Interview with Dr. Adewunmi Akingbola: Combating Hepatitis B in Nigeria

In this podcast, hear from Dr. Adewunmi Akingbola, founder of HealthDrive Nigeria, which combats viral hepatitis in underserved Nigerian communities through increasing awareness, screening and treatment.

Episode Transcript

(00:04):
- Welcome to the Lessonsfrom Lab & Life Podcast,
brought to you by New England Biolabs.
I'm your host, Lydia Morrison,
and I hope this episode bringsyou some new perspective.
Today, I'm joined by2024 Passion in Science
Award winner, Dr. Adewunmi Akingbola.
Dr. Akingbola foundedHealthDrive Nigeria's Community,

(00:25):
Hepatitis B Shield Project,
which combats viral hepatitis
in underserved Nigerian communities
through increasing awarenessscreening and treatment.
Adewunmi, thank you so muchfor being here today with us.
- Thank you very much. Imean, it is my pleasure.
It's my pleasure.
- Yeah, we're so excited
to have you visiting NEBand the campus today.

(00:47):
And to have you here to tell us about
HealthDrive Nigeria and its mission.
Could you share that with our listeners?
- Yeah, so HealthDrive Nigeria
is simply a nonprofit initiative
that is tasked to, or tasked to,
with the responsibility of campaigning
and increasing awareness about
viral hepatitis, yeah, in Nigeria.

(01:09):
So our mission is simply to reduce
the prevalence of viralhepatitis B in Nigeria,
because we discoveredthat, I mean, Nigeria,
I mean it's no news thatNigeria is hyper-prevalent
has this hyper-prevalence for hepatitis B,
but we also automatically,we also discovered that

(01:30):
there's very low awarenessof the disease in Nigeria.
And so, I mean the fact thatthere's an hyper-prevalence
and yet a low awareness of the disease
just keeps encouraging andsponsoring the hyper-prevalence.
And so our mission is to reduce
that prevalence of hepatitis B in Nigeria.

(01:54):
- Yeah, can you share what motivated you
to found HealthDrive Nigeria?
- Yeah, so I personally have a story.
Yeah, it's not my personal,like I'm not directly involved,
but I mean, it was avery critical experience
that shaped my perspective,

(02:15):
and ultimately bettered my passion
for tackling the maintenanceof hepatitis in Nigeria.
And it's in fact that whenI was in medical school
in my third year, more specifically,
we had this clinical rotation.
And when I was at the emergency,
we admitted about seven patients.
And interestingly, outof the seven patients,
five patients had liver decompensation,

(02:36):
second to chronic activehepatitis B infection.
And what was even moreshocking was the fact
that the followingmorning when I went back
to check on the patients, allfive of them had passed on.
It was shocking, very shocking
because even the way theylooked the night before,
they looked like they were already gone.

(02:58):
Their urine was Coca-Cola. You know, Coke?
Was Coke-colored urine.
They had lost too much weight.
They looked very sick withjaundice and it was bad.
It was really bad. So Imean, it was very shocking.
And then also that day,
I started my gastroenterology clinic.

(03:21):
And then I went to the clinic
and then out every 10patients that we would see,
about several of them havebeen managed for hepatitis B.
But I just saw how thepatients would just come in.
And the clinician would say "Oh,
how is your condition going?"
And then the patient willanswer, "It's going fine,"
as in this, as in that.
And out of 10 people,seven would be positive.

(03:45):
And even I, as a medical student,
I didn't even know about this disease.
Other medical students don't know.
That means if we, that was supposed to be
the most informed people in the country,
we barely know about this disease.
How much more people in the low
to middle income communities?
So that day I decided todo something about it,

(04:06):
and then I kick startedthe HealthDrive Nigeria.
I called together some of my colleagues
and senior colleagues, and westarted HealthDrive Nigeria.
- Yeah, so amazing to go from
sort of that observation, right?
That there's a disconnect between
the prevalence of this viral disease state

(04:28):
and people's awareness of, you know,
what's really affecting their lives a lot.
I could see how thatwould be sort of shocking,
to a new medical student,someone who's new to practicing
and to sort of see the lack of information
that doctors are able tooffer those patients too.

(04:48):
You talked a bit, I think about
why hepatitis is such abig problem in Nigeria,
and part of it maybe isthe lack of awareness.
But what else leads to sort of
the high viral spread levels that you see?
- Yes, it's also a lackof access to screening,
to testing, and also onaffordability of the vaccines,

(05:10):
because hepatitis B disease is incurable.
It cannot be cured, itcan only be managed.
It cannot be cured, butit can be prevented.
But people that test positivefor the virus, in fact,
people do not even have,
people barely have access to testing
to understand what theirstatus is at that point.

(05:31):
The ones that do and get tested positive,
cannot afford the medications
or do not even have accessto experts management.
With the gastroenterologist in Nigeria
that can expertly manage the condition,
they're less than 150.
For a population of about 250 million.

(05:53):
250 million. So there are very few.
- Wow.- And then also,
the ones that test negative
who do not have access to vaccines
and cannot also afford the vaccine.
So it's a combinationof all of these factors,
low awareness,inaccessibility to medications
for expert management,inaccessibility to expertise.

(06:16):
And also, for a largerpercentage of people
on affordability of the vaccine.
So all of these factors have,
have really enhanced the continuous spread
and reduced and limited intervention
to tackling the hepatitisB disease in Nigeria.
- So how has HealthDrive Nigeria

(06:39):
tried to address some of these challenges?
- Yeah, so initially when we started,
we first of all, started to increase
people's awareness about the disease.
But I soon realized that, I mean,
I could tell somebodyabout the disease today
and then can get testedtomorrow and test positive.

(06:59):
So I mean, awareness alone
wasn't gonna solve the problem,
but it was a good startingpoint because it confirmed
and yeah, it's confirmedour thought process
that people do not actually,
do not know anything about the disease.
So I mean, the fact that a disease exists
that is hundred times moreinfectious than H-I-V.

(07:22):
H-I-V, which is one of the mostfeared infectious diseases.
And there is a disease that is
hundred times more infectious than it.
And in a room of 10 people,
at least one personwould have the disease.
And people, they don't know about it.
I mean, our awareness campaigns
actually reaffirmed that thought process.

(07:43):
And also we then moved to
conducting free hepatitis B screening.
Yeah, so we did thatthe first, second time.
And in the third time,I also realized that,
I mean, even I myselfcould test negative today,
doesn't mean that I wouldn'tcome in contact with factors
that could lead me to become positive
to contract the disease.

(08:04):
And factors like, sharing needles, blades,
and even very commonfactors like, even using,
I mean, cutting yourhair in the barber shop
because not all barbers practice hygiene.
Right, so I mean, very commonfactors like drawing tattoos.

(08:24):
Yes, and even of people thathave the high viral load,
it could actually transmitthe disease through sweats.
Yes. Exactly.
So I mean, somebodycould test negative today
and test positive next week.
So it does not still solve the problem.
- Yeah.
- At best it just makes people aware
of their status at that time.

(08:45):
Exactly, so then I started thinking, okay,
what exactly can I do to,as would be a solution
that could actually solve this problem?
So since the disease is not curable,
what I can do is, we can try to prevent it
as much as possible.
- Yeah.- By encouraging people
to take up the vaccines.
But I mean, the only waypeople would be inclined

(09:08):
to taking up the vaccine iswhen it's affordable to them,
is when they don't have to spend 25%
of their monthly income on a vaccine.
That's the only way.
So I started looking for avenues
to step down the cost of the vaccines.
So I reached out to somepharmaceutical companies
and then we eventuallyreached an agreement

(09:30):
whereby if we have a large number
of people interestedin taking the vaccines,
you could actually step down the cost
of the vaccines to as low as50% of its original price.
So it was a good deal.
And, yeah, it was a very good deal.
So then we started by mobilizing people.
So each time we had avaccination campaign,
we mobilized 200, 250 people at a time,

(09:55):
and then we administer the vaccines
and we do our best to make sure
that they come back fortheir successive doses.
- And so how many doses does it take
to be fully vaccinated for hepatitis?
- Yeah, it takes three doses.
So previously, The WorldHealth Organization said

(10:15):
that we should give, after one dose,
we should give the seconddose after one month,
and then third dose after six months.
But for countries that havethe hyper-prevalence like,
Nigeria should be one month interval each.
- So it's really hard toget someone to come back?
- Yes.- For one day.
- Yes.- Each month.
- Yes.- For three months in a row.
I would imagine, and I would imagine

(10:36):
it's also very hard to make sure
that you have the vaccines in hand
to administer all those doses.
- Exactly, so in fact,since our inception in 2018,
there has never been a time where
we started with a particularnumber and we completed
and we finished vaccinatingthe exact same number.
Never been a time.

(10:56):
If we start with 250,
we end up vaccinating like, 180.
So it just drops per dose.So it's very concerning.
But at least the fact thatwe're able to start something,
we're able to vaccinate even
that 180 people, it's something.
It takes those peopleout of the statistics.

(11:18):
So yeah, so there's this tagline
that we've been usingfor World Hepatitis Day,
in the previous year is called
Finding the Missing Millions.
So, but each time we vaccinate people,
it takes those people out
of that Missing Millions statistics.
So those people willnever, ever be included
in that statistics anymore.
So at least it's working

(11:41):
and it's a very, very good initiative.
So one thing we've also realized is that
since we started, there'sbeen a very significant
awareness about hepatitis in
the southwestern region of Nigeria.
So I mean, we've seengovernments initiating
hepatitis elimination committees
and we've seen other institutions,

(12:03):
other non-profits also including viral
hepatitis in their medical outreaches.
So I mean, we used to haveseveral medical outreaches,
but most people just do forblood pressure, blood glucose
and malaria, they don'tinclude hepatitis B.
But I know that sincewe started our projects,
a lot of people have started including,
hepatitis B in their medical outreach

(12:25):
because they now see thatit is hyper-prevalent
and also it's possible toactually screen people for it.
So since then there's beenvery good awareness about it.
- Yeah, I wanted tocongratulate you, I think,
on the work that you've donealready in increasing awareness

(12:45):
because I think if people don't recognize
what the problem is, if they'renot aware of the problem,
then it's really hardto prevent it, right?
And the adoption that you've seen already
in terms of interest in taking the vaccine
with your vaccine clinics isobviously growing over time.
How many individuals, or how many doses

(13:06):
of the vaccine have you distributed?
- I can say that we havevaccinated about 10,000 people.
At least that's people thatwe started to vaccinate.
So we do have an exact numberof people that finished,
but people that started,at least one dose.
- Yeah.- Yeah.

(13:27):
It's about roughly 10,000.
- I think that's amazing.
Considering, you know, where you started.
And then I also wanted to talk to you
a little bit about the realnumbers of infected individuals
'cause you shared some statistics
during your seminar today,and it occurred to me
that like, they might notbe a true representation

(13:49):
of the infected population
because it is so hard toget the diagnostic tests.
And as you mentioned, they'renot frequently rolled into
other blood screeningsthat one might have done
when they're having blooddrawn and looked at.
So I'm curious where you would estimate
the sort of, the numberof infected individuals

(14:11):
or the size of theproblem to be in reality
compared to sort ofthose reported numbers.
- Yeah, so if my experience,
I think the reality is between
either one in five people
or one in eight people, you know, I mean,
for now this statisticssays about one in 12 people,
but I don't believe that, I mean,
that's the statistics from datathat they can actually get.

(14:35):
So, and most likely the data that they got
will be from the urban areas,not in the rural areas,
not in the low income communities.
And those are the communities
that actually have a higher risk
of contracting the virus andspreading it amongst themselves
because there's, I mean, theyhave no access to vaccines.

(14:56):
They do not even liketo visit the hospitals
and I mean, they are just there.
Right, so, I mean, andI've had opportunities
to conduct pilot testing surveys
in a few of these communities.
And in one particular community
we screened just 24 people
and we found six people tobe positive of the virus.
So that means at leastone in four persons.

(15:18):
- Yeah.- In that community
is likely, I mean,infected with the virus.
So it's a very massive andvery significant problem.
It's a very significant problem.
- Yeah. Huge problem.
How do you hope to see your project grow?
How do you hope to seeHealthDrive Nigeria grow

(15:39):
and reach more numbers in the future?
- Yeah, so first of all,
we are looking at conductinga Screen & Shield initiative,
this 2025 for the World Hepatitis Day.
So in this initiative, we wantto try as much as possible
to screen at least 5,000 people.

(16:01):
Yeah, so we will conductcommunity awareness campaigns
in communities across the country,
but also we want to scream at least
5,000 people across the country.
Yeah. So we want to that.
But again, another very important way
by which we want to grow in HealthDrive
is that we do not want to neglect

(16:21):
the people that test positive anymore.
I mean, most times when we find them out,
we speak to them, we tellthem what it is about,
then we recommend that they visit
the closest specialist hospital to them.
But I find out that most of them,
they don't even take any action
once they leave that place,

(16:43):
because there's a general belief that
as long as somethingis not killing people,
killing them, rightthere, it's not, I mean,
it can take the backseat.
So one way we want to grow,we do not want to neglect
that category of people anymore.
We want to follow them upclosely, as close as possible,
yet respecting their privacyand respecting confidentiality.

(17:05):
So we want to try as much as possible
to see how we can convert them
into being managed by experts.
Right, so that is one.
Also people that we test, that we screen
and are unvaccinated, forexample, if we do this Screen
& Shield initiative, ifwe screen 5,000 people,

(17:25):
if we find 4,500 people to be unvaccinated
of which I think we will find, I mean,
we need a form of entity.
We need an entity tofollow up these people,
to get them to a stage
where they had startedtaking the vaccines.
So that's why we are currently working on,
we are currently ideating a solution

(17:48):
that integrates artificial intelligence,
more specifically thenatural language processing
with WhatsApp, because WhatsApp
is very ubiquitous in Nigeria.
A lot of people, even inlow-income communities
have access to WhatsApp.
So we are thinking ofintegrating the AI into WhatsApp.

(18:09):
And then whenever weconduct the screening,
we would onboard, with their permission,
we would onboard theminto the WhatsApp bots
that's constantly sends them messages,
ask them questions.
And so the messages and questions
will sort of lead to themtaking their next step

(18:30):
in their management, eitherpresenting to the hospital
to be seen by an expert
of which the bot would also recommend
closest specialty centers to them.
And also for those that are unvaccinated,
the WhatsApp bots, AIwould ask them questions
and converse with them to lead them

(18:52):
to take their next step also,
and we should also give them information
about the closest vaccinationcenters around them.
So that is next, that isthe next thing for us.
And as usual, because Imean, one of our principles
is that we always wantto focus on the impact,
the potential impact, rather than
even the current present barriers, right?

(19:15):
So we know that, I mean,
developing such a solutionwould be a little bit expensive
'cause we're gonna haveto employ an engineer,
an artificial engineer, amachine learning engineer
that will build the bot andbuild the language model.
Yes, so what we're going to do that,

(19:35):
we're also gonna do some marketing, right?
For people that have already been tested.
Yeah, so that they canalso join Android bots.
So we are, for now, are just focusing on
trying to do it as much as we can
within our resources and our power.
- Yeah, that soundslike a really clever way
to stay in touch with those individuals

(19:57):
and to make sure that they'regetting up to date information
and reminders about their health.
You know, I think everybodyhas a hard time like,
managing their own healthcare,
and I'm sure it's morechallenging in Nigeria
where there are maybebelief systems in place
where people are perhaps distrustful

(20:20):
of the systems or hospitals
or just don't have the means
or resources to make use of them.
So I think that sounds incredibly helpful
and like a great resource.
So I can't wait to see something like that
come to fruition for you.
The Screen & Shield Project I think sounds
really interesting because it sounds like,

(20:43):
a longitudinal study of alarger cohort of individuals.
5,000 people will give youa lot of information about-
- Exactly.- You know, what
real levels of infection are.
- Yes.
- And what real levels
of vaccination are across the country,
and to help correlate sort of those two
and how it spreads through populations.

(21:04):
Sounds like very powerfulresearch to be engaging in.
- Yes.- So.
- Yes.- We'd be very interested
to see how that all pans out.
- Pans out.- Yeah.
If someone is interested inhelping your organization,
supporting them, either through time
or resources, how wouldthey go about doing that?

(21:24):
- Yeah, so I think itwould be very easy for them
to kind of reach out and thenwe can have a conversation.
So we would let them know,
so in the conversation we would work out
which areas that, that their support
would actually fit into.
But generally speaking, forthe Screen & Shield Project

(21:46):
and also the App Mate Project,
that's a project that has to do
with artificial intelligence.
It's gonna cost money tobuy these testing kits,
buy the pins, the pins thatwe use to draw the blood,
buy the swab, and alsorent a space, rent tables,

(22:08):
yeah, for each of theevents across the country.
So it's gonna cost some money.
Also, even developing the AI model
also cost money too, so I mean,
so that's why financialsupport is very appreciated.
But for the AI aspect, I mean, if anyone

(22:28):
has as a machine learning company
or can develop such model
and integrate with WhatsAppwithout charging us,
it will be internally appreciated.
We would really appreciate it,
because it just makes our work very easy.
We develop it and we also test it.
So in the testing, we'reactually gonna convert it
into an implementation research

(22:49):
whereby we're actually gonna test
and confirm its efficiency in linking
those people to care,as well as helping them
transition from their state
to the next stage wherethey seek management.
And we intend to write up the findings
and publishing it and publishing it, yeah.

(23:10):
So we would like supportfinancially, technically,
and every other form that anyone,
wants to support us with.
- Well, our listeners can find the details
about how to connect with you
in the transcript for this show.
And I just wanted to say one more time,
thank you so much, Adewunmifor being here with us today

(23:33):
and for sharing the storyof HealthDrive Nigeria
and the individuals that it's reached.
- Yes, thank you very much.
And please, if anyonewants to reach out, I mean,
once you type my full name on Google,
you'd see my emails, you seemy Instagram, my LinkedIn.
So, I mean, they're all easily accessible.

(23:55):
So just send a message tome and I will reply you.
I literally work around the clock.
Yeah. So thank you very much.
- You're welcome.
All right, listeners, thinkabout the skills you have,
think about the skills your network has,
and be sure to reach out
if there's anythingthat you can do to help.
Thank you for joining us for this episode

(24:15):
of the Lessons from Lab and Life Podcast.
Please check out our show's transcript
for helpful links fromtoday's conversation.
And as always, we invite you to join us
for our next episodewhen I'm joined by 2024,
Passion in Science Awardwinner, Samuel Ogunsola.
Samuel launched the ShapingAfrican Women in STEM program

(24:36):
or SWISAfrica, an initiative that aims
to inspire young African women
to pursue careers in science,technology, engineering,
and mathematics by sharing stories
of successful African women in STEM.