The Consul-General of Brazil in Lagos, Amb. Maria Figueiredo, on Monday, November 27, 2017 announced her government’s plan to share its philosophy of protecting small farmers with Nigeria.
Amb. Maria Figueiredo
Figueiredo made the announcement in Lagos at a Business Forum between a Brazilian Delegation, members of the Nigerian-Brazilian Chamber of Commerce and Industry and other Nigerian businessmen and women.
The consul-general said that it was imperative for Nigeria to protect her small farmers to be sustainable and self-sufficient in the production of food for home consumption.
According to her, about 70 per cent of food produced and consumed in Brazil is from the small farmers.
“We are really ready to share our philosophy for protecting small farmers with Nigeria.
“An official from my country’s Ministry of Agriculture will be visiting Abuja soon to share our philosophy for protecting small farmers with Nigerians.
“In Brazil, there are laws that are made to protect small farmers. So, I feel that Nigeria should also protect such farmers,’’ she said.
Figueiredo said that Nigeria should not only continue to promote big farmers, whose agricultural products were always exported to the international market.
She said that the delegation was visiting to explore the possibility to discover the Nigerian market for the importation of agricultural equipment from Brazil.
President of the Nigerian-Brazilian Chamber of Commerce and Industry, Mr Emmanuel Ibru, said that there would continue to be synergy between Nigeria and Brazil.
Ibru, who said that there was a lot for Nigeria to learn from Brazil, also announced his organisation’s plan to soon organise another visit to Brazil.
He said that the chamber would continue to encourage and promote trade and knowledge transfer between Nigerians and Brazilians.
Trade relationship between Nigeria and Brazil dates back to 18th century. Nigeria and Brazil enjoy warm cultural and trade relationship. Many Afro-Brazilians trace their roots to Nigeria.
Brazil is the largest country in Latin America and Nigeria is the most populous nation in Africa. Both countries are key players in the economies of their regions. Brazil is a leading political and economic power in Latin America. Nigeria is equally the leading political and economic power in West Africa.
Nigeria is the second largest trade partner of Brazil in sub-Saharan Africa and 11th in the world. Brazil is the third largest importer of Nigerian crude oil after USA and India. Nigeria balance of trade with Brazil is very favourable.
Brazil’s key industries are textiles, shoes, chemicals, cement, agriculture, motor vehicles and parts, other machineries and equipment. Major export products include aircraft, coffee, vehicles, soybean, sugar, rice, orange juice, iron ore, steel, textiles, footwear, electrical equipment, etc.
Brazil’s current account surpluses had continued to hit record levels, indicating that exports were growing strongly. Its income per head is now 12 times that of India and China.
Nigeria has a great deal to learn and tap from Brazilian experience.
A recent report on the state of health of Indians investigates and exposes the new and emerging environmental triggers of non-communicable diseases (NCDs) in the country.
Sunita Narain, director general, Centre for Science and Environment (CSE)
Titled: “Body Burden: Lifestyle Diseases”, the report, released on Monday, November 27, 2017 by a panel of eminent medical doctors, establishes that unless environmental risk factors are acknowledged and dealt with, India will not be able to curb NCDs responsible for more than 61 per cent of the deaths in the country.
According to the World Health Organisation (WHO), there are four major risk factors for NCDs – alcohol, tobacco, poor diet intake and lack of physical activity. The WHO says that, by investing just $1-3 per person per year, countries can dramatically reduce illness and death from NCDs.
However, according to Sunita Narain, director general, Centre for Science and Environment (CSE), the investment for India will be much higher.
“We believe the cost is going to be much higher considering that risk factors (in India) are many more than the four identified by the global body. These risk factors have multiple targets and can cause diseases which are not generally linked to them. For example, exposure to pesticides is known to cause cancer, but new data is emerging to link it to diabetes as well,” she says.
Similarly, air pollution is known to cause Chronic Obstructive Pulmonary Diseases (COPD), but there is little understanding on how this can adversely affect mental health. “Body Burden” highlights these linkages.
Says Vibha Varshney, the lead writer of the report: “Targeting environmental risk factors is essential if we want to meet the Sustainable Development Goal 3.4, which mandates a one-third reduction in premature deaths due to lifestyle diseases by 2030.”
“Though the WHO has identified the major risk factors for NCDs, it is still coy in calling out the real enemy – foods that are high in salt, sugar, fat and low in nutrition. It wants to play it as safe as possible so that it does not have to confront the real players and demand a restraint on their products, not through voluntary action but through government policies that restrict and restrain and put a premium on nutrition, not consumption,” says Narain.
Seven major health problems in India
Obesity: The number of overweight and obese people in India doubled between 2005 and 2015. Among individuals aged between 15 and 49 years, 20.7 per cent of women and 18.6 per cent of men have been found to be overweight or obese. Presence of obesogenic chemicals such as DDT, bisphenol A, MSG and arsenic in the environment were found to be important triggers of obesity. Besides regulating the use of these, marketing of processed foods too needs to be monitored. Increase in taxes on unhealthy foods, adequate labeling, and building an environment conducive to physical activity will be critical in combating the epidemic.
Mental health: More than 10 per cent of the country’s population over the age of 18 suffers from various kinds of mental illnesses. The lifetime prevalence of such mental illnesses is over 13 per cent. At least 150 million people in the country, affected by mental disorders, are in need of active medical intervention.
Lack of social support, changing diets and economic instability are the main triggers of mental disorders. Increased intake of sugar, too, has been linked to mental illness, making it imperative to find ways of reducing intake. An increase of PM2.5 in the environment by 4.34 microgram/cubic metre can increase the risk of Alzheimer’s. These risks, however, have not been considered in the mental health policies such as the Mental Healthcare Act, 2017.
Cancer: More than 1.73 million new cancer cases are likely to be recorded each year by 2020 in India. Commonly used household chemicals and cosmetics contain cancer-causing compounds. It is estimated that up to 20 per cent of cancer cases can be linked to environmental exposures of toxins. Tobacco and alcohol, air pollution and diets rich in meat and low in vegetables, are primary triggers. However, these triggers remain largely unaddressed. Moreover, cancer screening and medication remains extremely expensive.
Heart diseases: 26 per cent of all deaths in India happen due to cardiovascular diseases. Men and young are at a higher risk. In urban India, young and middle-aged people are at risk, while in rural areas, the elderly population is vulnerable.
Lack of physical activity has been identified as one of the biggest triggers of cardiovascular diseases. The easiest way out is to increase physical education. For this, policymakers need to prioritise pedestrian and cycling tracks and promote public transport and green spaces. Depression too has been found to be a risk factor for cardiovascular diseases. Those suffering from depression also experience changes in their central nervous system and hormones, leading to the possibility of disturbance in heart rhythm, which over prolonged periods can be dangerous.
Respiratory diseases: India had an estimated 22.2 million chronic COPD patients and around 35 million chronic asthma patients in 2016
.Other than air pollution from vehicles and industry, global warming also increases risk to respiratory health. Global warming has extended the duration of the pollen season and altered the timing, production and distribution of aeroallergens. Both pollen and air pollutants have risen simultaneously in the environment, leading to an enhanced airway inflammation, thereby increasing the frequency of respiratory allergy and incidences of asthma. Studies on the relationship between allergic respiratory diseases, asthma and environmental factors, such as meteorological variables, airborne allergens and air pollution are still limited, but important evidences are emerging.
Hormonal disorders: Every 12th Indian is said to be a diabetic. Data on other hormonal diseases is still not available. Small studies suggest that one in 10 adults suffer from hypothyroidism.
Hormonal balance is very delicate and is easily disturbed by exposure to toxins, air pollution and even food rich in fats, sugar and salt. Understanding of hormonal disorders is poor and this needs to be studied more. However, policies that reduce consumption of processed foods, increase physical activity and minimize exposure to chemicals would help maintain hormonal balance.
Food allergies: It is suggested that 25-40 million people in India could be suffering from food allergies. About 170 foods reportedly cause allergic reactions. Food labels that provide detailed information about constituents could be important in controlling this. Allergen labelling in India has so far been restricted to infant milk substitute. India does not have a mechanism in place that requires genetically modified (GM) foods to be clearly labelled.
At the UN Climate Change Conference in Bonn, Germany (COP23) held in November 2017, different countries and sectors came together to mobilise support for developing countries with the help of South-South Cooperation.
Panelists at the event
Collaboration and solidarity to address the threats of climate change is vital to enable a sustainable future for all. The pragmatic South-South Cooperation (SSC) drives an integral approach towards addressing overarching development issues, such as poverty eradication, the promotion of economic and social growth, and the protection of the planet.
COP23 strongly clarified that such cooperation is gaining strength and is playing an increasingly important role in climate action. Above all China, Brazil and Morocco put South-South Cooperation center stage in respective events at the conference.
China and the United Nations Office for South-South Cooperation (UNOSSC) hosted a high-level forum on South-South Cooperation on Climate change. The event positioned China as an active practitioner and supporter of this cooperation, which also supports China’s aim to become the largest contributor to climate action.
At the high-level opening of the event, the Prime Minister of Fiji and President of COP23, Frank Bainimarama, delivered the opening remarks on SSC. He highlighted that moving technology from North to South is as important as South-South cooperation. Many developing countries are increasingly addressing development and climate challenges in a successful and pragmatic way. SSC aims to spread this knowledge across the global south. China’s ability to plan for and deliver renewable energy, various energy resources are now available in parts of Africa which never had energy accesses before.
Jorge Chediek, Secretary-General’s Envoy on South-South Cooperation, and Director, UNOSSC, stressed his enthusiasm regarding SSC and the advances across the global South.
Global Partnerships are Key to Climate Action – The Examples of China, Brazil and Morocco
High-level participants from the global south as well as the UN system highlighted China’s role in implementing, measuring and sharing experiences with developing countries. UNDP Administrator Achim Steiner pointed out the responsibility of a just and fair global response to the climate challenge. Global partnerships between organisation such as UN DESA and UN Environment are essential to implement climate action solutions, he said.
Naoko Ishii, CEO of GEF, stressed the importance of non-state actors (including cities, the private sector and academia) and the necessity of a dialogue with these actors and governing institutions.
A keynote session between experts from different international and national institutions emphasised the high interest of developing countries in SSC. Accordingly, Bernd Hackmann of UN Climate Change acknowledged the importance of holistic approaches, including with respect to implementing the Paris Agreement and the national climate action plans (Nationally Determined Contributions, or “NDCs”). These areas of action need to be interlinked and integrated with countries’ sustainable development approaches to come to fruition, he said.
In addition to China’s High-level Forum on SSC, Brazil hosted an event that focused on reforestation activities in the framework of REDD+ in combination with SSC. The Ministry of the Environment is working in partnership with the Brazilian Cooperation Agency, which integrates the structure of the Ministry of Foreign Affairs, in the development of a Brazilian “Programme for South-South Cooperation in Climate Change and Forests”. The programme aims at generating solutions to common challenges, strengthening institutional, technical and scientific capacities, and promoting the engagement of developing countries in mobilising payment resources for REDD+ results. The Amazon fund and the National Climate Change Fund are the main Brazilian instruments for financing REDD+ related mitigation actions in this context.
The shift of programmes from being aspirational to generating genuine investments while looking for different partners are important factors to attracting finance. Morocco’s ambassador H.E. Aziz Mekouar promoted Morocco’s goal to invest 46% in renewables. Morocco also hosted a side event on SSC in the framework of COP23. A discussion took place between UNDP representatives and various national institutions such as the State Secretariat for Sustainable Development in Morocco. The event at the Morocco Pavilion emphasized the need to strengthen efforts to reduce greenhouse gas emissions and support the adaptation of countries most vulnerable to climate change. In this context, different perspectives and challenges of NDC implementation and options for how to catalyze their implementation through SSC were explored.
To provide an overview of the role and potential of south-south cooperation, the United Nations Southern Climate Partnership Incubator (SCPI) also released a report on Climate Partnerships for a Sustainable Future Report: An overview of South-South cooperation on Climate Change in the context of sustainable development and efforts to eradicate poverty.
The United Nations Human Settlements Programme (UN-Habitat) has signed a cooperation agreement with the Politecnico di Milano in Italy to carry out a feasibility study for the closure of the Ngong Town illegal dumpsite in Kenya and to design and construct a modern integrated municipal waste-to-energy plant.
The Ngong dumpsite
Solid waste arises from a wide range of human activities including domestic, commercial, industrial and agricultural. Managing solid waste is one of the most costly and complex urban services undertaken by municipal and county governments. The Ngong dumpsite receives a daily average of 50 tonnes of waste from Nairobi and from the local communities. There is no proper solid waste management in place with the waste dumped without processing or treatment which presents serious health and environmental hazards. The environment around the dumpsite is heavily polluted. The pollution includes surface and ground water, air, soil and crops pollution and visual blight.
Ngong residents in the proximity of the illegal dumpsite have complained of respiratory illnesses and skin infections. This has prompted the Kajiado County government to identify proper waste management and disposal as one of their development priorities. The Kenyan government approached the Italian Government to provide a long-lasting solution to the improper solid waste management and to create a pilot project that could be replicated in other towns in Kenya. The Italian Government is considering providing a soft loan to the Kenyan government for the design and construction of a modern municipal waste recycle and treatment plant, based on a sound feasibility study including social and environmental impact assessment. UN-Habitat will provide technical assistance and coordination for the environmental and social impact assessment.
The county government of Kajiado has allocated the land for the construction of a modern waste to energy plant away from the illegal dumpsite.
The Ngong dumpsite integrated municipal waste-to-energy plant
The cooperation agreement signed on Wednesday, November 22, 2017 between UN-Habitat and the Politecnico di Milano (POLIMI), which is the lead organisation in a consortium that includes the Technical University of Kenya (TUK) and LDK Consultants Engineers and Planners.
The feasibility study will:
Conduct a baseline diagnostic survey on the current status of the solid waste management in Kajiado County;
Design an integrated solid waste management system that includes the conversion of waste to energy;
Study the financial and technical feasibility of safe closure of the existing dumpsite;
Study the financial and technical feasibility of the design and construction of the new site;
Study the potential for resource recovery facility; and
Conduct consultative workshops and awareness raising.
The feasibility study will commence in December 2017 and end in March 2018. Waste to energy has been selected as the best option for the new landfill site because it is an increasingly practical and attractive environmental option for urban city officials and County Governments.
When completed, the new facility will recycle waste and generate energy for sale to the grid. Other benefits include; improved environmental sanitation due to the increased level of solid waste collection and the reduction of solid waste dumped; the provision of an affordable waste management system encompassing the collection, storage, transfer, treatment and disposal of waste; greater community awareness and participation in waste segregation and collection; the creation of new employment opportunities; and institutional capacity building.
Efforts to scale up domestic production of clean cooking solutions in Nigeria commences on Tuesday, November 28, 2017 in Abuja, courtesy of an initiative involving the Federal Ministry of Environment and the Nigerian Alliance for Clean Cookstoves.
Clean cookstoves imported under a Federal Government project
The endeavour will be kicked-off at the 2017 edition of the Nigeria Clean Cooking Forum, described as a landmark, annual gathering of government, professionals and entrepreneurs working to accelerate the production, deployment, and use of cleaner, more efficient cookstoves and fuels.
This year’s forum, according to a statement made available to EnviroNews, will support government efforts to scale up domestic production of clean cooking solutions in the country as well as contribute to meeting the country’s obligation to the Nationally Determined Contributions (NDCs). The event brings together over 200 participants including key policymakers, private sector leaders, foundations, research institutions, women’s groups and civil society stakeholders as well as international partners to discuss and proffer actionable steps towards scaling up domestic production of clean cooking solutions in Nigeria.
The statement discloses: “Research has confirmed that smoke from the traditional use of firewood is estimated to cause 95,000 deaths annually in Nigeria. After malaria and HIV/AIDS
, this would be Nigeria’s third highest killer mostly of who are women and children. Women and the girl child walk long distances and spend hours a week in search of firewood. This also contributes significantly to deforestation as well as the attendant consequences of climate change.
“Clean cooking will save lives, empower women, improve livelihood and combat climate change. It is a priority area in energy access that is central in achieving the goals of NDCs and Sustainable Energy for All (SE4ALL) Initiative in Nigeria. Clean cooking energy for all is not only possible but a right for the Nigerian citizens. The domestic market for clean cooking solutions must be developed through innovative partnership and support, thereby the government and private sectors needs to stimulate the market for ‘Made in Nigeria’ clean cookstoves.”
Minister of State for Environment, Ibrahim Usman Jibril, will formally open the event; while Senate President, Abubakar Bukola Saraki, will deliver the keynote address.
The forum’s sessions cover:
Strengthening the LPG market through public awareness for domestic consumption
Financing for clean cookstoves in Nigeria and expanding the market for clean cookstoves through standards and labeling.
According to the organisers, implementers of clean cooking solutions in the country will at the event share experiences, including challenges and lessons learnt. A session on Safe Access to Fuels and Energy (SAFE) will wrap up the forum, which will showcase a variety of clean cooking solutions.
An ecologist, Mr Abdullahi Aremu, has called on the government and other stakeholders to sensitise Nigerians to the dangers of bush burning, just as the harmattan season sets in.
Bush burning
Aremu, who is the Director-General, Advocacy for Environmental and Sanitation Integrity, a non-governmental organisation (NGO), gave the advice in an interview with News Agency of Nigeria (NAN) in Abuja on Monday, November 27, 2017.
He described bush burning as an abuse of environment, saying that it had negative consequences on soil fertility and by extension, crop growing.
He urged the residents of the rural areas, particularly hunters, to refrain from setting bushes on fire in their efforts to hunt down animals.
Aremu underscored the need for state and local governments as well as other relevant stakeholders to embark on public sensitisation campaigns on bush burning, particularly in the rural areas.
“There is need to educate Nigerians on the abuse of the environment and the importance of forests in efforts to tackle environmental challenges such as erosion and flooding,’’ he said.
He said that state and local governments should strictly enforce extant environmental laws so as to check illegal bush burning and the abuse of the ecosystem in their domains.
The AIDS Healthcare Foundation (AHF) on Monday, November 27, 2017 urged the Federal Government and other stakeholders to fulfil their pledge to fund the testing and treatment of HIV/AIDS in the country.
Minister of Health, Professor Isaac Adewole
Steve Aborisade, Advocacy and Marketing Manager of AHF, made the call on behalf of the Foundation on the sidelines of activities commemorating the organisation’s 30th global anniversary in Abuja.
The News Agency of Nigeria (NAN) reports that the commemoration had the theme “Keeping the Promise’’.
“Everybody has a promise to keep on HIV and AIDS, and the government needs to keep the promise on funding to end AIDS as a public health challenge by 2030.
“It needs to take ownership of the HIV response and not be dependent on donor partners. For instance, the South African government funds 80 percent its domestic programmes, and it is not dependent on donors.
“The budget (in Nigeria) is generally is not encouraging and health must be funded because health is wealth,’’ Aborisade said.
He further reiterated AHF’s commitment to re-strengthening its partnership with relevant stakeholders to eliminate mother-to-child transmission of HIV by 2020 and end AIDS as a public health challenge by 2030.
Dr Modupe Oduwole, National Strategic Intervention Adviser, UNAIDS, also called on the Federal Government to take ownership of the HIV response in the country.
Oduwole said it was important for the Nigerian Government to take ownership of the HIV response of its citizens as donor funds are now dwindling.
“Beyond ownership, there is also the need for integrated approach to healthcare delivery, and revamping the whole healthcare sector for better care.’’
Dr Uche Okoro, Project Manager, FCT Agency for the Control of AIDS, further commended the government on its intervention in the treatment of HIV and AIDS in the country.
Okoro said government was working towards the inclusion of HIV and AIDS treatment in the National Health Insurance Scheme (NHIS).
“This will help to reduce the out-of-pocket spending of persons living with the virus.’’
A Committee of European Union Member States is met on Monday, November 27, 2017 to discuss a licence extension for the controversial weedkiller glyphosate.
The European Parliament will decide on extending the approval of glyphosate
The EU licence for glyphosate will expire on December 15, and member states are divided as to whether they should agree to a five-year extension as proposed by the European Commission.
Glyphosate inhibits the growth of unwanted plants.
It is widely used in farming, but also to control plants in domestic and urban settings, and has been questioned amid concerns as to whether it might cause cancer.
So far, the commission has failed to secure the necessary support from EU member states for the renewal of the licence, despite proposing a shorter licensing period of five years, instead of 10 as envisaged originally.
In October, the EU parliament adopted a non-binding resolution to band the household use of glyphosate with immediate effect and end agricultural use by 2022.
Not taking care of the environment and thus allowing it to deteriorate has been fingered as the root of the upsurge of dissidents in the country.
L-R: Nnimmo Bassey, Prof. Babajide Alo and Ugochi Oluigbo at the Leslie Adogame environmental colloquium on Saturday, November 25
This was the assertion of panelists at the inaugural national environmental colloquium in commemoration of Leslie Adogame’s 50th birthday in Lagos on Saturday, November 25, 2017.
“Facilitating National Environmental Discourse for Agenda Setting for 2018” is the theme of the colloquium anchored by Mr Kayode Aboyeji of Ecogreen News. Issues discussed ranged from government policies, waste management and sundry issues bordering on environmental protection.
Adogame is the Executive Director, Sustainable Research and Action for Environmental Development (SRADev Nigeria).
According to Professor Babajide Alo, Director, Centre for Environmental Human Resources Development, University of Lagos (UNILAG), Akoka, the herdsmen issue is purely an environmental one.
Leslie Adogame
The migration and invasion of farmlands and public places by cows and the herders are due to desertification, he added.
Expatiating, the environmental expert identified 47 per cent of the herders as idle youths who lost their means of livelihood due to environmental problems in the North.
On the way forward, the don said those young herders should be captured and engaged gainfully.
“If you do the right thing when it comes to the environment, crime rate will drop because a hungry man is an angry man.
“Boko Haram came up because Lake Chad dried up and youths who were engaged became easy recruits of Boko Haram,” he said.
Setting environmental agenda for 2018, Nnimmo Bassey, environmentalist activist, author, poet and former chairman of Friends of the Earth International (FoEI), urged the electorate to look out for “parties or individuals whose manifestoes are environment-friendly”.
Pollution, he noted, is among the top 10 killers in the world, adding that “Nigerians are living in a polluted environment”.
For him, terrorism and gun-wielding policemen in the streets are other forms of pollution.
He urged government and other stakeholders to “protect our waters, protect our forests and talk to the cattle-owners who arm the poor herdsmen to kill poor farmers while they relax in their cosy mansions.”
Award-winning environmental journalist, Ugochi Oluigbo of Television Continental (TVC), in her own part of the discussion, asserted that Nigerians’ seeming illiteracy on environmental issues “is a structural problem”.
She said the twin evils of poverty and environmental issues were not making matters better, as hunger had made people to take environmental issues for granted.
The “Green Angle” presenter on TVC urged Nigerians to think about others while dealing with the environment.
Fixing Nigeria, she insisted, is a job for everyone because of “our structural problem”.
A guest, Anthony Akpan of Pan African Vision for the Environment (PAVE), canvassed thst environmental education should be included in the school curriculum. He also called on policy-makers to make adequate provision for environmental issues.
Prof. Alo agreed with him, noting that Lagos State tried it once, “but I don’t know the situation now”.
A new antiretroviral drug employed in the first line treatment of human immunodeficiency virus (HIV), will soon be rolled out to more Nigerians living with the disease, according to Africa Community Advisory Board and the Clinton Health Access Initiative.
Minister of Health, Professor Isaac Adewole
The drug, DTG (dolutegravir), is already available in developed countries and afforded by few Nigerians but at a very high cost. However, the Clinton Health Access Initiative is ready to accelerate the availability of the drug, which is considered an optimal treatment option. In comparison to Efavirenz (EFV), the current widely used first line drug, DTG is found to be more efficacious, durable, tolerable, of higher bioavailability, lower pill burden, and potential for fewer side effects.
A member of the Africa Community Advisory Board (AFROCAB), Mr. Obatunde Oladapo, said at a sensitisation meeting on Friday, November 24, 2017 in Lagos that several countries have changed or are in the process of making the transition to DTG-based first line regimen (and in fewer countries EFV 400mg) but more information is needed on how they are likely to perform in real world in low and medium income settings and that is the reason to engage communities in clinical trials.
“What AFROCAB is doing is that before this drug will be rolled out in Nigeria, the community will be adequately represented. AFROCAB will be involved in setting the standard of care, development and distribution of literacy materials and creating orientation workshop for support group leaders. Already 6,500 participants are enrolled in a clinical trial that began since June in three sites: Lagos University Teaching Hospital (LUTH), Jos University Teaching Hospital in Plateau State, and Federal Medical Centre, Makurdi, Benue State.”
According to him, the trials will last for a year till June 2018. Subsequently, the Clinton Health Access Initiative will make it available and accessible to the 3.1 per cent Nigerians living with HIV.
Speaking at the same meeting, Dr. Oliver Ezechi, Deputy Director of Research and Head, Clinical Sciences at the Nigeria Institute of Medical Research, welcomes the development, but argues that rather than making DTG a first line drug, it should be reserved as a life-saving third line drug for hundreds of people who have developed resistance to first and second line treatments.
“There are up to 50 people at our center (NIMR) who have failed both first and second line drugs. The third line drugs are not available and they are not free. A regimen costs N80,000 per month. How many patients can afford that monthly?” he lamented.
Usually, the first time a patient starts taking anti-retroviral drugs, he or she is given first line drugs. But the rule is that at least one percent of every such patient will develop resistance. The solution is to place him or her on second line drug. Similarly, every patient on second line drug will develop resistance, after which they will be placed on third line drugs.
Dr. Ezechi noted that since the beginning of HIV response in Nigeria (more than two decades ago), several patients have developed resistance to first and second two line drugs and since third line drugs are not available, accessible and affordable, they are inadvertently left to die.
“Since 97 percent of drugs are donated by donor agencies, will you blame PEPFAR, or Global Funds or any funder if they say they have no money to support people on third line drugs? That is why personally, I would have preferred this DTG is kept as a third line drugs because it is difficult to see patients that you have been caring for, going to die because of drug resistance,” he argues.
“I don’t agree with that,” Mr. Oladapo says. “I believe that using DTG as a first line drug is putting out best foot forwards. Moreover, it is already in Nigeria’s treatment guideline that DTG should be used as first line drug,” he adds.
In 2015 the World Health Organisation (WHO) included three drugs Efavirenz lower dose – EFV400, darunavir/ritonavir (DRV/r) and dolutegravir (DTG)DRV/r, and DTG in HIV treatment guidelines as part of alternative regimens. To date at least fifteen low and medium income countries have recommended DTG first line in their national guidelines. And five countries have already began providing DTG in their programs: Botswana, Brazil, Kenya, Nigeria and Uganda.
