The Lagos laboratory charges N70, 000 for a complete paternity DNA test (samples from a father and a child). A United Kingdom-based laboratory, with a branch office in Lagos charges $300 (N51, 000) for a simple paternity test per head. In South Africa, paternity test ranges between N30, 000 and N91, 000 depending on the collection lab visited in Nigeria.
An average lab that receives 20 of such requests per month, at the rate of N80, 000, has spent N19.2 million a year overseas. If 50 out of several laboratories in Lagos alone collect an equal number of samples on a weekly basis, then among them is over N960 million on paternity-related DNA analyses every year.
This is a fraction of several billions Nigeria loses to medical tourism on a yearly basis. An estimate has it that Nigeria’s capital flight on medical tourism was N250 billion in 2013, almost the size of the 2014 health sector budget put at N264.4 billion and more than half of Lagos 2014 budget size of N489.690b.
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Lynx DNA Laboratory in Lagos, affiliated with a popular laboratory in the Unites States, gets between three and five requests on the average per week, and 15 on monthly basis. A complete test goes for N80, 000.
The Managing Director of the lab, Dr. Kola Afolabi, noted that there were other products, besides paternity testing that Nigerians were demanding. They include maternity testing, DNA banking (to keep samples for posterity lasting between 15 and 25 years at the cost of N60, 000 plus); family reconstruction (N200, 000) or siblingship tests (N150, 000).
Besides identity management solution, researchers have difficulties taking samples overseas. Prof. Akanmu observed that for several years, with such molecular biology research laboratory missing in the system, several research applications by local researchers had been turned down by grant agencies.
A colleague of his recently won a landmark research grant to the tune of $70 million, to do a research on the genetics of cleft palate in West Africa. The researcher, collaborating with colleagues from South-Africa, Rwanda and Ghana, were given $20, 000 to develop a proposal for the study. On invitation to the United Kingdom, he was found worthy of the research, but was eventually denied the entire grant because “the research environment is not there (in Nigeria).”
“Rather, they would collect his entire specimen and spend half of the research grant to do all necessary tests elsewhere. Nothing could be more devastating,” Akanmu said.
According to the professor, people are also demanding to know if their unborn babies might have congenital abnormalities (prenatal testing) and they are finding answers through DNA analysis. Even prompt diagnosis of diseases like cancer, HIV, Ebola among others now relies on DNA testing.
Continuing, he said: “DNA testing, indeed, has a lot of applications. Pharmaceutical companies now develop drugs that attack DNAs of diseases like diabetes. People that are going to develop the genes that could lead to diabetes, now have treatments at the DNA level, not at the tissue level. The importance cannot be over-emphasized.”
The Chevron lab that tested Ebola Virus Disease
The immediate past Chief Medical Director, Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun, said the reason Nigeria was not embarrassed during the Patrick Sawyer and Ebola saga was because of the Chevron Molecular Biology Laboratory, which was commissioned in February this year.
Amidst the Dana Air plane crash chaos in 2012, a group of medical researchers at LUTH were miffed at the lack of adequate forensic capacity in the country. They began to work out the possibilities of a standard molecular biology laboratory that would conduct advanced medical studies including DNA analysis at LUTH.
Indeed, the amount they estimated was huge, but they convinced the corporate social responsibility department of Chevron Nigeria Limited (CNL) to buy into the capital-intensive project.
Some months after it was commissioned, the Chevron Molecular Biology Laboratory, LUTH, detected the first case of Ebola Virus Disease in Nigeria.
Osibogun said the team of experts at the laboratory raised the alarm on detecting the constituent of Sawyer’s blood sample. The state Ministry of Health, its federal counterparts and the World Health Organisation were immediately alerted to the beginning of what is now known as the successful containment strategy of EVD in Nigeria. Timing was crucial.
Without the laboratory, more people would have been infected in the country.
“We prevented all this because we have developed the capacity for avian influenza, so we can detect Ebola Virus. Today, we are the reference laboratory in the EVD outbreak in Nigeria. It is so important to develop human capacity and technology. They are our saving grace in this matter,” Osibogun said.
According to him, the lab (in the EVD episode) has saved more Nigerians than would be disclosed because in it lies enormous potential that can be tapped by today’s complex medical diagnoses.
Not only would the facility predict the onset of breast cancer disease (gene I and II) that is 40 or 50 years away, it will detect sickle cell traits at a very early stage of pregnancy. Sickle cell is the most common genetic hereditary disease in Sub-Saharan Africa – one of the reasons Chevron invested in the laboratory as part of its corporate social responsibility projects.
The facility can predict those that will be sick in the future, what sickness they will have and how they can be prevented. The laboratory will also enable LUTH to establish a stem cell transplantation unit, and a nuclear medicine facility. The laboratory cost Chevron Nigeria N100 million.
Akanmu added that for so long, “we have only been the receiver of that knowledge that had been researched and developed elsewhere. But today, we thank God; we are able to assemble what is needed to contribute to global knowledge.
“We need to do regionally and locally relevant research. We have been collecting our specimens, sending them overseas for highfaluting studies and they would publish them putting our names as collaborators. We need to be able to do our own,” he said.
Complex nature of DNA facility and Nigerian environment
The President of the Nigerian Academy of Science (NAS), Prof. Oyewale Tomori, said the lack of such facilities was not due to the dearth of requisite personnel. Indeed, Nigerian scientists are some of the best minds in the world, he said.
Tomori said it was most unfortunate that the two labs that identified Ebola were those funded by donors from other countries. Chevron donated LUTH lab, while the World Bank is responsible for the Redeemers University’s laboratory.
The renowned scientist said: “Where are those labs built by the Nigerian government? Is it that we don’t have the money or what? Something must be wrong with us, because we have all the resources. You talk of capacity building, are you saying I’m not capable?
“What we need now is enabling our capacity to function. That is what we need from our government and we will excel. After all, we go to Europe and win the prizes because their environment allows you to function. Here, the environment brings you down.”
Durojaiye, however, noted that some forms of DNA tests were available in the country, although not at the highest level. Reasons: “Because DNA testing is quite wide, manufacturers have developed easy to use, compact machines that are dedicated to perform a limited range of tests like HIV, hepatitis B, human papilloma virus (which causes cervical cancer), tuberculosis, etc. These machines can perform high volumes of these specific tests in short turnaround times and are very useful for diseases of public health importance where large populations are regularly tested. They are so to speak ‘closed systems’, because the can only do a limited range of tests.
“In other countries they have centres with fully automated, bigger and more robust ‘open’ platforms that can be programmed to perform a wider range of tests – be it virus, bacteria, cancer, genetic abnormalities, paternity testing, forensic tests, etc. These are the ones that are very expensive and cost hundreds of millions (over N500 million) to build and maintain. It cannot be maintained in a system where there are frequent outages and industrial strife,” he said.
On why private laboratories appear uninterested in the DNA business, the Chief Executive Officer of one of the laboratories in Lagos told The Guardian that the DNA facility was too capital-intensive for a single outfit to attempt. Investors, according to him, only delve into ventures where they are sure of their returns.
The CEO, who spoke on the condition of anonymity, said notwithstanding the existing market for DNA in the country, the demand was still inadequate to justify a DNA facility to service them.
His words: “In the case of Dana, The Synagogue, you heard that the samples were sent overseas for testing. Who pays for them? The insurance company or the state government? With crimes like rape, burglary, extra-judicial killings, murders and the likes, would an average family or individual request forensic services and pay over N200, 000 to resolve a case? Only the rich can afford this. The average Nigerian would rather resign to fate and move on with life. That is why several of these cases are never unravelled.
“The number of requests we get for this test might be thought to be substantial but when you procure the big machines with the capacity to run thousands of tests in a day, you need an economy where people are requesting several thousands daily in order to make it sustainable and justify its provision,” he said.
Afolabi of Lynx Laboratory also submitted that there was the need to localise the technology, though he feared that the existing market was still inadequate to sustain it for the private sector.
His words: “It is a huge economic investment for private individuals to go into, considering the fact that crises and disasters do not happen regularly. But a government that is conscious of lives and property still has to prepare for those challenges being faced in The Synagogue, Dana and the like incidents and having to ship specimens abroad. It should not be the case for a country of Nigerian’s status and wealth in Africa. But that is the situation now.
“The market is low as it is because the primary market that we sell is identity management solution. That is paternity and maternity tests. That market is not huge enough to attract an investment of such magnitude. This is because of the awareness that is still low and for the fact that it is a one-off thing, unlike other diagnostic tests.
“First if there is no dispute in the family, you don’t just wake up in the morning and say you want to know if you are the father of these children or not. The test that they are happy to come for is when families want to migrate and want to confirm biologically the maternity and the paternity of the children they are taking along. This cannot sustain the huge economic investment and scientific processes that must be gone through before it is ready.”
Afolabi added that there was no undermining the importance of such a facility in the country but that the onus was on the government to take it up as a responsibility. He said the joy of having the facility in the country was not limited to just identifying paternity or people in disaster period, but the security agencies could use it to fight crime.
On the social implication of such a facility and possible impact on families with paternity-doubts, Afolabi said it was where professional counsellors were needed. He explained that conducting DNA tests was not actually to break homes, “that is what people should understand.”
“The fear of the unknown is usually there; with people saying it is better you don’t know. But we have encountered cases where we detected that the father is not actually the biological father. What we did in that case is to engage the parties in counselling and see what circumstances brought about that. If they can explain to themselves, it is something forgivable.
“What would be done is that, if the mother is actually the biological mother, then they may trace the actual father and if not, fine. Ab initio, since he has been taking care of the child, then it will not be nice to rupture the family tie because of that incident,” Afolabi said.
According to Durojaiye, all the disaster-related pressures, and the loss of grants and huge revenues from the health system would be a thing of the past if the authorities take the right step towards a viable health sector.
His words: “A lot of time we look at isolated problems in the health sector, thinking we can proffer isolated solutions to them. But no! DNA testing and its support services can only exist in a system that works, a health system that is well-funded, sustainable and devoid of frequent industrial shutdowns and professional rivalry. Until we start advocating a universal compulsory health insurance, which is what I think the Nigerian Medical Association (NMA) should be fighting for now, we will remain incapacitated to keep up with the rest of the world.
“That is when we can bring sophisticated infrastructure and other things like DNA facility into the health system. The laboratories – public or private – will also be sure that they will have enough work to do, maintain the machines and pay adequate salaries to highly trained staff. It is not as if there were no sizeable need for these tests locally, the problem is that the vast majority of people that need them cannot afford to pay.
“The size of our health system, with the current arrangement, is so small because government is the sole financier. How many people can afford between N100, 000 and N300, 000 for DNA testing to diagnose cancer? The root of the problem is the funding of our health system. We need to reform it to attract more funding and make it more efficient and effective to reduce the current wastage especially in public hospitals.
“Imagine if each of 160 million Nigerians is insured with say just N10, 000.00 a year. That runs into trillions of naira annually from private sources only and then couple this with government’s funding. That money will be available to build needed capacity and stimulate more private sector investment in sophisticated equipment in a sustainable manner because the hospitals are rest assured that patients’ bills can be settled regardless of the cost of the services. It will ensure more efficient and effective use of funds because enrollees will demand quality service in return for their contributions. Doctors and health workers will not go on strike wantonly in that kind of system because you only get paid for services rendered.
“That is why these other countries like South Africa have such facilities today because there is health insurance and people can access any test, including DNA, to diagnose any type of cancer and also afford to pay for the required treatment including expensive cancer drugs and organ transplantation.”