Akin Jimoh: 00:10
Hello, welcome to Science in Africa, a Nature Careers podcast series. I am Akin Jimoh, chief editor of Nature Africa. I work and live in Lagos, and I’m passionate about promoting science and public-health journalism, in my native Nigeria, and across Africa.
In this series, we explore the practice of science in this wonderful continent: the progress, the issues, the needs, and in the words of the African scientists who are based here.
In this fourth episode, we speak again to Professor Oyewale Tomori, a Nigerian virologist, who is well known for his media commentary of the COVID-19 pandemic. He previously worked for the World Health Organization and now acts as government adviser on disease outbreaks.
So how did Africa respond to the coronavirus emergency?
Oyewale Tomori 01:16
The epidemiology of COVID in Africa is different from what is happening in Europe and other parts. That’s number one. And I think we should have recognized that before we planned our response.
Unfortunately, as always with Africa, we were depending on the West to guide us on what to do.
But I must say that both the West and us were totally ignorant about COVID. Nobody knew what we’re talking about. We were gambling, we’re just acting on the spot, and we’re running after the epidemic. We’ll make our response based on what information we have. If it changes tomorrow, we change our response.
And Africa was following gullibly, just like that. But yet, we’re dealing with two different epidemics, because of certain factors, population dynamics in Africa, and all that kind of thing. So whatever disaster was happening in other parts of the world was not that pronounced in the African region, but it should not have been like what they did in Europe, but should have been according to what information we have on our own.
Akin Jimoh: 02:17
So there was a varied response?
Oyewale Tomori 02:21
Sure. It has to be, but we did it. Ideally, we should have looked at that environment, decided our response. But if you remember at the beginning, everybody locked down, whether you’re in Africa or wherever. Did we really need to lock down? I don't think so (bandwagon effect).
But it was bandwagon in which the leader was as equally as blind as the rest of us. So it was the blind leading the blind. That’s where we are with COVID today. You can see what is happening with the vaccination, and the vaccines are coming out.
We knew when you get a vaccine, this is you get protection, but nobody counted on variants to mess up all of the whatever you build up with your vaccination.
Akin Jimoh: 03:02
So what has been the response to COVID In Nigeria?
Oyewale Tomori: 03:05
One of the greatest errors that I keep saying we made was to assume that it was the government that will control the epidemic. It is not the government that controls epidemics. It is human beings, you and I, that control the epidemic. It is like taking the public out of public health. That’s what happens. So you sit down at the headquarters and we set up a committee just going to look at it and say, forgetting that there’s a human aspect of it.
The movement of the COVID virus is from man to man, not from government office. And if I get the COVID and I don’t spread it to you, it dies within me. And therefore we don’t have epidemics going on. I think we should have stressed that the most, the more important player in the COVID epidemic was the human, the public, not the government.
Akin Jimoh: 04:01
At the initial stage I mean, we know of lockdowns, palliative, and a number of countries becomes majorly corruption, and so on and so forth. What would you say has been done well? You know, looking at all these varied responses. What have we done well?
Oyewale Tomori 04:21
At the global level, I must place kudos to WHO in respect of what people are saying about that. WHO was flexible enough to adapt its response based on the data that was available. It wasn’t a dogmatic thing that “This is the way you do it, this is the way you do it.”
You remember when COVID started. Now you look at the clinical symptoms, the signs and symptoms of COVID. It wasn’t what we had when we started from Wuhan.
Now other things have been added. So people are learning along as we go. I think that flexibility was probably the most sensible thing that we ever had, to then look at it and say, Look, this is obviously new, there was a lot of argument whether it was aerosol transmitted or wasn’t transmitted by aerosol, and all that kind of thing.
And then. So the response was based on all those. So back to the situation in Nigeria, I think the first thing that COVID did was to expose the flaws in our health system.
You know, like when we started the ACDC said, “We had to leave three, four laboratories that could diagnose COVID in Nigeria”
Why should that be 60 years after independence? That’s the question we’ll be asking ourselves, I quite agree that COVID, eventually, I mean, ACDC, eventually …. And we are like about 140 laboratories.
But then you want to also see what was behind the building of those laboratories.
Did you actually need all the 140 laboratories that they built, or could you have done with fewer, better managed, than we are getting?
And the reason I’m saying is that if you go back to ACDC, their website, on a daily basis, you find a page with at least 40 to 50 laboratories that are no longer reporting.
Even now, on a daily and regular basis, every week, go and check their website. They will give you a list of 50 to 40, 40 to 50 laboratories that are no longer reporting. So why set out with 140 if one-third of them are not going to report a few months after you started?
These are some of the things about our planning that we need to look at. Did we really plan properly? How many laboratories do we need? Could we have done with fewer, and improve the access of the laboratories to the states? Those are things. You know, I mean, I think I hope we’re learning from what…. but unfortunately, many of the African countries, once the epidemic is over, we forget whatever lessons we learned. And then when your next one comes, we start all over again from scratch.
And my worry is that now there are only 40 laboratories and these facilities are not functioning in another is continuous, more with join and won’t report any more.
Even right now, if you look at the figures of yesterday, only two or three states are reporting, I think we are eight cases, ten cases or something. It is not because those are the cases. This is a measure of who and who is tested.
Akin Jimoh 07:17
And now we have the National Center for Disease Control in virtually every country across the continent. We also have the Africa Center for Disease Control, Africa CDC. Will you say that these are meeting the expectations so far? For the continent?
Oyewale Tomori 07:39
It’s a good thing they were set up. But it is not such an opposite your question. I would rather have an African Center for Disease Coordination, rather than disease control. We should leave the control of those things to the lowest level, to the local government level, to the state level.
And then at the apex, we have a coordination body, not a controlling body. And it’s a little different. Because when you are the controlling body, you are now putting all the bodies of the 36 or 37 states in the country on your head. If you’re coordinating, then you’re only dealing with all those issues at the different levels that require your assistance.
If we decentralize the control to the lowest level of local government, state level, then our national centres, African regional centres, will be in a position to assist, to coordinate.
Where are their flaws? Where are their problems? This is what you would be looking at, not taking upon themselves the issue of the controlling themselves,
Now this lesson, I think we need to learn from what has happened. I’ll give you a good example. You remember there was a time when Nigeria imported (I think it was) monkeypox into America.
The discovery and all this was done at the county level. That will be our local government, our local government. The diagnosis was done at the local government hospital the way it happened. The only time they ever came to the American CDC was when it involved international travel.
We look at where it’s coming from, this place, what planes they come by, who are the passengers. That was when the US CDC came in.
But all of the little things, everything, diagnosis, was done at the local government level. By the time they finished that one, they were able to control that one. And that’s the message I’m trying to say that we don’t need a National Center for Disease Control. We need a National Center for Disease Coordination.
Akin Jimoh: 09:40
You know, there is this school of thought that Africa has done well when it comes to response to HIV, response to Ebola, and a number of other infectious diseases, response to polio, which you are, you know, involved in lightly.
How has Africa performed when it comes to public communication relating to COVID-19, testing and treatment, research in itself?
How has Africa performed, you know, when you compare, when you do a comparative analysis between, you know, response to those other diseases and COVID?
Oyewale Tomori 10:17
You set your own standard for what is done where. If it took Nigeria 40 years to eradicate polio, (I'm just giving an example) and it took under countries 30 years to do it, or 20 years to do it, would you say you did well? I don't know. I mean, these are not what I’m talking to you about. The first time we were to get this. I mean, you remember the setback we had with polio. I mean, when we boycotted vaccination, we did all that. And then you jump up at the end in 2020 and say “Nigeria did well.”
Akin Jimoh 10:50
So boycotting vaccination is at the local level.
Oyewale Tomori 10:53
There was the idea local level and then came gradually an international thing we had to solve.
But then so at the end of that huge opportunity said, We did well, what about during that period of record, the number of children that got infected with polio, because you boycotted. So when we talk about doing well I think it is a relative term. That’s number one.
To do with the other issues. You know, I think one of the greatest problem that we had with COVID, I'll tell you, you know, when COVID started, outside, the interpretation for Africa was it’s gonna be a disaster, you're gonna have dead bodies on the road. You know, if they couldn't handle Ebola, and this is happening in Europe. I mean, imagine what will happen in a state of Africa.
So at the conceptual level of Africa, it was like, COVID is going to kill all of us. Then we didn’t see anybody die. And then the interpretation was that COVID is a hoax, because we’re not seeing a dead body. So when you say you are going to die and didn’t die, and so you are a liar.
Now you tell me, you come and take the vaccine for what I didn’t die of. It’s a bigger lie. And so these are the issues that come up. Exactly. We came in. Now, why didn’t we die?
It’s a combination of so many things. If you look at the people, check who are dying in Europe, the elderly people, 50 years old, who have comorbidities, diabetes, hypertension, whatever.
Who are the people getting infected in Africa? Look at our own population pyramids. The majority of us are below 50, young, energetic people, (both in Europe too).
These are the people who are asymptomatic. So unless you test them, you won’t know you have. So we’re not doing enough. yet. We˘re not. That’s what I’m saying. But I’m asymptomatic. So I don’t know when I have it, you are not testing me. But remember, when testing started, it was we didn’t have the regions. It was what they gave to us.
So you have to maximize whatever you had, the only way to maximize that. Let’s leverage it to all those who are sick only, or maybe closest reIation/contact of that person.
So that’s who we were testing. So we’re getting 20 instead of getting 200 because we’re not testing those who are asymptomatic, who are going about spreading disease all over the place. You know, those are the issues.
So when our figures were lower, it’s not really any further lower. And in fact, it’s been proven. When you look at the surveillance that was done up to every week, you'll find the numbers jumping out.
We started with about 20% in Lagos at that time. The next second wave was 40%. The last study we did was about 70% of the people who just had antibodies to COVID. Where were they getting it? So they were infected, but they were not dying.
So immediately that concept of death was as we dealt with COVID. And we did not see death. So this was a problem. And that’s what has happened.
And that’s what I was saying that it was left for us at home to sit down and look at our data. Should we have approached it the way they said lock down? Let me give you a good idea.
You say keep a safe distance. In most of our areas in the slums of Africa where you regularly see 12 people staying inside one room, how are you going to do safe distancing?
But yet in our environment, we don't have offices where everybody is under air conditioner. We are out there in the open, in our marketplaces, you know. So why are we not looking at that and say instead of Europe that is locking up because of the people who are in their air conditioned office. Is it the same as in the market street when the sun is blowing and scattered wherever it is there?
Akin Jimoh 14:42
Compared with Europe and the US, the COVID-19 pandemic resulted in far fewer deaths in Africa.
The reasons are multifactorial. First, demographics. Elsewhere, most mortality occurred in the elderly, when in Africa the average age is much lower, Then climate. It’s possible that more temperate zones didn’t suit the virus. And then genetic explanations, and generally better immunity to disease.
It could also be that deaths were under reported. But as Professor Tomori says, there was a ripple effect of early lockdowns that will also have played a major part in saving African nations from more serious consequences.
In Nigeria, like many other countries in the world, the pandemic exposed flaws in the health system, and faults in the way that national government reacted to these unprecedented events.
Next, I ask Professor Tomori about how science can or should also contribute to the pandemic policies.
Is there an implication in that in terms of our research, research advice, you know, to government? Or what to do? You know, are we contributing in that line in a way that government will do a policy that will say “Yes, this is the way we are going, and is backed by research.”
Oyewale Tomori 16:16
We’re doing research for the world, not for ourself. Although we are part of the world.
We’re neglecting that part of us in our research, everybody’s doing, everybody’s doing whatever.
Are there other things in your own area that are actually preventing COVID? Are we making lip service to that kind of research? Simple things like I just mentioned.
How easy is it to spread COVID in an air-conditioned office as compared to outside air? Those are the kind of things we should be looking at? And then so that we provide an address to our government,
Should our government have locked down? It should come from us, from our research, not from what they are saying in Europe. It should come from us and say “Yes, we have looked at it and there was no need for a lockdown.”
If you do this one rather than say lockdown, we say “Avoid areas where there’s gonna be congressional people, like churches, like parties, like all those things.”
If you put an emphasis on those, ok, don’t go to big parties. Because you know, you can't “I’m gonna start dancing or singing.”
Forget it. You cannot wear a mask. Therefore, those are the areas we should have isolated.
Akin Jimoh 17:27
Is it possible for us to lock down, you know, the continent, in terms of not letting people come in?
Because it was a point that certain countries were noted, that should not come attend to the US and so on.
Is it possible for us at the African level, at the African Union level, to say that, yes, this is happening in Europe in these places. Don't come.
Oyewale Tomori 17:49
The decision to lock down is a country decision. It cannot be continental. Every country must look at his own situation. I mean, for example, it’s not everybody coming, let's say there’s a problem in India, Indian people don’t go to every country in Africa.
Therefore, each country will look at his own and see the local response. And that’s..so we can’t really have a continental approach to that.
Each country must do their own and look at their own situation and say, “Look, don't come from here, or go from here”. Otherwise, even South Africa, we’re not going to let them come into our place.
Akin Jimoh 18:24
There are other emerging infectious diseases coming up in the future. Are we prepared?
Oyewale Tomori 18:29
No. We are not. From what I see we’re not. And I’ll give you the… Well, maybe we'll learn a few lessons slowly like DR Congo. They are doing well with Ebola, they are managing repeated Ebola, of course, in Guinea, where (we’re lucky at the time), there was a second case of Ebola in Guinea, they perform creditably well.
But the longer the interval between epidemics, the more we’re relaxed and the less prepared we are. I think we need to get that information to our people, that the liberty from epidemics is eternal vigilance. It’s not a holiday thing. We go on holiday from surveillance. We can’t dare to do that.
Akin Jimoh 19:22
So liberty from epidemics….
Oyewale Tomori 19:24
….is eternal vigilance. Yes. So that means you know you the only way you can is you’re constantly in your surveillance is in place. Your surveillance cannot go on holidays.
It has to be a regular thing. Unfortunately, this side of the world doesn't understand your surveillance is good, and there's no epidemic then don't even see what you’re doing until the epidemic comes.
But then we don’t want to wait for the epidemic to come. See what happened with COVID and the way the world was thrown in disarray. But then you lose that.
And then I also say one thing. Global health security is anchored on national health security. If, I mean, epidemics don’t start all over the world at the same time. It starts from a place. Where you’re going to set up, I don’t know, therefore, each country must prepare the epidemic is going to start from you.
Akin Jimoh 20:12
Just like in treatment, you don't the reference system, you know, from the lookout, you know, to be secondary, then to touch and to specialize to even global.
Oyewale Tomori 20:23
So the starting point must be as strong in surveillance as the highest level.
Akin Jimoh 20:30
Do you have hope that Africa can respond to public-health crises in the future, especially when it comes to response to diseases like COVID, that requires vaccine?
Oyewale Tomori 20:44
I have to have hope. We all have to have hope. Otherwise, we give up. It is the hope we have that is making us to talk what we’re talking now. Where did we go wrong? How can we improve, because whether we like it or not, whether we have hope or not, the epidemics are there, the pathogens are there, they are there to infect us.
So it is the hope we have that we do well, that pushes us to do the right thing.
We must continue to have that hope. The only person that should be hopeless, is the one that is dead. Of course, he had nothing else to hope for. But each of us still alive, we must have hope that we can do better than we did last year. Otherwise, I will not … see the generation of my parents. What do we want to do? I used to give a good example, the house that my father had. Is that the house I want to inherit?
No, the official number of those who survived is about 37. But he knew in those days of childhood mortality, you must have lost almost the same number.
Akin Jimoh 21:55
He was like Sullivan.
Oyewale Tomori 21:58
He was close to that. Listen, I’m not going to look. I don’t want to inherit my father’s house. Nor do my children want to inherit where we are now. Because right now, the data, please know that they didn’t want to inherit even their own house, because this will not be better.
That’s the hope we have. And we keep pushing on and say, “Look, you know, this will be better for the future generation than for me.”
Akin Jimoh 22:24
Can Africa produce its own vaccine? Locally looking at all the innovations and experiences from the past.
Oyewale Tomori 22:32
Nowhere. It’s sustainability that’s the problem ? When you have different governments that have different opinions, different policies, and cannot sustain what you have, you know, building upon what you have, that’s what is happening.
Akin Jimoh 22:45
Are there examples of African Congo that are producing….
Oyewale Tomori 22:47
Let me start without going too far out of Nigeria. There is a Veterinary Research Institute in Rome. They've been producing vaccines since 1924. What happened? How did they do it? Yep, I was producing vaccine. Yes, there are some in Lagos. Yeah, in the Lagos one until we had changes of government and other because. Why didn’t you change your government affect? Affect vote?
These are the questions we'll be looking at. What did they do do to be able to maintain that that's what our scientists should be looking into. What lessons do they have from the one vaccine?
But there are other countries have been producing vaccines before, you know Senegal, and the yellow fever support system, I knew them for a long, long time. Yes, they are producing (Senegal).
But if you look behind that, and I keep seeing it and as the thing that when you say we see we have no community of people.
Without the Institut Pasteur being involved in what is happening in Senegal, there probably won’t be producing vaccine today. So why, what is what is the Institut Pasteur doing that we need to do here? If your other countries in Africa in another path, yeah, much better than us, Tunisia, Algeria.
And you see what they're doing. They’re much, much better. Let me put it that way.
They’re producing vaccines, maybe not the same type of vaccines. South Africa is doing well now. So let's hope in Africa, but then the greatest error Africa will make is for each country to start producing vaccines.
Because you know you have to control the market. And unfortunately, 4–5–10 years ago, there was an African vaccine manufacturing initiative. You go around and say look, on a regional basis. Let’s have vaccine production in Africa, not every country producing vaccine.
Tunisia you produce x, Senegal is already producing yellow fever. So keep producing Nigeria, you produce x or y we will buy from you.
So when we need the yellow fever you buy from us. So that way sustainability is there. So all of Africa yellow fever vaccine will be sourced from Senegal, you know, all of Africans, whatever whatever Nigeria's produce is sourced from Nigeria, then those things are valuable.
And Africa can be self sufficient in every vaccine, but at least 1-2-3-4. And when you have something, when it comes to negotiation then you can negotiate, if I have x vaccine, or you have y, that we're gonna use that to negotiate. I don’t have that vaccine you have. Well, you can tell me whatever condition you want to say you because I don’t have anything.
Take the example of what happened when Britain decided that knew they had this red, amber green, you know, for bringing people into Europe, and the rest of us who were using COVID, which they didn’t make in Europe, were in the red zone.
And we couldn’t go into you because we’re using COVID made in India. So what did Africa do? Africa went to Britain and accused them of inequity or racism.
What did India do? Me I have COVID vaccine Coffee, you have coffee, whatever, if you don’t take my coffee here, I will take your coffee, Britain is capitalistic and different to the rest of us who are using convenience began to ride on the Indian train to London.
So you know, this is the thing, you have to have some. No, you can’t go to the negotiation table with nothing. When you go there with your raw materials. When you get a bring nothing, you get nothing.
That’s it. So there is hope. There is hope. There has to be hope. I think I keep saying I should not be talking to you if I have no hope. And we should not be discussing why we're dissolving it. There's no room for us in Africa, there has to be hope. But it is the human being who makes sure that that is translated into reality.
Akin Jimoh 26:44
If I was to take one piece of advice from this conversation, it would be liberty from epidemics is eternal vigilance. There's much work to be done to avert another health crisis by seeing the wheel among African scientists, such as Professor Oyewale Tomori. Is there to improve national and Pan African policies for the future.
Now, that’s all for this episode of Science in Africa podcasts. I’m Akin Jimoh, chief editor of Nature Africa. Thanks again to Professor Oyewale Tomori. And thank you for listening.