Important note: Information in this article was accurate in December 2000. The state of the art may have changed since the publication date. IAVI Report - December 2000 / January 2001
Akin Jimoh
Abuja — From 15-17 January 2001, over 100 scientists, policy makers and representatives from multilateral organizations gathered in Nigeria's capital city for a "Consensus Building Workshop Towards the Development of a Nigerian National HIV Vaccine Strategy." It was an unprecedented event for the country, marking its first meeting on HIV vaccine development and attracting a level of interest far exceeding even that anticipated by the organizers, the National Action Committee on AIDS (NACA).
An overwhelming consensus was clear from the start: Nigeria, the most populous nation in Africa, must place high priority on participating in HIV vaccine development. That agenda dominated the rest of the meeting, and by the time the workshop was over, participants had mapped out the major elements of an interim plan, including specific goals and timelines. The finished plan will be adopted by NACA, the country's coordinating committee on HIV/AIDS, and will guide Nigeria's activities over the next 12-18 months. In the meantime, a long-range vaccine strategy is being developed and will be incorporated into the overall National Strategic Plan for HIV/AIDS that is also in the works.
Outside the conference hall, the workshop was also followed closely by the media and general public. That was because of the melodrama introduced by the presence of Jeremiah Abalaka, a surgeon who stepped into the national limelight in late 1999 when he announced his discovery of a "curative vaccine" for HIV/AIDS. His claims continue to attract enormous attention, fueled by the government's order last year that he stop dispensing his unproven treatment, for which he has never presented even the barest scientific description. Abalaka has openly refused to comply, setting off an escalating battle with the government that now includes mutual threats of court action. Accompanied at the workshop by a vocal entourage of supporters and insisting that Nigeria already has a vaccine, he created something of a circus atmosphere at several sessions, but the workshop managed to avoid being derailed from its goals.
Ibironke Akinsete, head of NACA, opened the meeting with an affirmation of the new government's commitment to combat HIV/AIDS — a drastic departure from the past military regime. Since taking office just over a year ago, the democratic government has established NACA as well as a Presidential Action Committee (PAC) on HIV/AIDS, chaired by Nigeria's President Olusegun Obasanjo, to ensure political coordination and top-level attention to the AIDS agenda.
They face a daunting task in this highly diverse country. Nigeria is home to one in five Africans, and its population of 108.2 million is spread over 250 ethnic groups and growing at an annual rate of 2.8%. It is divided into six geopolitical zones, 36 states and 774 local government areas, which complicates efforts to take concerted action. Since the first case of AIDS was reported in 1986, there has been a steady, although relatively slow increase in seroprevalence, from 1.8% in 1983 to 5.4% in 1999, according to the 1999 Sentinel Survey by Nigeria's National AIDS and STD Control Programme. The highest prevalence rate is in the 19-24 year age group, and 2.6 million Nigerians are now estimated to be living with HIV.
Nigeria's health minister, Tim Menakaya, emphasized another key goal of the workshop: to bring together the disparate players in AIDS work and establish cohesion to their efforts. Already several domestic institutes are active, including the Nigerian Institute of Medical Research (NIMR), the National Institute of Pharmaceutical Research and Development (NIPRD), the Universities of Ibadan, Jos and Maiduguri, and the Obafemi Awolowo University, all of which in the past have faced a severe lack of resources.
Several Nigerian researchers working overseas are also playing key roles. Alash'le Abimiku, an assistant professor at the Institute for Human Virology (IHV) in Baltimore, has established a base of activity there, in addition to her presence at the University of Jos and the International Center for Scientific Culture World Laboratory (ICSC-World Lab), also based in Jos, a middle belt city in Nigeria. The World Lab has played a key role in her work to identify the most prevalent strains of HIV throughout Nigeria, data which she presented at the meeting. She is also analyzing the immune responses typical of local populations and laying the groundwork for establishing a clinical trials infrastructure in the country, in collaboration with many in-country researchers.
Simon Agwale, also at the IHV, described the HIV vaccine candidate he is developing, based on the envelope genes of three different HIV strains (subtypes A/G and G, and a common variant of subtype C). The DNA is carried via Salmonella or Shigella bacterial vectors, which have the advantages of being inexpensive to produce and usable as oral vaccines, and which may also elicit both mucosal and systemic immune responses.
Participants identified a number of specific areas for action. These include:
Key to the success of these ambitious plans will be raising sufficient funding. NACA is looking at potential collaboration with existing programs like the Nigeria AIDS Prevention Initiative, which recently received a US$ 25 million grant from the Bill and Melinda Gates Foundation. That program will be implemented by the Harvard AIDS Institute and includes several activities which overlap with goals of the vaccine community, such as training Nigerian scientists to screen populations, analyze HIV strains and develop HIV/AIDS prevention and treatment strategies. UNAIDS and other donors are also seen as crucial to realization of the Nigerian plans. A further boost could come from the April 2001 Organization of African Unity (OAU) meeting where HIV/AIDS in Africa will be one of the major issues on the agenda. •
Akin Jimoh is a medical correspondent for The Guardian newspaper in Lagos, Nigeria. He is spending the 2000-2001 academic year at the Massachusetts Institute of Technology on a Knight Science Journalism Fellowship.
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