• Says Nigeria Was Already Alert Before COVID-19 Because Of Challenges Of Other Infectious Diseases
• Healthcare Challenges Far From Being Over – Experts
• Progress In Health Sector Too Little, Too Late, Too Lopsided – Tomori

Today, February 27, 2022, is exactly two years since the index case of the dreaded Coronavirus disease of 2019 (COVID-19), was confirmed in the country. But two years after that incident, an ongoing seroprevalence study conducted nationwide by the Nigeria Centre for Disease Control (NCDC), found that the prevalence of Sars-CoV-2 antibodies was 23% in both Lagos and Enugu, 19% in Nasarawa and 9% in Gombe.

Also, most medical experts, who spoke to The Guardian, were unanimous that challenges persist in the health sector despite the billions of naira sunk into the healthcare delivery system in the last two years.

Even though opinions are, however, divided regarding lessons learnt in the course of managing the lethal virus, health professionals maintain that the country remains, perhaps better prepared now than she was on February 27, 2020, but without a guarantee that she is ready for future pandemics.

According to them, challenges facing the sector, including inadequate training, shortage of intensive care equipment and facilities’ ability, keeping the required number of health workers in acceptable work climate etc., persist. They, therefore, urged the Federal Government to address key issues of human resources, financing, data management/research for evidence, local production of pharmaceutics and vaccines, as well as partnerships for health.

Taking a cursory look at the healthcare milieu vis-à-vis the country’s management of the pandemic, the Assistant Director-General, Health Emergency Intelligence, World Health Organisation (WHO), Dr. Chikwe Ihekweazu, said that the advent of COVID-19, which he described as an “unprecedented public health emergency,” has led “to a stronger focus on the importance of epidemic and pandemic preparedness. We are seeing a convergence of political will and public interest in strengthening health security in countries, but also at regional and global levels.

Ihekweazu, an epidemiologist, and former director-general of the NCDC said having taken the bold step: “We must rapidly increase funding and make these funding rapidly available, to improve preparedness across countries. Global health institutions like the WHO needs to be stronger in coordinating global response activities and we have begun to see these improvements such as with the WHO Hub for Pandemic and Epidemic Intelligence. We need to strengthen collaborations both within and between countries, and this is an area that the new Hub is working very hard on.

He continued: “From COVID-19, we know that no country is safe until every country is safe. Therefore, investments in preparedness must start now for countries, regions and globally.

He praised the Federal Government for showing political commitment and will in responding to the pandemic through the establishment of the Presidential Task Force on COVID-19, adding that the leadership by the Secretary to the Government of the Federation ensured a harmonised and coordinated multi-sectoral response.

“The foundation that had been laid in responding to outbreaks like Lassa Fever also enabled Nigeria’s response. At the beginning of the pandemic, the laboratories, treatment centres, and health workers that were available to respond to COVID-19 had been working on Lassa Fever. By building this, the NCDC and other institutions ensured that Nigeria has the foundational capacity to respond to a pandemic,” he said.

“The hard work and commitment of health workers across the country have been very critical. These health workers have been responsible for testing and vaccinating, treating cases, ensuring risk communications, providing supplies rapidly amongst others.

All of these factors must continue to be strengthened in preparedness for endemic outbreaks and the next pandemic,” Ihekweazu, a public health physician said.

Also shedding light on strides recorded by the country in the management of the pandemic, the Director, Prevention Programme and Knowledge Management, NCDC, Dr. Chinwe Ochu, said: “The country’s socio demography predisposes us to infectious disease outbreak. Yet we spend very little on health. At the beginning of the COVID-19 pandemic, all over the world, they were relaxed. Nigeria was already alert because of the challenges of other infectious diseases. At that time, we had our scanners for screening for Ebola and other haemorrhagic fevers. We were meeting and training rapid responders. Our preparation was higher than that of other countries. We had five molecular laboratories in five states before the first case of COVID-19. We now have 150 molecular laboratories, which was achieved within one year. Before COVID-19, we had 17 Surveillance Outbreak Response Management and Analysis System (SORMAS).”

The SORMAS is an open-source mobile and web application software that was developed to enable health workers to notify health departments about new cases of epidemic-prone diseases, detect outbreaks, and simultaneously manage outbreak response.

After two years of wreaking severe havoc in countries and territories around the world, many are still wondering why Nigeria was spared widespread misery in comparison to yet to what the United States and some European countries faced.

Ochu responded: “It is not only Nigeria that was spared, Africa was also spared. Why is Africa spared? Well, I would not say we are spared even though we are not witnessing serious negative impacts or outcomes as much as other countries are. But as for the true burden of COVID-19, like how many people have been exposed? We don’t have the figures. That is why we are doing a seroprevalence study because you cannot use the Polymerase Chain Reaction (PCR) test to judge.”

She continued: “How many people go for testing? People are continually exposed to COVID-19, but they say that it is common cold and the thing comes and goes. So, it is this seroprevalence survey that we are doing that will give us the actual burden. Results coming in show that over 50 per cent of the population have antibodies for COVID-19, meaning that they have been exposed to the virus. The true burden of the disease will be exposed when we can carry out an extensive study.

“We might be bragging that we have not been exposed to COVID-19, but how many times have we been tested? A lot of people are showing antibodies meaning that they have been exposed to the virus. It is still a work in progress, but there is no doubt that Africa has been spared, so to say, because we have not had the kind of trajectory that was predicted at the beginning of the outbreak, and we are thankful to God for that. We believe in God. You can imagine what happened in other countries happened in Nigeria. Which health system will absorb them? So we thank God that He is helping us. But scientifically, we need to check. Is it a matter of gross immunity? Is it anything genetic? There are many factors that people were trying to examine.

Unfortunately in the country, the funding for research is still very poor. The research questions are there, but we need resources to be able to address them.”

Also zeroing in on lessons learnt from the scourge, a virologist and Chairman, Expert Review Committee on COVID-19, Prof Oyewale Tomori, told The Guardian: “We were unprepared like other parts of the world. We depended too much on the West for guidance in running our COVID-19 controls, forgetting that ignorance of the virus and its behaviour was globally pervasive. We remain, perhaps better prepared now than we were in February 2020, but not a guarantee that we are ready for future pandemics. Our focus on COVID-19 was lopsided to the neglect of other infectious and non-infectious diseases.”

Asked to rate the country’s efforts to contain the pandemic, Tomori, who is also the pioneer Vice-Chancellor of Redeemer’s University, Ede, Osun State, said: “As for efforts, we expended a lot of energy and resources on a disease that did not match the hype and the anticipated devastation.

“COVID-19 met a Nigerian health system in a coma, and on a poor level of performance. Our surveillance system was in a rudimentary stage, with inadequate laboratory support, and critical healthcare delivery in an undesirable state, etc.”

On how the country can prepare for the next pandemic, Tomori, who is also a World Health Organisation (WHO) consultant said, there is a compelling need to decentralise preparedness activities into states and local councils’ levels, as well as involve communities in disease surveillance detection and reporting.”

While deploring the state of healthcare in the country, he regretted that “we know the right things to do, but have refused to do them. Our progress in the health sector is too little, too late, and too lopsided. We need to learn from errors of the past, identify our strengths and build on them, while we identify the gaps and implement programmes designed to address identified gaps.”
Tomori, who is also a WHO consultant.

For Professor of Public Health and Chairman, Lagos State Primary Healthcare Board, Prof. Akin Osibogun, the outbreak of the pandemic revealed some of the major weaknesses that are inherent in the country’s healthcare system.

Osibogun, who is also Provost of West African College of Medicine, told The Guardian: “Before the pandemic, we had only a few centres that could test for the virus, but two years down the road, the number of testing centres is in hundreds. Other gaps that became obvious include shortages in intensive care equipment and facilities’ ability. We also have manpower challenges that we need to address in terms of numbers, mix and quality.

“Despite these constraints mentioned earlier, the country has performed better than many other countries, including the developed countries in its response to the pandemic. We were possibly assisted by some genetic and environmental factors that protected us from recording horrendous mortalities recorded in some developed countries.”

Osibogun, who is also part of Lagos State’s COVID-19 containment team, said Nigeria needs a mix of financing mechanisms that would ensure the availability of quality healthcare that is accessible to the majority of Nigerians, just as he stressed that required investments in the sector cannot be effectively done by government alone, but by both public and private sectors within a defined framework.

Osibogun, who is also the immediate past Chief Medical Director of the Lagos University Teaching Hospital (LUTH), Idi-Araba, that the country must constantly review its strategies to address key issues of human resources, financing, data management and research for evidence, local production of pharmaceutics and vaccines, and partnerships for health.

A virologist and vaccinologist, Dr. Simon Agwale, told The Guardian is particularly elated over the country’s selection one of first Africa’s recipients of mRNA vaccine platform technology under the mRNA Global Hub that was established by the WHO and others to help fast-track vaccine manufacturing on the continent.

“While this is good news for all of us, there is still a long way to go. First, technology transfers are long and complex processes, with multiple steps and stakeholders, often taking years to complete, and from the announcement, the Hub itself would be ready by 2024 (that is if everything goes according to plan) to start transferring the technology to other countries. Of course, not all the countries identified are at the same level of development and technology transfer does not happen in a vacuum, meaning that there must be a facility, and all the needed infrastructure for the technology transfer to happen. Since there is currently no vaccine manufacturing facilities in Nigeria, in addition to the fact that it would take several years before these capabilities are built, we could begin to develop our local talents to support vaccine development and the manufacturing ecosystem.”

Agwale, who is also the founder and Chief Executive Officer (CEO) of Innovative Biotech Ltd, Keffi, Nigeria, and Innovative Biotech United States Agency (USA) Incorporation, added: “This pandemic has opened our eyes to see the importance of local vaccine manufacturing. We have to make sure that we are fully prepared for the next epidemic/pandemic so that what we are going through today in terms of vaccines shortages would not happen again.

Second, the diseases that plague us are not necessarily the diseases that plague the West, so capacity for research and development has to be built to enable us to address the peculiar diseases that are endemic to the country, example Lassa, Malaria, Human Immuno-deficiency Virus (HIV) etc.”

For a veterinary virologist at the Michael Okpara University of Agriculture, Umudike Abia State, Prof. Maduike Ezeibe, the fact Africans are less affected by COVID-19 suggests a level of herd immunity. “Common cold viruses are not new; it is only that there is now a new variant that is more pathogenic. Our circumstances and ways of life expose us to many infections so that we have levels of immunity against those infections while people who are not constantly exposed to the infections suffer more whenever they become exposed,” Ezeibe said.

As for lessons learned, the virologist said WHO recommended vaccination for control of COVID-19 without waiting to determine how long full immunity from the vaccines lasts to know when to revaccinate.

“COVID-19 vaccination should be repeated every two months to avoid the current rapid mutation to new variants. From current experience, revaccination every two months is hardly practicable. Alternative to that is that the world should approve medicines for a quick cure of the disease so that whoever gets infected is quickly treated and discharged. If the medicine is cheap and easy to access, people can treat themselves when they suspect they have been infected.”

He said to develop a medicine against disease, what is needed is to identify a biomedical marker (a feature of the causative agent, which normal cells do not have or do not need). “From literature, we have identified that viruses including COVID-19 virus have either positive or negative electrical charges and abnormal (tumour/infected) cells are negatively charged, while normal cells have no charges. All that is needed is to get medicines that have opposite electrical charges so that they mop the virus and infected cells,” he said.

But for a Consultant Obstetrician and Gynaecologist Dr. Celestine Chukwunenye, told The Guardian:

“As we mark the second anniversary of the deliberate and planned importation of COVID-19 into the shores of our dear country on Sunday, February 27, 2022, it is time for deep reflection and stocktaking regarding the devastation and harrowing experiences that the virus has left on its trail… even though the morbidities and mortalities recorded in African countries have been negligible compared to European, American and Asian countries.

However, there are several lessons to be learnt, but it seems little, if any, has been learnt.

“The research into biological warfare needs to be banned worldwide. International Port Health Services has increased and efforts should be made to continue improving Port Health Services. There is a need for the WHO to improve the monitoring of microorganisms that have the potential for causing epidemics and pandemics. The search for safer and more effective COVID-19 vaccines should continue. The WHO should develop and pursue policies that will balance the distribution of health resources between the rich and poor countries, especially policies to stem the brain drain from resource-poor to resource-rich countries.

The medical director of Optimal Specialist Hospital, Gbaja Street, Surulere, Lagos, said that while the government tried hard with the little resources at its disposal, non-governmental efforts seem to have been what contributed greatly to the low incidence and prevalence rates.

The quick resort to public health preventive measures by at-risk groups, the use of drugs, local herbs, and other remedies, and our hot climate helped us more significantly,” he added.

After a thorough review of the pandemic’s management, Dr. Ndubuisi Arua, a public health physician stressed the need to build capacity and ensure that the country acquires the capacity to take care of the health challenges of epidemic and pandemic proportions.

“The neglected public health system should be strengthened to appreciate more, the importance of preventive medicine. Water and sanitation were key in the control of COVID-19. Again, it will highlight the three-pronged relationship between agents (animals/humans), diseases and the environment. There is also the need to legislate and strengthen our public health laws.

It is also important to ensure interdisciplinary approach in research and sharing of information, just as health education and the passage of appropriate information and communication to citizens about diseases is imperative,” he said.

Arua continued: “Nigeria rating in the control of the pandemic cannot be better than its health system. Of course, it’s very poor. The capacity to prevent, detect, and respond to health risks is very poor. According to WHO Joint External Evaluation (JEE) of International Health Regulation (IHR), Nigeria was better prepared in the detect category, and performed badly in response category.”

He called for a holistic restructuring of the health sector particularly the public health sector, an effective national health insurance scheme, particularly community health insurance.