Professor Oyewale Tomori, President Academy of Science and, Chairman Experts Review Committee (ERC) on Polio Routine Immunisation In Nigeria, in this interview by Sade Oguntola, has decried the level of seriousness of Nigeria to health, saying it explains why Nigeria, since Ebola was discovered in 1976, is yet to come up with its cure, looming yellow fever epidemic and cases of polio.
Why has there been an increase in cases of diseases that were not around before and older ones also re-emerging; some of these diseases are transmitted also to humans from animals?
Things are changing because humans too are changing, our lifestyle has changed. Cases of zoonotic diseases, which are diseases of animal population, are also occurring because humans are encroaching into their environment. They have diseases among themselves and if you do not go there you do not get these diseases. There must be a direct contact with whatever thing that is in their environment.
Take the case of Ebola, which is the more current one, it is assumed that it is found in fruit bats and chimpanzees. The niche of the fruit bats had been eroded due to deforestation and so on. The cases found in places like Gabon have been traced to dead chimpanzees, which people used as their meat. Now in the ecology of the animal, whatever that has killed that animal, you may also contract. So Ebola virus is a good example of diseases coming to man because of his infringement on animal’s niche.
Many people assume that the current strain of Ebola circulating is the virulent one, is this so?
It is not really so. The mortality with the current Ebola is not as high as what it was in the past incidence. It was about 80 per cent in the past and we are getting about 50 per cent. If it was more virulent, it should kill more people. The death rate depends on many factors, including the person’s body immunity; the dose of the virus one gets; quality of accessed medical care and so on.
What could have happened in this situation is that in the area where Ebola occurred, Liberia, Guinea and Sierra Leone, their health infrastructures are almost zero. Soon after the war, they have not really recovered.
Also, the denial of the governments and the culture of our people contributed to the problem. First, when it occurred in Guinea, both Liberia and Sierra Leone said it is not their problem. And then the disease kept spreading to different countries. So there was the initial denial by our government. Even when they now found out that there was a problem, they could not cope. It was way beyond them.
Take the issue of the culture, when people get sick, you force them into a treatment centre, where they do not know or see what is going on in the centre, but the next thing is to see a dead body being brought out. So people are scared. Then, this is compounded with the fear that the doctor is also dying of the disease, too.
Of course, they say if cannot take care of their doctor, how can they take care of my patient. So, they will rather go and look for a traditional healer. All these are factors that helped the easy spread of Ebola.
Ebola is a disease said may probably be in existence for millions of years, looking at its family history. Is this true?
It belongs to the filoviruses, which are virus that are filamentous in nature. The earliest group to think about is Marburg, and then the Ebola group itself. Marburg has been in existence for quite some time, so also Ebola. Unfortunately, it is when you discover a thing that you say you have found it.
Like Lassa virus for example, it was first found in 1969. But there is evidence that way back between 1955 and 1957, missionaries who have been in Liberia had antibodies to Lassa virus. So Ebola virus could have been in existence for ages like any of these ones too.
First time it was in 1976 and if not for the fact that Belgium missionaries were involved, they probably would have gone and nobody will know that something happened because a lot of these diseases that happen in mothers village, nobody got to know.
Most of the diseases that were discovered in Africa, you will relate it to a foreigner. Take Lassa for example, American missionaries got sick when they went to Jos and that was how we found out; take Ebola, it was Belgium missionaries who were infected and you can name other virus.
These diseases have been occurring and affecting our people, but nobody cared about them until one expatriate comes and it becomes a big noise, which points to one thing: we do not care about our health. If Ebola had occurred in 1976 and we still do not have a vaccine for it, whose faults is it? If Ebola had occurred, say first in London in 1976, there would have been a vaccine for it now.
If Ebola had reminded where it was initially, without any spread, nothing would have happened. If we consider our health important enough, both the scientists and the government would take action about it both as a group and as Africans.
Does these explain the re-emergence of many diseases, including zoonotic ones?
It is possible for a new disease to re-emerge just as older ones might also reoccur when their control measures relax. Take measles for example, when there is up to 90 per cent measles vaccinate coverage, there will only be occasional cases of measles, and not an epidemic.
Now, if next year, the government does not buy measles vaccine or the funds for its vaccine is diverted into something else, because it is assumed that measles is no more a problem, there will be children who the routine immunisation will not take care of.
For instance, if there is 30 per cent immunisation coverage, for every 5 million children, you had only vaccinated 1.5 million children. At the end of that year, 3.5 million children have no protection against measles. Multiply that by another three years, you are talking of about 10 million children without antibodies and so why will you not get an epidemic?
So that is why diseases that we thought we had controlled come back. Control of any disease is eternal vigilance, if you have not eradicated any disease; you have to constantly be up pursuing it otherwise, it requires just a number of people bringing it back into that community. Where the vulnerable ones now becomes more in number than those who are protected, a stage is set for an epidemic.
Is that why we still have polio in Nigeria?
This year, we have had only six polio cases. However, we still have what is called vaccine derived polio in circulation, which brings the number of cases to about 20. Why is it a different story for polio? If other countries have controlled polio by doing proper high quality vaccination, we have not. In our country, the quality is not good; we are not sure whether the vaccines they have given are okay. We do not even know the number of our population to start with and so we do not know whether we are vaccinating every child. And once you have a population that is not protected, you will continue to have polio; this is what is happening in Nigeria.
Also, almost all election year is followed with an upsurge of polio cases and the reason being that the year before election, our government abandons everything, not just health, and all the money generated is channelled towards winning the election. Therefore, money is not available for vaccines, funds are not available for field activities and so if you take off a year vaccinating your children, you are going to have pay the following year with cases of the disease that is what is happening.
Currently, we have vaccine derived polio circulating which has been ranging since 2005 and we have not been able to control it. Nigeria has the highest number of vaccine derived polio cases in the world. And we do not talk about it. So whether it is the vaccine derived polio or the wild polio, the fact is that we still get polio cases.
The looming yellow fever outbreak, are we out of the woods?
No, the problem is still there. Yellow fever comes in circles and the circle is dependent on how many people are vulnerable. The last yellow fever epidemic was about 1991, but then what is our routine immunisation coverage like? The mosquitoes are still around and the virus is still around, all you require is one virus getting into the proper population and you have an epidemic coming.
How can Nigeria win the battle against these emerging diseases?
First, integrity of the government and the people. The government lies to us, and we also lie back to the government. Eternal vigilance must be there all the time. A very good disease surveillance system, it is like insurance. You do not realise the good of insurance until an accident occurs. So the thing is to keep insuring ourselves against that disease by having a good disease surveillance centre backed with good laboratories.