Why governments must prepare for pandemics
Covid-19 cases are rising nearly everywhere in the world, the World Health Organization reports.
The rise is mostly driven by the omicron variants BA.4 and BA.5, showing that the pandemic is changing but not over. It is clear that the global community would still feel more financial, social and health consequences of the pandemic. The end is not in sight.
In Nigeria, COVID-19 continues to wreak havoc on lives, economies, livelihoods and healthcare. The pandemic has killed at least 3,144.
According to the World Bank, the early part of the pandemic pushed Nigeria into its deepest recession since the 1980s, affecting mostly services and industry.
The economy recovered in later stages of the pandemic. However, inflation accelerated, especially for food items that the poor and vulnerable consume. The major lessons from the pandemic include the importance of epidemic preparedness and ensuring that response activities are multisectoral.
COVID-19 cases dropped significantly in Nigeria within the past year. However, cases are beginning to rise again. The Nigeria Centre for Disease Control (NCDC) recently reported 347 cases of COVID-19 and Lagos alone accounts for 265 (76%).
Six weeks prior, NCDC reported 88 cases, with Lagos accounting for 79 (90%). It is more worrisome that these COVID-19 data are under-reported. This shows COVID-19 is a present threat and Nigerians should not assume that the pandemic is over.
Indeed, the pandemic comes to an end when the World Health Organization declares it so. Until then, a sure way of ending this pandemic is for all eligible Nigerians to receive the complete doses, plus booster doses, of COVID-19 vaccines.
The current response is uneven and struggling.
To be sure, COVID-19 vaccination across Nigeria is uneven and struggling. Currently, about 21% of eligible populations have received full doses of COVID-19 vaccines. This percentage excludes those who have received booster doses.
The recent National Primary Health Care Development Agency COVID-19 vaccination data shows that every hour, 30,000 eligible persons are vaccinated in Nigeria. This is commendable. However, there are differences across geopolitical zones.
For example, the top five performing states are all northern states: Nasarawa, Jigawa, Kano, Kaduna and Kwara. The lowest five performing states are all southern states; Enugu, Edo, Akwa Ibom, Ebonyi and Bayelsa. As more work is required to increase COVID-19 vaccination coverage, southern states must step up.
Of course, as Nigeria ramps up COVID-19 vaccination, it is also battling with other infectious diseases.
Monkeypox, measles, and cholera are some of the other diseases we are grappling with and the threats of epidemics and pandemics are always on the horizon. Therefore, we must be prepared as a nation to detect, prevent and respond to infectious disease outbreaks. We must learn from our past to ensure that the Nigerian public does not experience severe financial, social and health consequences from the next pandemic. Here are four steps that should form the basis of any plan.
What must be done
First, federal, state and local governments must increase funding for epidemic preparedness. Indeed, it is cheaper to prevent and detect than to respond to an infectious disease outbreak. COVID-19 has shown how the impacts of pandemics go beyond the health sector. A simple way to implement this is via a budget line item called “epidemic preparedness” and then define what that covers.
For example, in local councils, it could cover the cost of provision of clean water in health facilities, setting up a good waste disposal system for communities, stipends for community health volunteers who are the first line in reporting infectious disease outbreaks.
The state government’s epidemic preparedness budget could cover recruitment and deployment of different cadres of health workers to last mile health facilities, setting up and equipping state government-owned laboratories, health communications and advocacy interventions etc. The federal government should budget and allocate more funds to NCDC to support its efforts to prevent and detect infectious disease outbreaks.
Second, involve the private sector in epidemic preparedness by tapping into its funds, innovation, creativity and networks. There are important lessons on how the private sector rallied to support Nigeria’s response to the pandemic through the Private Sector Coalition Against COVID-19 (CACOVID). This is unprecedented and has raised more than 38 billion naira supporting the provision of palliatives, creation of testing, isolation and treatment centers, provision of Intensive Care Units and molecular testing laboratories.
Going forward, there are other ways that private sector organizations can support epidemic preparedness. These include supporting the local health system in communities where businesses are located. For instance, a private company could provide boreholes and public toilets in communities. Public toilets are very important due to the contribution of 46 million Nigerians who stool in public to cholera outbreaks.
Third, federal, states and local governments should increase awareness on infectious diseases, their modes of transmission and ways to prevent them. Their messages should focus on how humans contribute to the emergence of infectious diseases. For instance, 46 million Nigerians stooling in public is a disaster waiting to happen. It is impossible to stop the spread of infections in this situation.
Furthermore, the interactions of humans with the environment and animals could lead to infectious disease outbreaks. For example, bushmeat is a popular delicacy in some parts of Nigeria. However, the process of catching animals and preparing them for consumption exposes humans to some pathogens that these animals carry. Infections such as monkeypox, Lassa fever, Ebola are examples and are known as zoonotic infections – meaning that they are transmitted from animals to humans. The government of Nigeria must ban hunting of protected animals.
Lastly, there is no health security without universal access to healthcare for everyone. Undeniably, global health security and universal health coverage are two sides of the same coin. This implies that it is impossible to fully achieve one without the other. As long as communities exist where Nigerians are unable to access quality healthcare, the threat of epidemics and pandemics looms. While there are community efforts to detect and prevent infectious diseases through the work of disease surveillance and notification officers, health facilities are key points of detection, prevention and response.
Sadly, due to high cost of treatment, poor access to healthcare, poor availability of qualified health personnel and lack of drugs and diagnostics, community members seek other alternative means of healthcare.
A way to achieve universal health coverage is through mandatory health insurance, which is now available nationally and in states.
Health insurance is a sustainable and equitable way to finance healthcare in Nigeria. Government budgets alone cannot fund Nigeria’s health system. It is time to convince Nigerians to channel the estimated $7.7 billion annual out-of-pocket expenditure towards health insurance.
COVID-19 will not be the last pandemic. Several epidemics are currently ongoing, destroying lives and livelihoods. We must continually invest in epidemic preparedness to protect our future. It is the right thing to do.
Dr Nsofor is a public health doctor and senior newv fellow at the Aspen Institute, Washington DC.