The sudden death of dozens of people in Ondo State recently after consuming a locally produced alcohol-based herbal concoction is a tragedy from which many people must learn a lesson, and which must put relevant government agencies on their toes. More than a hundred other people who were also affected are still battling to regain their health.

Expectedly, the government has responded by banning the killer-drink but that should not be the only action to take. The incident exposed a dangerous gap between the existence of regulatory bodies and their capacity to prevent hazardous substances from reaching consumers. The authorities must take urgent measures to close this breach and forestall future occurrences. Besides rigorous forensic investigation and treatment, the immediate response must include decisive action against illegal production and distribution. For a longer-term response, surveillance and regulation of informal alcohol production must be strengthened. There must also be an improvement in public awareness and a commitment to ensuring that communities have access to safer alternatives.

News that the police have arrested the suspected producer and over a dozen others, while substances suspected to contain methanol have been recovered for forensic examination, is welcome. The state government must now establish precisely what was consumed, where it was produced, how widely it has been distributed, who participated in the chain and how the product was able to reach consumers across three local government areas. The government should also trace and dismantle the supply chain and bring all culpable to justice.

The sudden death of 49 citizens, and 170 others reporting visual disturbance, weakness of the body, breathing difficulty and altered consciousness, after consuming the drink demands hard evidence of what was really responsible, rather than speculation. When the death toll stood at 29, the Ondo State Commissioner for Health said there were 60 suspected cases and a provisional case-fatality ratio of about 48.3 per cent. He stated that there was no laboratory evidence yet identifying the toxic agent, cautioning against rushing from epidemiological suspicion to definitive attribution.

Many fingers have been pointed to methanol poisoning as the most likely culprit, and with good reason. Preliminary findings by the National Agency for Food and Drugs Administration and Control (NAFDAC), based on gas chromatography of tested samples, confirmed the presence of high concentrations of methanol, a substance capable of producing metabolic acidosis, blindness, neurological damage and death. Cannabis indica was also detected in a significant number of samples, raising the possibility of a more complex toxic profile. Yet the preliminary findings are not the same as a completed forensic record. The authorities must still establish the precise chemical composition of what was consumed, determine whether methanol alone or in combination with other substances caused the deaths, and examine production methods to establish whether contamination occurred deliberately, accidentally or through grossly unsafe processing in the course of producing the product.

That sudden deaths linked to a common exposure could occur in several communities before the precise source is established points to a gap in community-based disease surveillance. The state said it became aware of an initial cluster after reports of sudden deaths in New Town on September 3, before identifying another cluster in Araromi-Obu. Later reports placed affected communities across Odigbo and Irele local councils. Traditional rulers, primary healthcare workers, patent medicine vendors and community leaders are often the first to observe unusual patterns. An integration of efforts among these groups and health agencies such as the World Health Organisation (WHO, NAFDAC and the National Drug Law Enforcement Agency (NDLEA) is needed to provide effective early warnings before an emergency develops.

The ban on the drink may achieve little result if the economic environment that produces the substance remains in place. Where regulatory oversight is ineffective, it could only be a matter of time before another dangerous batch will emerge after public attention moves elsewhere.

Authorities, therefore, need to map informal production centres and understand how ingredients for production are sourced. This should include establishing minimum production and hygiene requirements where informal production can legitimately be brought within regulation, while dismantling operations that deliberately evade the law.

NAFDAC, regardless of its operational challenges, has been a laudable addition to efforts to protect the country’s health through product registration and verification. Ironically, the mere existence of an agency does not automatically translate into regulatory control. The Ondo incident continues to show that Nigeria still has a bustling health-related economy that operates beyond formal systems. Public safety cannot depend solely on consumers knowing how to distinguish a registered and safe product from an unregistered and unsafe one. Enhanced regulatory intelligence is needed at the point of production. NAFDAC and relevant stakeholders in the states should have mechanisms for identifying unregistered alcohol and herbal preparations before they become associated with mass illness.

Care must be taken to avoid turning the tragedy into an indictment of traditional medicine. Herbal remedies in Nigerian communities have historically provided complementary healthcare. The Ondo incident concerns the circulation of preparations whose ingredients, alcohol content, production conditions and safety profiles may be unknown. Beyond that, there is no reason to jeopardise the livelihoods of many Nigerians who operate in this informal sector.

There is an uncanny precedent in the latest deaths. In 2015, the state was gripped by rumour of a strange disease outbreak blamed for almost 30 fatalities. The reported symptoms included sudden blurred vision, headache and loss of consciousness, followed by death. As with the latest incident, two communities in Irele council were reportedly affected.

At a media briefing, the Minister of State for Health, Fidelis Nwankwo, disclosed that initial epidemiological and laboratory investigations ruled out any infectious disease. He was, however, quoted as saying: “Epidemiological findings indicate a strong linkage of the outbreak with the consumption of local gin that might have been contaminated with methanol.”

Once bitten, the federal and state authorities should have become twice shy. Nigeria has indeed encountered similar trends before. Six weeks after the 2015 incident in Ondo, 84 persons in five local government areas of Rivers State suffered methanol poisoning, following a celebration that included ingesting local gin alongside a local dog meat delicacy. The poisoning claimed about 70 lives. The recurrence of a similar pattern raises questions. What was learned after previous incidents? What lessons failed to enter routine public-health practice? What are the chances of any recurring tragedy?

The Ondo investigation should be channelled towards producing a national review of the country’s preparedness for poisoning outbreaks, including the availability of toxicology testing and treatment capacity, especially outside major urban centres.