Nigeria’s Centre for Disease Control Demonstrates Outbreak Control Capacity

June 18, 2018

Monkey Pox, Yellow Fever, Meningitis, Lassa Fever – Dr. Chikwe Ihekweazu has been head of the Nigeria Centre for Disease Control (NCDC) for less than two years but has already had to deal with outbreaks of all these diseases.

Dr. Ihekweazu’s work has been complicated by the fact that healthcare in Nigeria is under-funded, many of the nation’s more than 32,200 health facilities are ill-equipped, almost three-quarters of the 186 million Nigerians don’t have health insurance, and the country has porous borders.

The NCDC was set up in 2011 to enhance Nigeria’s preparedness and response to epidemics through prevention, detection and control of communicable and non-communicable diseases.

But Dr. Ihekweazu’s appointment as CEO in August 2016 marked a turning point for the NCDC, and he is credited with leading the agency into an efficient disease detection and response unit.

Dr. Ihekweazu spent his first months in office assessing the country’s readiness for epidemics such as Ebola. “I met Disease Surveillance and Notification Officers without laptops and Laboratory Technicians with no laboratories,” Dr. Ihekweazu noted a few months after his appointment.

“Motivated and properly equipped health workers at the frontline of our surveillance work are critical to our disease control efforts. An effective public health laboratory is critical. Proper supply chain management for our medical supplies will ensure that we are always ready for any outbreak,” he said.

Dr. Ihekweazu admitted to having sleepless nights asking himself: “If we were to have another case of Ebola in Nigeria, would we have the laboratory infrastructure to make a timely diagnosis to recognize it and prevent a large outbreak?”

Ebola was the spark that galvanized the Nigerian government to devote more resources to the NCDC.

In June 2017, three years after the Ebola epidemic, a team from the World Health Organization (WHO) conducted a Joint External Evaluation (JEE) to test Nigeria’s capacity to implement the International Health Regulations (IHR). These are a set of mandatory benchmarks aimed at ensuring that member states are able to prevent the spread of diseases.

Nigeria’s JEE scorecard was littered with red warnings, with the country’s overall score only 39 percent. But the JEE highlighted the positive role of the NCDC, describing it as, “among the most noteworthy best practices observed in Nigeria.”

It described the NCDC’s outbreak investigations as “robust and timely” and praised its Emergency Operations Centre (EOC), which had been activated to respond to outbreaks, as well as its call centre, which the public uses extensively during public health emergencies.

In April 2018, WHO Director-General Dr. Tedros Adhanom Ghebreyesus praised the NCDC for its efforts to control disease during his first official visit to Nigeria, and commended the government for prioritizing the strengthening of primary healthcare.

“The NCDC has given the nation a sense of pride,” said Dr. Ifeanyi Nsofor, Director of Policy and Advocacy for Nigeria Health Watch, a civil society organization that advocates for improved health for Nigerians.

He described the NCDC’s Dr. Ihekweazu, an epidemiologist with extensive international training, as being instrumental in how Nigeria had changed its approach to fighting epidemics.

“He is the new fire in the agency. It is no longer business as usual. He has brought in the right way of doing things. He has the knowledge, the personality and the networks.”

By the end of 2018, the NCDC is expected to become an independent agency with its own budget, pending final sign-off of legislation by Nigeria’s president.

The JEE was conducted before the latest outbreak of Lassa Fever, a viral hemorrhagic fever from the same family as Ebola that is spread by rats. During this outbreak, which started in January, the NCDC proved that it was able to act fast to save lives. By late April, the outbreak had been largely contained, with 416 confirmed cases and 105 deaths, mostly in the south-west and concentrated in Edo, Ondo and Ebonyi states.

Health Watch’s Dr. Nsofor says that the NCDC’s use of research by local and international institutions to define the response to the outbreak as it happened enabled a quick and sophisticated response.

“There was real-time gene sequencing of the virus by the Irrua Specialist Teaching Hospital in collaboration with the Bernard Nocht Institute, Germany, and with this, NCDC was able to establish that the virus itself had not changed significantly in Nigeria. This meant a different reason for the large outbreak had to be found,” said Dr. Nsofor.

The Emergency Operations Centre (EOC) set up operations at these hospitals, coordinated by the NCDC, which brought together federal, state and local government, hospital staff and other experts.

All hospital staff members were involved in fighting the outbreak, from security guards who took people’s temperatures and dispensed hand sanitizer at hospital gates, to porters who transported patient samples to the laboratories.

Initially, only ISTH had the laboratory capacity to diagnose the virus. But the long drive through rainforests to ISTH meant that delays were costing lives, so by the end of February, FETHA’s laboratory had been upgraded to diagnose the virus. A 38-bed isolation ward was also built at the Federal Medical Centre, which had been battling to accommodate patients safely.

The Lassa Fever outbreak tested the NCDC’s systems, and proved it was able to lead a fast and comprehensive on-the-ground response that included extensive public education. The NCDC is continuing to improve capacity to deal with a relentless tide of infectious disease threats.


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