Polio, Lassa and Yellow fever: Where is the political will?

Since the conception of Nigeria as an independent country it has struggled with a number of deadly viruses and diseases. The most prominent and reoccurring have been polio, Lassa fever and yellow fever. These three have plagued parts of the country for many years and appear sporadically, peaking and dipping throughout the country’s history. Under colonial rule vaccinations were kept for the expatriates and British citizens in the country. The indigenous population was mostly ignored and this allowed the viruses to spread unchecked throughout the country. It wasn’t until later in the country’s history that measures were taken to slow the spread and commence eradication of the disease.
Reemergence of viruses

The return of the polio virus in 2016 sparked a mass emergency vaccination campaign. The return was seen in two young children in the Northern part of the country, in areas affected by the Boko Haram insurgency. The return of the polio virus is especially disheartening for the country because it was a year away from being declared polio free by the World Health Organisation (WHO). WHO guidelines state a country must not experience any new cases of the wild polio virus for three years before being declared polio free. The return of polio can be attributed to presence of Boko Haram. The insurgency has made it very difficult to get necessary treatment and vaccines to that area of the country, allowing polio to creep back in.

Lassa fever has however been more prominent than polio in Nigeria, springing up every couple of years mostly between June and December. There has been a decline in the severity of break outs but it must still be taken very seriously and focus should be placed on prevention. Since December 2016 a total of 501 cases have been reported with 104 confirmed deaths. A total of 17 states have reported cases of Lassa fever with Lagos being the latest, confirming a case in June 2017. Lassa fever can be contracted from food or household items contaminated with rodent urine.

Yellow fever is an acute virus that is passed on to humans by mosquitos and can become an outbreak very quickly because it is a contagious virus. Yellow fever has not seen a serious outbreak in Nigeria in recent years but the possibility of a nationwide epidemic in rising with the yellow fever rearing its head again in 2017. The WHO has warned the country of an “imminent epidemic” if appropriate steps aren’t taken. This is especially worrying for Nigeria, as a densely populated country the outbreak can be rapid and blindsiding. The first case was seen in November 2017, a seven year old girl in Kwara State. Confirmed by the Nigeria Centre for Disease Control (NCDC) and reported to WHO. Between June and December 2017 a total of 341 suspected cases of yellow fever have been reported in 16 states. Of these cases 62.8% are male and 66% are under the age of 20.

Call to Prof. Isaac Adewole to act
Professor Isaac Adewole is the minister of Health for Nigeria and there have been outcries for him to act accordingly and help Nigeria reduce number of viral outbreaks that the country experiences. Nigeria’s health sector has a number of issues; poor financing, inadequate number of health personnel per capita, poor support infrastructure, dearth of equipment and little or negligible investments in research. The National Association of Medical Doctors (NARD) has come out to say that the Ministry of Health needs to be more proactive when dealing with epidemics. The president of NARD, Dr. Ade Faponle, has said the county does not have a prepared template to handle the outbreak of infectious diseases and works retroactively. Prof Adewole himself has made it clear that for the Ministry of Health to combat the viral outbreaks it needs more funding from the Federal Government. This came after the 2018 proposed budget was released and there was a percentile cut in the health budget when compared to 2017. Adewole is doing what he can with the resources at his disposal. In 2016, he announced that the Ministry of Health will be partnering with the private sector to create a Bank of Health. Adewole declared that Nigeria’s health scene needs a presence from the private sector and the government cannot bear the burden alone. The Bank of Health aims to provide resources for those in the private sector who wish to set up health facilities in the form of single digit interest loans with long repayment periods. Prof. Adewole backed this move by saying: “We have decided to work with the private sector in the coming year because they have the discipline, resources and efficiency to drive the sector.”

Cost of doing nothing: Non intervention
Nigeria needs to act swiftly in order to quell the outbreaks of the aforementioned viruses. This has not been entirely the case of late but the country is working hard to stop the spread of diseases. The Ministry of Health is quick to give updates of cases in different parts of the country and also report each new case of any potential epidemic to WHO for advice and support. Also, when polio resurfaced in the country the Ministry of Health was quick to issue an emergency vaccination campaign in order to boot polio once and for all. Even going as far as vaccinations for neighboring countries in the Lake Chad area. The need for intervention by the government has often come late or has been very weak. This was the case in Ebonyi State, a state with a large Lassa fever outbreak. It was discovered that 3 out of 9 cases were from people who had been sent home from the hospital but went on to contaminate others.

The country’s health sector has been underfunded for many years and the federal government needs to do more in order for Nigeria to have a health sector that can convincingly fight the spread of viruses and epidemics. Nigeria has been heavily reliant on donor and international help to fight its immunization battle. Since 2001, Gavi, an international public-private health actor, has committed $697 million to Nigeria’s immunisation bid. Gavi has stated Nigeria has a number of challenges, such as uneven infrastructure and immunisation coverage, geographical barriers and anti-vaccine movements. Government officials need to be aware that the country cannot be reliant on other actors to solve its problems forever. Gavi support is winding down as Nigeria is no longer classified as a low income country; Gavi’s criteria for offering support. This means by 2021 Nigeria will have full responsibility for the immunisation of its citizens.

However, these haven’t stopped Gavi seeing some positives. The Nigerian government is aware of what needs to be done and commitment from state governors is promising. Some states are trying to take a proactive response while no cases have been reported in their territory. States neighboring affected locations are beginning to take proactive actions to prevent the further spread of the disease to their territory. In Enugu, for instance, a 22-member committee on Lassa fever was inaugurated by the Nigeria Medical Association (NMA) in January 15, 2018, and similar actions have also taken place in Benue.

Future reemergence of polio in Nigeria
The reemergence of polio is more probable than one may assume in Nigeria, especially in the North East. For the last decade or so the Ministry of Health has provided vaccines to all local government areas in the country. The main drawbacks during this campaign are that there is little record of who has received that vaccination and some places were simply inaccessible. To be fully protected from polio a total of four vaccinations are needed. Upon returning to LGAs the Ministry of Health requires people to remember this information, this will be especially difficult for young children where the virus is most prominent. The Boko Haram insurgency has hampered the eradication of polio because of the instability it has introduced to the area. The presence of Boko Haram makes those areas in North East Nigeria inaccessible to healthcare workers. The displacement of people not properly vaccinated can also lead to issues for neighbouring states and start the outbreak cycle again. The Federal Government recently claimed that Boko Haram has been “completely defeated,” therefore, there should not be any future problems in getting necessary vaccines to the North East region of the country, but how true is this?

However, Boko Haram isn’t the only adversary to nationwide immunisation. Poor infrastructure also hinders vaccines reaching the most impoverished parts of the country, where polio is most likely to reemerge. Tens of thousands of people are hampered for this very reason. Without the necessary vaccines around the country Nigeria can slip further back in its fight to eradicate polio. A fight that was nearly won.

The confluence of these three diseases – yellow fever, polio and Lassa fever threatens the emergence of virulent epidemics at a time when we were almost out of the woods on these matters. The Lassa fever, like the Ebola first killed the doctors, then the nurses.

In all these cases simple basic hygiene by washing and cleaning the hands would have helped but we have no clean water. Most important however, is the apparent lack of political will to see these problems as holistic and to solve them accordingly.

Mr. Bill Gates of Microsoft has agreed to pick up $276 million of unpaid bills for polio vaccines issued to us by Japan. I cannot believe that the Ministries of Foreign Affairs and Health cannot dissuade Japan from taking this money and that we cannot, should this be possible, not spend that money more profitably to bring to an end the threats caused by yellow fever, Lassa fever and polio. My fear is that now that the election is coming, these matters will get worse and when money is voted for eradication and treatment, it will end up in the political soup of re-election.