Earlier this year, we wrote a blog wondering aloud about the N701Million (USD5M) allocated to the Nigerian Centre for Disease Control (NCDC) that year. We wrote at the time; “we could neither find a physical address nor a website“. We were criticised by some colleagues for not doing enough due diligence to establish the existence and functioning of this institution. So, we recently went in search of the office and found the headquarters on 50 Haile Selassie Crescent Asokoro, Abuja. When we announced this on twitter the first reply we got was:
@nighealthwatch wow! Great i was wondering too if this agency actually exists in Nigeria but they need to be more active. Kudos guys
We can also confirm that the NCDC has a new office as well as a reference laboratory, soon to be completed in Gadua Abuja (as presented in the Minister of Health’s mid-term report). Sadly however, despite the recent distress among Nigerians about the paucity and inaccuracy of the information emanating from several government officials in reference to the on-going outbreak of Ebola disease in West Africa (see: Rumors of Ebola in Nigeria: the blind leading the blind?), the Nigerian Centre for Disease Control still does not yet have a stand-alone website. Should you Google Nigeria Centre for Disease Control, what appears is the country page for the American Centers for Disease Control (CDC) in Nigeria.
To begin with, we are thankful that we have this centre and acknowledge the hard work of the many colleagues who have driven for its existence. There have been many pronouncements in the past; one in no less than THE LANCET in 2008 that Nigeria was establishing a centre for disease control. Even at the time, the article was a little skeptical, mentioning that “….the main challenge in establishing a national network of new centres is government bureaucracy“. In 2010, the current Vice president, Namadi Sambo is reported to have “directed” the Federal Ministry of Health to to establish a centre for disease control, in Nigeria. With the support of the Country Director of the US CDC, Dr. Okey Nwanyanwu, the Centre was set up, with Professor Abdulsalami Nasidi, a Former Director of Public Health as its “Project Director”. It currently sits within the management of the Federal Ministry of Health (FMoH), under the supervision of Dr John Kehinde, a Director at the FMoH. Our understanding is that a bill is being taken to the Nigerian House of Representatives and Senate for the Centre to become a full parastatal. This is apparently despite the on-going rationalisation of Federal Government parastatals.
One of the biggest achievements of the NCDC is the Nigerian Field Epidemiology Training Programme. This is a programme that currently trains about 50 Nigerians annually, working in the public health departments of Federal and State Governments in the art and science of disease prevention, outbreak detection and control. After the two year programme, run in collaboration with the US CDC, the fellows acquire competence in field epidemiology and also get a masters in Public Health. The programme has won quite a few awards and has produced excellent graduates that are contributing to the capacity of infectious disease epidemiology across the country.
Our understanding is the the NCDC has a current staff strength of about 200. Its response to emergencies is guided by a policy dated 2012: National Health Emergency and Response Policy. During the current Ebola threat, the NCDC has re-activated isolation wards, agreed with hospitals across the country, supplied reagents for testing and trained staff. It has recently been involved in the investigation of the lead poisoning incident in Northern Nigeria, establishing integrated disease surveillance and supporting the work of the polio eradication programme.
The question on your mind now might be – so what is your assessment? I will offer two answers. One is a response in the Nigerian context, to which I will say, as we say….”They are trying!”. Professor Nasidi has done a great job in advocating for the centre and taking it to where it is today.
If I were to give an honest opinion, having earned my living through infectious disease epidemiology for 15 years, about the preparedness of the centre to deal with the risk of emerging infectious diseases, I would be very worried. This is is why;
On the 23rd February, a woman arrived in Toronto on a flight from Hong Kong and developed worrying symptoms. On the 5th March 2003, she died of un-recognised SARS (there was an outbreak going on in Asia). Subsequently, the transmission chain from the index case resulted in at least 6 generations of transmission. Apart from the public health impact, this cost the Canadian economy about $1 billion! Remember – this is Toronto, Canada! One of the most developed countries in the world both in terms of their diagnostic capacity and intellectual capital. Now imagine if that aircraft landed in Lagos, specifically think about the Murtala Mohammed International Airport. The busiest airport in the largest economy in Africa! When I have previously shared this anecdote, it seemed far-fetched. But with the on-going Ebola outbreak in our neighboring countries, maybe not so? Imagine an aircraft, arriving with patients ill with fever and features of an upper respiratory tract infection. These are often the only early features of most dangerous illnesses; Ebola, Lassa….and anything else. Do I have the confidence that the NCDC will have the appropriate capacity to mount an appropriate control effort if necessary? Honest answer – I don’t know.
Understanding the risk posed by infectious diseases is critical to the health security of Nigeria and other countries. In recognition of this, the new International Health Regulations (IHR) came into effect in 2005, to which of course we are signed up to. This legally-binding agreement provides a framework for the coordination of the management of events that may constitute a public health emergency of international concern. Countries had until 15 June 2012 to meet their IHR core surveillance and response requirements, including at designated airports, ports and certain ground crossings. The question our political leadership should be asking is, do we have this capacity, and if not, how can we acquire it.
Apart from the risk of emerging infections, we need to see the NCDC take a leadership role in endemic infectious diseases, not just the epidemic prone ones. We would love to see the website of the NCDC (well first we will like to see a website!), contain regularly updated surveillance information for common infectious diseases in Nigeria; TB, HIV, Cholera, Malaria etc (as in South Africa). I would love to see the NCDC active on all communication channels from radio to twitter (as does the US CDC). I would love to see a confident NCDC called upon to explain to Nigerians what the risks are to these diseases and what they should do to protect themselves.
The NCDC has to be a visible part of our society, assuring the populace and providing confidence in our government’s capacity to protect its people.
But I guess, the NCDC can only be part of the broader context of what Nigeria is, where health issues do not have sufficient prominence in the general discourse of the country and there is a lack of urgency. It is our country, maybe we get what we deserve as we do not hold our public officials to account when things go wrong.
In our usual way, the Punch reports that Federal Minister of Health, Dr Onyebuchi Chukwu, in a meeting in Luanda, Angola last week has requested that a new proposed African Centre for Disease Control and Prevention, be located in Nigeria! He is then quoted as citing the Nigeria Centre for Disease Control as a yardstick for the request! he goes on to say that Nigeria was the first in Africa to establish such a centre. (…sadly this is not true, Sir – the South African National Institute for Communicable Diseases has existed many many years before the NCDC). The Honourable Minister is then quoted as saying…. ““Nigeria, so far, has the best disease surveillance system, according to WHO, on the continent of Africa.”.
Meanwhile – I am off for my evening prayer meeting. Ebola is not our portion! Let me hear you say ……Amen!
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead