By Elizabeth Chimobi
Professor Iruka Okeke is a distinguished academic in the field of Pharmaceutical Microbiology at the University of Ibadan, Nigeria. With a strong foundation in Pharmacy from Obafemi Awolowo University, where she also earned her Master’s and PhD in Pharmaceutical Microbiology, Professor Okeke has dedicated her career to advancing the understanding of microbiology, particularly in the areas of antimicrobial resistance, genomics, and molecular microbiology.
In this interview with E-Naija, she shares insights from her research, the importance of mentorship and training in science, and her vision for the future of global health in the face of rising challenges such as antimicrobial resistance.
What initially sparked your interest in AMR research?
It was two things. First of all, as an undergraduate pharmacy student realizing the importance that antimicrobials have had in our lives. The fact that there’s so many things we can do now, so many types of surgery, it’s it’s much safer to give birth to children. Small injuries don’t become fatal. So learning that all of that was due to antimicrobials and then learning that all these miracles were at risk of disappearing, I think that was my first introduction to antimicrobial resistance. The second thing is that we had an excellent professor who taught us, microbiology then, and he was very interested in antimicrobial resistance.
So how would you describe antimicrobial resistance to someone who is unfamiliar with it, has never heard of it? How would you describe that?
It’s actually not hard to describe it because most of us have had to take antimicrobials, sometimes referred to as antibiotics.
When we’re sick. If you have an infection like a fever or, an infected wound, there’s a good chance you’ll be prescribed some of these medicines. For adults. They often come in capsules. And we take them for about 5 days and then you get better.
Antimicrobial resistance is a phenomenon where the germs that are causing these diseases are no longer responsible, responsive to these medicines. So instead of dying as they normally would so that you can get better, they continue to live, and then that means that the medicines don’t work.
Why is AMR such a significant, health problem, particularly in Africa?
It’s a really important problem in Africa for a number of reasons. First of all, we have more infections. Part of the reason why we have more infections is that we’re lacking certain infrastructure that would protect us from infections. Many of us don’t have access to clean water.
Many of us don’t have good sanitation systems that take away, waste. Sometimes our food is not of the ultimate quality. So those things place us as higher risk of infections. And then just the fact that the the climate is warmer and more humid means that germs can thrive more commonly here. So that’s one reason why we have a higher burden, of infections in general.
Another is that we have a younger population. Children are more vulnerable to infections. And so all of these things add up to there being more infections in our setting. And for that reason, we have a greater dependence on the drugs that could potentially treat these infections.
Could you briefly elaborate the mechanisms by which bacteria develop drug resistance?
So, bacteria that would normally be sensitive to an antibiotic can actually gain the ability to pump the antibiotic out of the bacterium so that it cannot harm them, kind of like putting burglary proofs around your home. So that, external people can’t come in. Sometimes they can actually destroy the antibiotic.
They can actually break it down. Or other times, if the antibiotic attacks a particular target inside the bacteria, the bacteria can, create a new version of that target that is no longer, attackable by the antibiotic.
So the Institute of Health Metrics and Data Evaluation reported that in 2019, there were 64, 500 deaths attributed to AMR in Africa. What factors contribute to such high mortality rates?
There are several factors contributing to the issue. Firstly, germs are increasingly resistant to antibiotics. This means that infections that could have been treated effectively 30 years ago might now be caused by bacteria that no longer respond to standard treatments. While some locations may have access to more expensive drugs that can treat resistant infections, in African settings, particularly in Nigeria, these drugs are often either unavailable or unaffordable.
Additionally, when first-line drugs fail, there are few alternative treatments that might save lives in cases of resistant infections. A third significant problem is the lack of effective diagnostics. Without proper diagnostics, it’s challenging to determine whether an infection is resistant or susceptible and to identify the appropriate treatment. Often, if a patient does not respond to the initial treatment, there may not be an opportunity to try alternative drugs if they are already critically ill. This lack of diagnostic capability contributes to the high mortality rates from resistant infections.
Nigeria currently ranks 185th out of 204 countries for age standardized mortality rates associated with AMR. What specific challenges does Nigeria face in combating AMR?
It’s a whole range of them. One of them is that we just have a lot of people. We have a lot of people in an area where infections are very common, then obviously, we have a greater challenge. As many people know, our health system is struggling with this large burden of patients who have infections. We don’t have enough doctors, nurses, medical lab scientists, pharmacists that could help, to deal with people who are sick.
And as you know, many of them are leaving the country. So this is actually exacerbating that problem. Another problem again is the infrastructure. Many Nigerians in fact, most Nigerians don’t have access to, what we would call portable water, which is water that is safe to drink. Many Nigerians do not have access to a safe toilet system. So if one person gets infected, the chance that it will spread to others is quite high. Access to even health care facilities. But in parts of the North and the East, people may have to travel significant distances to get access to a quality, health facility.
And they may not have the resources to be able to do that and may choose to stay at home, visit the facility too late, and then that means that it would be harder to treat them. Our health systems are lacking in drugs, diagnostics, the things that are needed to manage patients optimally. And, also, there are ways to prevent infection that are not adequately deployed. Vaccine uptake in some of our towns and villages is quite low.
Vaccines can protect from infections. And then if people are protected, then that means that they wouldn’t get sick in the first place. And then the new vaccines have come onto the horizon that are yet to be adopted in Nigeria. A few a couple of years ago, malaria vaccine became available. A typhoid vaccine has been available longer than that, and neither of those are available to Nigerian citizens at this point.
How does the mortality rate for AMR in Nigeria compare to other issues like entreec infections, respiratory infections, cardiovascular diseases?
it’s an interesting question because for many of those diseases, there’s actually an overlap. People who, die from enteric infections die because they got an infection usually because of contaminated water, contaminated food, or a sanitation system not optimal. And then they got the infection, and then they were not treated. So when somebody dies of an enteric infection, they could have died from the enteric infection, they could have died from antimicrobial resistance, or they could have died from both. And in fact, in the resistance field now, we now say, did someone die with a resistant infection or because of a resistant infection? And sometimes it’s not difficult it’s not easy to tell, to tell the difference. So for most infections, I mean, you mentioned enteric infections, you mentioned respiratory infections, Antimicrobial resistance basically layers on that and, makes those diseases worse.
And then for some other conditions that are not infectious, like, you know, diabetes and cardiovascular infections, yes, it’s quite possible for people and and in general, older people to succumb to those conditions irrespective of antimicrobial resistance. But antimicrobial resistance makes it harder for example for people with diabetes to live their lives because they are too prone to infections. So it’s very difficult sometimes to sort of decide which is more important than the other. We really just have to deal with disease in general, and preventive strategies work best in that regard.
The World Bank predicts that AMR could result in 1 to 3, 400, 000, 000, 000 GDP dollar losses annually by 2030. In your experience, how does AMR affect the economy on such a large scale?
When people have resistant infections, even if they survive, they’re away from work and school longer. You know, if you had an infection that was sensitive to antibiotics, you’re typically better in three days.
If you have a resistant infection, you can be ill for a long time. That infection can cause damage that could lead to long term illness or even disability or even death, and all of that leads to a lack of a lowered, productivity. It’s expensive to treat resistant infections. While you’re trying to figure out which drug the person needs, you need to start buying expensive things like oxygen. The person may have to be admitted into hospital.
All of these things have costs. So antimicrobial resistance is actually very expensive, and this is why we should be doing the relatively inexpensive things to prevent resistant infections in the first place. So by 2050, it is estimated that AMR could cause up to 10, 000, 000 deaths annually, matching the current global death of the toll of cancer.
What global measures are being taken to prevent AMR?
The projected numbers are indeed alarming, but they represent potential outcomes if no action is taken. I was involved in a working group that examined antimicrobial resistance from various angles, and some colleagues modeled the impact of specific interventions on these projections.
Improving infection prevention in hospitals—such as ensuring that healthcare workers have access to handwashing facilities—could reduce nearly half of the deaths caused by antimicrobial resistance. Additionally, enhancing community water and sanitation could prevent around 250,000 deaths annually. Access to clean water, proper sanitation, and effective vaccines for children could collectively prevent nearly 200,000 deaths each year.
While vaccines and sanitation improvements come with costs, they are relatively affordable and offer additional benefits, such as promoting better overall health and development in children. Implementing these simple, already available interventions could significantly mitigate the projected impact of antimicrobial resistance by 2030.
You recently received an award from the American Society of Microbiology.
Can you tell us a bit more about the work that you’re doing that led to this recognition?
It’s a huge honour to have received this award. The award is the Marcellus Schecter Award. It’s given once a year to somebody in a lower and mid or middle income country who is doing microbiology research. And, I think one of the things that was, of interest to those who nominated me and also to the selection committee is the way that we’re using genomic science to understand the spread of infections in Nigeria and elsewhere in Africa.
So, Nigeria Center For Disease Control, NCDC, has a system that looks at how bad antimicrobial resistance is in the country. So this, surveillance system needs some kind of quality control.
So my group’s genomic work helps to quality control that system so that we can have that system. We’re sure of the quality of the data. The data can be used in Nigeria to understand what the resistance situation is, And the data is also forwarded globally to the WHO so that they have a record of where resistance is a problem worldwide. Some of that work is also showing that, you know, typhoid is a huge problem in Nigeria, that it’s spreading, and that typhoid conjugate vaccines have the potential to prevent that spread and a lot of the illness that we have, in Nigeria. And also that we need, you know, better water sanitation and and hygiene systems to prevent the spread not just of typhoid, but of other diseases.
So as a Calistas Juma fellow, what specific projects or research area are you currently focusing on?
So as I mentioned before, we we’re using genomic science, and genomic science is really just studying the DNA of living things. We study the DNA of bacteria that cause illness.
And as I mentioned, we’re generating genomic sequences of bacteria that cause infections in Nigeria, and this is important for those who want to control disease. But once we’ve generated those sequences, we can look at them again, sort of, reuse them if you like to be able to understand how to develop better diagnostics, better drugs, better vaccines. And so this is what we’re doing with the Callistus Tumor Fellowship. We’re basically using those sequences that are already being generated for surveillance to understand how we may better tackle bacteria in the future. And by we, I don’t just mean my group.
I mean, our work when we study these things, when we find out things about these bacteria, this can feed into groups around the world that are already doing work to develop vaccines, drugs, diagnostics. And then also as we’re doing it, we’re doing it with trainees so that we’ll have more people within Nigeria that know how to use genomic sequences, for these purposes and for other purposes. I think this is really critical for our development. There’s a lot that you can do with genomics that’s happening all over the world, and I think Nigeria needs to be part of that revolution.
So how does your work contribute to our understanding of how bacteria colonizes, you know, colonize humans and gain drug resistance?
So, think of intestine. It’s in there. It lives there. And you are eating and drinking and going to the toilet, which means that liquid and solid is constantly flushing past that bacterium. And so the question is why does it stay there? Why doesn’t it get flushed out with your food and your drink when you go to the toilet? And the answer to that is that most bacteria actually do get flushed out, and some bacteria are more competent to stay within your intestine. Some of those bacteria that are very good colonizers are actually good for you.
They are the bacteria that live within us and protect us from disease causing organisms. And some of them are, organisms that can cause disease. They have come in, and they’re gonna hang on and do something dangerous. So by studying how bacteria hang on, we can get better insight as to how the good bacteria stay there, but also how to dislodge the bad bacteria so that they don’t cause disease.
So what strategies do you think are most effective in combating AMR in developing countries like Nigeria?
I think it’s really important to emphasize that while researchers are looking for many new strategies and approaches for dealing with antimicrobial resistance, and this is definitely work that is needed, there are actually existing things that we can do to, prevent and deal with antimicrobial resistance.
First of all, most of the well, I shouldn’t say most, but a lot of the antimicrobial resistance problem is actually within hospitals. People who have infections in hospitals, often end up spreading those infections to other people. Or sometimes people who come into hospital for some other reason acquire an infection that is resistant to antimicrobials. The reason why hospitals are such hot spots for acquiring resistant infections is that the patients are sick.
When you’re sick, you’re more vulnerable to infection. So that’s one thing. And then the other thing is that they need care. So someone has to come and attend to them. That person is also attending to somebody else.
There are a lot of devices that are used to administer drugs and take care of them. And so there’s a greater risk that a bacterium that is resistant will be introduced into a patient who is sick. Now doctors and nurses know this. So they have infection and prevention protocols, to make sure that they prevent spreading infection from one person to another. But when they have too many patients to deal with or too few resources to use for infection prevention, then there’s a chance that infections will spread.
And so we really need to beef up how we implement infection prevention and control in Nigerian hospitals. It’s an excellent guideline, by the NCDC on what hospitals should do to prevent spreading infections. And if those guidelines are properly implemented in all health institutions, not just our teaching hospitals, but even primary health care centers, private clinics, and so on. We could prevent a lot of the cases of resistant infections as well as a lot of the deaths. Now outside of hospitals, a lot of people get infected with resistant organisms because they ate contaminated food or they drank contaminated water or, somebody who was preparing their food did not wash their hands after going to the toilet.
So improving water, sanitation, and hygiene practices, again, has the potential, to prevent a lot of the resistant infections. And then vaccinations, the existing vaccinations that are available in Nigeria, things like, the streptococcus pneumonia vaccine, rotavirus vaccine, that can actually protect children from infections. Mothers who have babies should go and get these vaccines. And then there are other vaccines that I think we need to lean on our health policy makers to be able to get for Nigerians, including typhoid vaccine and the newly, developed malaria vaccine.
So how important is public awareness in the fight against AMR? Do you think people are actually aware that AMR is a thing in Nigeria? And how important is it to create public awareness in it?
I think public awareness is primary. Spoken to people. Some are aware of antimicrobial resistance, some have sort of an understanding of what it is, and some have never heard about it. And interestingly, I think what is particularly dangerous is that many people who have heard of antibiotics and antimicrobial drugs have not heard of resistance. And one of the things that promotes resistance is using these antimicrobial drugs when you don’t have an infection.
So, the way it works is that bacteria are all over the place. They’re all around us. Most of them are harmless. But when you use antibiotics, you kill off, the ones that are susceptible, and then only the ones that are resistant are around. And this is actually one of the reasons why, antibiotic resistant bacteria are common in hospitals because they have to use, antibiotics for the sick for the sick patients.
So it’s very important for people not to use antibiotics unless a doctor has determined that they have an infection. And then that way you protect the sensitive bacteria, which in turn protect us from resistant, infections. So the law in Nigeria says that if you live in a city that has hospitals and, pharmacies, you’re not supposed to buy antibiotics without a prescription.
Many Nigerians do this. And so one of the things to think about is, you know, when you think you have an infection, you have a fever or you have diarrhea or you have a cough, the correct thing to do is to go to a health professional who can determine whether that is the kind of infection that needs an antibiotic.
Many of the coughs and colds we have are caused by viruses. Viruses cannot be treated with antibiotics. And so when we take antibiotics, when we have those conditions, we’re just essentially worsening the antimicrobial resistance problem. So it’s very important for us to communicate this to other people even if we’re not health professionals. Every November, we have a big, antimicrobial resistance awareness week.
But not just in November, I think in our day to day conversations in the marketplace at parties, we should tell our friends, our relatives only to use antibiotics when they’re prescribed. And when they are prescribed, to use them as prescribed to make sure that you clear the infection.
So what role do collaborations, global collaborations and funding play in addressing AMR, and how can that be improved? Are there points of improvement, and how can that be improved?
It’s very, very important to emphasize that almost everything we do with AMR is dependent on collaborations. I described the fact that we have a surveillance system in Nigeria. Is a collaboration between doctors, nurses, and medical lab scientists in health facilities. The National Center For Disease Control, which is sort of collating the information, the National Reference Lab, and our group at the University of Ibadan.
We’re all working together to make this surveillance system work. Another example is, I mentioned infection prevention and control that prevents antimicrobial resistance. This again is a collaboration between many people. Some of the people who are, are important for infection prevention and control in hospitals are not doctors and nurses. They’re the people that make sure that doctors and nurses have clean gowns, they have clean sheets on the beds, all sorts of things.
So collaboration at the local level, but also at the global level actually, is very, very important for dealing with antimicrobial And, pharmaceutical industries that used to lead on this, And, pharmaceutical industries that used to lead on this are less interested in doing this because it doesn’t give them a lot of revenue. And so it’s very important for, those of us working in the scientific space to come together and collaborate in order to help develop not just drugs actually, but also vaccines and, diagnostics. And very often, the very different specialized scientific techniques that you need to do this are only available in 2 or 3 labs around the world. And so it’s important for, 1 lab to do 1 aspect of this and be able to collaborate with another lab, perhaps in a different country or on a different continent to be able to do other aspects.
Here in Nigeria, it’s very important that we understand the bacteria that are causing resistance in our setting to make sure that drug and vaccine discovery attempts happening elsewhere have the information they need to make sure that those drugs and those vaccines will work in our setting when they are developed. And so it’s very important to have scientists across the globe working on the problem of antimicrobial resistance.
What are the biggest challenges you face in your research on AMR?
Well, I think, first of all, I’ll just say that antimicrobial resistance research globally is underfunded. When you think of how much research goes into, cancer or HIV, for example, it’s several fold more than research into antimicrobial resistance.
That’s not to say that we need less resources for cancer and HIV. These are important issues that are killing people as well. But, obviously, there is more, more funding needed. Working in Nigeria, even if you’ve got your funding, you also have to deal with the challenge of getting the equipment and the consumables that you need to be able to do this work. Some very sophisticated reagents are needed.
Many of them are not made in Nigeria. They have to be imported. And just the logistics of getting those things when you need them is a challenge that we in University of Ibadan and researchers across the the country face on an on almost a daily basis. So being able to get the resources, get them into the country, past the ports, Sometimes, I mean, University of Ibadan is a university. It’s a government institution.
It’s a public university. The research that we’re doing is important for education and development of our country. And sometimes we’re being asked for duty, import duty, to clear items that are being used for this purpose. They’re not being used for any commercial purpose. So that’s one thing. Another thing is that it takes a long time to be able to do the kind of science that we do. We start with, people who already have degrees. They do post, graduate training, and they do training beyond that called post doctoral training. And the fact that we find it very difficult to retain people after they have become skilled is a huge challenge for us. So, you know, we we spend years training people so that they have the competencies to do these things.
And then, you know, they jack back to Europe or North America, and so we lose that capacity. So being able to retain the people that we train we have very high quality training programs in Nigeria. We invest a lot of resources in training people, and we don’t, create the environment that motivates them, to want to stay and use their skills in our country.
So are there any recent breakthroughs or promising developments, in the field of AMR that you can share?
So, a number of researchers around the world, us included, are now looking at the idea of rather than creating drugs that kill bacteria or prevent them from growing as antimicrobials, all the available antimicrobials, that’s what they do. They either kill the bacteria or they prevent them from growing. Could we create medicines that just prevent them from making us sick? So the rationale behind this is that the, when you prevent the bacterium from making you sick, then your own immune defenses overcome the bacterium rather than the drug.
And we think that doing this might make those drugs less likely to be prone to antimicrobial resistance. I say we think because it’s very early stage development. We’re essentially doing these experiments in the lab. They have not yet been tried in humans. But we’re essentially trying to develop drugs that may do that, may inhibit the ability of the organism to have disease or to hang on in an infection, and then perhaps your system could just wash them out.
And if we do that, we think that the evolutionary pressure for the bacteria to fight back and become resistant might actually be, lower. So that’s something that’s actually very exciting, different approaches for dealing with resistance so that when we do have medicines, they will last longer. As I mentioned before, it’s a very early stage, but it’s also very exciting to be part of this kind of, innovation here in Nigeria.
Earlier, you spoke about training scientists and about talent retention. Obviously, this all begins with an interest in the space. So what advice would you give to young scientists interested in pursuing a career in microbiology and AMR research?
One of the things I often tell people is that while my research is crucial for public health and patient care, my enduring fascination lies in how fascinating bacteria are. When you observe bacteria under a microscope or on petri dishes, they can be surprisingly beautiful. They are fun to study and work with. I encourage students in university to consider taking a microbiology course if they have the opportunity, as it allows them to see and understand bacteria up close. If you have an interest in genomics and genetics, bacteria offer an excellent starting point because their genomes are simpler than those of humans. So, if any of this sparks your interest and you’re in high school, you should focus on mathematics and science courses—biology, chemistry, and physics. These subjects will prepare you for a degree in microbiology or a related field at the undergraduate level.
If you study microbiology as an undergraduate and find it as fascinating as I do, I highly encourage you to pursue a postgraduate program. Many universities offer advanced degrees in microbiology or related fields like biochemistry and medical laboratory science. These areas provide deep insights into microorganisms and how we can manage them to prevent diseases.
Looking ahead, what are your goals for your research over the next decade?
I believe training is incredibly important. I hope to see more young people doing the kind of work I’m currently engaged in, whether they are working alongside me or elsewhere, and in turn, mentoring others. My goal is to build a strong network of researchers and labs focused on combating infections in our country.
Given our high burden of infectious diseases, we need a robust scientific infrastructure dedicated to addressing this challenge. I also hope that some of our current work will lead to the development of new drugs, vaccines, and diagnostic tools that can be used to fight infections. While much of our research is still in the early stages, I hope to see it progress into translational research, where we can test these vaccines and drugs in patients to determine their effectiveness. Our understanding of genomics is also expanding, and there are new approaches being developed in this field.
I hope that here in Nigeria, we can develop new approaches—beyond anything I can currently imagine—that will enable us to fully harness the information contained in genetic sequences.
What does the future of global health look like if the issue of antimicrobial resistance (AMR) is not adequately addressed?
That is a future I don’t like to imagine. I believe things will be very dire if antimicrobial resistance (AMR) is not addressed because we are developing new drugs at a much slower rate than bacteria are developing resistance.
If we fail to tackle AMR, infections could become our greatest challenge, not just in healthcare but in everyday life. This is why we must act now. As I mentioned earlier, we already have tools at our disposal—we don’t need to wait for new discoveries to take action.
We can raise awareness, improve infection prevention and control, use vaccines, make more judicious use of existing drugs, and better utilize diagnostics.
These steps need to be taken now so we can avoid facing a bleak reality 10 years from now. It sounds like you’ve had a very exciting career path over the years.
What has been the most rewarding aspect of your career so far?
I feel very privileged to do what I enjoy on a daily basis and to see progress in the work we’re doing. However, my greatest satisfaction comes from seeing others achieve the same.
That’s why training and mentoring are so important to me. Watching someone come to university uncertain about their future, and then seeing them grow into a scientist capable of doing even more exciting things than I have, is incredibly rewarding. For me, training and mentorship have been the most fulfilling parts of my career.