Adewunmi Akingbola – Passion in Science Award winner 2024

Dr. Adewunmi Akingbola:
I'm very pleased to be here and to also be presenting this project to everyone of us here, and I honestly wish and hope that we will have a nice time chatting about this project this afternoon. So, please feel free to keep your questions. I'd like to take your questions, because one thing I found out about questions and answer exchanges is I actually learn a lot from there. So, the major reason why I was able to complete my master's project in Cambridge was because I presented the project in about five conferences, and as I kept presenting, I understood what I was meant to do, and thankfully I was able to finish in time.

So, yeah, I'm Adewunmi Akingbola. I am a Nigerian. I'm a Medical Doctor trained in Lagos University Nigeria, and I am also an Infectious Disease Epidemiologist trained in University of Cambridge, UK, and more specifically King's College. So, yeah, the backstory to Cambridge is the Oxbridge system, we have a college system where in Cambridge you have 31 different colleges. So, if you're admitted to the university, you must also be admitted to a college or else your admission is null and void. So, I was in King's College, which is arguably the richest and the most famous college in the Oxbridge system. Well, it's not arguably, because they don't even have Oxford counterparts. They like to think otherwise.

So, I'll be taking us through my project, HealthDrive Nigeria, more specifically on Finding the Missing Millions through Viral Hepatitis Intervention Campaigns. So, another backstory is I founded HealthDrive Nigeria in 2018 because I was doing a clinical rotation there at the Lagos State University Teaching Hospital. So, that evening we admitted about eight patients in the emergency ward, and six of them, they had liver decompensation secondary to chronic active hepatitis B, and two of them, the remaining two had CKD, that's chronic kidney disease, and another condition. I can't remember.

But what caught my attention was the fact that the following morning at 11:00 AM when I went back to the hospital, all six of them had died in the same night. I'd started my clinical posting before then, but I'd never seen such events before where six people with exactly similar conditions, exactly similar presentations, and then passed away at the exact same period. So, it really shook me because also that following day was the day I would start my gastroenterology clinic. And so, as I was recovering from that shock, I went into the gastro clinic only to find out that in every 10 people that we saw in the clinic, at least seven of them were being managed for hepatitis B. At least seven of them. So, I know while growing up, my mom used to mention, "Oh, wash your clothes because of hepatitis B. Oh, drink water because of hepatitis B." But I never really came across the reality of the prevalence of the disease until I started that clinical rotation. And it was also in that rotation I discovered that people can have the active virus and the chronic... I mean the virus has two stages, active stage and the chronic stage, and very few percentage of people cross from the active stage to the chronic stage. And most times whenever people cross from the active to chronic stage, in Africa it's most times a death sentence. Because the management from that stage until the end stage, it's very expensive, and there's very little accessibility to drugs, to medications, and also very little accessibility to testing.
So, that day I left the clinic with a resolve to do my best to create awareness, because I also realized that if I as a medical student did not know that the virus was that bad and the viral prevalence in Lagos State was that bad, I could beat my chest that 80% of Nigerians did not even know anything about the virus. And interestingly, even medical doctors did not even know that they needed to take the hepatitis B vaccine.

So, I first of all identified it as an awareness problem, and I kickstarted a project called HealthDrive Nigeria. And this slide just summarizes the individual formal estimates. And I can assure you these estimates are just data that can be accessed. I can assure you in low to middle income communities in Lagos State, where they do not even have any access to testing... Without access to testing, there's no way you would actually have an accurate representation of the prevalence and burden of the disease.

So, I can assure you that the prevalence is much more worse, because we did some testing. We did pilot surveys, pilot testing of different communities, and there was a particular community that we tested in Lagos State. Out of 24 people that were screened, six people emerged positive. That means in that community, if I had a larger sample size, it's possible that at least one in every four persons in that community would test positive. That's a ridiculously high prevalence for a disease that sort of determines if one lives or dies. Because also, one interesting fact about hepatitis B is the fact that it's a hundred times more deadlier and more infectious than HIV itself. So, the major reasons why I think we found out that Nigeria has a higher prevalence is the fact that there were inadequate screening opportunities for people in low to middle income communities, there was very limited public awareness, and also the high cost of vaccines. So, we started by wanting to create the awareness, and then I realized that I could tell somebody about the virus today, and it does not mean that the person is free from the virus. The person could go and share a blade or share a needle with somebody else and then contract the virus. So, it does not really help. It does not actually solve the problem. It's a starting point, but does not solve the problem.So, from there we graduated into conducting free hepatitis B screening. So, also I realized after a while that if I screen somebody today, or even if I am screened today, it does not mean that I am protected against the virus. Because if I am screened now, I can go and still share the same needle even with my knowledge of the virus and my knowledge of my status at that time. So, I knew that it does not still solve the problem. So, what could we do?

Then we realized that actually the vaccine at that time in 2018 or 2019 costs about less than $1.00. Probably $1.00 Or $1.50, but people could not still access it, because $1.50 or $2.00 in naira then was about 600, 1,000, 1,500 naira, which was a lot for people earning less than... For people that cannot afford one or two square meals per day. So, it was a lot.
So, a resident of a low-income community would have to spend about 25% of their income to just get themselves tested or get themselves vaccinated for hepatitis B. It was a lot. And people would just think that, "Oh, it's not necessary since it does not kill them at spots." So, that was when we decided, okay, if we actually wanted to provide a solution, we needed to find a way to make vaccines more affordable for people. And because there's also the ethical aspect of it, by making vaccines more affordable, there's a risk of also tampering with the quality of the vaccines, which is not a risk that anyone can actually afford. So, what we did was that we contacted pharmaceutical companies that were certified and licensed, we discussed with them and asked them how far they can actually go to reduce the price. Let me move this a bit. So, we discussed with them about how far they can actually go, and then they gave us the percentage discounts that they can work with for us. And then we looked for external partners that would also help to step down the cost of the vaccines. And also at another point we reached an agreement that if we can have a large number of people wanting to take the vaccines, they can actually step it down a lot more for us, up to 50% off, and that was a very good deal.

So, in 2020, 2021, we started to mobilize people in communities. So, if for each vaccination exercise we have up to 250 persons... Because the more people the company vaccinates, the more discount we can get on the vaccines, and automatically it translates into affordability for people in low to middle income communities. So, we started by conducting the free hepatitis B screening, then we helped them to gain affordability for the three-dose vaccines. We also continued with community education and awareness, and we also continued to test the people.
And also as a form of attraction, whenever we conduct this free screening and vaccinations, we also intend to include other basic tests like hypertension, blood glucose, malaria, and a couple of other prevalent diseases in each region. So, it really serves to attract a lot of people. So, we use majorly rapid test kits that test the surface antigen at that time. Once it's positive, we know that the person is currently infected, so we then take further steps. We try to refer them to tertiary hospitals in their regions for expert management. So, if they test negatively, we encourage them to participate in our next vaccination drive, even if they cannot at that time.

So, this is an example of us screening, and this is a vaccination exercise by... She's a certified nurse and a nursing practitioner, and also worked with one of the pharmaceutical companies that actually helped us to step down the cost of the vaccines. I want to take us through some of our videos, just a few of them just for you to see. Yeah. So, we have several videos like that. I just wanted us to see how it looks like, how conducting these initiatives in Africa looks like. Talking about it is actually different from visualizing it, because there's so many variables that you would tend to not factor in when you visualize it in your mind from my words. But if you see a video, you understand even beyond my words, and even from the people, from the beneficiaries, you can almost see why they cannot afford some of these very important interventions. So, as a part of what we want to do next, every year we have this World Hepatitis Day that is celebrated internationally, and is on the 28th of July every year. And so, for this year we are planning to do a Screen & Shield initiative. More specifically what we're trying to do is we're trying to conduct a nationwide awareness campaign and free screening. So, we intend to screen at least 5,000 people across the country, and the way we want to do it is very simple.

We have identified a partner as the Nigerian Medical Student Association, because I was part of the association as a medical student. So, the association has membership in 50 medical schools in Nigeria. And each of the members, each of the medical students, we are always trained on how to conduct screenings right from our second year in medical school. We have the training from second year to final year. So, we're usually very, very skilled at using all kinds of rapid test kits. All kinds. So, we are partnering with Nigerian Medical Student Association. Each member association in all 50 medical schools across the country, we hold an awareness campaign in their community as well as a free screening initiative in their community of at least up to 200 people in each community. So, automatically if we engage all 50 medical schools and if they each screen at least 200 people, we should be able to screen up to 10,000 people in one day. So, it's a try. It has not been done before in the country. And even I myself, it's probably the biggest thing I would do so far as far as this project has been. But I think it's very achievable, because I've realized since I started working on this project, partnerships and collaboration is actually the gold, is actually the gold in this field, in this area.

So, since then... We're planning to actually launch this initiative in two weeks time, because the World Hypertension Day is this weekend, and we also want to do a free high blood pressure screening for some young people in particular in Lagos State, but it hasn't been set. So, our goal is at least 5,000 people, focused on underserved and high-burden communities. So, the member associations would be responsible for actually locating the communities around them that actually need it the most, and then they would go there. Often the way we do it is once we identify a community, we first reach out to the community local leaders. We work with them because we cannot actually raise enough awareness about any initiative in local communities because there's an existing superstition that, "Oh, the government wants to reduce the population, and then the best way to reduce the population is they have to do all of these things." But if they hear it from their local leaders, it makes mobilization very easy. So, we partner with the local leaders and partner with trusted institutions in the communities like the mosques and the churches. So, whenever we do that, it makes mobilization easier. Each member association actually does that in each of the communities and medical schools. So, we intend to do the awareness campaign work across all of those communities and also free on-site screening across the 36 states of Nigeria.

Also, this is another initiative that we are working on, because we realize that whenever we screen people and vaccinate people, it's very difficult to follow up to with them. Because we go to several communities at the same time, and then when you get their contact number, you call them, they don't answer, or they answer and they just lose interest. So, we realized that we needed to develop an entity that would help us to constantly follow up with people that test positive and people that are unvaccinated, because the vaccine has to be taken in three doses, one-month interval. And so, whenever people miss any month, they have to start again, and that alone can be discouraging. So, we discovered that we needed to find a way to follow up closely with people, and the best way that we have seen is actually leveraging artificial intelligence. That's the natural language processing. And especially through WhatsApp, because we have seen that about more than half of the Nigerian population are actually using WhatsApp. So, WhatsApp is more ubiquitous than ubiquitous itself. WhatsApp is very widespread in Nigeria. So, we are planning to integrate in an AI bot with WhatsApp, and then whenever we screen people and vaccinate them, with their permission we onboard them, and then the bot can always send follow-up reminders. And also we are planning to integrate a linkage to care system where we have a list of centers in different communities where people can access expert management. So, the bot would always refer them to their place. So, one way we want to do this is we want to do this as a form of implementation research, because we also want to see how far it can go to actually increase linkage to care, how far it can go to actually convert people from being unvaccinated to being vaccinated. And also we want to see how far it can make people actually present for expert management in a hospital. Because currently our methods are not working. So, it's research we tend to do within a two-year period, and we would write papers on it and also publish it for other communities like ours to be able to learn from and make use of.
I guess the next few slides did not save. So, the last slide was just how people could partner with us and support either of the initiatives, either these or the first one, that's the Screen & Shield 2025. We appreciate partnerships in terms of the kits, the hepatitis B kits, because they're a little bit expensive in Nigeria. And yeah, currently we have methods to acquire them for free, but for this initiative that we are about to do, we tend to screen up to 5,000 people.

So, we need a number of kits. So, we need to either purchase them, or if we have more partnerships that could supply kits, it'll also go a long way. And also I think for this particular one, any form of support is actually welcome and appreciated. So, without taking much of our time, thank you very much for having me.