ANALYSIS | African Countries’ Response to COVID-19 Pandemic – The Case of Nigeria

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Nigeria’s quite proactive response to COVID-19 offers other African countries immense learning opportunities

 

Chikwe Ihekweazu, director-general of the Nigeria Centres for Disease Control (NCDC)

 

On Friday, February 28, Nigeria confirmed its index case of the Coronavirus Disease 2019 (COVID-19), making it the second African Union Member State (after Egypt) and the first in Sub Saharan Africa, to do so.  With a Gross Domestic Product of $375 billion and a population of 200 million, Nigeria is Africa’s biggest economy cum most populous nation, respectively. Consequently, one out of every four black Africans is Nigerian; this explains why what happens in the country reverberates across the continent.

Though it lacked a proper epidemic preparedness and response mechanism at the time, Nigeria did successfully battled the 2014 Ebola Virus Disease (EVD) outbreak in West Africa.[i] Although the then young Nigeria Centre for Disease Control (NCDC) had to hurriedly establish an ad-hoc Emergency Operations Centre (EOC) in Lagos, soon the country was effectively wrestling with the disease, ultimately earning the World Health Organisation (WHO’s) commendation.[ii]

In consequence, the EVD outbreak was a ‘wakeup call’ to Nigeria on the need for a robust epidemic preparedness and response mechanism, necessary for tackling the outbreaks of public health emergencies. As a result, the NCDC continued to consciously upgrade the country’s disease preparedness and response infrastructure and capabilities. Nigeria’s potent response to EVD was attributed to three factors i.e capacity to respond in a timely and aggressive manner; human capabilities; as well as effective health systems governance.[iii]

Ever since the EVD experience, NCDC has evolved into Africa’s best National Public Health Institution (NPHI), in terms of capacity for infection prevention and control.  It has since then efficaciously responded to numerous other disease outbreaks including thousands of cases of Yellow Fever; a severe outbreak of Meningitis; several Polio outbreaks; a massive Cholera surge; the country’s first cases of Monkeypox in decades; as well the largest outbreak of Lassa Fever in Nigeria’s history, which the Centre currently battles alongside COVID-19.[iv][v]

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Response Capacity

Nigeria’s success in responding to COVID-19 is largely thanks to the capacity of its NPHI. Established in 2011, NCDC was meant to enhance the country’s “preparedness and response to epidemics through prevention, detection and control of communicable and non-communicable diseases.”[vi]

In the beginning, the Centre lacked a legal mandate hence was constrained by dearth of human and financial resources. However, in 2018, Nigeria’s President Muhammadu Buhari assented to a bill for an act establishing the NCDC as a “full-fledged parastatal”, which led to improvement in its emergency coordination, surveillance, and risk communication capacities. [vii]

When the Ebola outbreak occurred in 2014, only one laboratory in Nigeria had the capacity to test for the disease.  As part of Nigeria’s 2018-2022 National Action Plan for Health Security (NAPHS), the NCDC has established a network of national and subnational reference laboratories, many of which are now part of the WHO’s global laboratory network.[viii] [ix]Also, NCDC had months ago established Rapid Response Teams across all of Nigeria’s 36 states, as well as helping 23 out of Nigeria’s 36 states set up their own EOCs, linked to the country’s national incident coordination centre.[x][xi]

Ahead of the COVID-19 outbreak, the NCDC had also set up what it calls the ‘coronavirus preparedness group’ which “meets daily to review the situation globally, assess the risk of spread and improve on Nigeria’s level of preparedness based on new findings and insights.”[xii]  As well as providing public health advisory to Nigerians on what to do if there was a suspected case – before the partial and later complete closure of Nigeria’s entry-points – the NCDC had intensified screening for especially passengers from China and other COVID-19 affected countries.[xiii]

Even though Nigeria is Africa’s most populous nation (population: 200 million) and was the first country to confirm a COVID-19 case in black Africa, the country has, as at April 11, recorded far fewer number of cases and fatalities – 305 cases; seven deaths – relative to other African countries. For example, South Africa (population: 59 million) has thus far recorded over 2,000 cases with 24 deaths while Egypt (population: 100 million) has recorded around 1,800 cases with 135 fatalities.

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 Lessons for African countries

Albeit some contend the few cases of COVID-19 in Nigeria are as a result of fewer people being tested or even ‘sheer luck’, the relatively low number of cases and fatalities could be linked to the effectiveness of the country’s epidemic preparedness and response mechanism. Others even argue Nigeria’s response mechanism might be even more effective compared to that of the United States of America (USA) where COVID-19 cases, as at April 11, are over half a million with about 20,000 fatalities. [xiv] Consequently, they reason, the USA has got much to learn from Nigeria – in terms of responding to pandemics.[xv]

Indeed, Nigeria’s response to COVID-19 offers a lot of lessons and learning opportunities to fellow African countries, at least. So far, the country’s effectiveness in responding to the contagion has earned it the respect and admiration of its peers in Africa. In February, its head, Chikwe Ihekweazu, was part of a 25-member team of experts on a joint WHO-China fact-finding mission on COVID-19 to China.[xvi]

Some of the key factors responsible for the NCDC’s success in its response to COVID-19 are; first, investment in epidemic preparedness and response (infrastructure and capabilities) at national and subnational level.[xvii] Second, transparency and accountability in reporting cases, deaths, recoveries as well as efficient risk communication, one that ensures timely countering of misinformation, disinformation and fake news.

Third, investment in a network of cross-country laboratories which guarantee prompt testing of suspected patients, followed by aggressive tracing of primary, secondary and tertiary contacts of infected persons. Fourth, political will on the part of the Nigerian government which saw the elevation of NCDC into an independent agency, guaranteeing the Centre adequate human and financial resources. Five, the Ihekweazu-led NCDC team which has been very proactive, resourceful and committed to safeguarding the health security of Nigerians.

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Challenges

Despite its impressive record in preventing and containing the outbreak of diseases including COVID-19, the NCDC is not without its own challenges. Although 2.5% of Nigeria’s statutory Basic Health Care Provision Fund is supposed to be dedicated to funding the Centre, it is still underfunded. Consequently, effective implementation of the $439 million-worth NAPHS is being stalled by lack of funding.

Funding the plan requires the contribution of Nigeria’s federal, state and local governments which will enable the NCDC to establish public health labs and EOCs all over the country’s 36 states. Moreover, while the ventilator is a key equipment in providing intensive care for patients suffering from respiratory failures resulting from severe cases of COVID-19, currently, only 1 ventilator is available for every 1.2 million Nigerians. [xviii]

Subsequently, if Nigeria would suffer a full-blown outbreak, the country will not have the capacity to provide clinical care to the resulting high numbers of patients – due to paucity of key facilities such as ventilators, medical oxygen and electricity. Also critical are diagnostic facilities; although NCDC is working to increase the number of testing laboratories across Nigeria, a country as vast and populous as Nigeria still need to do much more to ensure timely access to testing for all. [xix]

 

A version of this article appeared in the May edition of Governance Link; the newsletter of the African Peer Review Mechanism (APRM) 

 

 

 

[i] https://www.africannewspage.net/2019/03/op-ed-its-high-time-nigeria-gets-robust-epidemic-preparedness-funding-mechanism-by-adam-alqali/

[ii] https://www.premiumtimesng.com/news/top-news/168371-world-health-organization-commends-nigeria-over-ebola.html

[iii] https://www.theguardian.com/global-development-professionals-network/2014/oct/31/ebola-nigeria-state-public-sector-calestous-juma

[iv] https://www.thinkglobalhealth.org/article/anticipating-coronavirus-west-africa

[v] https://www.devex.com/news/nigeria-struggles-with-largest-recorded-lassa-fever-outbreak-96773

[vi] https://ncdc.gov.ng/

[vii] https://ncdc.gov.ng/news/156/president-muhammadu-buhari-signs-bill-for-an-act-to-establish-the-ncdc

[viii] https://ncdc.gov.ng/themes/common/files/establishment/5e88f9e22d2b4e4563b527005c8a0c43.pdf

[ix] https://ncdc.gov.ng/news/211/nigeria-announces-three-new-laboratories-for-yellow-fever%2C-measles-and-rubella

[x] https://www.theafricareport.com/24046/how-nigeria-is-preparing-for-the-coronavirus/

[xi] https://www.forbes.com/sites/andrewwight/2020/03/24/what-the-us-could-learn-from-nigerias-response-to-covid-19/#993bc4d56375

[xii] https://www.theafricareport.com/24046/how-nigeria-is-preparing-for-the-coronavirus/

[xiii] https://www.theafricareport.com/24046/how-nigeria-is-preparing-for-the-coronavirus/

[xiv] http://www.ipsnews.net/2020/03/nigeria-knows-better-fight-corona-us/

[xv] http://www.ipsnews.net/2020/03/lessons-from-nigeria-in-responding-to-coronavirus/

[xvi] https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

[xvii] http://www.ipsnews.net/2020/03/lessons-from-nigeria-in-responding-to-coronavirus/

[xviii] https://www.story.dataphyte.com/health/covid-19-only-one-ventilator-exist-for-every-1-2-million-nigerians/

[xix] https://www.premiumtimesng.com/news/top-news/384620-nigeria-adds-two-laboratories-to-test-for-covid- 19.html

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