By Patrick Dele Cole
Since the conception
of Nigeria
as an independent country it has struggled with a number of deadly viruses and
diseases. The most prominent and reoccurring have been polio, Lassa fever and
yellow fever. These three have plagued parts of the country for many years and
appear sporadically, peaking and dipping throughout the country’s history.
Under colonial rule vaccinations were kept for the expatriates and British
citizens in the country. The indigenous population was mostly ignored and this
allowed the viruses to spread unchecked throughout the country. It wasn’t until
later in the country’s history that measures were taken to slow the spread and
commence eradication of the disease.
The return of the
polio virus in 2016 sparked a mass emergency vaccination campaign. The return
was seen in two young children in the Northern part of the country, in areas
affected by the Boko Haram insurgency. The return of the polio virus is especially
disheartening for the country because it was a year away from being declared
polio free by the World Health Organisation (WHO). WHO guidelines state a
country must not experience any new cases of the wild polio virus for three
years before being declared polio free. The return of polio can be attributed
to presence of Boko Haram. The insurgency has made it very difficult to get
necessary treatment and vaccines to that area of the country, allowing polio to
creep back in.
Lassa fever has however been more prominent
than polio in
Yellow fever is an acute virus that is passed on to humans by mosquitos and can
become an outbreak very quickly because it is a contagious virus. Yellow fever
has not seen a serious outbreak in Nigeria in recent years but the possibility
of a nationwide epidemic in rising with the yellow fever rearing its head again
in 2017. The WHO has warned the country of an “imminent epidemic” if
appropriate steps aren’t taken. This is especially worrying for Nigeria , as a
densely populated country the outbreak can be rapid and blindsiding. The first
case was seen in November 2017,
a seven year old girl in Kwara State .
Confirmed by the Nigeria Centre for Disease Control (NCDC) and reported to WHO.
Between June and December 2017
a total of 341 suspected cases of yellow fever have been
reported in 16 states. Of these cases 62.8% are male and 66% are under the age
of 20.
Call To Prof. Isaac
Adewole To Act
Professor Isaac Adewole is the minister of Health for Nigeria and there have been outcries for him to act accordingly and help Nigeria reduce number of viral outbreaks that the country experiences.Nigeria ’s health sector has a
number of issues; poor financing, inadequate number of health personnel per
capita, poor support infrastructure, dearth of equipment and little or
negligible investments in research. The National Association of Medical Doctors
(NARD) has come out to say that the Ministry of Health needs to be more
proactive when dealing with epidemics. The president of NARD, Dr. Ade Faponle,
has said the county does not have a prepared template to handle the outbreak of
infectious diseases and works retroactively. Prof Adewole himself has made it
clear that for the Ministry of Health to combat the viral outbreaks it needs
more funding from the Federal Government. This came after the 2018 proposed
budget was released and there was a percentile cut in the health budget when
compared to 2017. Adewole is doing what he can with the resources at his
disposal. In 2016, he announced that the Ministry of Health will be partnering
with the private sector to create a Bank of Health. Adewole declared that Nigeria ’s
health scene needs a presence from the private sector and the government cannot
bear the burden alone. The Bank of Health aims to provide resources for those
in the private sector who wish to set up health facilities in the form of
single digit interest loans with long repayment periods. Prof. Adewole backed
this move by saying: “We have decided to work with the private sector in the
coming year because they have the discipline, resources and efficiency to drive
the sector.”
Professor Isaac Adewole is the minister of Health for Nigeria and there have been outcries for him to act accordingly and help Nigeria reduce number of viral outbreaks that the country experiences.
Cost Of Doing Nothing:
Non-Intervention
Nigeria
needs to act swiftly in order to quell the outbreaks of the aforementioned
viruses. This has not been entirely the case of late but the country is working
hard to stop the spread of diseases. The Ministry of Health is quick to give
updates of cases in different parts of the country and also report each new
case of any potential epidemic to WHO for advice and support. Also, when polio
resurfaced in the country the Ministry of Health was quick to issue an
emergency vaccination campaign in order to boot polio once and for all. Even
going as far as vaccinations for neighboring countries in the Lake
Chad area. The need for intervention by the government has often
come late or has been very weak. This was the case in Ebonyi State ,
a state with a large Lassa fever outbreak. It was discovered that 3 out of 9
cases were from people who had been sent home from the hospital but went on to
contaminate others.
The country’s health sector has been
underfunded for many years and the federal government needs to do more in order
for Nigeria
to have a health sector that can convincingly fight the spread of viruses and
epidemics. Nigeria
has been heavily reliant on donor and international help to fight its
immunization battle. Since 2001, Gavi, an international public-private health
actor, has committed $697 million to Nigeria ’s immunisation bid. Gavi
has stated Nigeria
has a number of challenges, such as uneven infrastructure and immunisation
coverage, geographical barriers and anti-vaccine movements. Government
officials need to be aware that the country cannot be reliant on other actors
to solve its problems forever. Gavi support is winding down as Nigeria is no
longer classified as a low income country; Gavi’s criteria for offering
support. This means by 2021 Nigeria
will have full responsibility for the immunisation of its citizens.
However, these haven’t stopped Gavi seeing
some positives. The Nigerian government is aware of what needs to be done and
commitment from state governors is promising. Some states are trying to take a
proactive response while no cases have been reported in their territory. States
neighboring affected locations are beginning to take proactive actions to
prevent the further spread of the disease to their territory. In Enugu , for instance, a 22-member committee on Lassa fever
was inaugurated by the Nigeria Medical Association (NMA) in January 15, 2018,
and similar actions have also taken place in Benue .
Future Reemergence Of
Polio In Nigeria
The reemergence of polio is more probable than one may assume inNigeria ,
especially in the North East. For the last decade or so the Ministry of Health
has provided vaccines to all local government areas in the country. The main
drawbacks during this campaign are that there is little record of who has
received that vaccination and some places were simply inaccessible. To be fully
protected from polio a total of four vaccinations are needed. Upon returning to
LGAs the Ministry of Health requires people to remember this information, this
will be especially difficult for young children where the virus is most
prominent. The Boko Haram insurgency has hampered the eradication of polio
because of the instability it has introduced to the area. The presence of Boko
Haram makes those areas in North East Nigeria inaccessible to healthcare
workers. The displacement of people not properly vaccinated can also lead to
issues for neighbouring states and start the outbreak cycle again. The Federal
Government recently claimed that Boko Haram has been “completely defeated,”
therefore, there should not be any future problems in getting necessary vaccines
to the North East region of the country, but how true is this?
The reemergence of polio is more probable than one may assume in
However, Boko Haram isn’t the only adversary
to nationwide immunisation. Poor infrastructure also hinders vaccines reaching
the most impoverished parts of the country, where polio is most likely to
reemerge. Tens of thousands of people are hampered for this very reason.
Without the necessary vaccines around the country Nigeria can slip further back in
its fight to eradicate polio. A fight that was nearly won.
The confluence of these three diseases – yellow fever, polio and Lassa fever
threatens the emergence of virulent epidemics at a time when we were almost out
of the woods on these matters. The Lassa fever, like the Ebola first killed the
doctors, then the nurses.
In all these cases simple basic hygiene by
washing and cleaning the hands would have helped but we have no clean water.
Most important however, is the apparent lack of political will to see these
problems as holistic and to solve them accordingly.
Mr. Bill Gates of Microsoft has agreed to pick
up $276 million of unpaid bills for polio vaccines issued to us by Japan . I cannot
believe that the Ministries of Foreign Affairs and Health cannot dissuade Japan
from taking this money and that we cannot, should this be possible, not spend
that money more profitably to bring to an end the threats caused by yellow
fever, Lassa fever and polio. My fear is that now that the election is coming,
these matters will get worse and when money is voted for eradication and
treatment, it will end up in the political soup of re-election.
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