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Diplomacy in Action

A Fresh Look at Africa: Advancing Sustainable Agriculture & Health Outcomes


Remarks
Office of the Science and Technology Adviser
Dr. Nwadiuto Esiobu
Washington, DC
July 11, 2012

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JONATHAN SHRIER:  Welcome everyone. Good morning. I’m Jonathan Shrier. I serve as the Special Representative for Global Food Security here at the State Department, and one good thing about that role is it means that I’ve had the benefit of Diuto Esiobu’s services over this past year. So, it gives me great pleasure to be here with you to introduce her. Diuto came to us through the Jefferson Science Fellows Program, which is run out of the Science and Technology Adviser’s office and is a really wonderful public-private partnership that enables the State Departments to benefit from the expertise, wisdom, and energy from tenured faculty members from U.S. universities, and the partnership part of this public-private partnership is that we provide a job role in the State Department and other agencies such as USAID for a year for the fellows. The universities continue to pay their salaries, so that’s a very good partnership from our perspective.

So we’re very, as I said, glad to have had the services of Diuto, and let me just give you a short introduction to what she’s been doing and what she’s done before and what she’ll be going on to do. So, Dr. Nwadiuto Esiobu has been serving as the senior science advisor in the Secretary’s Office of Global Food Security and has spent, also, some of her time advising the Bureau of Oceans, Environment, and Science in the Office of International Health and Biodefense here at the State Department. This year has been an extremely busy and productive period for the Office of Global Food Security which, under the U.S. presidency of the G8 and, therefore, under our chairmanship of the L’Aquila Food Security Initiative launched at the G8 meeting in 2009, we’ve hosted a very successful meeting of the follow-up group established to track this important, multilateral, international food security initiative.

We hosted the meeting here at the State Department and Diuto was very much involved in the organization and execution of that meeting. In fact, she convened the section of the meeting devoted to agricultural research for development and helped develop strategies that led to pioneering breakthroughs in transparency and accountability systems for food security, including tracking donor assistance for agricultural research that contributes to development outcomes. She also provided leadership and insight to the multi-agency technical task force in developing U.S. negotiation papers for the G8 Summit. She played key roles in organizing and hosting forums for promoting innovative U.S. public-private partnerships for global food security.

Dr. Esiobu also provided extensive science advice as the lead person in the Office of Global Food Security for biotechnology, biofuels, water, and natural resource management, climate change, and so on. She was also the delegate for our office to The Comprehensive African Agricultural Development Programme or CAADP, which the U.S. plays a very large role in, and she also was our liaison to the work of Grow Africa, which is a multi-stakeholder partnership to promote agricultural development in Africa. She’s been invaluable in crafting the agriculture and food security framework for the U.S.-Nigeria Binational Commission, and we look forward to her continued engagement with our office.

For the Office of International Health and Biodefense in the Bureau of Oceans, Environment, and Science, she created a write-up on the public health efforts, sorry, the public health effects of counterfeit and substandard medicines, which serves as a technical guide, and she also led efforts to Ethiopia and Nigeria to generate awareness on the dangers of counterfeit and substandard medicines. She initiated and helped host the first ECOWAS diplomat’s forum on this subject of counterfeit and substandard medicines.

Dr. Esiobu earned her PhD in microbiology from the University of Leuven, Belgium and she also did postdoctoral in molecular biology and biotechnology at the Massachusetts Institute of Technology. She’s the director of the Microbial Biotechnology Laboratory at the Davie Campus of Florida Atlantic University, where she teaches and conducts research in environmental health and environmental sustainability. Dr. Esiobu has developed probes for rapid detection of pathogens. Her lab is developing microbial genetic fingerprints for monitoring soil and environmental health. I wish we had a laboratory back in the office so that she could do some of this work for us, but we just have computers and desks.

She’s published over 50 peer-reviewed articles and manuscripts in diverse fields of applied microbiology, including biological nitrogen fixation in tropical soils. Diuto has played leadership roles in various committees of the American Society for Microbiology, Florida Educational Department, and the Technology Council of Broward County. She’s received many awards for her efforts, including the ASM International Professor Award, and was recognized for outstanding service to the International Education Committee of the ASM. Dr. Esiobu was named the 2011 Faculty of Distinction by the Florida Atlantic University President’s Council to honor her outstanding academic and professional contributions to FAU, to the state of Florida, the nation, and the world. Diuto is married and is the mother of four children, the youngest of whom just graduated high school and is headed to Harvard University in the fall. So, please help me welcome Diuto Esiobu.

NWADIUTO ESIOBU:  Thank you very much, Jonathan. Thank you and good morning, everyone. I’m really thrilled that this moment eventually has arrived. I want to thank Jonathan especially for all the opportunity he afforded me in the office. I learned a whole lot about diplomacy; I watched him navigate the OXY group [spelled phonetically] and steer them to the port to transparency to which they agreed to report all the funding and how they did it. I want to thank Kate Russell, also the Chief of Staff and the Global Food Security Office for holding me by the hand and teaching me what clearance meant. I also want to thank all the office members, including Kate, there are three Kates in the office: Kaitlin, Kate, and another Kate, and you all were terrific. I thoroughly enjoyed my time in office. Also, Steve, I don’t know if Steve is here in the office, I wanted to thank all of you.

I want to thank every friend that I’ve made since I came to Washington DC because you all made my stay here terrific; it’s a memorable one I will never forget it. I go back to the university knowing two things I didn’t know: that it was okay to copy what others wrote and that that wasn’t plagiarism; on campus, that’s not allowed. My students know that very well.

The second thing that I have learned is that the word “clear” means something really unique, I will never forget it. It has a special place in my dictionary from now on.

So, those are two special things I’ll take home from the State Department. I’d like to recognize my colleagues, the Jefferson Science Fellows, who are here also, and many of whom have already delivered the wrong lectures. I want to thank you for your friendship and these are distinguished scientists and I don’t know how I found myself in their midst. I want to thank you that I really, thoroughly enjoyed being part of that group.

And talking about Jefferson, the name will bear, I had to stop while I was preparing this lecture to think about this endowed, precious, great advocate of liberty and of freedom whose name I bear, and I am honored to bear in fact. And I couldn’t but contemplate on some of the issues regarding his impression about the black being inferior to the whites at the time when he was alive. And then I came to think about the fact that at the same time, about like half a mile -- half a world away in India and in Africa, there were Africans who thought others were inferior to them. There were Indians who had people whom they called outcasts.

I concluded after my contemplation that if Jefferson was here today, I am sure he join the golden chorus of “Amazing Grace,” how sweet that sounds, and I am sure he would say “I once was blind, but now I see.” I am so honored to bear that name, the name of a distinguished president and the author of the Declaration of Independence, which, in fact, is what makes us great as a nation. So -- and I actually still borrow a lot of inspiration from him, he said in writing the declaration and drafting it, of independence, “I didn’t make any references to big textbooks.” He said “I just presented it to make clear things that should be clear to humanity.” And that’s what I plan to do in my presentation today.

Before I continue to the crux of the matter today, to the main topic of this commission, I would like to dedicate this presentation and, in fact, my service here, to Dr. Boris Magasanik who was my mentor at MIT. He is 92 years old. I went to MIT end of March to tell him that I’ll be dedicating my lecture here to him. He is very weak and I am so happy he is alive to hear me publicly acknowledge him and thank him for all that he has done. He is a mentor beyond compare; that’s just how I can express it.

My father is gone. His golden heart stopped beating in 1999, but there is no way I could be standing here without him, my inspiration and hero even though he is a zillion miles away from me if he’s still there. He told me about a man named Pasteur Louis and one thing that man talked about: microbes. That’s how I ended up being a microbiologist. Pasteur Louis, after microorganisms were discovered, and found out how diverse the microbes were and all the things they could do, good and bad. He said “Ladies and gentlemen, I am persuaded that these microorganisms will have the last word on Earth.” And it is true, over time, that we have seen that the scientists at that time did not even know 1 percent of what we now know, even though we know also that we’ve just discovered 5 percent of the microbes on our planet. So I say to my students and I say to myself “That means there’s a lot of work, but we’ll continue to work to postpone that last word.”

So the topic today is “A Fresh Look at Africa: Advancing Agricultural and Health Outcomes.” I think that a more accurate title today would be “A Fresh Look at Africa and a Little of Everything.” I plan to weave scientific models with what I understood diplomacy to be; this was my first encounter with diplomacy in the State Department. So, in the discussions, I will use stories about microorganisms, gene expression to explain what I understand the diplomacy is about, and I’m going to share a lot of my personal deductions, what I have come to infer from the many readings and draftings that I made while I was here. And this will be our agenda for today.

“A Fresh Look at Africa.” Why a fresh look at Africa, you would wonder. Why should we take a fresh look at Africa now? Well, there are so many reasons and I know that we have a squad of outstanding diplomats all around the world, embedded in all corners, in Africa who, of course, bring feedback to the State Department and a lot of information that guides what we do. So I thought to just summarize some of these and then quickly go on to the model I’ve drawn up on what I think is the situation and the problems with African development.

Everyone knows that the current population of Africa is 1.1 billion. Africa as a continent, and 1.1 billion people there. And you can tell at the tone of my voice that is actually an estimation because many African countries have not conducted a thorough census in the recent past, but it’s the most reasonable estimate of the number of people on the continent of Africa. The population growth in Africa is growing the rate of 2.2, that’s a gross average. Some countries like Mali have a very high growth rate, where the women have an average of five children or more.

And it is not just that the population is growing, but the fact that there is a very high proportion of young people, of young people who don’t have jobs. Because you can see in this small slide there, you can see proportion of unemployed youth there, and then those who are inactive. This recording actually takes into account young people who were in school, those who didn’t know what to look for, but it just tells us that about 50 percent of the young people don’t have anything doing. Seriously. And, so demographically Africa is coming up with a large population of young people who are not being steered in the right direction. That’s one point to know.

The second reason we need to look at Africa right now is a health challenges on the continent. Everybody knows about the scourge of HIV/AIDS and so many people who have died. I will not preach to the choir because you all know about that very much. But what struck me was this slide. In fact, this slide seemed to have a high disease button as well because it’s kind of fuzzy. You can see that out of 1,000 people in Africa, there are 600 that are somewhat ill. Another interesting part of this graph is the fact that the females, the women who are usually the bedrock of the economy in many African countries, are more sick than the guys. That’s not so for many other regions of the world. That is true for Africa and for Latin American areas. Because of all the volatility the others’ mismanagement of resources, everybody knows about.

Another reason we should take a close-up -- another look at Africa, is that the opportunity is great. Somebody said that “history is not destiny.” Africa has inherited the young people in Africa today. Some countries the mean age is 15 years and there have inherited a tainted legacy. But the good news is that history is not destiny. So there can be -- there are many opportunities for change. President Obama and his words call this “a new moment of promise,” and there is a changing program on the continent largely due to the Internet and the electronic communications that has shrunk the world into a small place where the young people have seen things that work. So, there is a big paradigm shift from people who are looking for give-outs or donations to people who want to be contributors themselves, to development. And not just in Africa, but beyond their borders as well. The youth are positioned, like I said, for the new era -- new technology era, and the large human resources can actually be tapped, many of them not used.

Look at the projection: by the year 2050, there’ll be 2 billion Africans and a large proportion of that number would be young people, and you can see them cheering you all there. All right, so these are more reasons why we should take a look at Africa now, surveillance and emergent disease. With climate change, we expect that there will be newer microorganisms, emerging and changing, shifting and drifting the genes, but so a closer look and a relationship a corporation with Africa would allow better control and surveillance of this situation. Especially counterfeit medicines that I’ll be talking about in some depth in a few moments. It would help to cut biocrimes and, of course, mitigate climate change and things like that; there is also the thriving diaspora that would help to drive that.

This is perhaps an unconventional slide, but I like to use this in my class to talk about frame shift mutations. And at first look, you read something from the slide, and at the second look you would find something else from the same slide. So this is the reason we should take a fresher look at Africa regardless of what intelligence we had had or what we’d thought in the past. So the same letters could read two things that are exactly opposite.

So what kinds of signals do we see on the continent and how do we interpret those? To take it home, I decided to show my favorite segment in microbial genetics, which is gene expression. I see, I like to liken diplomacy as the DNA regulating gene expression to ensure cellular survival. So let me wind back a little bit.

There are two things we can learn and how we can associate a fresh look to Africa with microbial gene expression. The first is that microorganisms constantly sense the environment; they have proteins in their membranes, so they sense changes in temperature, pH, and things like that. And they send back signals to the DNA which is the blueprint of the cell, and that’s through proteins that we call signal transducers. Those proteins bind to the DNA to let it recognize what is happening in its environment, and then the DNA responds.

The proteins and the signal transducers are like the Foreign Service agents, they’re like the workforce that we have, the diplomats around the world that collect information continually and feed it back to the State Department and to the government. The DNA is the policymaker in the cell. In response to the signal is receives, it expresses a portion of itself, through what we call transcription, to produce a message in the form of an RNA.

This is when the government makes a policy, and this policy, then, is translated and applied to the different regions of the world where they apply to. In this case the message from the DNA is G-O-D-I-S-N, you spell it to the end. And you agree with me that this could be read anyhow. It could be read as “God is now here” or “God is nowhere.” So what does the cell do? That’s the second lesson.

The first lesson we’ll learn from the cell is that it constantly monitors its environment and responds appropriately for the cell’s survival. The second lesson we learn from the cell is that this message that is released is not translated randomly; it is guided to the ribosome by a leader sequence. The leader sequence positions up there and helps it to bind to the ribosome at the right position that allows the bigger part of the ribosome -- I don’t want to go into the details of gene expression -- to then read the frame correctly, so that the translation of the message is appropriate for the particular condition that the cell is responding to. So that means that you can then read this right. So the second lesson is that the leader sequence guides the message.

The message is like the country-led initiatives, but I think the U.S. continues to play like the role of the leader sequence, to position that message in the ribosome so it is properly expressed. Lastly, another that’s a sub-lesson from this, is that as the environment changes these can be spliced to mean different things. So there is a post-translational modification that happens to give you different products from exactly the same message. So we’ll see why we have to take a look at Africa. Even when we think we know it all, we need to guide the message and translate it in many different ways.

All right, what are the driving factors for the underdevelopment, the stagnation in Africa that has endured for so long? From when I was born, Africa has been poor. Remains poor to this day and that’s many decades ago. What are the driving factors? Most people think they know. But I sat down to see if I could see anything different. So I came up with this model. There may be things that we know well, but we might need to take a fresher look at.

From this model, you would notice that the disease burden is high and the crop yield is low. If only we could switch it, then Africa would be fine. If we could switch the low this way and switch the high disease burden to that, to high crop yield, I am persuaded that this would move out of this vicious cycle.

Food and security is a product of all of these, so it goes like in a continuous cycle. But during my stay here at the State Department, I had enough time to think about why the disease burden is Africa is high. There are all the reasons everybody knows: poor hygiene, poor nutrition, a lot of microorganisms in the environment because of the climate. I’m not sure many people consider the role counterfeit and substandard medicines play in Africa.

I did a little bit of work on that with IHB in my search for why this vicious cycle has remained and not been broken over time. And I find that this probably contributes greatly to the high disease burden, and then my next few slides, I’ll try to justify my claim, even though I don’t have a lot of time to do that, and by exacerbating the high disease burden you see all the consequences that follow: impaired child development and poor adult productivity. That leads to -- I’m not excusing corruption, which is a major factor in mismanagement, but of course their judgment will be poor if they don’t have good brain development. Sanitation and all that contributes and you see that cycle going there. That, of course, would lead to low crop yield. There’s another input I would like to talk about today which is this. The two major inputs that I would like to spend a little bit of time on and then propose some solutions on.

Counterfeit and substandard medicines. It’s a growing global challenge, this issue, but the problem is worse in Africa. So bad, that I actually wept. I read over 100 articles on counterfeit and substandard medicines in Africa, that is in the context of my service to the International Health and Biodefense Office of the OES. And I found out, I think, that is does contribute significantly to food and security in Africa because people are rarely totally healthy.

They are in a vicious cycle of being ill and only a healthy person could cultivate the farm and produce food. And I think it impedes development because it’s a real source of major economic losses to a vulnerable population, and it does threaten the future of anti-microbials on the continent. And because microorganisms don’t usual ask for visas that might become a global issue if nothing is done.

Some facts to get you on my side on this speculation. Is there -- we don’t know exactly the numbers -- in other words, what is the proportion of medicines that are counterfeit? So it ranges anywhere from 20 percent in developed countries to 70 percent in some African countries and it varies from one type of medicine to another.

There is a consensus, however, that the scale of this problem of counterfeit and substandard medicines is very high, and that something must be done. It is so high -- the magnitude of it is so bad that it would require, I think, an international intervention for something to be done to break that drive of the vicious cycle. African countries lose 12 billion dollars annually, and that’s the project of the OECD from weak treatments of diseases and the consequences thereof.

In addition to that, African countries lose 50 billion dollars from the tuberculosis scourge, and they keep re-infecting themselves and retreating themselves because of counterfeit medicines. A vulnerable population—I didn’t even realize that they could most of that amount not to talk about losing it to just counterfeit medicine intervention. The WHO reports large numbers of deaths and this is workforce, that Africa badly needs, that die annually from substandard medicines. I think that the height of this burden in Africa should be blamed, in part, to the counterfeit medicines and, in fact, it’s been shown, from fingerprinting those medicines, that the vast majority comes from Asia.

I conducted a small survey in Ethiopia, and this survey is, of course, not just that it is small in size, but it is a self-select group. But what you see from this survey, it measures those who are aware of the problem of counterfeit medicines in Africa as well as those who have a personal experience or encounter of somebody who has been effected. The summary of the slide is that a hundred percent of those surveyed knew about counterfeit medicines who were from Africa, almost 20 African countries were represented there.

But what surprised me the most was that this would have been a group of elites. It was a society where you had medical scientists and pharmacists in Ethiopia last year, when I did this survey, and I expected that these elites should know about counterfeit medicines but shouldn’t have anyone very close to them who have had the problems because they should be able to educate them.

But the problem is so bad that not even the experts can tell the difference between fake and real. This slide shows us something that also drives the model that I shared with you. You would notice that about 65 percent -- some reports say 48percent of counterfeit medicines are antibiotics, antimicrobials in general. The disease burden in Africa, the vast proportion of that high disease burden is of infectious diseases: tuberculosis, HIV, and pneumonia sometimes, and, of course, Malaria, the big player. So the antimicrobials are the vast the majority of the counterfeits and that corresponds to the high burden of infectious diseases in Africa. So this might have a very strong correlation there.

This shows us what is in the fake medicines that have been examined. Forty-three percent of those medicines don’t have any active ingredients so the sick time is high; the time away from work is very high. And some of them, of course, die from no treatment, thinking they had already taken medicines. But this is what is very worrisome to me as a microbiologist: Twenty-three percent of the proportion I examined of the counterfeit medicines, antimicrobials, don’t have very weak doses.

What this is to the microbe is a selection pressure that allows them to shed genes for resistance. So it drives the emergence of multi-drug resistance. Because the counterfeit medicines have a sub-clinical dose, a sub-lethal dose, of the active ingredients, the microorganisms are able to proliferate, mutate, adapt, and rapidly share the resistance genes.

So the outcome is that people will contract the illnesses from the first line -- first group of people who were ill would be affected by resistant organisms and this grows in magnitude in that order so it’s like a cascade of a problem that requires intervention. So it ruins years of investment of developing these drugs, and some Africans treat this as an issue of developing their own drugs, but I made it clear to them in Ethiopia that the problem of counterfeiting will continue; it doesn’t matter where the drugs are produced. And it will be important to combat this at international scale, to break it.

Now back to the second pressure. In the model, I identified two drivers of the underdevelopment in Africa. One is the counterfeit and substandard medicines, and the second is low agricultural input poor soils. And some of that is not man-made and some of that can be corrected by man in fact.

The FAO predicts that by 2050, when there’ll be more than 2 billion Africans, that would have to produce a lot more food by 60 percent compared to the levels of 2007. From this graph, you can see the growth, where the green is Africa -- that is the growing population of Africa and you can see that, clearly, more of this food production needs to happen on the continent of Africa.

In fact, 80 percent of the increase in food is expected to happen in the continent of Africa and Latin America. That is where we have arable land, of course, to intensify agriculture. This tells you -- the portion of this graph here, the proportion of land that is currently being cultivated and what is not being cultivated but has the potential of being cultivated. We do have some in Africa, but what would be the outcome? The yield is still very low. Fertilizer use in Africa is at an apologetic level, there, compared to the rest of the world, It is not surprising that agricultural output in Africa is, therefore, very poor.

Now, the soils that need to be cultivated in Africa have been classified into different categories based on how productive they are. The summary here that we take home is that the soils are generally poor, requiring a lot of intervention. But what is the solution to that? What can be done to improve agricultural yield, and what are the other problems that we currently see and worry about in Africa?

The first issue is a big issue and intensification -- so this is the paradox: we must intensify agriculture to feed the growing population that is burgeoning rapidly and do we have keep the first thing cutting down to reach that goal? That’s the question.

We’re not just saying that the long rotation and fallow systems in Africa are declining very rapidly and some people put it at 65 percent that the land is already degraded, Africa’s land, 65 percent already degraded and blame 30 percent to man-made activities including urbanization, deforestation, and things like that.

Everyone agrees that the nutrient balance in the soils is very low, has a negative balance, and plants do need those nutrients to grow. If we will have to intensify agriculture, we must find a way of restoring these depleted soils. The question remains: what are the technical remedies that would be best suited for Africa and its people?

Some people say organic fertilizers and inorganic -- but that’s a sweeping statement. The requirement will be different from one location to another. And what sort of organic fertilizers would be required? And some people propose using biotechnology, biotech crops, nitrogen efficient crops, and still we don’t have a renewed or healthy soil. Because even if those plants are efficient in their use of nitrogen, soils need to be replenished.

As I already said, about 80 percent of the project expansion in arable land and the intensification of agriculture must happen in sub-Saharan Africa and Latin America where the arable land still exists. And this is actually the figure that tells you that. This is Latin America and the blue shows you arable land that could be used by intensification, irrigation, and technology and this is Africa. So we do have the land. The problem, though, is that the land here is very poor in nutrients. So, how do we boost or restore this land? And that’s how we can cope. Because you can see, we’re running out of land, arable land, in other regions of the world.

This is a transition to the presentation to the technologies that I’ll be presenting. The drive is for change in Africa. If we decide to reinterpret or reexamine what the problems are, by taking a fresh look, we know everyone agrees that these are the three things we need to do to move Africa to the next level: increase agricultural output, and the value chain thereof, for both big and small farmers. We couldn’t just promote big farmers because the vast majority are rural dwellers and we can’t just dwell or work with the rural farmers because we must expand the scope and scale of agriculture.

We must improve the health of the people through good nutrition, good health systems, and controlling infectious diseases which constitutes the bulk of the disease burden in Africa. Of course, there is a growing trend of noncommunicable diseases such as diabetes and things like that, but this day -- if this intervention of good nutrition were to come in then Africa would be able to avoid extending the non-communicable disease burden. And then capacity building is critical so that they could have self-sufficiency and be able to drive development themselves.

All right, so advancing health outcomes and the next -- I’ll just be sharing some of the things that we’ve done in my lab and that other scientists have also contributed in terms of that knows and detecting infectious diseases. The need for infection diagnostics

The culture of laboratory medicine is very foreign to Africans. They usually either guess, self-treat, self-diagnose, and sometimes don’t try doing anything at all, and then spread the disease. Misdiagnosis is quite prevalent due to poor training of the technicians and counterfeit test kits. During my visits to Africa during this year here in the State department, I received very many reports of counterfeit diagnostic kits for HIV and other diseases. That broke my heart. And those kits usually give negative results and the vulnerable people go back to the community not realizing that they are ill. And this, perhaps, is a major driver of the high disease burden in Africa.

So it also leads to a high carrier and transmission rate where the people would go back and continue to spread the disease amongst themselves. This explains therefore why this graph is the case. You see this graph tells you global infectious disease dates by region, and you can see Africa contributes more than 50 percent of global deaths from infectious diseases -- clearly saying something about the disease burden of the carriers, the transmission rates, and the community retain detection methods. There are very many of them, and I have listed on this table the ones that commonly are used in Africa would be culture methods, where they exist, and biochemistry. They’re easy, not expensive, but the problems are many: false negatives and false positives, and we have serology. They are very rapid serologic tests in which to look for antigen antibodies, so sometimes we have antibody libraries and we get samples from the sick people.

Put a drop on it and it can have a glutinational clumping that is an indication that of a positive result and that’s pretty rapid. Almost every clinic in the United States today runs serology tests on people who come in with pharyngitis, like you have a strep throat or something, and then you’ll be able to see it rapidly within 10 minutes. The problem however is that in Africa the storage conditions are not prime. Those antibodies decompose readily or break down, and so you would have a false negative even if you were real. And most of the HIV kits that are used are based on serology and their DNA probes and polymerous chain reactions. Many of these have high specificity. They require a lot of technical intervention and things like that. But we developed in my lab peptide nucleic acid probes. They’re very much like DNA probes but they overcome some of the problems of the DNA probes that have a net negative charge on them. The peptide nucleic acid probes have a net neutral charge on them so we can have incital detection in real time almost. Within 90 minute to six hours would be able to detect those organisms. But the disadvantage here is that you need an expert to design this premise.

Another benefit of these probes that we use is the face that microorganisms change continually. When Pasteur Louis said that these microbes will have the last word, he didn’t even know about how microbes emerge and change. And sometimes the changes could be a quantum leap; it’s not a gradual evolution. So when the pathogens in Africa change and we keep looking for the serologies that we developed in other countries, we might miss them. But these probes will be looking at the blueprint that made the organisms and will be quite specific in the detection. So what makes a good diagnostic tool? I earlier said here and I -- and the time is running since we didn’t start right on time -- so it would be good to have results in real time. In fact, in Florida where we have lots of beautiful beaches, the beaches sometimes are closed and due to maybe high levels of E. Coli and things like that. It takes two days to get the results out when the sample of the beaches routinely. We found that the microorganisms for modeling get distributed out from the reach of the beach users within eight hours. So that means that the beaches really close down after the microbes have gone because of the time it takes to process the samples that were obtained.

So that was a major driver for the study that we did to develop these probes that would give us good detection of the microbes in real time. And if a person is really ill, it would count -- be very useful. So we need the detection tool to be highly sensitive. We would like it to be specific so you don’t have misdiagnosis and all that, and we would like to detect only viable cells. DNA probes in general will detect the DNA in the environment, whether they are of dead cells or not. But the peptide nucleic acid probes that I’m going to talk about in a few seconds, would only detect live cells. And that’s because we bind the ribosome that is only made by living cells. Here is the principle behind the peptide nucleic acid probes: every organism, even if they look exactly the same under the microscope, has a blueprint -- its DNA. In its DNA it’s got segments that are hyper-variable regions that are unique to it. We can target those segments of the DNA to know what organism this is by designing a probe. We use primers to design the probe and make many copies of that in the lab.

Now if this organism is dead, the unique sequences will still be there, present. So we could detect a dead fragment, but only living organisms would produce ribosomal RNA or messenger RNAs. So in the ribosomal RNA we’ve got those hyper-variable portions that we can also target, and that’s what our probe does. Instead of binding the DNA which would still be there if the cell is dead, we would bind only the RNA that is made by living cells by making an antisense probe that binds to the RNA instead of the DNA cell. This is the-DNA has a pentaphosphate backbone, and because of the intense negative charge the phosphate bonds have, it’s difficult to send it through an intact cell.

So we have to replace the backbone of the DNA with a neutral piece -- oftentimes glycine or other molecules. But the sequence of the base pairs remain the same. So with those probes we can send those into the cells, and from the color we can tell which organism, if we have fluorescent microscopes. Or we can do chemoluminescence in which case we’ll be looking at light. It’s a very simple straightforward technique. This is all that the students used to do this in the lab, so nothing really sophisticated. Anyone in African can do this, would be able to detect microorganisms rapidly so they can have proper treatment. If you took chemoluminescence, that is the result from fluorescent detection depending on how you tag your probe. You can tag it with a fluorochrome or you can tag it with horseradish peroxidase where you do some light emitted. So you can find light but it’s highly specific. You wouldn’t get the light if it’s not the organism. 99.99 percent specific. We’ve tried extensively.

So what impact would this have on infectious disease burden in Africa? Certainly it would lead to a healthier Africa and a healthier world if that were to be expanded and used broadly. Agricultural outcome: nitrogen is needed for amino acids and for nucleic acids. Without nitrogen there would be no life on Earth. So it’s the most single and most important element in plant production. The irony of the matter is that in this room the atmosphere here has 78 percent nitrogen. Each time you breathe in and out, you breathe in nitrogen and you breathe it out. The reason is that the elemental nitrogen is a knot. It has a triple bond; extremely stable. There is only one enzyme in the biosphere that is able to process the elemental nitrogen into fixed nitrogen so we can use it in organic forms. That enzyme is found only in microorganisms, the enzyme nitrogenase. So biological nitrogen fixation for a long time was the only way that plants could grow. All the living things could get nitrogen from the vast reservoir in the atmosphere. But the problem now is that with industrial output of nitrogen fertilizers, we are skewing the nitrogen cycle off balance. The press doesn’t talk about this a lot. Everyone talks about carbon, but this perhaps is doing equally the same amount of havoc, if not more, because we’re using it in large quantities in agriculture.

And then we have before us the challenge to increase agricultural output, which means that we would need much more nitrogen. And that’s just the reason we have to think about incorporating or having an integrated approach in supplying the nitrogen needed for growing plants. Another approach would be about technology where we can use the nitrogen efficient crops, the maize that has been made. But that’s good where you have soil where it can grow. What kind of bad technologically-advanced crop would grow on the soil? So you can see that the need to restore the depleted African soils, if we are to expand and meet the needs of the food shortfall that’s projected to happen, would lead to do some biofertilization and biological nitrogen fixation which would reduce pollution.

That is the nitrogen cycle and I don’t want to spend a lot of time in it. Everybody knows that when you eat it decomposes and goes back and then the protein is made. We consume that and that’s nitrogen in the atmosphere. The cycle has been distorted. Okay that is the nitrogen, molecular nitrogen, in the air can be fixed through nitrogen fixation and the nitrogen goes into ammonia, which as a fact happens at room temperature. And the industrial process takes a lot of energy to do that. So biological nitrogen fixation and the inoculant technology. There is nothing new about this technology. That was my very first thesis in school and I don’t want to tell you my age, but its many decades ago that I did my first research into producing inoculants for African farmers for cowpeas and soybeans. But the problem is oftentimes the microorganisms available on ground there are not well-adapted. And we don’t need to engineer any of the organisms, we just need to screen for the appropriate organisms and use a base to create that inoculant. Fact: newer technologies for making inoculants don’t use peat, or lignites which are used to make the peat, the inoculants. You can have them in a broth properly preserved and then mix them with other fertilizers to apply.

We can use nitrogen 15 to measure to know exactly what amount of nitrogen is going into where and be able to plan which kinds of soils need more organic or inorganic input. The benefit of nitrogen fixation, biological nitrogen fixation, is that the plants get the nitrogen as needed. Unlike in the inorganic fertilizers where they might have--we might have a lot of runoff before the plants actually take them. So an integrated effort is needed to be able to guide the policies and the design of intervention for African desertification that must happen in Africa if they should become food secure. That summarizes how smart agriculture for food secure Africa would need biofertilizers and other input.

We must build capacity, and this is the only picture I could think of that would communicate the need for building capacity. It doesn’t matter what we give as technology, and you can see the Africans eating with their hands. There is a golden spoon to eat that food from. So this food to me is like the open-source data that we plan to create. We plant genomes and all the other data voices that we’re going to make available to them to be able to use that and modify their own plants. But if they are enabled to scoop and use those data well of what uses it, making it available. So building capacity, teaching them to use this, and being the leader sequence in the open reading frame of this whole process is what would help speed up. So here I’ve been doing some outreach and I thought to share some pictures with you. The chevron built a big biotechnology in the northeastern part of Nigeria where the Boko Haram has been harassing people. And I’ve been there three times, helped them to develop that lab and run workshops three times, so here are some more person-to-person mentoring. And most of the students you see have today gone on to get their PhDs and run labs. And here is more of the workshops that we have been doing in the past seven years, training the Africans to understand biotechnology at its root so they will be able to contribute and also drive the development of biotic crops. Of the crop that is stable to them that is not widely used.

To conclude towards a -- well, I have to have three conclusions. The first step in the conclusion is the African parable about the eagle and the farmer. The farmer who had a lot of poetry and he went out for a walk one day and he found an egg as he walked. He picked it and looked at the egg. It looked intact, so he took it home and put it under his fowl to brood. And then when it hatched, it was just another chicken. And the chicks picked worms on the ground, like, picking grains all over. And one day he saw that amongst the chicks there was one that looked a little different. It was picking worms with the others, but it seemed to have some strength, but it didn’t fly. So he picked it up and took a closer look and it turned out to be an eagle -- an eaglet. So he nursed the eaglet and let it go. And he said to the eaglet, “That’s where you belong, you don’t pick worms.”

Well the reason I share this is that many people here are like farmers, and there are very many in eaglets in African picking worms. They do not know they are bold where they belong. I think we can tap into those cultural resources. The world truly needs them. And that brings us to the true conclusion of this presentation, which I’ve mentioned most of this before, but that we would need regional centers of excellence for research, and training, and technology transfer in city so that they don’t come out and not get a wholesome training. I think that would complement even Africans coming out here also to be trained. The take-home that summarizes everything I hope that you heard me say: that nitrogen fixation is key to solve fertility, crop quality nutrition, that an integrated approach is important so that we’d have a healthy environment, that biotechnology is indispensable, and the sooner the Africans embrace this, the better. On health, addressing counterfeit medicines at an international level or scale is very important and that might help to break that cycle, the vicious cycle of high disease burden and low crop yield.

Ultimately I hope that I have convinced you that it is time to take another look at Africa. That policy should be built around the identified drivers of underdevelopment, including the ones that we already know. And finally, only a nourished, healthy, rural Africa can drive development goals. And thank you.

Do we have time for questions?

QUESTION:  I would like to ask a question.

NWADIUTO ESIOBU:  Yes.

QUESTION:  Thank you very much for a very interesting lecture. Especially I loved the connection you made between the gene expression and now this and the activities of government. That was brilliant. I’m so sorry that the conditions are poor in Africa. And there are several factors that affect the DNA leading to several kinds of the mutations initiating the gene disorders from soma and multifactorial. And I wonder if there is a disease in particular in a common conflict disorder, like a diabetes or cancer, you could say is in high frequency in Africa. This is the first question.

NWADIUTO ESIOBU:  Okay, yes, I’ll take your questions and then answer.

QUESTION:  Okay. And of course the frequency of the infectious diseases are very high. I wonder, what is the percent of the HIV-infected people?

NWADIUTO ESIOBU:  The proportion?

QUESTION:  [affirmative]

NWADIUTO ESIOBU:  Okay, so I’ll take those two questions. I’ll answer the HIV one first. The numbers are changing every day and it depends on which country. In Cameroon for example, they said 7 percent of the population. In Uganda the numbers were much higher. But the good news is that with the PEPFAR intervention and the big global response to the HIV problems, the numbers are declining overall.

QUESTION: Could you say that the HIV is the highest frequency among all infectious diseases that you see in Africa? Is it the highest?

NWADIUTO ESIOBU:  Yes. In this current time HIV and malaria top the list.

QUESTION:  Thanks. Could you discuss anything about the common complex disorders or genetic disorders? You mentioned about the mutations that you can see in high frequency because of the environmental exposure. Is there any genetic disorder you may deem?

NWADIUTO ESIOBU:  There are many genetic disorders, but unique to Africans what comes to mind would be Sickle Cell Anemia. And again, that is not evenly spread throughout the continent.

QUESTION:  The damage is on a single gene level, and I wonder if there is a… the factors during the time of the meiosis and the reproduction cells are affected by some environmental factors. You may have to search that if the --

NWADIUTO ESIOBU:  -- Okay, are you talking about epigenetics and the role of that in disease?

QUESTION:  No I’m talking about -- you mentioned about the mutations that frequently occur in African population. I don’t know the factors, what are, but I wonder if the mutations affect them on a chromosomal level, on single gene level, or maybe the dozen genes are involved, leading to several common complex disorders. I wanted to know which disease you could name that in a high frequency in Africa. That’s my question.

QUESTION:  I think, Diuto, she is referring to antibiotic resistance. You know, that was where the mutation -- where that was giving rise to the new organisms.

QUESTION:  No not really, what I mean is that DNA can be damaged by the environmental factors. It’s not necessarily the microorganists. So I don’t know what the factors that are leading to the damage of the genetic material.

NWADIUTO ESIOBU:  Oh, I see --

QUESTION:  -- That is my question. So it can be, again, on a single gene level, can be on a chromosomal level, it can affect just multiple genes leading to several different common complex disorders. I wonder what is it the situation --

NWADIUTO ESIOBU:  -- I am not aware of any reports of frequent mutations in Africa and how much that contributes to the disease burden. I have, however, seen that women who use fire-woods to cook may have mutations in their peripheral cells, peripheral blood cells. That has not been shown to make them come down ill, but impacts may show down the line. And by the way, the lifespan of an average African is 48 years so they probably don’t live that long to begin to see the impacts of the smoke and of the habits, if that’s what you’re referring to.

QUESTION:  Right but the age of-you mentioned, about 48 years old, it can be not connected with the genetic disorders; it can be just the infectious diseases.

NWADIUTO ESIOBU:  [affirmative]

QUESTION:  It’s not necessarily that, you know, the person developed genetic disorder. That is the cause of the deaths. So, I mean, each of the factors, I’m just curious. I wanted to know.

NWADIUTO ESIOBU:  Well yeah, thank you very much. Yeah. Thanks. Yes, Peter.

QUESTION:  I’m here to thank you very much for a very interesting presentation. I would like to ask a question about African agriculture and depleted soils. You mentioned all three major nutrients: nitrogen, and phosphorous, potassium. And then you concentrated on nitrogen, with which I agree the more nitrogen fixation the better, but can you tell us a little bit about to what extent African agricultural soils are deficient in phosphorous and potassium? And if so, what possible remedies could be carried out? Where could one get the additional phosphorous or potassium suitable for African agriculture?

NWADIUTO ESIOBU:  Thank you very much. From my readings, potassium is not in a serious limitation but phosphorous, yes. And organic fertilizers will provide that. They’re usually rich in phosphorous and nitrogen.

QUESTION:  I’ll agree with that, Diuto, but you only get the organic fertilizer high in phosphorous if you have the phosphorous in the first place that the organic fertilizer could take up.

NWADIUTO ESIOBU:  Then you start with the inorganic fertilizer, Peter.

QUESTION:  Is there a source of inorganic phosphate available in -- to African farmers --

NWADIUTO ESIOBU:  -- Yes there are, and there are in fact some microbial inoculants that help to mineralize the phosphate. The soils there have some phosphorous in them. Bacillus species are used in unlocking the mobilized phosphorous. Yes, please?

QUESTION:  Great talk --

NWADIUTO ESIOBU:  -- Thank you.

QUESTION:  Even though I only heard part of it. The question that I had relates to the policy implications of what you were talking about relating to counterfeit drugs. Do you know any of the folks that are in our intellectual property enforcement office?

NWADIUTO ESIOBU:  Yes, I worked with them also while I was here. But the Africans hate to hear that. When I went to Ethiopia they didn’t want to talk about the intellectual property rights and I told them what difference -- I asked what difference it made. Their people were dying either way, but they were actually astonished to see some of the numbers I shared with you here. So the new thing that is happening is that the WHO members have agreed to approach this problem from a sphere that’s different from the intellectual property perspective. So there is generated this year, 2012, a group that will be focused on looking at public health implications and effects of counterfeit and substandard medicines. And with that they hope to bring to table all of the countries that have been reluctant in addressing the IPR issues.

QUESTION:  This is very interesting beyond what we usually think of in this country when we think of intellectual property enforcement and that is -- what did you say, how many? 200,000 out of the malarial deaths you believe are caused by counterfeit drugs? --

NWADIUTO ESIOBU:  -- that’s right.

QUESTION:  It’s that kind of statistic that if the IPE folks haven’t heard that from you, I think it would be very helpful to them to hear it, and I’d be happy to facilitate that if that would be helpful.

NWADIUTO ESIOBU:  Thank you. Yes?

SANDRA LANEY:  Hi. Sandra Laney from the STAS office. I’m also interested in the counterfeit and substandard medicine problem that you’ve very nicely highlighted here as a real problem and source of potential food insecurity, et cetera. I’m wondering if you know the source of -- is the primary source of these counterfeit and substandard medicines, is it intentional? Is it lack of regulatory effects of the pharmaceutical companies that are producing it? Is it storage of the medicines leading to a decreased efficacy? How much of that is known and what is being done to address the problem?

NWADIUTO ESIOBU:  That is an excellent question and the precise reason for which there was inaction for a long time. Countries like India, Southeast Asian countries always argued that these were not counterfeit medicines. They were probably substandard because there were maybe results from problems in packaging or errors in manufacturing and those are classified as substandard. And the others that are deliberately manipulated, maybe for greed or corruption, those would be the counterfeit. I approached the problem from one perspective: it didn’t matter to the microorganism until the humans, whether these were errors -- even if they are sincere errors or whether they were deliberate. The impact on community health is the same. Five hundred children, babies, under the age of five, died because they were given paracetamol in Nigeria in on year, ten years ago. Vulnerable populations, so from my perspective and the public health angle, it is immaterial whether the error was sincere or whether it was deliberate. I mean what it was a sincere error or whether it was a deliberate act of counterfeiting. The impact will be the same.

SANDRA LANEY:  I agree completely. The impact is definitely the same but the source of or the mechanism of addressing the problem might be different. Is this a better knowledge of where the actual source of the medicines is coming from or the problem with the medicines? Do you know if -- at what point you-did you put in a policy that somehow eliminates both the counterfeit medicines and the substandard medicines from getting out to the population. Is there anything being done to address the problem?

NWADIUTO ESIOBU:  Yes. So I have made four proposals. Four main things. I don’t want to go into the details of them. The first one is to empower the consumer. Raise their awareness so that they can screen it at that level. The second is to have international regulations that would allow the detection and confiscation or destruction of such medicines. So that is technology-based. And the third would be to educate the caregivers so they would be able to select the appropriate medicines and talk to this. Also part of awareness. And what was the fourth one? I think I shook hands with Perry from Texas. Nobody caught that joke.  [laughter]

He had the presidential--the presidential debate, and he counted three things and didn’t remember the third one. So he said he had his high energy drink eight hours before the meeting. So I don’t remember what the fourth thing was.

SANDRA LANEY:  Thank you.

NWADIUTO ESIOBU:  You’re welcome.

QUESTION:  [Inaudible] strong intellectual property law will help?

NWADIUTO ESIOBU:  Yeah. Actually that-I remember now, I remember now. It is to help the manufacturing. So if these are errors, problems that they have -- they sincerely don’t know how to package or put those things together -- then they need help in the manufacturing to do it right. Intellectual property laws are good but it should be handled on a different platform I think. But they are all important to getting those things done. Any other questions? I want to thank you so much for your patience.



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