Failure to diagnose monkey pox exposes Nigeria’s poor lab capacity

• We Can Now Test For Monkeypox- NCDC Boss
The recent monkeypox outbreak again exposed the country’s inability to promptly identify emerging infectious diseases outbreak through specialised laboratory tests, and respond swiftly to the threat, without external help.

As a signatory to the international Health Regulations (IHR) of 2005, Nigeria is committed to have the capacity to identify (through lab test), protect against and respond to public health risks.

Unfortunately, this was not the case during the outbreak, as none of the national laboratories was able to test and identify the disease. This development necessitated that specimens had to be taken to the World Health Organisation (WHO) reference laboratory in Dakar, Senegal for analysis.

Consequently, for more than two weeks after the outbreak (from the September 22 to October 13), there was no conclusive confirmation that the suspected case was actually that of monkeypox.

According to experts, the implication of this is that the country may be dealing with a dangerous outbreak, but unsure of what it is dealing with on time, thereby giving room for a lot of things to go wrong during the waiting period.

For instance, during the waiting period for the monkeypox confirmation, different statistics on the actual number of cases were being bandied, even as the large number of suspected cases (94 cases) and the manifestation of the disease had already caused fright and panic.

There was also confusion on the mode of transmission, and how to deal with the situation, until the result from Senegal confirmed only nine cases as against the suspected 94.

Because of the country’s inability to manage the crisis promptly, the panic created led to the rejection of polio vaccines in some communities- a regress on the progress achieved with polio vaccination over the years.

Be that as it may, experts are of the view that the situation would have been different if diagnostic centres in the country were functioning optimally.

The National Centre for Disease Control (NCDC), the public health institute responsible for these laboratories- manages the national and regional public health laboratories. This includes, the Central Public Health Laboratory in Yaba, Lagos State (a national reference laboratory, and a WHO designated reference lab for the diagnosis of measles, rubella, and yellow fever); the National Reference Lab in Gaduwa, Abuja, and other network of NCDC collaborating laboratories, spread across the country.

These public health laboratories are meant to provide diagnostic services for diseases of public health importance in the country such as Ebola Viral Disease (EVD), monkey pox, meningitis, cholera, measles, yellow fever, rubella, polio and others.

Unfortunately, these labs are not functioning at the highest international standards due to lack of funds and manpower.

The NCDC, was established in 2011, in response to the challenges of public health emergencies and to enhance Nigeria’s preparedness and response to epidemics, through prevention, detection, and control of communicable and non-communicable diseases. Its core mandate is to detect, investigate, prevent and control diseases of national and international public health importance.

But more than five years after its inception, NCDC is still not legalised, hence it does not have the full capacity to source for fund, or to act on its own, outside the Ministry of Health.

Investigation by The Guardian reveal that out of the N714m budgeted for the NCDC in 2017, only N16m is for recurrent expenditure for the entire year. And it is not certain if the amount has been fully released, as at the time of this publication.

This amount, industry players say is not enough to take care of the staff, surveillance, response and laboratory reagents needed to maintain the diagnostic centres nationwide, for an entire year.

A former NCDC staff and the Chief Executive Officer of EpidAlert, Dr. Lawal Bakare, told The Guardian that lab testing is one of the biggest challenges facing the NCDC.

According to him, Nigeria does not have the capacity to carry out lab testing for many emerging infectious diseases.

“We have the problem of finance and lack of human capacity. Even privately owned labs in the country are not getting the finance they desire either,” he said.

He continued: “From the national security point of view, any micro-organism is best tested in our lab first. If this is not so, we lose the opportunity to understand what is happening in our system. It took weeks before the result from Senegal was received. Because the lab is not ours, we could not determine when the result would be out. Even if we don’t have the money to fund all the public labs in the country, at least we can fund the national reference lab at Gaduwa, Abuja, so that it would have the capacity to carry out such diagnosis. There is also the need for us to train our manpower.”

National President of Association of Medical Laboratory Scientists of Nigeria, Alhaji Raheem Toyosi, who spoke in the same vein said government needs to give priority to disease surveillance, by improving infrastructures and capacity of laboratories.

“We need to scale up our human resource capacity, and there should be national preparedness. We need to look out for these diseases even before they break out by carrying out surveillance…”

He added that when these diseases breakout, there is need to increase awareness and educate the populace on the nature of the disease, how to prevent and deal with it, so that false news and panic would be prevented.

While presenting the 2018 Appropriation Bill to lawmakers recently, President Muhammadu Buhari, stressed the need for the National Assembly to quickly pass a bill for an Act establishing the NCDC.

He said this would further consolidate on successes recorded in stemming the tide of disease outbreaks in the country.

Buhari recalled the number of outbreak of diseases in the country in 2017 including, that of meningitis, yellow fever, monkeypox, and lassa fever, describing them as alarming. “To further improve our response to such outbreaks, we are working to upgrade our integrated disease surveillance and response system. This will further enhance the efficacy of our diagnostic and clinical management process,” said.

Speaking with The Guardian on the need to legalise the NCDC, its chief executive officer Dr. Chikwe Ihekweazu, said legalising the public health facility will enable it have full mandate to carry out its function to protect the citizens.

“It will enable us recruit the right staff and get the funding we need. Presently, we get funding from the Federal Government alone. We hope there would be an increase in the funds we receive.

If legalised, we would be able to apply for funds from international partners,” he said.

On why the facility could not carry out the suspected monkeypox test in the wake of the outbreak, Ihekweazu said, “the reason is because we have not had monkeypox in the past years, so the specific reagent was not available. We have the capacity, the human resources and equipment, but no reagent. But last week, we got the reagent and our reference lab can now carry out the test for monkeypox, as well as, measles, yellow fever and other infectious diseases.

He added that the facility still requires more resources to function at full capacity.

Although the Federal Government has upgraded the reference lab in Abuja, the other labs nationwide, still need attention.

On this, he said: “The national public lab in Lagos requires a lot of renovation, so do other labs, but we cannot do everything at the same time. All these are work in progress, and they require a strong legal mandate. Once the NCDC is established legally, we will recruit the human resources we need and function better.

Despite all its limitations, the NCDC has been able to curb many disease outbreaks. The highest of its achievement was the control of Ebola outbreak in 2014.

On the monkeypox outbreak, the NCDC boss said the outfit has established an emergency response team nationwide.

“A National-level Emergency Operations Centre (EOC), led by the NCDC with support from our development partners, is coordinating outbreak investigation and response. The EOC includes the Federal Ministry of Agriculture and Rural Development, as well as experts from partner agencies.