Nigeria defeated Ebola! That was the single story. No one asked about how the N1.9B released for the response was used. What institutional capacity had been built? No one asked how to integrate the National Polio Emergency Operation Centre that took a lot of the credit for the Ebola response into a national emergency centre for all infectious disease outbreaks. How should we use the skills of the over 200 Nigerians that contributed to the African Union’s response to the Ebola outbreak? No one asked how we used the “opportunity” that Ebola presented to build a strong National Centre for Disease Control.
No one asked. All we did was celebrate that Nigeria defeated Ebola, giving ourselves pats on the back!
As the country continues to grapple with an on-going outbreak of Lassa fever , and anxiety continues to grow on the potential impact of emerging diseases such as Zika virus, Nigerians are coming to terms with the realisation that the rapid control of the Ebola outbreak in 2014 represents yet another missed opportunity to build the institutional capacity Nigeria needs to protect itself in the long term. In addition to its responsibility to its own population, the International Health Regulations (IHR) of 2005, to which Nigeria is a signatory, commits the country to have the capacity to identify and respond to public health threats. To develop the expertise required to respond to public health threats and to adhere to the IHR, specialised institutions are needed. Such expertise is often found within national public health institutes.
A national public health institute is a science-based organisation that provides national leadership and expertise to achieve substantive, long-term improvements in the public’s health. National public health institutes generally lead disease surveillance and outbreak investigations, provide reference laboratory services (specialist diagnostic services for rare organisms and confirmatory tests requiring specialised infrastructure and resources), and advise their governments on development and evaluation of interventions in public health.
We have a nascent national public health institute in Nigeria: the National Centre for Disease Control (NCDC). Its headquarters are physically located off Ebitu Ukiwe Street, Jabi, Abuja. It has been a line item on the re-current budget of the Ministry of Health since 2010. In the 2016 budget, the Federal Government proposed an allocation of N450M, 95% of which is for capital projects and only N4M to recurrent expenditure for the entire year (which would include staff, surveillance, response, laboratory reagents etc). This is just one more abnormality with the current 2016 budget disowned by the Minister of Health.
Our investigations found that it is proposed the NCDC should to evolve into a parasatal of the Federal Ministry of Health. A copy of the draft bill can be found here: (In order to make your own conclusions on the quality of the draft bill, find here a link to the draft bill for establishment of the National Public Health Institute of South Africa). For all intents and purposes, NCDC is still nominally under the Directorate of Public Health of the Federal Ministry of Health. It is constituted by a handful of NCDC contract staff, and staff ‘seconded’ from the Federal Ministry of Health, with varied levels of expertise and commitment to the vision of an NCDC.
To its credit, the National Centre for Disease Control played an important role in leading the response to the Ebola outbreak in 2014 (although this leadership role is often claimed by several other institutions) and subsequently provided a large portion of the expertise deployed by the African Union to support the control of the outbreak in Liberia, Guinea and Sierra Leone. The most successful programme under its management is the National Field Epidemiology Training Programme. The physical infrastructure for a reference laboratory has is apparently close to completion in the Gaduwa area in Abuja, with USD1M worth of laboratory equipment, donated by the US CDC, apparently lying idle awaiting installation.
It is not hard to imagine where the conflict relating to the NCDC lies. Departments and sub-departments of the Federal Ministry of Health are, currently carrying many of the functions that the NCDC would eventually be carrying out. While the role of a Ministry should normally be limited to policy formulation, monitoring and evaluation, the Nigerian Federal Ministry of Health has evolved into a fully operational entity managing everything from the procurement of drugs to the surveillance of infectious diseases. Taking these functions away and aggregating them into a new centre with shared resources to carry out functions across disease areas as proposed by the new bill, will inevitably require a lot of courage by the new Minister of Health.
However, the truth is that we do not need another “parastatal” like the others in the health sector. We need a unique professional institute, with a strong scientific base in epidemiology and microbiology that will lead cutting edge surveillance,; reference laboratory functions and research that Nigeria needs to protect itourselves citizens. Mckinsey in a recent report said that one of the factors that contributed to Nigeria’s successful response to the Ebola outbreak was “fastpaced analytics and frequent synthesis”. Sadly, none of that capacity has remained with the NCDC, as it struggles to provide data on the current Lassa fever outbreak.
The Honourable Minister of Health needs an institution that he can rely on to provide the expertise to detect and control outbreaks without needing to set up a new committee for every new one.
For all this, courage is required.
This is not the time to look at the names of the current Senior Consultant Epidemiologist, the current Director of Public Health, nor the current Director of the NCDC. This is the time for courage to make a decision on what is best to assure the health security of Nigerians, now and into the future.
We must overcome the misplaced euphoria of our successful control of the Ebola outbreak in 2014 and start asking ourselves some hard questions, questions that will require a strong science- focused institute to provide answers. Why does the current Lassa Fever outbreak have one of the highest case fatality ratios ever reported? Why are cases being reported in geographical areas over 1000o kilometres apart? Are rats really driving transmission? These questions need a strong science- based organisation to answer them.
Globalisation and threats of new and re-emerging diseases mean that national public health institutes are needed to ensure competent and efficient responses. They should provide a stable locus of expertise, continuity of experience, scientific knowledge, and appropriate human, technical, and financial resources to tackle public health challenges. Nigeria needs a Centre for Disease Control that has both the scientific capacity, as well as real command and control capability, as well as access to specialized human and operational resources to execute response to infectious disease threats.
Courage is needed to do this. Courage.