Infectious Diseases: Nigeria needs proactive approaches to tackle future health crisis [Pulse Contributor's Opinion]

The COVID-19 pandemic has showed the world a new meaning of ‘global epidemic’. The respiratory and air-borne virus quickly reached almost the entire world within few months of its original outbreak in China, infecting more than 50 million people and killing over 1.2 million. The pandemic exposed Nigeria’s lack of preparation for any disease outbreak despite the numerous infectious diseases which have plagued the country for long. Nigeria's panicked and fire-brigade approach to setting up isolation and testing centers in the peak of the outbreak, despite having being aware of the international spread for months, provide prime examples of what the country should make sure never happens again.

Health Ministry says 122m Nigerians at risk of contracting Neglected Tropical Diseases. [sabin]

Pulse Nigeria

It is a fact that many countries have been battling different infectious disease within their territories prior to the global COVID-19 outbreak. For instance, the USA has been troubled by influenza virus, some parts of East Africa are still battling Ebola resurgence while Asian countries are trying to manage Middle East respiratory syndrome coronavirus. Nigeria has also seen rising Lassa fever infections. All of these diseases are not in the mainstream news because of the way they are being managed and contained

Many countries, like the USA, have structures and measures in place to effectively combat sudden infectious disease outbreaks. The most prominent among these measures is infectious disease surveillance. Infectious disease surveillance is very important in monitoring the health of a population. It is carried out in three ways:

  1. Describing the current burden and epidemiology of disease,
  2. Monitoring disease trends, and
  3.  Identifying outbreaks and new pathogens.

Surveillance could be passive or active. Passive surveillance means waiting for a ‘serendipitous discovery’ of cases by medical practitioners or health workers and reporting it. Active surveillance means being deliberate about the search, and actively seeking for infectious disease within the community.

Unfortunately, Nigeria currently lacks both. Although passive surveillance is being carried out for most infectious diseases in Nigeria, the expensive and grueling nature of active surveillance leaves much to be desired in the whole setup. Most of the diseases currently being actively or passively monitored are those with funding from international bodies like Poliomyelitis, and recently COVID-19.

The recent upsurge of cases of Lassa, for instance, showed that local diseases with no international funding are being ignored or mismanaged. According to the Nigeria Centre for Disease Control (NCDC), the country faced unprecedented outbreaks of diseases such as Cerebrospinal Meningitis, Lassa fever, Yellow fever, Cholera and even Monkey pox in 2017. Although NCDC claimed they responded with emergency tactics, our responses to recent outbreaks are still faulty three years later.

While this article is not aimed at criticizing the nation’s public health sectors, there are so many loopholes to fill to avoid major disease outbreaks in the future. The lack of complete digitization of the entire disease surveillance and reporting network in the country, as well as an online database where anyone can access to be updated and to report notifiable diseases, is a big problem.

The channels provided for disease reporting in Nigeria are too complicated, mostly unavailable, and they lack encouraging responses. Most Nigerians don’t even know how to report because they don’t even know the case definitions for most of these diseases. Also, personnel involved in most of these surveillances are not rightly trained and updated in what and how to do their jobs, neither are they remunerated and compensated for the hazards they face in carrying out these obviously dangerous tasks.

Perhaps, the most important issue here is the lack of facilities and equipment needed to carry out these surveillances, either passive or active. Nigeria’s COVID-19 response was embarrassing and at the same time scary. We are not prepared for an epidemic of such magnitude until it was confirmed to be present in the country. This is the same thing that happened during the Ebola outbreak a few years ago. We should be better prepared for future outbreaks, not only for worldwide outbreaks such as COVID-19, but for our own localized diseases as well.

The isolation centers set up during this COVID-19 outbreak must be upgraded, maintained and well-equipped. Similarly, isolation centers must not be seen as another prison yard where inmates are kept in terrible conditions. Case definitions for diseases must be well-stated and standardized. There should be no reason to keep people in isolation when their symptoms have not matched the case definition of the disease suspected.

Testing centers can be set up within the isolation centers and test results must be provided in a timely manner to avoid patients distrusting the system. The centers must be well-funded and equipped with right-skilled and motivated personnel and state-of-the-art machinery which must be well-maintained and upgraded regularly to produce results as at when needed.

After these, perhaps, we can start having faith in our disease management system again in Nigeria.

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Pulse Contributors is an initiative to highlight diverse journalistic voices. Pulse Contributors do not represent the company Pulse and contribute on their own behalf.

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About the author: Tayo Fasuan is a virologist, molecular scientist and writer. He runs an applied microbiology and bioscience company and has written about disease management for many years. He was recently part of the COVID-19 surveillance and testing in Nigeria.

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