Unveiling Nigeria’s Epidemic Preparedness: Going Beyond Headlines

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In the verdant fields of Nasarawa State, 43-year-old Mrs. Mariamu Jubril toiled tirelessly, her hands weathered by years of nurturing the crops that sustained her family. Yet, beneath her unwavering resolve, a silent battle raged – one that would test her resilience.

Jubril recounted how it all began with a persistent fever, accompanied by bone-deep aches and unyielding fatigue. Initially dismissing it as a common malady, she sought solace in the comforting embrace of her faith, finding strength in the fervent prayers offered by clerics for her swift recovery.

“However, as days stretched into weeks, my condition only worsened.

“Misdiagnosed with typhoid and malaria, my struggle took a perilous turn, as the true culprit, Lassa fever, silently ravaged my body,” she lamented.

It was not until she returned to Keffi from Lafia that the convergence of modern medicine unveiled the harsh reality.

“My diagnosis sent shockwaves through the medical staff, who recognised the gravity of my condition with collective gasps of dismay.

“With treatment underway, I waged a valiant battle against the relentless virus that threatened to snatch away my life.

“Days turned into weeks, each moment tinged with a flicker of hope akin to a fragile candle in the wind.

“Yet, even as the fever subsided, leaving me weakened but alive, another devastating blow awaited,” she recounted, her voice tinged with sorrow.

She said that the toll of the illness had impaired her hearing, plunging her into a world shrouded

“Undeterred, I refused to succumb to despair. With the same determination that fueled my days in the fields.

“I sought a solution, only to be confronted by the harsh reality of my financial limitations.”

According to the World Health Organisation (WHO), Lassa fever is a hemorrhagic fever that causes serious damage to various organs, reducing the body’s ability to function. The virus is contagious and can spread from person to person via bodily fluids, including saliva, urine, blood and vomit.

According to the Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria faced a significant outbreak of Lassa fever in 2023, recording 4,702 suspected cases, including 877 confirmed cases and 152 deaths between epidemiological weeks 1 and 15. The virus is endemic in Nigeria and parts of West Africa, primarily transmitted by the multimammate rat.

Public health experts have said that responding to the outbreak was challenging due to concurrent emergencies. The experts explained that symptoms vary, and diagnosis can be difficult, with most cases being asymptomatic or mild, but potentially leading to severe illness. Laboratory testing is necessary for confirmation. Cases have been reported in states bordering Cameroon and Benin. However, regional and global risks are considered low, as transmission occurs mainly through contact with contaminated food or household items, with minimal human-to-human transmission.

This year (2024) marks 55 years since the identification of the virus causing Lassa fever in the village of Lassa, in Borno State, Nigeria. Nigeria, like many countries around the world, has faced its fair share of public health crises in recent years.

From combating outbreaks of infectious diseases like Ebola, typhoid fever and malaria to the ongoing battle against Lassa fever and other preventable illnesses, Nigeria has been at the forefront of confronting the challenges of epidemic preparedness. However, beyond the headlines that often spotlight immediate responses to these outbreaks, lies a deeper narrative about the country’s ongoing efforts to enhance its epidemic preparedness and response capabilities.

In recent years, Nigeria has made significant progress in bolstering its public health infrastructure and enhancing its capacity to detect, respond to and prevent future epidemics. A pivotal aspect of these efforts was the establishment of the National Centre for Disease Control (NCDC) in 2011. As the nation’s premier public health institute, the NCDC plays a vital role in coordinating the surveillance, detection and response to infectious disease outbreaks. Leveraging a network of state-level epidemiologists and laboratories, the NCDC has been able to swiftly respond to disease outbreaks and curb their spread.

In addition to the NCDC, Nigeria has invested in training healthcare workers and fortifying its healthcare system to better address public health emergencies. Emergency response teams have been established, and contingency plans devised for a spectrum of potential epidemics, ranging from infectious diseases to natural disasters. Furthermore, the country has enhanced its disease surveillance and reporting systems, enabling swifter and more accurate detection of outbreaks. Implementation of electronic reporting systems and the establishment of a national database for tracking disease trends have empowered public health officials to promptly identify and respond to potential threats.

Nevertheless, challenges persist in Nigeria’s epidemic preparedness efforts. Experts cite funding constraints, inadequate healthcare infrastructure, ongoing security concerns and environmental changes as obstacles to the country’s ability to effectively respond to epidemics. An associate professor of infectious diseases and public health epidemiology, Dr. Ishaku Akyala stressed the need for sustained investment, collaboration and commitment from stakeholders to strengthen public health infrastructure, improve healthcare services, enhance disease surveillance and promote public health awareness.

The director-general of the NCDC, Dr. Jide Idris, expressed concern over the recurring pattern of preventable diseases claiming lives in Nigeria despite the nation’s awareness of disease patterns and their seasonal occurrences. He emphasised the importance of preventive measures, advocating for a proactive approach to disease prevention rather than reactive responses. Idris outlined the NCDC’s strategic roadmap, which prioritises preparedness, detection and response to public health emergencies, underscoring the government’s responsibility to prioritise citizen protection and disease prevention.

He emphasised the importance of collaboration between Federal and state governments, advocating for a holistic “One Health Approach” that involves sectors beyond healthcare, such as agriculture and the environment. Highlighting the zoonotic nature of diseases like Ebola and COVID-19, Idris stressed the need for multi-sectoral partnerships to effectively combat these diseases. He cited ongoing collaborations with health commissioners and the Nigerian Governors Forum and underscored the importance of understanding social determinants in different states.

Renowned Nigerian scientist and former Vice Chancellor of Redeemer’s University, Prof. Tomori Oyewale harped on the need for a multidimensional approach – which integrates research, data analysis and stakeholder engagement – to epidemic preparedness. He advocated for comprehensive strategies that include research, stakeholder engagement, public discourse, advocacy, resource allocation and international collaboration to address health security threats comprehensively.

While Nigeria has made commendable progress in enhancing its epidemic preparedness and response capabilities, continued efforts are essential to overcome existing challenges and effectively mitigate future outbreaks. Collaboration, investment and a multi-sectoral approach are key to strengthening the nation’s resilience against infectious diseases and safeguarding the health of its population.

Nobody hopes for emergencies, but being prepared is crucial to tackling them. Citizens desire a strong emergency response system capable of efficiently and swiftly managing outbreaks and critical scenarios.

In a significant development within Nigeria’s healthcare landscape, the NCDC’s budget allocation for the fiscal year 2024 highlights key shifts in funding priorities aimed at bolstering the country’s disease prevention and response capabilities. The total sum allocated to the agency in the 2024 Federal budget stands at N4.356 billion, which stakeholders in the health sector say did not indicate a strong commitment to safeguarding public health amidst evolving global health challenges. Among the notable changes reflected in the budget were increases in specific budget lines dedicated to critical areas of disease prevention and response.

Procurement and distribution of pharmaceutical and non-pharmaceutical supplies for the National Strategic Stockpile witnessed a significant boost, with an additional N30 million allocated from 2023 to 2024. This increase underscores the heightened focus on enhancing stockpiling capabilities to support disease detection, prevention and response efforts nationwide. Similarly, sustained efforts in combating antimicrobial resistance are evident through a N5 million increase in funding for antimicrobial resistance surveillance in sentinel sites across the country. This augmentation, health economists said, did not reaffirm the country’s commitment to monitoring and addressing the growing threat of antimicrobial resistance, a critical aspect of public health preparedness.

While investments in certain areas saw an upward trajectory, the budget also reflected strategic adjustments and new priorities. Despite maintaining the same budget allocation for equipping the NCDC headquarters with communication and response infrastructure, the introduction of new budget lines highlighted a forward-looking approach to strengthening Nigeria’s public health infrastructure. Of particular significance was the introduction of interventions to develop capacity for public health informatics, emphasising the importance of harnessing data analytics, modeling and forecasting to enhance emergency preparedness and response.

Additionally, the substantial allocation of N95 million for strengthening subnational health security underscored the imperative of bolstering health security at the subnational level, complementing efforts at the national level. Furthermore, the establishment of new budget lines dedicated to training, capacity building, and subnational emergency response highlighted a proactive stance in fortifying the country’s readiness to combat emerging health threats effectively. However, amidst the strategic realignments and increased investments in key areas, reductions in funding for the dissemination of surveillance outputs and the digitalisation of disease surveillance signal potential shifts in priorities or resource allocation strategies.

Nigeria’s epidemic preparedness demands a concerted effort encompassing diverse stakeholders, innovative strategies and sustained investment to safeguard public health and mitigate the impact of emerging diseases. As the country continues to navigate the complexities of public health emergencies, it is clear that a concerted effort to improve epidemic preparedness is essential for protecting the health and well-being of its citizens. By investing in strong public health infrastructure, training healthcare workers, and enhancing disease surveillance systems, the country will be taking important steps toward building a more resilient and responsive healthcare system that can effectively address the threats of future epidemics.

Racheal Abujah
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