Abstract
On 1 October 1960, Nigeria gained its independence from the United Kingdom at a ceremony witnessed by the author of this book, who attended as a student representative. During the 50 years since this critical event in the history of Nigeria, the Nigerian health service has changed from one in which most senior posts were held by expatriates, and the system run to serve the needs of a colony, to a service run by Nigerians for the population of Nigeria. The working lives of the Nigerians whose careers have spanned most of this period of change are coming to an end and it is important that their experiences are recorded for posterity.
Recent books by Kelsey Harrison (An Arduous Climb: from the creeks of the Niger delta to a leading obstetrician and vice-chancellor) and by Ade Lucas (It Was the Best of Times: from local to global health), record the distinguished careers of an obstetrician and university administrator and of an internationally renowned specialist in public health who were both brought up in southern Nigeria in families with a tradition of Western education.
This autobiography by Idris Mohammed, from north-eastern Nigeria, records the experience of someone brought up in a very different environment where access to Western education was limited and where the author was fortunate to be given the education that allowed him to pursue a distinguished academic career.
Mohammed describes his upbringing in the small town of Gombe, his undergraduate training at University College Hospital (UCH), Ibadan, Nigeria and his subsequent postgraduate training at Nottingham University and the Canadian Red Cross Hospital, Taplow, UK where he established links with the UK which he maintained after his return to the University of Maidugri, Nigeria. Here he worked for over 20 years as head of the department of medicine, chief medical officer for the teaching hospital, and finally as vice-chancellor. His autobiography describes the many challenges that he met along the way and reminisces about some of those who helped him and others who did not.
In northern Nigeria, major epidemics of meningococcal meningitis occur every few years. It is, therefore, no surprise that Mohammed gravitated towards meningococcal disease as the main focus of his research. Two of his key research achievements were undertaking and monitoring a mass vaccination campaign in Bauchi province in 1978 and documenting the massive Nigerian epidemic of 1996 during which nearly 100,000 cases were documented during a period of a few months.
As a result of his experiences in 1978, he became a strong advocate for mass prophylactic vaccination with the polysaccharide vaccines that were then available rather than waiting until an epidemic had started and then vaccinating the population at risk, the WHO policy. Mohammed sets out clearly the reasons why the reactive vaccination policy was not satisfactory and subsequent experience has shown that he was right. However, WHO and other authorities were reluctant to recommend mass prophylactic vaccination on the grounds that polysaccharide vaccines induce only short-lived protection, at least in children, and do not prevent nasopharyngeal carriage.
This situation has now been changed by the recent development by the Meningitis Vaccine Project (MVP) of a serogroup A meningococcal conjugate vaccine that it likely to provide long lasting immunity and to prevent carriage. This new vaccine (MenAfriVac), produced by the Serum Institute of India at an affordable price, has been prequalified by WHO and mass vaccination commenced in Burkina Faso, Mali and Niger at the end of 2010. It is anticipated that immunization will commence in northern Nigeria in 2011.
Because of his expertise in meningococcal disease, Mohammed was asked by the Ministry of Health to go to Kano as leader of a task force established to deal with the 1996 epidemic. This led to his involvement in the trovafloxacin (Trovan®) case in which a clinical trial of a new antibiotic, manufactured by Pfizer, was undertaken in children admitted to hospital with meningococcal meningitis, allegedly without proper ethical approval or informed consent. This story, first publicized by the Washington Post in December 2000, led to an international outcry and initiation of a legal case against Pfizer in the USA, which the company eventually settled for a substantial sum. The chapter of the book which describes how Mohammed stopped the trial, backed up by copies of original documents from the time of the trial, and the way some groups in Nigeria turned against him as a result of his action is one of the most interesting chapters in the book and a valuable personal account of this important event which turned a spotlight on some of the activities of ‘big pharma’ in the developing world.
As indicated by the book's title, politics is never far below the surface of any activity in Nigeria and, as in the case of the Trovan® affair, Mohammed was brought face to face with this reality when he was appointed chairman of the national programme of immunization, a highly political position in view of Nigeria's then appalling immunization rate and widespread rumours of corruption in the immunization programme. The chapter of the book that describes his experiences as chairman of the board suggests that these rumours were well justified and that corruption reached high places.
Mohammed has strong views on medical education in Africa, the importance of medical research in Africa and on the failure of most African governments to support any of these activities in an appropriate way. His views on these topics are set out in further chapters of the book and, although his comments are sound, I found these sections less interesting than some of the more personal parts of the book as they have been covered previously by others.
Academics, Epidemics, Politics provides a well written account of a unique professional career and documents some of the current challenges to public health in Nigeria. It provides an informative and enjoyable read for anyone interested in Nigeria or public health in West Africa.
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