From Ebola to COVID-19, NCDC builds sinews to fight infectious diseases

Sir: As of 31 May 2020, Nigeria had 10,162 confirmed cases of COVID-19 infections. The country managed to discharge 3,007 persons while recording 287 deaths. Nigeria recorded 553 new cases on Saturday 30 May 2020, the most significant number of cases in a single day.

The global figure was 6,407,451 cases, 2,862, 610 recoveries and 377, 834 fatalities across 216 countries and territories.

Public concern over the COVID-19 pandemic naturally turned the focus on NCDC. It was the first time most citizens would hear of the specialist public health institution.  But it played a significant role in the management of the Ebola epidemic of 2014. It led the efforts to contain any spread of the disease after Dr Stella Adadevoh and her team at First Consultants Hospital, Lagos forcefully stopped Liberian vector, Patrick Sawyer, from spreading the disease. Ebola took the lives of Sawyer, Adadevoh, and a nurse, Obi Justina Ejelonu.

Indeed, NCDC earned commendations from the Federal Government and the European Centre for Disease Prevention and Control, which acknowledged Nigeria’s decisive role in controlling the Ebola outbreak. The European Centre commended the Federal Ministry of Health and the staff of the Ebola Emergency Centre who coordinated the management of cases, containment of outbreaks and treatment protocols in Nigeria.

In 2020, NCDC became public property. It was on the lips of citizens daily as it coordinated the management of the pandemic in Nigeria, releasing figures of infections, deaths, and recoveries. Its mandate, as the country’s national public health gatekeeper, is to lead Nigeria’s preparedness, detection and response to infectious disease outbreaks and public health emergencies. Essential functions revolve around coordinating surveillance systems to collect, analyse, and interpret data on diseases of public health importance.

Its task also includes supporting states in responding to small outbreaks and leading the response to large disease outbreaks. It develops and maintains a network of reference and specialised laboratories; conducting, collating, synthesising, and disseminating public health research to inform policy while leading Nigeria’s engagement with the international community on diseases of public health relevance.

Before now, the NCDC had set a five-year mission – 2017-2021, targeted at protecting the health of Nigerians through evidence-based prevention, integrated disease surveillance and response activities, using a one health approach, guided by research and a skilled workforce.

Dr Chikwe Ihekweazu, a trained infectious disease epidemiologist of over 20 years’ experience, is the director general of the agency. It functions with 213 staff from its headquarters and the National Reference Laboratory in Abuja, as well as from the Central Public Health Laboratory in Yaba, Lagos. It has six directorates- the Public Health Laboratory Services, Prevention Programmes and Knowledge Management; Emergency Preparedness and Response; Surveillance and Epidemiology; Finance and Accounts as well as Administration and Human Resources.

Although the NCDC commenced work in 2011 with the excision of some departments from the Federal Ministry of Health, it was not until 2018 that President Muhammadu Buhari signed an enabling Act establishing the critical agency. It inherited from the Federal Ministry of Health the Epidemiology Division, the Avian Influenza Project and its laboratories, as well as the Nigeria Field Epidemiology and Laboratory Training Programme.

In addition to managing the Ebola epidemic, NCDC has been at the forefront against annual outbreaks of rodent-induced Lassa fever. Its website describes Lassa fever as an acute viral illness and a viral haemorrhagic fever with increased outbreaks reported annually in Nigeria.  Experts recognise Lassa fever as endemic in many parts of West Africa, including Nigeria, Benin, Ghana, Mali, and the Mano River region. It probably exists in other West African countries as well with estimated 400,000 cases and 5,000 related deaths annually in West Africa alone.

As part of its response measures, NCDC activated the National multi-sectorial Lassa fever Emergency Operations Centre to coordinate response activities across the states. In contrast, states with confirmed cases have enabled state-level EOCs. National Rapid Response Teams were deployed from NCDC to support response activities in ten states, even as states activated public health emergency operations centres.

Besides, five Lassa fever molecular laboratories in the NCDC network functioned at full capacity to conduct tests within the shortest time. The agency is also supporting states and embracing risk communications and community engagement activities using television, radio, print, social media, and other strategies.

While COVID-19 has re-positioned NCDC as a strategic national agency, it now has an uphill task to scale up its services in readiness to tackle infectious diseases. At the last count, the country had 29 laboratories across to test samples for coronavirus. The target of the Presidential Task Force, PTF, on COVID-19 is to have at least a laboratory in every of the 36 states.

Since the outbreak of the COVID-19 pandemic, NCDC has provided professional and technical direction for managing many health concerns and medical response via detection, treatment, testing and prevention by mobilising fierce and strong therapeutic resistance working closely with states and all stakeholders.

“When COVID-19 emerged a few months ago in China, we immediately started building up our laboratory capacity. In four months, we activated 12 labs across the country to bring testing closer to the people and to make sure we have at least one lab in every zone. We keep pushing to get one in every state.

“We have achieved this mainly by leveraging on existing molecular laboratory capacity within our network and some centres within the country. We now can test 10,000 people per day across the network”, Ihekweazu said at one of the daily briefings by the PTF.

With 29 testing laboratories and a shift in strategy by adopting a precision approach, the NCDC and the PTF have underscored the importance of aggressive containment of the disease through risks communication and community engagement.

Against complaints of low-test numbers across the country, NCDC has explained that it could not purchase and stock test kits in large quantities because of environmental conditions in Nigeria. It actually procures only limited units at a time but the agency has planned for two million test kits over three months.

“Since the beginning of the outbreak, we have deployed our digital surveillance tools to link our labs, emergency operations centre and treatment centres all together in a single electronic web-based data connection platform. We continue sending PPE’s to states to support their response and to protect the health care workers in every state in Nigeria.

“We have developed clinical guidance and public health guidance and we have trained over 25,000 health care workers in all the states in Nigeria. While we support the states, we continuously encourage them to take more ownership of their response because that is critical to the success of the national response strategy,” Ihekweazu emphasised.