In this interview with PREMIUM TIMES' Owoseye Ayodamola and Adebowale Nike on March 2 in Abuja, the Chief Executive Officer of the Nigeria Centre for Disease Control, Chikwe Ihekweazu, speaks on the outbreak of Lassa fever in Nigeria, government's effort to improve testing of specimens and the activities of the agency since he took office at the helm of the agency in August 2016. Mr. Ihekweazu doubles as the Director of the Regional Centre for Surveillance and Disease Control (RCSDC), an agency of ECOWAS recently opened in Abuja to serve the 15 countries in the sub-region.
Premium Times: Nigeria has recorded 110 deaths from Lassa fever in 18 states in the first two months of 2018 as reported by your agency. Knowing that this disease has been in the country for 49 years, what is behind the rapid spread of the disease and what efforts are you taking to stem the tide?
Ihekweazu - There is no magic bullet for Lassa fever, unfortunately. Lassa is endemic in our environment. The virus is with us. The host animals, (the multimamate rat) is in our environment. In a way, there is no magic bullet and this is really a marathon and not a sprint.
Why are we having a big outbreak this year, is the question on everybody's mind. The three possible causes - it could be a change in the virus, it could be a change in the rat or it could just be that we have improved our surveillance system so much that we are now finding cases that were previously not being found.
This is at the heart of the work my colleagues are doing at the moment - epidemiologist, virologist, everyone working together to get to the bottom of what is driving this epidemic and work out preventing them in the future. There are many unknown questions about Lassa and there are lots of efforts now to find answers to the questions.
PT: In the last two years, Nigeria has battled about eight major disease outbreaks (Hepatitis A, Cholera, Yellow Fever, Meningitis, Monkey-pox and Lassa Fever) some of which became of endemic status due to failure of early detection. With the three new virology centres in the country, are they well-equipped and have the personnel to handle disease detection or are we still going to depend on WHO lab in Dakar, Senegal? And can the centres handle cases from across the country?
Ihekweazu: We have high earned laboratories that can do molecular diagnosis for rare diseases like Lassa and Monkey-pox, which is what they are there to do. However, for the other diseases causing outbreaks such as cholera and meningitis, we can diagnose that in almost every state capital here in Nigeria.
So with the different levels of laboratories, different capacity, different capabilities, to keep this working is not cheap and not easy. You need very skilled professionals. We are really working hard. One of my five big objectives this year is to grow our laboratory capacity like I told you. You cannot do surveillance without diagnosis; it is like driving blind. So we are working hard to increase this laboratory capacity. It is by no means enough. If not, we will not be pushing as hard as this.
It is a long journey because it is not a problem that money can solve alone because you can buy equipment but you need to train people, build confidence, get the specimens into the laboratory and get the results out. It is about building a system, which is a work we are doing every day.
PT: There have been reports of states inflating data on cases of diseases and deaths in their localities due to the funds they get as compensation to work with? How trust worthy are the official figures from diseases surveillance from the states? Have you had such reports since you resumed office, and what are you doing to have accurate data for disease outbreaks in the country?
Ihekweazu: For disease surveillance, we actually have a very strong network of colleagues across the three tiers of government. They are called disease surveillance and notification officers. Every local government has a team and we have a team at the state level and they all report to us at NCDC. It is very difficult to inflate numbers or do anything with the numbers because firstly, you need test results to confirm the case and at the local government level people go out to their houses to confirm cases for certain diseases.
You cannot do it for all diseases, things like malaria, because there are too many of them. But definitely, for diseases like meningitis, cholera, Lassa fever, monkey pox, we actually verify each specific case down to the home, make sure we have all the data and collect data and accumulate data to the national level and report it to WHO.
PT: We have been monitoring some PHCs in the country and we noticed that most of them are in dilapidated states and not having the necessary equipment to diagnosis diseases. Most do not have essential working materials such as gloves, disinfectants among others. How has your agency been working with the state governments to ensure that the PHCs are functional, since they are often the first port of call for disease detection and treatment?
Ihekwazu: For the work that we do, surveillance and outbreak response are completely dependent on having a good primary health care system. When the president made the primary healthcare the focus for his agenda in the health sector, it actually made our job a little bit easier. The Minister of Health, Isaac Adewole , you will see has also put primary health care in the heart of the agenda. The National Primary HealthCare Development Agency (NPHCDA) is really pushing hard on that agenda.
However, you are right, in some places our PHCs are not what they should be. It is not an easy problem to solve, we have up to 30,000 to 40,000 primary health care centres across the country, some are in a very difficult to reach areas. I think the journey has started. We are now working with those improved PHCs so that the services they provide are improved and we have access to their data and they are competent and confident to deal with patients.
PT: The NCDC launched a five-year Strategy and Implementation Plan (2017-2021). What is the target of this plan and how far have you gone into implementing it?
Ihekweazu: When I started as the Chief Executive of the NCDC, we immediately decided to give ourselves some targets to meet over the next five years. Together with all the partners working with NCDC we established a target for ourselves in the key five areas of work - surveillance, reference laboratory services, public health, emergency preparedness and control and prevention.
From this, we set ourselves clear objectives of what we want to achieve, timelines, goals over the next five years so that we can hold ourselves accountable for our period of service to Nigeria and NCDC. We have just about ended the first year. We have achieved some of them, we have not achieved all of them. We keep pushing everyone to meet all our target so that we can really grow this agency to fulfill the aspirations of Nigerians and make sure they have the confidence in the agency that we have the ability to protect their health.
PT: You said you have achieved some of them, can we know which ones and how easy has it been in achieving them?
Ihekweazu: We have five big goals which are broken down to several objectives and then several activities. In every grand vision, you never achieve all of them. We will achieve some in some areas and not all. For example, in our reference laboratory centres, we want to have one reference laboratory in each of the six geopolitical zones. We have three at the moment, and we will keep pushing on each and every one of them and see how far we can push ourselves on each and every area we are working on.
PT: Has NCDC been working on the Tropical Neglected Diseases in Nigeria (TND)? If so, what has been the progress?
Ihekweazu: We are definitely working on TND. We are responsible for all the surveillance and outbreak response. However, in terms of the programmatic response to some of these neglected tropical diseases, it still lies in the Federal Ministry of Health. But whenever there is a new cluster, schistosomiasis, ascariasis or leprosy, we will always get involved to see why we are having more cases of these diseases.
Our priority at the moment is to deal with what we call epidemic prone diseases and once we can get a better hand of that, we will be expanding our scope and make sure that Nigerians are protected from all diseases that can cause harm.
PT: What is the latest on the bill to establish the National Centre for Disease and Control (NCDC), which has been on the floor of the senate? Why is the bill yet to be passed? How will the bill becoming law impact on your agency?
Ihekweazu: The bill has actually progressed fairly quickly and quite far from the floor of the senate. We had a public hearing about a month ago and now it is going to the final stages where it would be read for the fourth time and hopeful, will be passed and sent to the president for action.
The bill will fundamentally change the way we work, it will really enable us to grow, to employ the right people. At the moment, we are still dependent on the civil servicing structure to recruit. But we really need specialists. We need specialists in epidemiology, virology, microbiology; we need a certain level of expertise to build the NCDC. This has to be a science-based organisation. That is how similar organisations across the world are and it will enable us grow in that unique direction. Our public hearing was very good, I do not think there is a single word of opposition around the need for Nigeria to have a NCDC. I think there is a general consensus of the importance of an agency like this and we are all looking forward to having the bill passed as soon as possible.
PT: In terms of training, NCDC is meant to be a centre to train students and researchers in fields such as epidemiology, virology, among others. How far has this been going? And passing the bill, how will this enhance knowledge for Nigeria in terms of disease detection and control and also in exporting knowledge out of the country?
Ihekweazu: We already have a very strong field epidemiology training programme. Ours is one of the strongest across the continent. We train over 300 epidemiologist, many of them now working here. But what this will help us to do is to expand that scope. Apart from the 40 to 50 epidemiologist that are trained here every year, what we want to do is go down to the first lines, the PHCs, make sure everyone knows the basics of what to do in public health, what are the first things they should do immediately they see a case. NCDC will be a repository of knowledge for the country and not only Nigeria but the rest of West Africa.
PT: ECOWAS states recently commissioned the Regional Centre for Surveillance and Disease Control (RCSDC) in Abuja. What does the centre mean for disease control and surveillance for Nigeria and West Africa?
Ihekweazu: It was really a moment of pride for me when the Minister for State for Health, Osagie Ehanire, hosted the Minister of Health from Togo, Moustafa Mijiyawa, to cut the tapes in the Regional Centre for Surveillance and Disease Control. It showed that we have moved on to the region from where we were in 2014 and 2015 when we had the Ebola outbreak. I think that was a wake up call for all of us that these diseases and bacteria do not recognise borders, and can spread across the borders. Therefore we have to learn to work together. RCSDC is the response to that.
We are happy that it is being hosted in Nigeria. Even though there are 15 countries in West Africa, half of the population of West Africa are Nigerians. In a way, this is really where it should be. NCDC is going to have a very strong working relationship with RCSDC, we are going to provide them with a lot of data they need to do their work. But it will also attract a lot of interesting position to Nigeria that would help them develop their capacity to support the rest of the region. We are excited about the opportunity, it is a new organisation, they will rely a lot on NCDC for support, and as they grow, to support the region on all the other work they have to do.
PT: What is your advice to Nigerians, especially with the recurrent diseases outbreaks and new diseases springing up in the country?
Ihekweazu: Two things. Firstly, there are lots of scepticism about government agencies generally. I do not think we should all be painted with the same brush. There are quite a number of government agencies and Nigerians that are working very hard and in difficult circumstances and long hours and really trying to do their best to do the work they are supposed to do. While we have every reason sometime to be sceptical about government, we should also be proud of those people working hard to make a difference.
Secondly is for everyone to take personal responsibility for their own health and well-being. Lassa fever in a way is a perfect example. I tell people it is a complete preventable disease, if you cover your food stuff, prevent rats from getting in to your homes and prevent contact with rats. There is so much NCDC can do, there is so much the state and federal government can do, but what we cannot do is get a way to watch over everyone.
We are asking everyone to take responsibility, do what they can do, get their children immunised, keep their environment clean, get the heaps of refuse out of the front of their homes and just make a bit of an effort to keep themselves healthy. And we will continue to work in supporting everyone and the heath care till it is better and organised.