Nigeria: 'Nigeria Still At Moderate Risk of Ebola Outbreak'

No object that can not be chlorinated can exit the high risk zone. Dona Ebola treatment center in Conakry.

Dr. Chikwe Ihekweazu is a consultant epidemiologist and the Chief Executive Officer (CEO) of the Nigeria Centre for Disease Control (NCDC). Ihekweazu in this exclusive interview with The Guardian said Nigeria is still at moderate risk of Ebola Virus Disease (EVD) because of the ongoing epidemic in the Democratic Republic of Congo and that the country is already strengthening preparedness for another outbreak. The epidemiologist among other things explained why the country might never be able to stop the persistent Lassa fever outbreaks.

*Extremely high temperatures contribute to spread of meningitis, malaria, Lassa fever, cholera

Climate change is becoming more drastic and it has health consequences. What are the consequences for Nigeria?

Climate change is a global problem for all countries. We are now experiencing higher temperatures than usual, across the world. Nigeria is a tropical country and what this means is that we will experience even hotter days. The health consequences of climate change are vast- directly and indirectly. There will be huge impact on the transmission dynamics of infectious diseases, which can have an impact both on human and animal health. Extremely high temperatures also contribute to the spread of respiratory diseases such as meningitis and vector borne diseases such as malaria and Lassa fever. We have also begun to experience increasing incidence of flood. This contributes to water-borne diseases such as cholera. There is also a potentially large and yet unknown impact on agriculture and the environment, which can all, affect health.

Nigeria, like several other countries, has to be better prepared to respond to the health effects of climate change. This emphasises the importance of strong collaboration across environmental and health sectors- one we have made progress in strengthening. One other critical area to focus on is research, as the impact of climate change is not fully understood.

It has been very hot and humid I most parts of Nigeria. The condition has dire implications for measles, chicken pox and meningitis. What is the situation now?

While we cannot change the weather, we can mitigate its impact. We must focus more on protecting ourselves and our health. It is important to ensure proper ventilation in our home at all times. For diseases like measles, irrespective of the weather, it can be effectively prevented by a vaccine given to every Nigerian child for free at health care facilities. Parents whose children are ill from communicable diseases like measles and chickenpox should keep them away from school and other public gatherings to prevent spread. These are diseases that resolve easily with proper medical care.

Are we still expecting Disease X?

We can never stop expecting Disease X. Disease X is an unknown disease or pathogen that may happen at any time. The microbes- viruses and bacteria- that we are fighting do not stop fighting back. There is continuous mutation and we do not know what the next pandemic is or when it will come. Therefore, we continue to strengthen our capacity to prevent, detect and respond to these.

The Ebola situation in DRC is getting worse. Are you concerned?

The Ebola situation in DRC is worrisome as despite the use of a vaccine, the spread has continued. The conflict in the country has affected outbreak response, as dedicated health workers and treatment centres are being attacked. Although Nigeria is still at moderate risk as assessed by the World Health Organisation (WHO), we are strengthening our preparedness. In April, the West African Health Organisation supported us with three thermal screening cameras placed at the Abuja new terminal, Kano and Enugu airports. This is in addition to the cameras previously provided by the Dangote Foundation for screening at points of entry. We are better prepared for an Ebola outbreak than we were in 2014, and will continue to improve on this.

Why was Nigeria not considered for the pilot study for the malaria vaccine despite the fact that we have the highest burden?

In December 2015, WHO issued a call for expressions of interest from African ministries of health to collaborate in the malaria vaccine implementation programme. Of the 10 countries that responded positively, only three were selected for the programme based on pre-specified criteria. Our malaria programme is working closely with WHO to learn from the experience of other countries and leverage on this after the pilot phase.

Measles has become a problem globally because of vaccine rejection. What are the implications for Nigeria?

There is absolutely no basis for measles vaccine rejection. It is quite unfortunate and a drawback in public health, that there has been a 300 per cent rise in measles cases globally in 2019. Given the availability of the measles vaccine, we should not be experiencing the increase in measles outbreaks as we are seeing. In Nigeria, the issue is not overt rejection, but passive. We are currently experiencing an outbreak of measles in Nigeria with majority of the cases recorded in Borno. Working with our sister agency, the National Primary Healthcare Development Agency (NPHCDA), we have found that about 68 per cent of current measles cases currently recorded in Nigeria have not received a single dose of the measles vaccine- a vaccine that is free - at every primary healthcare centre. The insurgency in the region has also affected peoples' access to care. We will continue to work with relevant authorities including NPHCDA, traditional rulers, security agencies and others, to improve risk communications on the disease, increase uptake for the vaccine and revise strategies to reach hard-to-reach areas.

Despite your efforts, Nigeria has continued to record more Lassa fever cases and deaths. Why and what are the solutions?

Lassa fever is endemic in Nigeria. This is because the virus is prevalent in our rodent population and these rodents transmit the virus to humans. Until rodent to human transmission can be prevented and an effective vaccine is developed, we will continue to record cases. Until we have a vaccine, prevention depends on all of us, together.

Despite the increase in the number of reported cases in the last two years, we have also seen a decrease in the number of deaths from Lassa fever, compared to previous years. This may be related to our improved surveillance, diagnostic, case management and risk communication architecture. Working with the Irrua Specialist Teaching Hospital, Edo State, we carried out a national training to build the capacity of health workers to manage Lassa fever cases effectively. We have begun to increase our understanding of case fatality from the disease and realise that most deaths recorded are due to delay in presentation of cases to the health facilities. In addition, we have established a sample transportation system that enables samples to be sent to any of the four reference laboratories within 24 hours of sample collection. The samples are tested immediately, and results provided in a quick and efficient manner to guide clinical and epidemiological response.

While we work towards long-term solutions such as a Lassa fever vaccine, we continue to focus intensively on promoting clean environment, increasing awareness on the disease and developing structures for improved response

NCDC continues to coordinate a multisectoral Lassa fever Technical Working Group in collaboration with the Federal Ministry of Agriculture and Rural Development (FMARD), Federal Ministry of Environment and several partners.

These Ministries have begun activities to sensitise farmers on food safety practices, institute rodent control and environmental sanitation measures at the community level.

It is important for all Nigerians to take more responsibility, as the prevention of Lassa fever lies with all of us. We must keep our environment clean, store our food in rodent proof containers, avoid self-medication and ensure proper hygiene at all times.

The world just celebrated the immunization week. Why the renewed vaccine rejection globally? What are you doing to prevent possible situation in Nigeria?

The immunisation week celebration is part of global strategies to create awareness about vaccine preventable diseases. In Nigeria, this was led by NPHCDA. The activities were aimed at raising awareness on immunisation and the critical importance of vaccines.

For polio, NPHCDA has leveraged on the strong influence of traditional rulers and other highly respected stakeholders to reduce vaccine rejection and encourage every child to be immunised. There are increasing concerns about the safety and side effects of vaccines, usually borne out of ignorance and lack of awareness. These are all unnecessary; vaccines are safe.

However, we continue to work closely with NPHCDA, the agency with the primary mandate for immunisation in Nigeria, to inform people of the risks of vaccine rejection. We should not be experiencing large outbreaks of measles and yellow fever, because the vaccines to prevent them are available and effective.

How far with the Lassa fever vaccine as discussed during the international conference in Abuja?

At the Lassa fever International Conference, we had presentations from several science institutions and vaccine developers. There were excellent updates on progress towards developing a vaccine. We must remember that there are several steps involved in the production of vaccines and drugs. At the moment, we are working closely with the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI), to support the initiation of clinical trials. This is a process that requires careful detailing for us to get it right. Our national Lassa fever research consortium meets regularly to review progress and map out the fastest but safest processes for the world to have a Lassa fever vaccine.

What are the other things people who do not receive vaccines can do to prevent diseases?

It is extremely important that where vaccines are available for diseases, people receive them. Vaccines are the single most effective method to prevent diseases.

However, there are diseases such as Lassa fever where vaccines do not exist yet. For these diseases, preventive measures are important. Most infectious diseases are transmitted in environments that are poorly maintained. It is important to ensure proper sanitation in homes and around you, avoid overcrowding, ensure proper ventilation, ensure food is cooked and stored properly, avoid self-medication and direct contact with people who are ill.

Can we do without vaccines?

Vaccines are the most cost effective and beneficial way of preventing diseases. The global success in the eradication of smallpox is largely attributed to the smallpox vaccine. Therefore, we must continue working to ensure that we have vaccines to protect us from infectious diseases.

Last year we had serious issues with the Cerebro Spinal Meningitis (CSM) vaccine for subtype C. Do we have the necessary vaccines now?

This year, we are better prepared with lessons learnt from the previous outbreak.

Although the sero-group C meningitis vaccine is still too expensive for mass preventive vaccination campaigns, our sister agency NPHCDA, that is responsible for vaccination, procured vaccines for reactive vaccination. This was done prior to the onset of this year's meningitis season. At the onset of the meningitis season, we carried out reactive vaccination campaigns in some wards in the northern part of the country with confirmed outbreaks. The country still has access to the global stockpile of sero-group C CSM vaccine for reactive vaccination, if we exceed our national capacity.

With the limited availability of vaccines, it is important for Nigerians to protect themselves. Avoid overcrowding, sleep in well-ventilated rooms and importantly, visit a health facility immediately if you experience symptoms such as sudden high fever and neck stiffness.

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