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Why Nigeria must take responsibility for epidemic preparedness

It is no news that Nigeria’s health budget is miserably low. Sadly, the failure to prepare for health emergencies have made the country spend more in combating disease outbreaks.

Like the yet-to-be overcome COVID-19, the health emergencies in Nigeria now also have economic dimensions that could substantially pummel the economy; creating both health and economic emergencies at the same time.

In recognition of the scale of the challenge facing the country and the inability to respond appropriately to epidemic preparedness, despite the financial and technical support from multinationals, governments, and philanthropies, major parts of Nigeria’s National Action Plan for Health Security (NAPHS) remains unfunded without significant public investment.

There were several in-kind and cash donations made to the Nigerian government from foreign aid agencies, including the EU, which gave Nigeria a grant of €50M to tackle the Covid-19 pandemic and the World Bank’s Regional Disease Surveillance Systems Enhancement (REDISSE) Project, for instance, is currently funneling US$90 million into efforts to strengthen Nigeria’s epidemics preparedness.

Serious questions have been raised on how long Nigeria will continue to rely heavily on foreign sources to keep her people safe from disease outbreaks and the sincerity of the Federal Government in its response, especially with respect to taking care of the most vulnerable.

Others still have questioned the epidemiological surveillance, emergency response capability, critical care infrastructure such as oxygen, ventilators, research & development capacity and how the poor disproportionately continue to pay heavy price in pandemic because of the government’s lack of preparedness or empathy for its people.

Despite the present threat of COVID-19 and other predicted epidemics, Nigeria has continued to fail for the umpteenth time to meet the Abuja Declaration by African leaders in 2001 and the World Health Organisation (WHO) to allocate, at least, 15 percent of yearly national budgets to health.

Only 4.526 percent (about N592.166 billion of the proposed N13.082 trillion) was allocated to health despite the ongoing COVID-19 challenge and the threat of another pandemic.

Nigeria has been experiencing a severe outbreak of diseases such as cholera, meningitis, and hemorrhagic fevers, especially Lassa fever and depending on the morbidity and mortality rates of these viruses, a significant percentage of the population has been impacted.

Following the Global Health Security (GHS) 2019 Index analysis finds no country is fully prepared for epidemics or pandemics. Collectively, international preparedness is weak. Many countries including Nigeria do not show evidence of the health security capacities and capabilities that are needed to prevent, detect, and respond to significant infectious disease outbreaks.

Based on rapid response and mitigation of the spread of an epidemic, Nigeria is ranked 68 and scored 43.8 out of 195 countries. The report further revealed that Nigeria fared even worse across indicators such as zoonotic disease prevention; emergency preparedness and response planning; health system capacity and healthcare access.

Preparedness is key to averting such health and humanitarian crises in the future and Nigeria can take responsibility to fight and prepare ahead on epidemics. A continuous collaboration in preparedness, characteristically connecting surveillance, risk reduction and capacity building, demands considerable effort and commitment by both the private and public investment.

If Nigeria’s philanthropic responses to the epidemic continue to generally follow these two tracks: that of responding to the immediate crisis, such as donations of cash and in-kind items by private and public healthcare providers, and that of addressing the economic effects caused by epidemic restricting businesses.

Strengthened surveillance capacity across the local, state, and national levels, inclusive of the private sector, and strategically intensified in potential hotspots, with capable support from sufficient human resources and diagnostic infrastructure would be critical to timely identify and respond to outbreaks.

The early evidence suggests that investments in preparedness have mattered ahead of epidemics. Having learned from the COVID-19 outbreak experience, Nigeria should begin to think through its funds to prepare ahead for the epidemic.

With plans for fund investment, the country can arrange for computational epidemiology that makes use of big data, artificial intelligence, and algorithms for early detection of remarkable patterns or groups of illness. The patterns help assess the risk of an outbreak, forecast the disease trajectory and provide inputs for issuing warnings about possible outbreaks. Governments will get the much-needed time to prepare for and take appropriate preventive and curative measures.

Also funding research investigation, improve epidemiological surveillance and emergency response capability is crucial to getting the epidemic preparedness under control.

“Nigeria has a big economy and a strong private sector. It is time to draw more on the strengths of its private sector to combat and prepare ahead of epidemics. Apart from money, the private sector can drive community engagement, communication, procurement, and even the manufacturing of drugs and equipment.

“Nigeria and Nigerians are resilient. We must not forget that preparing ahead of epidemics is also saving the citizens from psychological warfare in the face of fear, socio-economic depression, and lockdowns. Nigerians are fighters and can fight this off,” said Oladoyin Odubanjo, former chairman, Association of Public Health Physicians of Nigeria (APHPN), Lagos Chapter.

Chikwe Ihekweazu, director-general, NCDC, said Nigeria needs to build on its progress with the COVID-19 response and extend to other areas of health security.

“If Nigeria wants to strengthen its surveillance system, it must move to an integrated digital system, owned and led on by government institutions such as NCDC, which has the mandate for infectious diseases.

“NCDC, as Nigeria’s leading national public health institute needs to expand its capacity and achievements but requires the funding and political commitment for this,” he said.

Odubanjo also said that government needs to increase funding for epidemic preparedness and awareness. States in Nigeria need to demonstrate the serious impact of the disease and the governors should also provide adequate funds for a sensitive disease surveillance and response system.

However, preparedness for pandemics and health emergencies has a high return on investment, estimated at $2‒7 for every $1 committed. As it stands, Nigeria’s epidemic preparedness is a risk that has greater potential for catastrophic economic impact.

The global health security agency has advised that leaders should take steps to build and maintain robust healthcare and public health workforces that play a major role in biological crises. National Action Plans for Health Security (NAPHS) should take into account specific benchmarks to improve and finance the overall health system and its workforce.

Meanwhile, Nigeria could achieve this with a hand deck by a vigilant health emergency response, and a well-equipped healthcare system indispensable for crafting an appropriate response to epidemics. We cannot be sure of what new outbreaks the future will bring, but we can be sure that if we do not prepare for them today, our tomorrows could be catastrophic.

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