have money but the truth is, they have money. In those days, states and even local government areas have health department. Before it even gets to the state level, the local government level has already sorted it out. It is only when it is beyond them that they call the state level. That is division of labour. I think if most states manage their resources well, they can provide basic essentials for their people. They all depend on the allocations from the federal government, yet they end up building hotels with the money. Good governance includes accountability, getting the right priority. Should you build a statue or should you build a school? In most of the governor’s houses, you find 10 to 30 cars and all required is just one for field work for health workers to go to the field when there is an epidemic.
PREMIUM TIMES: Polio eradication is a priority for the country, and you said Nigeria is the only country in Africa that has not yet interrupted transmission.
Tomori: Nigeria is the only country that has not yet interrupted transmission. We cannot tell when polio will be interrupted in the country because we don’t know how many people are yet to be reached in the North-east. No surveillance is being done, so we do not really know, until we clear and have access to that place before we know when we are finishing. You know, when the federal government took over certain parts like Gwoza, it was then we found four cases of polio, which have been circulated four years before that time. So we do not know what is going on there.
So each time we say Nigeria has not had polio for the last 16 months, always qualify it in the area where we have access. So we cannot say when. But it is an unfortunate thing, because this is a disease we would have cleared in no time. Countries in Africa that has cleared polio did what is called supplementary measures. With two or three campaigns, they cleared polio. Their routine immunisation was 80 per cent and above, what it required was just a little supplement to mop up those who don’t have immunity. But when your country is having three per cent coverage, how much campaigns will you do to cover up for the remaining 97 percent? Routine immunisation has gone crazy for years and we are facing the repercussion now.
Before Boko Haram, we had the chance to eradicate polio but we misused the money. Even the people who go to the field to vaccinate, pour away the vaccine and tick their registers. Lack of integrity is also a major problem. States do not give the money required and when they give it, someone is stealing it, local government is stealing it. So long as that is going on, we will continue to have same issues that we have.
PREMIUM TIMES: Can we say there is no polio in any other place in the country, aside from the North-east?
Tomori: We have activities we check regularly to know whether we have polio. There is something we call AFP surveillance. Your surveillance will reach a level that you can detect every AFP case. Laboratories must be good enough to test any AFP case and know that this is AFP case but not due to polio.
The evidence of vaccination should reach virtually every child in the country. At least 90 to 95 per cent of the children in a country should be vaccinated. It is not only vaccination that protects children, good sanitation is important. How do people get polio? People defecate in a wrong place, the water flush it to your water system and it finds its way into the food. But if you have good sanitation, fewer and fewer people will have polio because they have been immunised and the rest of us are protected.
And gradualy, the disease will die out because there is no way to spread it. We can do that with polio and small pox. But when you have an intermediate vector, that is something else is doing the transmission between two people, then that becomes a major problem because you also have to take care of that vector. That is why we cannot eradicate yellow fever, we can only put it under control.
PREMIUM TIMES: If we are certified polio free today, and with the culture of laxity in this country, whereby immunisation level can drop, what plans do we have in place to keep the status and ensure the disease never resurfaces again?
Tomori: There are some countries we said are free of polio but in monitoring their immune immunisation cases, they are far below and they are been called back. So long as there is one or two countries with polio, every country must continue to vaccinate and keep the immunity level up. So it is a continuous thing. There was a time Nigeria went to Hajj and infected some people in Yemen, who took it back to their country.
PREMIUM TIMES: With your experience as a scholar and a field researcher, what lessons have you learnt from epidemic control in Nigeria?
Tomori: I thought we were wise but unfortunately we are stupid. The basic things we need are there. We have controlled epidemic in this country before, then why can’t we do it now? It is not because we do not know what to do, but it is because we do not want to do the right thing. We do not focus on what needs to be done, we will not provide resources to change these things and that is why we are stupid.
PREMIUM TIMES: On the slash of HIV budget, cancer management, and in fact the health sector budget suffered a major cut. What is the implication of this to Nigeria?
Tomori: Unfortunately, I have not read the full details concerning the cut in the budget. Like they said, they have to because they are representing your community and my community. But it is not enough reason to cut off essential things. Why would you want to put up 6,000 new projects in one year budget? A few are understandable but there are some essentials things that should be left. And that is why I said, I do not understand this batch of people. They are not putting it there because they want to work, but because they will go to the back to collect the money. Nobody is saying you must approve every budget the federal government brings but put some senses. For me, it is just to say that it is unfortunate that such thing happened. And people are saying, why should he sign? If he didn’t sign, it is the same people that will criticise.
They made a point about people not coming to defend their budget and that was the reason it was delayed. If I bring a budget to you and say I want to spend N600, and they call me to defend and I didn’t show up. That means you can give me whatever you wish. So why waiting for people to defend their budget? Give them whatever you think they need. Most of them, including the LGAs take whatever they are given because they go to share the money, this is one of the reasons I never worked with the government.
PREMIUM TIMES: There is the scare that the world will face another unpredictable epidemic, of which most countries are not prepared to find, stop and prevent its spread, including Nigeria. If this happens, can Nigeria see a way through?
Tomori: In most epidemics, there is always a way out even if it kills 200 million people. It is obvious that we are not prepared. Today it is Cerebral Spinal Meningitis, tomorrow is Lassa fever and so on. One point I will like to raise is, how did we succeed with Ebola? Because we were scared. The fear of Ebola made the government put so much resources to stop the spread of the disease. But they do not have respect for these other diseases because they don’t affect people at the top. Almost on a daily basis during the Ebola outbreak, the Minister of Health was always giving the number of cases because they were scared. Self-preservation made us deal with Ebola.
When Ebola came, we were very lucky as a country. Because if the sick person that came into the country got to Calabar which was his destination, so many people would have died. At the time he came, doctors were on strike so he ended up in a private hospital. Even at the hospital, it took them three days to discover it was Ebola. So many people got infected already, this shows that preventive measures were not taken. During this incident, they allocated over N1 billion but where is the money now? They have misused it again. So we are not ready for the next one that is coming. It is sad to say, but if another disease outbreak occurs my country will not be ready.
PREMIUM TIMES: What stage are we on vaccine production in the country?
Tomori: We must understand that vaccine production is not like drug production, or suya making. People’s lives depend on it. So extra care must be taken in ensuring that what we produce will not harm anybody. And to do that, you have to get yourself out of this Nigerian attitude of doing things. It takes about 10 to 12 years to produce vaccines. So far what the board has done is to identify what needs to be produced for the country. So we are working with NPHCDA on that.
So long as we are under GAVI transition, there is no way we can compete with GAVI . So we have to look out for the vaccines nobody is producing. Number one is, are there disease in Nigeria which nobody is producing vaccine against? Are there vaccines Nigeria is buying which are not being supported? These are what will determine the vaccines to produce and also there are two approaches. The partners we have are producing X vaccines in bulk, then we can bring it t to Nigeria and then finish it up. That is also a training programme for us when we finish our own.
In the interval, we can say this vaccine which nobody is producing is a problem in Nigeria, let’s work with that one. Or this vaccine being produced outside before, nobody is interested in it. Should we take it up? We need at least eight years to put the building in full state. So far now, the May and Baker have a plot of land in Otta where the factory will be built. We are in discussion with NPHCDA. Because, this transition issue we had to wait. If they would not support us, what do we do? It is now we know we will be getting their support, so we had to start planning with that in mind.
PREMIUM TIMES: So are you saying in the next 10 years, Nigeria will be able to stand and say yes, we are producing vaccines?
Tomori: I believe we can. Once we lay the foundation for integrity, commitment and accountability then we can make it. It is for the company to make up its mind. After all, drug companies are making money. But the major problem in Nigeria is succession.
PREMIUM TIMES: What is stopping us from having Lassa fever vaccine?
Tomori: Decisions about vaccines to use comes from outside. Nobody talked about Ebola until they had cases in some countries like Spain. But humanitarians say children are dying so they want to help but it is not for them to decide for us. It is not for GAVI to come take care of my child for me because when I was making the child, I didn’t call GAVI. China are making their own vaccines for their people to stop dying, they don’t want to sell it to you. And when they want to sell it to you, they get WHO approval.
But the first thing in their mind is that, I am not going to produce anything that will harm my people. Like in Emzor where one of the workers was caught on camera selling codeine, yet it affected the entire company. All that is required is one character to mess up. Someone is messing up in a company and you are saying you do not want to be a whistle blower? But when that person damages the image of your organisation, it affects you.