‘Why Lassa fever vaccines have not been developed’

Prof Idris Mohammed is a professor of medicine and immunology, and a foremost scholar in cerebrospinal meningitis and other infectious diseases. Mohammed who is also a past Chief Medical Director of the University of Maiduguri Teaching Hospital (UMTH) and a life fellow of the Royal Society of Medicine, United Kingdom, speaks on COVID-19 vaccination and […]

Prof Idris Mohammed is a professor of medicine and immunology, and a foremost scholar in cerebrospinal meningitis and other infectious diseases. Mohammed who is also a past Chief Medical Director of the University of Maiduguri Teaching Hospital (UMTH) and a life fellow of the Royal Society of Medicine, United Kingdom, speaks on COVID-19 vaccination and how to tackle infectious diseases in the country among others.

There is still widespread hesitancy and misinformation about COVID-19 vaccines despite the third wave and detection of the Delta variant in the country. What do you think is the way out of the situation?

Rejection or resistance to vaccination have been there for a very long time. It is that resistance that has been extended to COVID-19 vaccine. When the vaccines arrived in Gombe, we gathered all traditional rulers, all the emirs, commissioners and the governor, we were going to take the first shot, but one particular traditional ruler raised an alarm that it must be stopped because

he read somewhere that there are some side effects.

We also had meetings with religious leaders and still met resistance from some Islamic Ulamas. One of the most vocal ones said he was never going to recommend it. But luckily for us, he was invited to Saudi Arabia for a seminar and one of the conditions was that he should show evidence for vaccination. So he had to submit himself for vaccination twice. I did not know that had happened until one day I met him in the mosque. Someone said the Imam is calling you so I went to see him, he said ‘Professor that vaccine is very safe. I took it and see I have no problem.’

So, resistance to vaccination is based on ignorance and conspiracy theories because even when we administered the meningitis vaccine they said there was HIV in it and it can cause family planning. It took five years for us to convince them that it was not true. So the media should help us to educate people about their resistance to all newly introduce medications.

With new vaccines, you have to be vigilant and pharmacovigilance is one of the most important ways to detect early side effects so that we will take action against them.

How were you able to secure administration of cerebrospinal meningitis vaccination in the country?

argest epidemic of meningitis in history was recorded in Nigeria and that is because of our carelessness. We were the first to do mass vaccination against meningitis in 1977 or 1978 in Bauchi State.

While I was in the United Kingdom, I read somewhere that there is a polysaccharide vaccine that can terminate the meningitis epidemic. However, because the polysaccharide vaccine is seen as not effective, the World Health Organisation (WHO) refused to advocate for a vaccination with that polysaccharide vaccine.

It was the same vaccine that we used in Bauchi State in those days, under a military administrator. He gave directions to ring the manufacturer in Paris, France. Within two days we got information that we could get the vaccine to cover the whole of Bauchi State for 280 thousand pounds and that the vaccine will be delivered within one week. Believe me, they kept their word, delivered it in one week and in three weeks we vaccinated the people and the entire was epidemic terminated promptly.

That encouraged the neighboring states to do that routine vaccination and for about ten years we never had an epidemic of meningitis.

Later people pulled back and became unconcerned and that is why we had the large epidemic in 1996 where more than one million people were infected with 12% mortality. That has never happened in the world before and the WHO then raised an alarm that they had written in their books that mass vaccination against meningitis is not recommended even in areas of high infection and death.

When our report came out, they said well this is just one incident let’s wait for more of them. That was when the severe epidemic came and that was when so many people were affected. You know for every one person reported, there were ten unreported. So in fact, we were talking about 10 million Nigerians infected with about 120,000 deaths. That raised an international alarm and a group of scientists was able to go to Bill Gates to say that there were some Africans who have been showing that the Polysaccharide vaccine can stop meningitis but WHO  has refused on the ground that the vaccine is not effective.

Actually, polysaccharide  are not effective enough because they are T cell-independent; they are to generate immunological  response so that if you are injected with the polysaccharide and a person gets infected the body does not recognise the organism so it does not amount to an immune response. That is why WHO rightly was skeptical but then it showed if you vaccinate twice it will be effective as a vaccine.

In any case, those people persuaded Bill Gates to donate 70 million dollars to produce the vaccines. And since 2010 when it was introduced till date, we have not heard of a massive epidemic of meningitis anywhere in the world.

So you advocate for massive cerebrospinal meningitis vaccination in endemic areas?

Yes, actually and with this new vaccine there is evidence that if you vaccinate twice you do not need to vaccinate for another five years.

What is your advice on handling the Delta variant in the country?

The advice will be along the same line with handling the other variants. The Delta variant of course is highly infectious, deadly and spreads very fast. This is the one that affects children far more than the first newly described COVID-19. People should redouble their efforts and protect themselves from getting COVID-19. They must fully observe the four cardinals principles of prevention. That is social distancing, wearing of a mask, hand sanitation particularly, those aspects.

And now that we have a vaccine, thank God the AstraZeneca vaccine has been found to be highly effective against the Delta variant, they should get vaccinated. You know the Delta variant started from the country where AstraZeneca was produced.

Overcrowding is a very critical issue in this. Because Nigerians I have to say, are not very disciplined. If you say a meeting should not contain more than ten people, you will find a thousand and if you say they should keep four feet apart they will be rubbing shoulders around, and they will also be speaking to each other without a mask and coughing into people’s mouth.

 Lassa fever is another public health concern in the country, despite the mortality and cases recorded, the country has continued to witness outbreaks annually. In fact, over 50 years after the disease was discovered in the country there is still no vaccine for it. What do you think is the way out?

We are still looking for the Lassa fever vaccine, HIV vaccine and a whole lot of them but have still not succeeded. The problem with Lassa fever is that it is highly infectious and very deadly. So those who deal with it have to be twice extra careful if they need to be 100% careful, they should be 200% careful handling the samples.

But the problem with vaccines development, first of all, is that pharmaceutical companies need to spend a minimum of $150 million for one vaccine, and that is for a cheap one, and yet you may not even succeed. So with Lassa fever, it is not easy for companies to handle sending samples from patients from West Africa to Europe to use the serum to extract the antigens against which they will prepare the vaccine. It is time and money-consuming as well. So there are very many reasons why the vaccines have not been developed.

With respect to HIV, the virus undergoes a change every now. The particular infectious agent changes it outer body character every now and then, so if you prepare a vaccine today against the prevalent organism by the next six months it has changed its outer code. So, the vaccine you have prepared will not be effective in that one, so that is the primary problem that HIV vaccine developers are facing. That is why; they have not made much progress despite the fact that the National Institute of Health (NIH) has spent billions of dollars trying to find this vaccine.

As an immunologist, do you think Nigeria has harnessed the gains in the field of immunology?

Unfortunately, the answer is no. Nigeria does not give enough support and funding for research.

How does research benefit the health sector?

The Nigerian government and the population at large need to know the great importance of research in development. Research leads to innovation, innovation leads to progress and unless you conduct research, you cannot innovate and you cannot progress. So research, development and innovation are the keywords in the development of any country and that is why we are left behind. The developed countries gave the money and have the will, we do not have the money and we do not have the will and that is why we are far behind.

Secondly, people should learn to accept new medications when they are introduced and not unnecessarily be suspicious of the composition. Those who developed the research must have looked at all the potential complications and found that there are no serious ones to affect human beings before they are introduced in the country.

What do you think Nigerians can do in terms of emergency response and preparedness given our background of epidemics and now a pandemic?

For about four years I was deputy chairman of the ministerial committee on emergency preparedness and response. The minister was the chairman and in his absence, I chaired the committee. Despite 60 years of trial, Nigeria’s effort of developing an emergency preparedness and response mechanism has failed and till date, there is no proper emergency preparedness and response in place to address epidemics or pandemics that occur without notice.

That is the truth of the matter, but with the establishment of the Nigeria Centre for Disease Control (NCDC) and also with greater awareness that has been brought about by COVID-19, people are now appreciating the need for emergency preparedness and response and I hope that we move forward from then on and make progress.