In July of 2014, right in the midst of the West African Ebola outbreak, a Liberian American man brought the ebola virus to Lagos – a city that is home to 21 million people, and one of Africa’s busiest hubs. According to the former director of the American Centre for Disease Control, Tom Frieden, “if it had gone out of control in Lagos, it would have gone all over Africa for years”. This is not an insignificant statement. Lagos is such a metropolis that its potential fall is seen in apocalyptic terms.
What is so memorable about the 2014 Ebola outbreak, is not that we had a potential pandemic on our hands, it is that Nigeria responded so quickly. Over the years, in collaboration with international agencies Nigeria had been building infrastructure to tackle polio and HIV/AIDS, this infrastructure was immediately put to work – within three months, every person who had contracted Ebola was found, and after 19 cases and 8 deaths, Ebola was over, and a potential pandemic halted in its step.
Nigeria’s course of attack was three-fold:
- Tracking of all potential cases
- Ongoing monitoring of those cases
- Rapid isolation
Additionally, measures such as vigilant disinfecting, screening at ports-of-entry, and a lot of groundwork including approximately 18,500 in-person follow-up visits from a total of 894 identified contacts were carried out. Such a robust process was declared by the WHO as a “piece of world-class epidemiological detective work”. Such high praise was indeed merited.
The present day
Fast-forward to 2020, the world is in midst of a global pandemic not seen since the Spanish Flu of 1918. As of April 17, 2020, WHO figures show 2,074,529 confirmed global cases of the novel coronavirus [COVID-19] and confirmed deaths at 139,378 globally. With the first case seen in Wuhan, China, in December 2019, and now spread to a total of 213 countries inclusive as well of independent territories, it is therefore no exaggeration to say that it is potentially the worst pandemic of the modern age. And it shows that time is our most valuable asset. Nigeria’s index case was on February 28, and according to the latest figures from the Nigerian Centre for Disease Control (NCDC), we are currently at 442 cases. Therefore, this is something to be taken seriously.
So, considering Nigeria’s recent success in battling a viral epidemic, why does Nigeria seem so underprepared to tackle coronavirus? There are a number of reasons for this. But first some crucial differences between the Ebola virus and COVID-19 should be made clear. First, as a respiratory disease COVID-19 spreads far more easily than Ebola, which was transmitted only through direct contact with bodily fluids. Secondly, COVID-19 has a long incubation period of 10-14 days, during which infected persons can spread the disease unbeknownst to them. Ebola on the other hand developed rapidly from the period of contraction, often leaving infected persons in critical condition within a matter of days. With these in mind we will now look at why Nigeria is so underprepared:
- Testing has so far been restricted to those who indicate a strong possibility of infection
- There are a limited number of test kits, and with so little testing we have no way of knowing the spread of the virus
The major lesson taken from the Ebola epidemic – contact tracing, is made redundant simply by the speed at which the virus spreads. With the exponential rate at which infected cases rise, the two to three weeks it takes to trace a contact simply does not work. Currently, nobody in Nigeria has any idea of the true spread of coronavirus.
Now, interestingly Nigeria already has a governance framework to address epidemics, which has evolved with each health crisis the country has faced. It is the Integrated PHC Governance strategy otherwise known as Primary Health Care Under One Roof (PHCUOR). This reform was promoted by the Nigerian government to integrate primary healthcare structures under one state-level body. And following its success it tackling the ebola crisis, it was signed into law by the former president Goodluck Jonathan in December 2014, as the National Health Act [NHA] 2014. This policy is based on the principle of ‘three ones’ – one management, one place and one monitoring and evaluation system. This system was responsible for addressing the Avian Influenza epidemic is 2006, and more recently the Ebola outbreak in 2014. Under the governance of the NCDC, this system provides a structure that is technically sound and holistic. However, one key element that is lacking is the power to make political decisions on effective governance strategies. And as we shall see in the following section, that singular vision is complicated by the Nigerian political reality.
While Nigeria has reached a general consensus that ‘social distancing’ is the most effective method at flattening the curve. However, social distancing brings with it an array of problems that also require solutions. In asking citizens to stay at home, the government has to account for the fact that a vast majority of people live in overcrowded and underdeveloped slums, and do not have the financial luxury of not hustling for their daily bread. In a special address to the nation on Sunday evening March 29, President Buhari finally spoke substantively on what steps Nigeria will take, one month after our index case. In addition to in initially lockdown of Abuja, Lagos and Ogun states, Buhari outlined a tripartite approach that will be led Presidential Task Force in collaboration with the NCDC and the Ministry of Health. The role of the task force will be to adapt global best practices to the Nigerian context, it has an initial budget of N15b to contain the spread. Part of this budget will be set towards relief materials for vulnerable citizens and internally displaced persons (IDPs).
While is a lack of transparency on the exact amount set aside for relief materials, it is a good start. However, there is still a controversy on why Lagos state for example has received two-thirds of this first tranche. For example, both the United States and the United Kingdom who have announced government schemes to address those whose employment is negatively affected by the city shutdowns, there is a clearer sense of how those funds will be utilised. This is where we question the implementation of the singular and holistic vision originally laid out by the Health Care Plan. Can this tripartite approach function effectively, why is the NCDC led by a separate task force? The answers to these questions are unclear. Fourteen days after President Buhari’s special address, he confirmed that the lockdowns in the aforementioned states would continue for another two weeks, but with increased restrictions on movement and market trading.
The first two weeks of the lockdown showed that far from adopting global best practices into the Nigerian context, human rights abuses, police violence, and suppression of the press have instead been the case. The effects of these are already being felt in cities like Lagos which thrives on the informal sector and forms a significant portion of Nigeria’s GDP. When asking a street vendor or a taxi driver, who likely lives in a slum, and has to hustle every day for his daily bread, to stay indoors, you are asking that citizen to make an impossible choice – starvation on the one hand, or abuse by security officers on the other. A 2017 study of the informal economy in Africa, showed that the informal sector was not only a key component of Sub-Saharan Africa, but in countries like Nigeria, contributed up to 65% of GDP. Thus, there is a pressing need to critically appraise the appropriateness of our response so far, and actually develop a policy response that is grounded in the political, economic and social reality of Nigerians.
We also know that the information space will also be a significant vector with regard to crisis management. A great fear is the negative impact of disinformation; we have seen in Nigeria scam messages attempting to deceive Nigerians into parting with sensitive information, or messages claiming to provide cures and so on. The past month has seen everything from stories claiming African are immune to COVID-19, to cases of chloroquine poisoning following the botched communication by President Trump on the FDA’s apparent greenlighting of the drug.
This brings us unto the major issue – more than ever, this is a time for effective leadership, clear communication and transparency. Instead we are seeing cases where state governors take affairs into their own hands by claiming their states have Biblical protection, while some other states are closing their borders. The success in 2014, has perhaps blinded the leadership to the deep structural flaws in the Nigeria healthcare system – lack of resources, poor investment and an over-reliance on foreign aid has put us in an unfortunate position. Most countries have closed their borders and are focusing inwards, Nigeria cannot simply turn and escape from its own problems. The time for true leadership is now. President Buhari has finally moved into action, but it is uncertain if it is for the better or for the worse.
Alhassan Ibrahim is a Programme Assistant with CDD West Africa.