Creative grit.
COVID-19 and The Global South, episode 1--A chat with Marycelin Baba

Marycelin Baba
I have one weakness. and that weakness is my passion for my work, my passion as a virologist. By the time I deliver virology to you, you would like to even come and start practicing virology.

Vivien
That’s Dr Marycelin Baba a virologist at University of Maiduguri in Nigeria.
Hi and welcome to conversations with scientists, I’m Vivien Marx. For a feature in Nature Methods, I have been speaking with scientists across the Global South about their work on COVID-19. The link to the story is in the show notes, also in the transcript.
https://www.nature.com/articles/s41592-022-01439-w
Yes, COVID-19 is an infection we are all tired of, too many have died, too many have long-COVID. What I found as I spoke with scientists in labs across the Global South is a resolute, creative attitude about COVID-19. So this is episode 1 in a series of not-sad stories about COVID-19. It’s a bit of armchair travel, today it’s an audio journey to Nigeria. I asked Mary celin Baba to pronounce her name so I know how to try and pronounce it.

Marycelin Baba [1:15]
My name is like Celine Dion, the popular musician. So my name, you just add Mary to Marycelin add Mary to Celin. Then it becomes Marycelin Baba. Baba. Even your dad. How do you call your dad? Baba. Some of us say Baba, and it's the father. So my name is very simple and it's English.

Vivien
So now, of course, because of what you said, I need to ask you if you sing. Do you sing? I mean, Celine Dion is of course, quite good. But do you also sing?

Marycelin Baba
No, I don't sing. I'm a scientist.

Vivien
Nigeria is a country with many languages. Many, many languages.

Marycelin Baba
Ah, my God I don't know how many. I think it's over 700 because every tribe has its own. But the commonest , the majority type three Ibo, Hausa and Yoruba. That's the commonest three major

Vivien
So do people speak all three or do they have to figure out. Okay, I speak Haussa.

Marycelin Baba
We don't understand ourselves. Among the three, the common language for everybody in Nigeria is English. And then you have the English, different versions. You have the Pidgin, you have some others. That is English, the pidgin. Sometimes even me. I don't understand.

Vivien
Wow. In your lab what do people when they're pipetting and staring at their Excel sheets, what do they talk to one another in? Or is it just English? I see.

Marycelin Baba
English is the language of instruction from primary school to the tertiary institutions. Let me say something. If you don't have at least credit in English language, you cannot enter university.

Vivien
Dr Baba spends time on research and she teaches.

Marycelin Baba
Our first port of call is to teach, train, build capacity, interact with physicians, interact with scientists all over the world. And I work on the bench.

Vivien
COVID has hit everyone hard and Nigeria is no exception. But as someone in a lab that is WHO supported and accredited she felt she and her team were ready. I mean nobody is ready for a pandemic but she felt they were as ready as one could be.

Marycelin Baba
COVID pandemic or COVID era, to so many people is curse because they lost people, unfortunately. But to so many people, COVID is a blessing. So as a scientist, I will tell you here that COVID was both a mixture of a combination of blessing and a curse. Now I come back to the scientific aspects. My lab in particular because we are WHO accredited lab so primarily designated for polio, for diagnosis of polio. So when COVID did come in, so we had to because it was the most then most befitting lab, to fit in without much effort, without much from, we swung into action.

Vivien
Many labs faced supply shortages during COVID. Marycelin Baba and her team had an advantage, as an WHO accredited lab WHO sponsored lab.

Marycelin Baba [4:00]
Because we are WHO sponsored. So we have basically everything. We have everything. We have the enzymes, we have the pipettes. We have the pipette tips. Because COVID is virus, is virology, polio is virus. So the basic things that were needed to perform the initial tasks we had it. But in the hospital that belongs to Nigerian government, those things were not there.

Vivien
She and her team had previously worked with viruses and had the supplies and know how.

Marycelin Baba [6:00]
We could do RNA extraction because we normally do RNA extraction for polio. So we could also do RNA extraction for COVID. We could do a master mix for polio. So we can also do it for COVID. That's what I'm telling you, that the WHO setting provided the template that was more cost effective and was less time consuming to kick off with COVID work

Vivien
And because Marycelin Baba is talking about polio a bit, just wanted to say that wild-type polio is gone in Nigeria but there are polio variants. They exist because vaccination is not 100% there is what is called an immunity gap. If any of this sounds familiar to COVID, yes, it is similar.

Marycelin Baba
The problem is that in Nigeria, there's no more wild polio. Yes, Nigeria is a certified polio free country. But the only problem we are having right now is the variants, the mutated kind of polio just like you have variants for COVID. You have variants. And those variants are not wild. They are not wild. It's a mutated form of the vaccine strain because of the immunity gap.

Vivien
Her base of operation, the standards, the routine of being able to work with viruses has been protective in her lab.

Marycelin Baba [7:20]
Nobody in my lab. You know, like I told you, that template, the base that I said, we are a WHO accredited lab, is very important because we are already prone to that kind of work. So all we needed to do was to put in all the biosafety biosecurity measures that we have been trained by WHO and for polio into place and then adapting.

Because polio is biosafety level two work, while COVID-19 requires minimum of level three. Minimum of level three. So because of that, we just had to step a little up by using the relevant PPE. We did not have a single casualty. Nobody in my lab contracted COVID. None.

Every day we had a team that did disinfection, disinfection using appropriate. Knowledge is powerful. Knowledge is powerful because we are already a virus lab.

There were some other labs, that just set up COVID testing, they closed down after a few because the people, they were not their priming was not there. It was not just do this. Don't do this. No, it's something that has to be inside.

And because like I'm a virologist so I know what COVID is. I know its weakness, I know its strength. I know what needs to be done. So I had to coordinate the testing, training the people on a regular basis.

We were having technical meetings every week to make sure that the needful was done if there was any problem we discussed and then look for. In case of spillage we had to talk about how do we handle spillage. So that biosafety biosecurity measures. Like I told you, we were already imbibed because of polio background. So it makes it so easy for us.

As lab-people we have to adapt the necessary biosafety and bio security measures. And remember now polio is also adequately contained so that under no circumstance should it escape from either the staff or anything outside the community. So that discipline is there because for over 19-20 years we've been trained. WHO has trained us on biosafety measures.

Vivien
Much of the work related to COVID-19 involves sequencing. Sequencing the RNA of the virus to tease out what particular variant it is. Finding out how it has changed and evolved. Which variant stays, which new ones emerge.

Marycelin Baba does not have access to large-scale sequencing facilities so she collaborates with others. Collaboration has been particularly important for addressing COVID-19. Collaboration among scientists that is. Collaboration between governments is a different matter. And it works in some cases and in others, as we have seen, it does not.

So collaboration between scientists, for example in this case Marycelin Baba worked with Christian Happi at Redeemer’s University in Ede, Nigeria. His lab was the one that sequenced the first SARS-CoV-2 virus from Africa in 2020.

Marycelin Baba [11.25]
Yes, he was the one, Professor Happi, yes I'm collaborating with him. We were not directly involved in the sequencing but what we did was to send isolates we got to a sequencing laboratory, some of them. There is one sequencing laboratory in the Western part of the country, some we sent in a project we did with in collaboration with Italian government. So they did the sequencing for us because we don't have sequencing facility.

Vivien
One important part of studying COVID-19 is to use assays, which are tests to see if the virus is present in a sample. Some assays are more complex than others. With one type of test, quantitative RT-PCR, one needs to adhere to certain procedures, there is training, there are supplies needed, instruments. That’s expensive and takes resources. The result is quite accurate. But. Not every facility has these instruments, has skilled staff. There are other kinds of tests, rapid tests that require fewer supplies and less training.

Marycelin Baba [12:30]
Yeah. The Lamp essay, let me use this word. It depends on the assay. The conventional diagnostic test is the QRT-PCR. That's conventional. But you see, it's very sensitive. Very sensitive because it detects acute infection and it picks the virus once it reads. That is the virus. Now, there is a small issue there because especially in developing countries before COVID, many laboratories were not equipped to cope with that kind of sophisticated, skill demanding technique.

Vivien
The instruments?

Marycelin Baba
The equipment, the instruments , the human capacity, human resources and the skill, the qualifications, so many factors . In 2020, many labs in Nigeria were not empowered to handle COVID testing. Now, I am telling you the truth more than 50 laboratories is well equipped to handle COVID and other related infectious diseases.

Vivien
One of those infectious diseases is Lassa fever. It’s viral and endemic to Nigeria and endemic to other countries in West Africa. Just recently there was another outbreak. Symptoms are not entirely unlike COVID, Fever and difficulty breathins. But it can also lead to bleeding and sometimes death.

Marycelin Baba [14:15]
Lassa fever has a problem. because you cannot handle it in above safety level two facility. Because if you adapt, there is a way you can handle Lassa fever. It all depends because Lassa fever and COVID are highly, highly infectious.

Vivien
Lassa fever might even be more infectious than COVID.

Marycelin Baba
It is airborne, it can be inhaled. Lassa can easily spread by air. That's why it's very contagious. It can clear the whole community within few hours and days.

Vivien
Lassa Fever can infect a community, say, a village, in hours to days. Wow. With COVID, the infection prevention measures put in place in Nigeria were helpful to stem the spread of the virus that causes COVID.

Marycelin Baba [15:15]
The spread of the preventive measures was very good. This hand sanitizer and the wearing of the mask and what other one? Avoiding is. A major something? That is yes, major something was the mask and sanitizer. So with that could be an end of virus. It's so sensitive, very sensitive to disinfectant like alcohol and all those components in the hand sanitizer.

Vivien
Marycelin Baba is a committed academic who teaches and does research. But COVID-19 amd other infectious diseases mean that she gets involved in diagnostic assays and tests.

Marycelin Baba [16.00]
I am an unadulterated academic. Academic means teaching and research. So I combine, I'm so interested in teaching, and I'm so interested in the diagnostics, and I'm so interested in the research. So I was coordinating that COVID testing here from 2020-2021, but because now, by then, the hospital has built a befitting lab for COVID. So I was mandated by Nigerian CDC to optimize that lab certify it fits for COVID testing, which I did.

People like us, we are professionals. And no matter what happens as a professional and a public health, you have to be conscious of the public health. I'm not a politician. I was also mandated to optimize another COVID lab at the state level, state government. I went there. They did not have the basic, and they asked me to authorize them to start testing. I said never. I refused. Even if I was to be killed, I don't mind.

I would have caused an epidemic if I allowed them to use the wrong facilities, wrong equipment, wrong lab space. That was not suitable. No, I wouldn't do that. I refused that until they modified the laboratory to fit the tests before I could certify them, and I followed up, till so now the lab is capable. They are testing. There is no casualty. Nobody in the two labs I had optimized. Nobody. None of the lab staff contracted COVID none.

Vivien
Marycelin Baba made sure that her team and any scientists and staff she came into contact with who worked on COVID wore the appropriate personal protective equipment (PPE). It takes discipline. And passion. She wants her training and passion to last far beyond this pandemic with COVID.

Marycelin Baba [18:20]
I have one weakness. and that weakness is my passion for my work, my passion as a virologist. By the time I deliver virology to you, you would like to even come and start practicing virology. I told you, I'm teaching. So we are training, I'm training and I'm retraining and I continue building capacity.

We have students here. They come here to their lab, we train them, we train them on basic techniques in virology and they come in even after graduation. They come with under internship. I spend one year in the hospital. So they rotate. So building capacity on biological techniques is like my food. It's like food I eat on a daily basis.

And it gives me pleasure because, you see, like, now I'm over 60, a time will come. I have to leave, then new ones have to take over. And if they don't practice it well, it would be a failure on my own part if I don't pass the skill , if I don't pass the skill, it would be a failure on my own part.

Vivien
What is important to her is to give her trainees experience so they can work anywhere. They want to work in science and medicine. Whether they can find a job will depend on many factors but they have the training for working on COVID and the virus that causes COVID.

Marycelin Baba [19:50]
Anybody that passes through this lab can fit him anywhere in the world. That one I can guarantee. That is a guarantee. Anyone that can say it passes through this lab successfully transfer that person to any virus lab anywhere in the world. They can cope. They can compete with their contemporaries anywhere in the world. And now, right now, there are some students that have graduated, they don't have jobs. Now they are coming into their lab voluntarily to keep themselves abreast.

The good thing with virology is that once you gut the basics, you just need a small boost for you to step into any other one. If you know how to do PCR, RT-PCR, you can work with yellow fever, you can work with dengue, you can work in an HIV lab, you can work with Ebola if you can handle COVID, because the requirement for containment for COVID is like Ebola.

Vivien
In Nigeria if someone sets out to become a researcher, they have to pass through the typical stages of training, that’s true anywhere. Marycelin Baba is a virologist.

Marycelin Baba:
I have a PhD in virology, medical virology

Vivien
Work in academia in Nigeria and this is true elsewhere, too of course, takes commitment. And a willingness to earn less than others.

Marycelin Baba [21.15]
For us in academics, you have to go through the basic. That means university from high school to university, from university. And it depends on your choice. Some people don't want academics because there is no money. No money in academics or some people up to work in research institutes. There are some research institutes. So if they work in the research Institute or they work in a university. So either of these institutions will give you the opportunity to practice as a researcher.

The salary is small. Some will work in oil companies and make better money and more highly paid. Some will work in central bank. Those people have highly paid job compared to but, we are satisfied as academics. My passion is academics.

Vivien
She is passionate about academia and especially about viruses.

Marycelin Baba [22:20]
Virology is the most interesting aspect of science, in my opinion. I may be wrong, But that's what I think, you know, considering it being the smallest among all the microorganisms. The smallest. But they are more impactful compared. The biggest among them is a protozoa. But you hardly hear the havoc protozoa cause you hardly hear the havoc bacteria cause you hardly hear this. This smallest being is interesting. There's something interesting I want you to capture that. These viruses we are talking about, they are inanimate object outside the host.

A non-living thing outside the host. They only become living thing when they enter the suitable host. So how do you see it? And once they enter the host, they knock the host down and use everything the host has for their own benefit. It takes wisdom to do that.

Vivien
She chose to work in viruses when few others in Nigeria had an interest in virology. And she has a message about why this matters. Learning about viruses, studying them and having a way to differentiate between the different kinds of viral infections all fit together. If you are listening and are someone who donates to research, you might find this next part interesting.

Marycelin Baba [23:50]
When I picked interest in virology 1982 by then, I did a first degree in microbiology, and virology was a branch. Then in Nigeria, nobody knew about virology in Nigeria. Nobody was interested in virology in Nigeria. There were no reagents, no facilities, nothing for virology, nothing. People were interested in bacteriology because they could just graduate and just open their own lab and practice and make money.

People were interested in microbiology, where they can work in industry, might be working in, what do you call it? Water, where they can analyze water or industrial food industry, all those kinds of things and to make money. But I was wondering, why are people not interested in virology? And since many people were not interested, I became interested. So the best virus I worked with was rubella. Rubella. And rubella, that is known to cause congenital defects in women. So that was my first project. From there, I picked interest and my second degree, I worked on polio. Then I became a member of one of those working on the polio eradication program.

Then my interest continued to yield. Do you know when I did my PhD, my PhD, I noticed that HIV was dominant and became political. And you know I don't like politics. And my boss then was so much interested in HIV active. HIV was like a personal project, and I did not want to have problems with my boss, so I opted out. Then I went into literature and I discovered that arboviruses were detected I selected confirming Nigeria in the 70s and after 70s, no more work.

Nothing. I noticed that they said that the initial state of infection caused by arboviruses are like malaria. You cannot clinically, by symptoms, you can't differentiate, they all present with fever. Then I told myself that it's possible that many cases that we call malaria are not malaria, but arboviruses. Then I became interested. So I now did my PhD collecting mosquitoes, collecting malaria cases and then testing to find out whether they were arboviruses or not. I'm confirmed then my interest continued.

Now it's confirmed everywhere that malaria and arboviruses is the only laboratory. And up to now, as we are discussing, we don't have facilities for routine detection of arboviruses . That's why if you Google my name, you see, I am on arboviruses. I am advocating that researchers should not grant donors. Please. I want you to use this forum to help my voice that grant donors are more interested in sponsoring basic molecular research in virology with complete network of the diagnostic and the therapeutics. Did you get that?

Vivien
I really like how Dr Baba hammers in points important to her. Research, in her view, has to have a view of where it ultimately will be applied. When you have malaria you have fever. Fever is also true for other viral infections like dengue. But dengue is not treated the same way malaria is. And dengue can be deadly if not treated.

Marycelin Baba [28:00]
I've done many research to show that people that thought they had malaria were actually infected with dengue, yellow fever, West Nile. And those people must have bled with hemorrhagic fever with symptoms. They will go to native doctors and die there because once those symptoms start, it's difficult for them to survive.

The grant donors, they are not interested. They are only interested in basing molecular research. And this basic molecular research in most cases are not translated into diagnostics and therapeutics that will have direct impact on the patient.

Vivien
Of course, Dr. Baba says molecular research, basic research they matter.

Marycelin Baba
There should be a balance. There should be a balance. What is the top priority? The health of the people, the health. Let's face reality, in Nigeria right now, there is no routine diagnosis for viral diseases. What is now done routinely is called it an HIV that was externally funded.

Vivien
If it’s not possible to do a battery of tests when someone seems to have an infection, healthcare personnel cannot determine what is ailing someone. And that can cause harm and on many levels, on a personal level and on a more country wide, even global level.

Marycelin Baba [29:30]
I will tell you the possible harm that can cause. Now, from my personal experience, people in Nigeria, the typical Nigerian mentality that once you have fever it's malaria without a lab test. Without even a lab test, it's malaria.

And because the whole country is infiltrated with diverse malaria drugs, anti-malaria drugs. So they don't even need to seek health facility for malaria, they will just go to the patent medicine store in the streets and price as many anti-malaria as they give fits. That is tantamount to drug abuse. And that alone, again, is contributing to the global burden of antimicrobial resistance.

Most of those arboviruses, the symptoms mimic malaria at the initial stage, but many of them are self-limited. So if somebody is taking anti malaria for virus infection, it has no effect. It has no effect.

But because most of them are self limited, When they have finished their course, the symptoms will go. So they may be thinking the next latest malaria. I took that had it said no. Some people, if they take anti-malaria and change to another one, thinking that it's resistance , then they would switch to antibiotics thinking that it's bacteria. But you see, all these things contribute to what I call drug resistance Because it took this no laboratory test and it is only laboratory test that can tell you this is viral. This is non-viral . There is none. Because the facilities, the reagents for this viruses are not there.

I want to use your forum to let the people know that grants should please also divert a little bit and balance by encouraging and supporting grants for diagnostics and therapeutics, especially for developing countries.

Vivien
In a country such as Nigeria there are many infectious diseases to battle. Not just HIV, not just COVID. Marycelin Baba talks about this multitude of viruses because ultimately, to her it is about helping people by helping research build in a path to diagnostic tests and treatments.

Marycelin Baba [32:15]
I went for one conference in 2019. I was sponsored by us initially. We used to call it to us. What do you call it? Organization of Women in Science in Developing World. Yes, I was sponsored. So I went there for a conference and I used and, you know, many organizations were supporting malaria, supporting malaria projects, malaria research. And I told them, I said what guaranteed them that what they thought was malaria was actually malaria.

I have the problem. like I told you, I'm passion driven passion for the patient, passion for the patient who died of these viral infections. And I can't help. There's nothing I can do.

Vivien
What is needed in a given situation is a physician with a hunch about what might be causing someone’s fever. It’s about the index of suspicion, the very first or the early impression of what might be ailing a patient.

Marycelin Baba
The suspicion index for arboviruses in Nigeria is very low. Low among both physicians is very low because they are the ones to request for investigation, for a lab test. It's the doctors that request. So when the suspicion index is low among the doctors, then how will they request for the test?

Vivien
Many viruses and viral infections are endemic, at home in Nigeria. The funding for viral research and its applications, that’s hard to come by.

Marycelin Baba [34:00]
Many research have revealed that these viruses are endemic and they have revealed their burden. They have revealed their impact. Those ones are endemic, there is none. My sister. Do you know that in my research work, those little ones I did, I got sponsorship. If I did not get sponsorship from organization, I wouldn't have done it. I wouldn't have. And then look at now: to buy an ELISA kit elite $1,000 $ 1005. So how much if you are doing in a laboratory involving how much would you recover? The patient will pay. It's difficult.

But if we have enough grants that grants are now producing diagnostics and you see the whole market, every place is flourished with diagnostics. Everything will come down. Everything will calm down.

Vivien
With grants in place to help determine which viral infections and which viruses are playing a role, things would be calmer. Arboviruses are the group of viruses Marycelin Baba studies. They are transmitted by mosquitoes.

Marycelin Baba
It's arbo because it is transmitted by insects. By mosquitoes in particular, all viruses that have been transmitted by mosquitoes are called arboviruses. So you now see, in Nigeria here the commonest infectious disease is malaria, and malaria is transmitted by what? Mosquitoes. And all these mosquitoes are there. The mosquitoes that transmit malaria can also transmit virus. Then you have some let me see. Like Aedis egyptii, it can transmit four viruses through a bite.

It can transmit Zika, it can transmit Chikungunya, that cause . It can transmit Zika, that cause congenital syndrome like we hear about in Brazil. It can transmit yellow fever. And, you know, this is yellow fever zone. It can transmit dengue. The four of them can be transmitted by this. This place is mosquito Island, so to speak. Nigeria is mosquito Island

Vivien
Nigeria is mosquito island and each bite can transmit viruses, even multiple types of viruses. Ouch, that’s tough. What it means is that a way is needed to have differential diagnosis. This is malaria, this is yellow fever, this is dengue. Fever doesn’t automatically mean one type of viral infection.

One issue with diagnosis and this is true for COVID as we now all know, a precise result can be expensive. qRT-PCR calls for skill and specialized instruments. But there are simpler tests. They are less precise that qRT-PCR but they are needed to do differential diagnosis.

Marycelin Baba [37:00]
Differential diagnosis, because you cannot just say any febrile case that is malaria negative. No, because they can be co-infections . Malaria and viruses, they coincide. I have in my research shown that. So you have to do differential diagnosis to establish the real causative agent.

Vivien
RT-PCR is desirable as tests go but it is expensive and it requires skill to run. Another class of tests is called loop-mediated isothermal amplification or LAMP. Instead of doing what RT-PCR does. which is thermocycling, the approach amplifies DNA directly. DNA forms a kind of loop and self-primes, and is amplified so you can measure more easily what is in a sample. When COVID-19 spread ,many labs started looking at ways to make quick turnaround assays. New England Biolabs had developed a LAMP assay in its parasitology division, which is devoted to diseases in developing countries such as river blindness.

When COVID-19 emerged, New England Biolabs optimized their LAMP test for COVID-19 and donated LAMP reagents to the ICGEB, the International Centre for Genetic Engineering and Biotechnology. That’s an organization set up by The United Nations Industrial Development Organization. New England Biolabs together with ICGEB and financed by the Bill and Melinda Gates Foundation sent a LAMP assay to labs in Cameroon, Ethiopia, Kenya and Nigeria to test and evaluate it. Marycelin Baba and her team evaluated it in Nigeria.

Marycelin Baba [39:00]
When we were talking about COVID diagnostic, when we were talking about and I told you that. The gold standard is qRT-PCR. Now the New England Biolabs they have produced in the test and it's molecular based. They call it LAMP isothermal kits. It is very good. In fact, I was part of the lab my lab was one of those pioneers that evaluated the kits. Do you know the kits is almost like PCR but it does not require skill level. It does not require skill level. It does not require complicated analysis like you do for PCR. It does not require PCR machine. It's so simple.

Vivien
In Nigeria, Marycelin Baba has built capacity for COVID-19 testing, she has helped establish labs with appropriate biosafety features and she trains people. Many labs in Nigeria were unfit for working with SARS-CoV-2 in 2020 but she and others have made it such that there are more than 50 labs across the country able to handle COVID-19 and other infectious diseases. Her work on arboviruses can now continue. With a view to diagnosis and treating people with differential diagnosis.

Marycelin Baba [40:40]
It would be a delight for me to collaborate with anybody that can help me actualize my dream. And my dream is how to develop cost effective diagnostics for arboviruses so that we can initiate differential diagnosis of these arboviruses in Nigeria. Because if the diagnostic kits are cost effective, especially if they are locally, if they are made produced with local material, it will bring down the costs and it will be available. It will be available. And then it will be easy.

Vivien
That was conversations with scientists, Today’s guest was Dr Marycelin Baba of the University of Maiduguri in Maiduguri, Nigeria. And I just wanted to say, because there’s confusion about these things sometimes. The university of Maidugiri didn’t pay to be in this podcast. This is independent journalism that I produce in my living-room. I’m Vivien Marx, thanks for listening.