There is no certified treatment, rapid test kit for COVID-19, says Ehanire

DR. Osagie Emmanuel Ehanire, Minister of Health, a certified General and Orthopaedic Trauma Surgeon, in this interview with CHUKWUMA MUANYA, said, among other things, that there is no certified treatment or World Health Organisation (WHO) validated rapid test kit for the treatment and diagnosis of the novel coronavirus (COVID-19), insisting that to contain and end the pandemic, all Nigerians must take responsibility, abide by all provided guidelines and work together as a society.

The number of new cases of COVID-19 has continued to rise almost by the hour. There are concerns of another total lockdown. Why are we recording a spike in cases? What are your recommendations on how to reverse or address the situation?
The COVID-19 outbreak is a global pandemic, with over four million cases worldwide and growing numbers in many countries. The focus for us as a country is to protect all Nigerians through accurate risk communication, effective aggressive contact tracing of infected individuals, testing the right people and supportive symptomatic management.

We will continue to engage with international and national experts to take the right evidence-based decisions at the right time and at every stage of the response until this outbreak is contained and ended in Nigeria.

Some schools of thought have called for a total lockdown for at least one month as one of the key solutions. What is your take on this?
We have seen lockdowns yield varying results in many countries around the world, including here in Nigeria. What is most important for us as a team is that we will continue to work to provide the best response that is suitable to all aspects of the Nigerian society. Our priority is to ensure the safety and wellbeing of all Nigerians by using appropriate global, national and local measures. There must be a guided purpose for every decision.

As I previously stated, the right decisions at the right time at every stage of the response until this outbreak is contained and ended in Nigeria.

Some state governors were observed recently to be working contrary to laid down measures by the Nigeria Centre for Disease Control (NCDC). What are you doing about this?
The response to COVID-19 requires a whole of society approach from all Nigerians. The need to take responsibility for our loved ones, the Nigerian people and ourselves has never been higher.

Our focus is to run a coordinated response, working together as elected and appointed officials in government, our partners and stakeholders to contain COVID-19 in Nigeria. The federal government will continue to support and work with states to ensure the safety of Nigerian citizens.

Has your expert committee on COVID-19 resumed and how do you intend to achieve your mandate of containing the virus?
The advisory expert committee is here to ensure we are optimal in our coordinated response. Along with the international community, the government of Nigeria at all levels, as well as our in-country partners, the expert committee is here to support us in ensuring that we are making the right decisions based on evidence suitable for Nigeria at every stage of the response in this global pandemic.

Is it true that the federal government has placed orders for the Madagascar herbal tonic to be distributed to states after tests by the National Agency for Food, Drug Administration and Control (NAFDAC)? Do you support this and recommend herbal remedies for COVID-19 and what is your take on Prof. Maurice Iwu’s claim?
Nigeria has a clearly defined protocol of introducing any new medication in Nigeria to ensure the safety of our citizens. Therefore, any proposed medications, international, local or herbal remedies, and treatment options must go through the relevant and rigorous scientific process to provide us with detailed information.

We are interested in providing a cure, but we must also ensure the safety of any remedies for utilisation in Nigeria. The safety of Nigerian citizens is also a priority for the Nigerian government. If any drug successfully goes through that process, then the Ministry of Health, along with relevant research institutions, like Nigeria Institute for Medical Research (NIMR) Yaba, Lagos; Nigerian Institute for Pharmaceutical Research and Development (NIPRD) in Abuja and NAFDAC will inform all Nigerians.

Another big issue is that of the Almajirai and Internally Displaced Persons (IDPs). What are you doing about the virus spreading so fast among these people?
Globally, the COVID-19 pandemic is especially challenging in humanitarian settings and with migrant populations. This, like every other aspect of the pandemic, is a concern for the Nigerian government. We are working with the security agencies and international partners and will continue to encourage all Nigerians to abide by the regulations that drive the ease of the lockdown, especially on inter-state travel. The different arms of our response will continue to engage and sensitise communities.

We have also engaged traditional rulers and religious leaders, who will continue to lend their voices to sensitise Nigerians and to encourage them to abide by government’s restrictive advisories, with every stakeholder taking responsibility in this whole of society approach. This is what we expect and ask for, and this is what all efforts of government and partners will be channelled to, for all Nigerians, including the Almajirai and Internally Displaced Persons (IDPs).

Have you succeeded in arresting the situation and addressing the issues in Kano State?
Kano State has been a concern for the federal government in the response to COVID-19, with the rapid progression of cases and even a need to temporarily shut down the molecular laboratory in the state. A team of experts has been deployed to Kano to provide expert technical support.

There has also been an extraordinary level of cooperation and collaboration among all arms of government, donors, development partners, private sector, emirates councils, Islamic and Christian religious groups, community-based organisations, unions of road transport workers and many more state actors. There is solidarity at its finest. We still have a long road ahead until we contain and end COVID-19 in Nigeria, but this kind of solidarity here at home and globally.

There are many individuals involved in the COVID-19 pandemic response in Nigeria. NCDC has deployed over 440 people to support 34 states and the Federal Capital Territory (FCT) through our Rapid Response Teams (RRTs) and trained over 13,000 healthcare workers on Infection, Prevention and Control (IPC) across the federation.

These include technicians, ad-hoc staff, such as sample collectors, contact tracers and cleaners at the health care facilities. This response comes with great risk, especially for those on the frontline, as about 812 healthcare workers have been infected in the course of the response, including 29 NCDC staff.

Over far 3,239 patients are said to have been treated for COVID-19 and discharged. What is the treatment process; what are the cocktails of drugs and therapy they are given?
Globally, there is no certified treatment for COVID-19. We must remember that the rigours of science for recommending a drug as treatment for any condition are in place for a reason. There can be no knee-jerk reactions. We must value every Nigerian life and thread with the respect and dignity that is merited by the life of every Nigerian.

We are currently aligned with global, regional, national and local expertise and guidelines for supportive management of COVID-19. We are working with colleagues to run clinical trials and explore all options. Our priority remains making sure that we are making the right decisions, at the right time and at every stage of the response until this outbreak is contained and ended in Nigeria.

What is the total cost of treating one patient and who pays for this? Is it the patient, state or federal government?
The testing and treatment of patients for COVID-19 in Nigeria is free. It has been designed to ensure financial protection of Nigerians while accessing these services.

These costs vary, depending on the length of stay and the severity of the clinical case. Our focus is to work in solidarity with the government at all levels and with all stakeholders to achieve our broader goals of protecting the lives and livelihood of all Nigerians.

Due to the country’s low capacity to test, there is a growing black market for COVID19 tests. What are you doing to shut down this dangerous trend? People are reported to have resorted to buying these tests for $350 for a pack of 15 after allegedly calling NCDC for days and not getting through?
Nigeria is using reverse transcriptase polymerase chain reaction (RT-PCR) for the testing of COVID-19. Though rigorous, it is currently the most reliable method for the laboratory confirmation of COVID-19, given its high sensitivity rate. PCR tests directly detect the presence of the virus in the body.

Currently, there is no rapid test kit (RDT) validated by the WHO. While rapid test kits can give results in under an hour, they are not as accurate as PCR and this inaccuracy can lead to a chaotic response.

We will prioritise the use of RDTs that detect active infection once a validated RDT becomes available. Until then, we will keep working to ramp up our national test capacity, towards moving further forward from the 23 current molecular laboratories.

What must be emphasised is the need for all Nigerians to take responsibility, abide by all provided guidelines and work together to contain and end COVID-19 in Nigeria.

What is your blueprint on how to reverse the brain drain and medical tourism?
Brain drain arises from lack of employment at home or offers of better opportunities abroad to highly skilled workers. I urge, especially state governments, to offer employment to doctors, particularly where there is an alarming shortage. We are also studying how to find capital at an affordable interest rate to help young doctors start private practice.

Do you have plans to involve Nigerian doctors in the Diaspora in your efforts to improve health sector performance?
Yes, we are piloting an initiative to bring home Nigerian doctors from Europe and America, who volunteer to work in our hospitals during their leave time to share cutting-edge skills and knowledge with home-based colleagues.

Why is the budgetary allocation to health still less than five per cent?
I would like allocation to health to reach the 15 per cent recommended in the Abuja Declaration, but we do understand that for now, we have seriously competing national and food security priorities that the government must urgently address too. I feel health-funding will improve with time. We also must appreciate that despite this, the Basic Healthcare Provision Fund (BHCPF), as a new funding stream, is now yearly released to the sector.

How many Nigerians are living with HIV and how many are receiving treatment?
About 1.9 million Nigerians are infected with HIV and about one million get treatment free. Many of the rest do not even know their status. “Know your status” and “test and treat” are part of the strategy of the Federal Ministry of Health (FMoH).

Nigeria has one of the worst statistics in terms of pediatric HIV treatment. Any improvement?
Pediatric HIV derives largely from mother to child transmission during delivery and Prevention of Mother To Child Transmission (PMTCT) is an important item in our HIV elimination strategy. It is done by detecting the mother’s HIV status during antenatal care visits and putting positive ones at once on treatment to defeat most transmissions. To scale this and such intervention up to rural and underserved areas, we advocate the need for functional Primary Healthcare Centres (PHCs) in every ward in the country.

Over 70 per cent of HIV activities in Nigeria are funded by the US. Is there any money for HIV in this year’s budget?
The US government is a great partner, not just in fighting HIV/AIDS, but other challenges. We also get support from Global Fund and other partners, without whom it would not be easy. The government of Nigeria does its best in the circumstances. All must work together to eliminate diseases of global concern by 2030.

There have been claims and counter-claims on HIV cure. What are you doing to probe these claims?
We are interested in all serious claims aiming to address challenges to the health and well being of mankind. But to be taken seriously in the outside world, we do work with scientific tools and evidence. Claims that cannot stand scientific scrutiny will fall by the wayside by themselves, while others bounce upward.

What have been the challenges to HIV control in Nigeria?
Funding in the midst of national priorities is a great challenge. I hope it improves as public revenue increases and pressure on the budget from security, food and energy urgencies are satisfied. Behaviour risk communication needs to be stepped up, with high priority to youths in age-appropriate and culture-sensitive HIV education. Key groups need to be addressed too.

Persons living with HIV in correctional centres are often neglected, according to a new report by the WHO. What are you doing about this?
Nigerian correctional centres have medical units to take care of persons in custody. The FMoH is not directly in charge of these units, but we are ready to support correctional institutions in all their needs, including HIV.

What is your blueprint on how to improve healthcare in Nigeria, especially on HIV control?
We are working on our country-specific National Action Plan for Universal Health Coverage (NAPUHC) derived from the Global Action Plan for UHC, urged by WHO at the last United Nations (UN) General Assembly. It is based on a robust system of PHCs as platforms from where to conduct very many health interventions to reduce disease burden by over 50 per cent.

It includes deliveries, vaccination, health education and check-ups, testing for HIV, malaria, tuberculosis (TB), etc and mass administration of preventive drugs, even disease surveillance and notification.

Though the federal government supports the development of PHCs financially and technically, they are statutorily under local and state governments. That is why the President has been calling for more state attention to this segment of the health sector.