Controversy trails COVID-19 tests for travellers as nations open up

• COVID-19 travel testing industry has enjoyed easy money with webs of corruption reinforcing it, says Pate
• Nigeria should not rush into discarding all measures put into preventing the spread of disease, says Tomori
• COVID-19 testing laboratories are not ‘fleecing points’, says NCDC
• Syndicates providing means to contravene requirements for COVID-19 vaccination, tests a global phenomenon

Despite the announcement, on Monday, by Presidential Steering Committee on COVID-19 (PSC-COVID-19), that fully vaccinated arriving travellers would no longer be required to take a pre-departure Polymerase Chain Reaction (PCR) COVID-19 test, controversy still trails COVID-19 protocols for international travels.

The Federal Government (FG) said fully vaccinated in-bound travellers would, however, be subjected to rapid antigen test at the airport by the Nigeria Centre for Disease Control (NCDC) within the arrival hall of the airport free of charge.

The decision was coming after complaints by many travellers over the cost placed on the PCR test and alleged corrupt practices and profiteering.

There are reports that COVID-19 test centres in Nigeria have become fleecing points. While the world is stepping down on protocols that limit movements and interactions, including testing for COVID-19, Nigeria is proliferating centres, where people are exploited and less testing taking place.

The Guardian investigation had shown that there is a syndicate at International airports that aid travellers evade paying for the post-COVID-19 test of N53,000 by collecting between N30,000 and N40,000 from such passengers and passing them through immigration on arrival.

The situation has raised several questions. What is government’s plan regarding freeing some of the COVID-19 protocols? How much actual regulation and monitoring is going on to check abuses? Are there plans to relax some of the COVID-19 measures as obtained in some other climes?

A Nigerian physician and politician who currently serves as the Global Director for Health, Nutrition and Population at the World Bank Group and Director of the Global Financing Facility for Women, Children and Adolescents (GFF), Prof Muhammad Ali Pate, had told The Guardian on Monday: “Nigeria’s COVID-19 travel protocol is certainly standing out as an outlier, we are seeing countries removing barriers for fully vaccinated travellers and not requiring tests from them; such as Senegal, United Kingdom (UK) and European countries.

Pate was appointed Julio Frenk Professor of Public Health Leadership at the Harvard T. H. Chan School of Public Health. Pate is also a former Minister of Health in Nigeria. His appointment in July 2011 followed his success as the Executive Director of the National Primary Health Care Development Agency (NPHCDA). He is formerly the Chief Executive Officer of Big Win Philanthropy and an Adjunct Professor of Global Health of the Duke University Global Health Institute.

Pate added: “Unfortunately the travel testing industry has enjoyed easy money on the back of the pandemic, webs of corruption reinforcing it. There is definitely a need to reassess it, especially a situation where widespread domestic local transmission is going on without meaningful community testing. A situation where COVID-19 test is only required for travel in the absence of free testing for public health measures, suggests other reasons beyond public health concerns.”

Chairman, Expert Review Committee on COVID-19 and a consultant virologist, Prof. Oyewale Tomori, said he does not think Nigeria should rush into discarding all the measures put into preventing the spread of the disease.

Tomori, who is the pioneer Vice-Chancellor of Redeemer’s University and former President, Nigerian Academy of Science (NAS), said Nigeria should adopt a targeted step by step approach for the following reasons: “We have not yet seen the end of COVID-19. The World Health Organisation (WHO) continues to warn about this. Over one million cases per day are still being reported globally. A few countries are seeing an upsurge in the number of cases, sometimes as high as 5,000 daily, and China, for example, has locked down one or two cities.”

Tomori said the decision to massively roll over the preventive measures in the UK and other countries in the West was not based on scientific evidence, but political and socio-economic considerations.

He said in countries where protocols are being relaxed, a majority of their population is already (fully) vaccinated and protected, so they can afford targeted/step by step relaxation, but not total relaxation.

The virologist said given the epidemiology of the disease in Nigeria and the abysmally low vaccination rate, “we should not copy what other countries with different epidemiology and higher vaccination rates do. Perhaps in Nigeria, we could continue the use of masks in public buildings where a lot of people congregate- government offices, schools, worship centres, social gatherings etc.”

On laboratory testing, Tomori said it should be limited to unvaccinated outbound persons travelling out to foreign countries and in accordance with country-specific guidelines. Regarding inbound travellers to Nigeria, he said: “I still think, given our low vaccination rates and likely vulnerability of our population, we should still insist that vaccinated, as well as unvaccinated persons coming into Nigeria should come in with negative laboratory results until our vaccination rates reach acceptable level. In particular, I will suggest that the elderly, especially with co-morbidities, should wear masks, at all times when in the public space. Remember, we are dealing with a largely unvaccinated and possibly vulnerable population, and therefore we must at all cost limit the introduction of the virus into our nation.”

Tomori said checking abuses is not only a government affair. “It includes the individuals- the traveller and government official (acting in his or her personal capacity) colluding to abuse the regulations. It is an individual matter to break the rules and regulations that government makes. It is a make and break situation, government making and people breaking the rules and regulations,” he said.

On plans to relax some of the COVID-19 measures as obtained in some other climes, Tomori said: “I already mentioned that the Presidential Steering Committee (PSC) is working on this matter. What is important is not cutting and pasting other country rules and regulations without considering Nigerian specific epidemiological and scientific evidence.”

Reacting to the existence of a syndicate at the International airports that aid travellers evade payment for post-COVID-19 test, Tomori said: “Of course, I will not be surprised if that is happening. Anywhere in this world, where there are human beings, such unscrupulous syndicates are available to offer dubious services to willing accomplices. We are not alone in this crooked deceit to side-track rules and regulations. We need to continuously expose such crookedness.”

A professor of anatomy and consultant reproductive endocrinologist who co-pioneered the in vitro fertilisation (IVF) research in 1984 and his team successfully delivered the first test-tube baby in Africa in 1986, Oladapo Ashiru, told The Guardian: “The situation in Nigeria is full of anomalies. It smacks of the desire to defraud the population and the FG must put a stop to it. When you travel to virtually all the countries that have maintained a strict regulation on COVID-19, all they require from you is proof of double vaccination. And if you have the booster, it is a bonus. You are given easy entry without harassment. These include United Arab Emirate (UAE), Austria, UK, United States of America (USA), and several other countries.”

Ashiru, who is also President, Academy of Medicine Specialties and Medical Director, Medical ART Centre, Maryland Lagos, said: “If you are not vaccinated you are required to produce a negative COVID-19 test, at most 72 hours before arrival and that is it. This is not the case in Nigeria. Regardless of whether you are triple vaccinated or not, you do a COVID-19 test before you leave Nigeria, before you return and two days after your return- Three tests costing so much, a complete rip-off. We have looked at the issue at the Academy of Medicine Specialties and we would soon give an advisory to the government that there is no scientific basis for such repeated tests, except to make money out of innocent Nigerians. I wonder what these people would have done if they were in charge of our public health during days of Yellow fever or cholera vaccination.”

Director-General, NCDC, Dr. Ifedayo Adetifa, in response to The Guardian queries, acknowledged the express concerns of Nigerians regarding the Nigeria International Travel Portal (NITP), COVID-19 testing pre-and post-arrival in Nigeria.

Adetifa said the NITP was developed by the private sector and is managed by Nigerians in the public sector as one of several measures introduced to limit the risk of importation and spread of COVID-19 in the country. “Despite challenges in the functionalities of the site, mostly related to payments using foreign cards, we have continued to work extremely hard on its improvement,” he said.

The public health physician said while the NITP site is hosted on NCDC’s domain, all funds for testing purposes are paid through the bank to the accredited private laboratories. Adetifa said no funds from private testing are received by NCDC. COVID-19 testing in government laboratories remains free of charge for public health purposes. “Testing for personal purposes such as travel are paid for by individuals to be conducted in private laboratories. The current travel advisory and public health safety measures are under review by the Presidential Steering Committee on COVID-19 and will be updated shortly,” he said.

On reports that COVID-19 test centres have become fleecing points, the NCDC DG said while the NCDC understands the challenge Nigerians have had with respect to the cost of PCR tests for travel, it is important to clarify that COVID-19 testing laboratories are not ‘fleecing points’. In addition, the NCDC has no role in determining the costs of tests, which are arrived at by states and the respective laboratories.

On how much actual regulation and monitoring is going on to check abuses, Adetifa said: “Allegations of ‘less testing’ have been made without any provision of evidence or detail. The PSC and the NCDC have investigated every case of sharp practices in the COVID-19 travel lab network. Laboratories have been suspended and supervised corrective actions as applicable ensured.

“In addition, we have put in a lot of effort to ensure transparency and accountability for all the laboratories within the NCDC COVID-19 laboratory network. We have monthly meetings with coordinators and data managers of public and private laboratories to review performance, troubleshoot and address other challenges. As part of this effort, a quality audit and supervisory visit have been in progress since January 2022. This was planned for Q3 2021 but postponed on account of the fourth pandemic wave. Through our logistics and supply chain management system, we also ensure accountability for medical and laboratory supplies for the public laboratory network.

“NCDC’s role is to support states to strengthen the national public health laboratory network as part of its mandate. It does not regulate laboratories – which function is in the domain of states and the professional councils. States have a responsibility to ensure that all laboratories, both public and private, are in compliance with protocols (for travel, etc.) as established by the FG of Nigeria through the PSC-COVID-19.”

On whether there are plans to relax some of the COVID-19 protocols and measures as obtained in some other climes, Adetifa said the NCDC makes technical recommendations to the PSC-COVID-19 for travel and other aspects related to the COVID-19 response. He said PSC-COVID-19 follows an evidence-based multi-sectoral and country risk-based approach in arriving at decisions on travel, public health safety measures, etc.

The NCDC further explained: “Just yesterday, the PSC-COVID-19 revised the current travel advisory and public health safety measures as announced in the press conference and as will be covered in full details in the upcoming PSC-COVID-19 press release. Some of these changes include abolishing curfews, recommending only discretionary use of facemasks outdoors, removing the requirement for pre-departure PCR tests and introducing sampling for testing at the airport for fully vaccinated travellers intending to travel to Nigeria, etc. Please look out for these details from the PSC-COVID-19 secretariat ahead of them coming into effect on April 4, 2022.

“The NCDC has continued to support the nationwide COVID-19 vaccine campaign by the National Primary Healthcare and Development Agency (NPHCDA) to boost the COVID-19 vaccine uptake by Nigerians.”

On said the issue of syndicates providing means to contravene requirements for COVID-19 vaccination and COVID-19 tests, Adetifa said: “Our colleagues in the Port Health Services of the FMoH who process travelers have reported to PSC-COVID-19 syndicates in Dubai and Saudi Arabia that are the sources of falsified COVID-19 test results and vaccination certificates. They have also detected falsified documents provided by others working in Nigeria. In every instance, travellers have been made to comply with Nigeria’s travel advisory and for Nigeria, colluding personnel at the airports and laboratories have been dismissed and laboratories sanctioned,” he said.

Adetifa said the key issue here is fellow citizens who make a conscious decision to avoid complying with extant travel protocols and consequently exposing themselves to being fleeced by other unscrupulous and ill-meaning Nigerians who see the pandemic response put in place to protect collective and individual health as an opportunity to swindle fellow citizens.

He said the NCDC, though not physically present at the airport works collaboratively with government institutions stationed at the airport under the leadership of the PSC-COVID-19 to ensure strict implementation of Nigeria’s COVID-19 travel protocols.