Ebola: Tracking Nigeria’s readiness for another outbreak

With the lack of vaccines for Ebola Viral Disease (EVD); unavailability of personal protective equipment; huge shortfall in budgetary allocation to the health sector, as well as, inadequate funding of critical institutions in the sector including, the Nigerian Institute of Medical Research (NIMR) Yaba, the National Hospital Abuja and the Lagos University Teaching Hospital (LUTH) and the strike by health workers under the aegis of the Joint Health Sector Union (JOHESU) among others, the country appears ill-prepared to combat any outbreak of EVD.

Signs of unpreparedness are also visible at the Mainland Hospital, Yaba, which was where Ebola patients were quarantined in 2014, when the disease broke out in the country.

A visit by The Guardian to the facility showed that activities were at low key, and two of the wards that were dedicated to Ebola patients are now being used for other ailments.

A doctor who spoke to The Guardian said the toned down activities within the hospital was due to the ongoing strike by health workers.

He, however, buttressed recent claims by the Lagos State government that the “Ebola Ward” had been activated, and a simulation exercise recently conducted to test the preparedness of personnel within the hospital to attend to Ebola-related emergency.

The medical doctor, who preferred anonymity admitted that the ongoing strike by health workers would negatively affect how any Ebola patient would be attended to, since doing so requires serious collaboration between the various medical professionals.

But Lagos State, which was the first port of call of the index case in 2014 says it is not leaving anything to chance since the latest outbreak.

The state Commissioner for Health, Dr Jide Idris, said the state government is collaborating with the Federal Ministry of Health in putting measures in place to prevent the entry and spread of the disease.

Idris maintained that there has not been any case of Ebola or suspected case; therefore residents of Lagos need not panic, but should ensure they daily observe high hygienic practices.

The last time there was an outbreak of the disease in the country, it was through Lagos, the reason the state government says it is following the outbreak of new cases in Congo.

Idris said: “Factsheets on Ebola for health workers has been sent to the CMD of LASUTH, medical directors of general hospitals; the Primary Healthcare Board; Health Service Commission and chairmen of Association of General and Private Medical Practitioners, Association of Laboratory Scientist of Nigeria, Association of Nursing and Midwifery Association of Nigeria and morgue operators.

“The state and LGA Disease Surveillance and Notification of Officers (DSNOs) have been sensitised on Ebola and other viral haemorrhagic fevers, especially on prompt reporting of any detected suspected cases of Ebola and other VHFs by the ministry in collaboration with the World Health Organisation.”

He said as part of general preparation for handling any epidemic, the state government collaborated with the Nigeria Centre for Disease Control (NCDC), and the West African Health Organisation (WAHO) in March 2018 to organise Yellow fever outbreak simulation exercise to strengthen the preparedness and response of all levels of health workers to health emergencies which has similar principles for control of EVD.

To ensure the borders are kept safe, Idris said the state is collaborating with the Port Health Services of the Federal Ministry of Health on the commencement of regional screening of passengers from (DRC) and neighbouring countries for any suspected cases of EVD or other VHFs.

The former Chief Medical Director of Lagos University Teaching Hospital (LUTH), Professor Akin Osibogun, who played a prominent role in curbing the 2014 outbreak said, “Hopefully, we have learnt from our experience in managing the 2014 outbreak. That experience however needs to be supported with a strengthening of our health system particularly at the primary healthcare level. We need to have continuing community education and mobilisation against disease outbreaks; we need to train and retrain our health workers to have a high index of suspicion and provide them with the required prevention, diagnostic and treatment tools/technology. We need a robust disease surveillance system that can rapidly pick any emerging disease threat, and we need to have strengthened epidemic response system to help quickly curtail and control any outbreak, not only of Ebola, but of any diseases.”

The consultant public health physician/epidemiologist said as soon as the outbreak in the DRC was announced, “public health physicians and others have been at alert and efforts are already on toward creating awareness among the general population. The government has already instituted measures for border screening and alertness. Unlike in 2014 when we had only the laboratory at LUTH and the Redeemer University is assisting with the diagnosis, there should be at least six or more tertiary facilities with the diagnostic capability. All these, however, is not to suggest that we can rest on our oars.”

On precautions that Nigerians travelling to countries where there is Ebola outbreak, he said, “The World Health Organisation has not recommended any travel bans. However, travellers to any country with an outbreak must exercise extreme caution with regards to coming in contact with body secretions including sweats, saliva, blood etc. It should be noted that the virus can also be transmitted in reproductive tract fluids and travelers need to have all information. Of course, likely animal sources are equally to be avoided.”  

Commenting on why the country is yet to acquire Ebola vaccine, the Chief Executive Officer (CEO) and National Coordinator of NCDC, Dr. Chikwe Ihekweazu, told The Guardian: “Ebola vaccine is being used for the first time ever to respond to the outbreak in the DRC. The vaccine is currently administered to people who have been in close contact with those infected, or those who are likely to be in contact with a case.

“Vaccines are not commercially available and only available through WHO when an outbreak has been addressed. Given that Nigeria does not have any case of Ebola currently, we do not have vaccines in the country. However, we are working very closely with the WHO to monitor the situation in DRC and strengthen Nigeria’s preparedness in the event of an outbreak.

“The most utilised route of entry by passengers from the DRC is through our major international airports in Abuja, Lagos, Enugu and Port Harcourt, but there is no direct flight. The National Port Health services have strengthened screening procedure in these locations.”

On how prepared the country is in case of any outbreak, he said “Nigeria is much safer and prepared than it has ever been,” said Ihekweazu.

The epidemiologist told The Guardian: “Events in the Democratic Republic of Congo (DRC) have caught the attention of the global health community once again. The DRC government confirmed an outbreak of EVD on May 8, 2018. This outbreak has come with real and perceived threats to local, national and global health security, with countries placed on different levels of alert by the WHO.

“In Nigeria, the risk of spread has been classified as moderate by WHO, similar to all countries in Africa. The key question that has been asked by many Nigerians is ‘how prepared are we for another outbreak of Ebola?’ This can be attributed to the country’s experience in 2014 when an imported case of Ebola from Liberia led to the death of eight people including four health care workers. The dramatic events that followed this outbreak have led to an increased awareness and risk perception by the population, about the dangers of the disease.”

He said about four years after Nigeria’s experience in responding to this outbreak, there have been several subsequent outbreaks in the country including Lassa fever, Monkeypox, yellow fever and cholera. It is imperative therefore to review the level of preparedness and reassure Nigerians.

Ihekweazu added that after the 2014 Ebola outbreak in West Africa, a key lesson was that the preparedness and response capacity of countries requires significant investments to strengthen their health systems. In light of this, he said, many countries have begun to set up national public health institutes (NPHIs) that will focus on building the technical expertise to lead on prevention and preparedness as well as response capabilities.

The epidemiologist said: “The NCDC was established in 2011 prior to the Ebola outbreak. However, the outbreak in 2014 was the young agency’s first experience in leading the response to a major outbreak. At the time, an ad-hoc Emergency Operations Centre had to be established and only became fully functional days into the outbreak. The Lagos University Teaching Hospital was the only laboratory in the country with the capacity to confirm cases. A Rapid Response Team had to be hastily assembled, temporary isolation centres had to be erected in strategic places and other similar ‘ad-hoc operations’. The EVD outbreak left us with a lot of lessons- the most important being the benefit of preparedness.

“Four years after, we have learnt that indeed national public health institutes have to be the focus of disease preparedness and response activities. They can and should provide leadership in disease surveillance and outbreak investigations, reference laboratory services, including specialist diagnostic services for rare organisms, and advise their governments on development and evaluation of public health interventions. This is the role NCDC now plays, creating a better health security infrastructure for Nigeria than what we had in 2014. With this, Nigeria is much safer and prepared than it has ever been.”

The epidemiologist said in 2017, in line with the Global Health Security Agenda, the NCDC opened up its infrastructure and domestic resources for a Joint External Evaluation (JEE) led by the WHO and experts from other public health institutes supported this across the world. “This peer review process highlighted several gaps and provided key recommendations towards strengthening our health system to effectively prevent, detect and respond to outbreaks and threats of public health importance. Close to a year after this process, several gaps have been closed; a stronger political commitment and a multi-sectorial workforce established, and we are in a better position than ever before to respond to outbreaks,” he said.