Ebola: Examining FG’s Poor Prevention Preparedness

Given the lingering Ebola Virus Disease outbreak in the Democratic Republic of Congo that has now claimed over 1, 000 lives, Martins Ifijeh writes that should Nigeria be afflicted with the disease again, the Nigerian government is only about 39 per cent prepared to tackle the threat

If you tell an average Nigerian that the country’s number one dreaded disease, Ebola is lurking around the corner and may just be few hours away from entering into the country, the most certain reaction will be ‘God forbid’, or ‘It is not our portion’.
But they also forget that it is not the portion of the Democratic Republic of Congo (DRC) to experience another outbreak that has now killed over 1, 000 persons. They forget DRC is also as religious and prayerful as Nigeria, yet the virus again found its way into their lands and has lingered on till this day.

The average Nigerians are not the only ones guilty of this. Government thinks same way too through its actions. In the face of impending threats, it will not put optimal measures in place to prevent them. It believes it is a nation under God, hence it is protected. This is the approach it used when Boko Haram was still brooding. It has used same pattern a number of times in the health sector to the point Nigeria now ranks among lowest among countries in many health indices globally. It was also used in 2014 when Patrick Sawyer brought in Ebola into the country, only that through sheer luck and providence, the country defeated the outbreak at the expense of eight productive lives and at least $180 million, according to World Bank figures.

Fire Brigade Approach
This is what is also playing out in the country’s poor preparedness level on prevention of another Ebola outbreak should there be a leak from DRC or any other country at risk, as the virus is just one traveler or even two hours away from making the country activate its usual fire brigade approach. DRC is about two hours travel by air to Lagos.

And when this fire brigade approach is activated, the Central Bank of Nigeria’s vault would be thrown open, and all the monies it has refused to spend on prevention will be used 100 times over to quell the epidemic. It is the only way Nigeria spends money, especially on health and other human capital areas. After all, politicians argue that they would rather spend money on infrastructural development and other things that are tangible and can be measured in physical terms by their constituents. To them, disease prevention, health in general and other human capital areas cannot be measured, hence the reason they pay lip service to these areas.

This perhaps explains why the country has refused to increase healthcare budget from the abysmally poor amount it presently allocates despite the importance the sector is to economy and security of the nation. Heads of States in Africa’s agreement through an Abuja Declaration of 2001 that healthcare sector be given at least 15 per cent of a country’s national budget and World Health Organisation’s recommendation for at least 13 per cent of national allocation has not changed Nigeria’s stand on healthcare budgeting as the nation is still hovering between three and five per cent.

Underfunding of Disease Preparedness
One of the areas that has continued to suffer from this poor healthcare funding is disease preparedness, especially since the lean 3.9 per cent of national allocation given to health will be spread across several areas of healthcare demanding equal and in some cases higher attention.

No wonder a health advocate, Dr. Chioma Nwakanma during the Health Editors Media Roundtable in Lagos last week, and organised by the Nigerian Health Watch, decried that the federal government has not given priority to preventing outbreak as the funds needed for this do not get attention, noting that if eventually outbreaks like Ebola occur for the second time, it definitely would cost the country far more than what it has refused to release for its prevention.

A research conducted by Nigeria on disease preparedness and published on www.preventepidemics.org has shown that the country is only 39 per cent prepared for disease outbreaks like Ebola, even though the country is very much at risk of the virus considering travel pattern of Nigerians, proximity to area of outbreaks, and the cosmopolitan nature of the country with different persons from all walks of life visiting the African giant on a daily basis.
The data showed that Nigeria ranks only 20 per cent on National Legislation, Policy and Financing of disease outbreaks; 20 per cent on Biosafety and Biosecurity; Antimicrobial Resistance 40 per cent, while International Health Regulation Coordination, Communication and Advocacy ranks 40 per cent.

The study also showed that on preparedness, the country ranked poorly at 20 per cent, with on emergency response operation, it ranked 45 per cent; medical counter measures and personal deployment ranked 20 per cent; linking public health and security authorities ranked 20 per cent; and risk communication ranking 48 per cent.
On national laboratory system, the country ranked 40 per cent, 55 per cent on real time surveillance, 50 per cent on reporting, and 60 per cent on workforce development.

In summary, Nigeria ranked 31 per cent on ‘Stop Outbreaks’, 37 per cent on ‘Protect from Other Health Threats’, 39 per cent on ‘Prevent Outbreaks’, and 51 per cent on ‘Find and Verify Outbreaks’.

The Nigerian Situation
In a recent article authored by a Fellow, Nigerian Academy of Science, Prof. Oyewale Tomori and published in the Conversation, it was argued that Nigeria still lags behind in addressing disease outbreaks, and most importantly in preventing them.
Tomori said weak system of disease control and over dependence on foreign aids for surveillance were some of the reasons Nigeria still suffer from various outbreaks, including Lassa fever.

He said: “All levels of government in Nigeria have, for many years, neglected and underfunded the health sector in general and disease surveillance, in particular. As a result, the country has been unable to detect, rapidly and efficiently control or respond to outbreaks.

“As a result, Nigeria now depends too much on foreign aid for disease surveillance. It’s difficult for the country to coordinate assistance programmes that are funded and run by international NGOs and other partners with defined objectives. This has resulted in a haphazard and uneven development of the national disease surveillance system and the failure to establish a national functional laboratory network. The country has failed to sustain the structures and facilities that were used to control Ebola in 2014.”
Tomori said the control of the 2014 Ebola outbreak in Nigeria was a combination of chance and an eventual commendable but rare performance of the country’s national disease control system, adding that Nigeria was able to limit the Ebola epidemic through a combination of factors – the laboratory confirmation of Ebola virus disease outbreaks, the rapid declaration of an emergency by the government, the setting up of an emergency operation centre and the aggressive tracing of contacts.
He said soon after Nigeria was declared free of Ebola, the emergency operation centre was closed.

Relaxed Borders, Habit
It is no longer news that travelers coming into Nigeria are no longer checked by the usual ‘Ebola machine’ for high fevers or other symptoms of the dreaded disease. One then wonders if the airports, with high human travelers, relaxes its precautionary style on Ebola prevention, what then happens at sea ports and land borders.
The citizens are not left out of this. During and after the last Ebola outbreak in Nigeria, institutions, as well as homes imbibed the culture of using hand sanitisers. But as a country often used to fire brigade approaches, almost everyone has relaxed on the highly recommended habit.

Cost of Ebola
Aside the human loss associated with Ebola outbreaks, the World Bank in 2015 estimated that it cost Nigeria $186 million, and that the country’s economy was indirectly affected mostly by lost trade through closed borders, disrupted supply chains, marked reduction in travel and tourism, and cancellation of international events, and that was just with the relatively small outbreak the country had.
World Bank also said at the time that based on the Nigeria Centre for Disease Control (NCDC) evaluation, Nigeria would only need roughly US$0.40 per person per year to establish a preparedness infrastructure that protects Nigerians.

It also warned that should there be a pandemic in the country, it would cost an annual loss of US9,662,722,821 (that is 3.51 trillion naira) and annual loss per capita of US$53.03 (19,269 naira). While everyone believes Ebola is only in DRC and may likely not find its way to Nigeria, it is important to state that DRC is closer to Nigeria in terms of distance (2058km) than Liberia (2925km) were the 2014 index case, Sawyer came from, and they both about two hours away by air. And whether it comes from DRC or any other nation, it might only be a matter of time until our preparedness levels are tested.

A famous quote by Vital Strategies, an international organisation says: “An infectious disease can travel around the globe in just 36 hours. It is not a matter of “if” there will be a new disease outbreak that threatens millions of lives, but when.”
Therefore, the most important question remains thus; will Nigeria get its priority right as the incumbent government commences its second tenure later this month? That remains to be seen.

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