Nigeria: One Year After, Five Gaps in Nigeria's Management of Covid-19

28 February 2021
analysis

Nigeria recorded its first case of COVID-19 a year ago.

It is exactly 12 months since medics were summoned to what became the first confirmed case of COVID-19 in Nigeria. Since then, over 155,000 infections have led to more than 1,900 deaths.

While Nigeria, like most African countries, has not suffered from the worst effect of the pandemic, unlike its European and American counterparts, the Nigerian government has made some blunders and faced some challenges in managing the virus. PREMIUM TIMES highlights five of those challenges.

It was a Thursday afternoon on February 27, 2020, when authorities announced that an Italian tested positive for the disease, two days after he flew into the country via a Turkish airline that landed at the Lagos airport.

The case was the first in West Africa and just the third to be confirmed in Africa after those in Egypt and Algeria.

According to Lagos health authorities, the Italian upon arrival stayed in a hotel near the airport on the evening of February 25, 2020 before proceeding to his place of work in neighbouring Ogun state the following day.

Lafarge Africa Plc, a cement manufacturing company in Ogun State, invited the unidentified Italian to inspect some installations of machines bought from a Swedish firm, the company's Industrial Director, Segun Soyoye said.

"He fell ill on the 26th February and was transferred to Lagos State Biosecurity Facilities for isolation and testing. COVID-19 infection was confirmed by the Virology Laboratory of the Lagos University Teaching Hospital, part of the Laboratory Network of the Nigeria Centre for Disease Control, NCDC", the Lagos health ministry said in a statement.

All those that had contact with the Italian -- a total of 39 people, including four health workers at the company's clinic -- had to be quarantined by the Ogun State Government while contact tracing of the people on the same flight with him was initiated by the Lagos State Government and the NCDC.

Response started at snail pace

In its initial response, Nigeria was slow to act at a time when each day of inaction mattered in terms of both the eventual public health harm as well as the severe economic costs, health experts say.

COVID-19 was first identified in December 2019 in Wuhan, China. The World Health Organisation (WHO) declared the outbreak a Public Health Emergency of International Concern in early January 2020, meaning that Nigeria and much of the African continent had some time to make key decisions.

By the end of February 2020, COVID-19 had proliferated around the globe, emerging in every continent except Antarctica, prompting many governments and businesses to try to stop people travelling or gathering in crowded places.

Two days after Nigeria reported its second infection - a contact of the Italian national - the World Health Organisation (WHO) upgraded the status of the COVID-19 outbreak from an epidemic to a pandemic on March 11, with a strong call for countries to "detect, test, treat, isolate, trace, and mobilise their citizens to ensure that those with just a handful of cases could prevent the wider spread of the deadly virus."

The global health agency also warned that porous borders, a continuing flow of travellers and poorly resourced healthcare systems meant the risk of an outbreak across Africa was "very, very high." It raised significant concerns about the ability of "fragile health systems" to cope.

Health professionals including the Nigerian Medical Association (NMA) warned the Nigerian government to shut its skies and borders to prevent further importation of the virus from European and Asian nations where the disease had started to spread.

But the government appeared not to heed that advice until the country's caseload rose to at least 30. International flights were still operating despite rising cases overseas, making Nigeria particularly vulnerable.

On March 18, the government announced it was restricting entry into the country for travellers from China, Italy, Iran, South Korea, Spain, Japan, France, Germany, U.S., Norway, UK, Switzerland, and the Netherlands. All five cases reported that day came from some of the blacklisted countries.

Three days later (on March 21) when the Nigerian government announced it would close its two main international airports in the cities of Lagos and Abuja for one month, 10 additional cases were announced, nine of whom are Nigerians that had travel history to the UK, Spain, Netherlands, Canada, and France.

"The real question is why let the virus into the country in the first place? This is important because, for all intents and purposes, COVID-19 arrived Nigeria not as a matter of inevitability, but almost by the government's own invitation," Oyewale Tomori, a virologist said in an article published by Daily Trust.

"The federal government had at least three clear windows of opportunity to shut the virus out of Nigeria altogether. Unfortunately, the government did not take any of them", Mr Tomori, the immediate past president of the Nigerian Academy of Science, noted.

After a prolonged silence amid rising concerns, President Muhammadu Buhari on March 29 eventually announced the shutdown of Lagos, Abuja, and Ogun State initially in what heralded the country's response to the outbreak.

Sweeping lockdown measures followed in other states with the banning of interstate travels, shutting of schools, offices, sporting, and social activities with services considered to be non-essential closed.

Opaque Management of funds

The president had on March 9 constituted the Presidential Task Force (PTF) on COVID-19 chaired by the Secretary to the Government of the Federation (SGF), Boss Mustapha, with membership from various sectors.

Since then, the PTF has coordinated a multi-stakeholder response to the pandemic while providing technical and material support to states to manage the outbreak.

The PTF also serves as an advisory body to the president on specific decisions such as imposing and lifting lockdowns. It provided daily feedback to Nigerians on the work being done to contain the pandemic through media briefings.

Sani Aliyu was appointed as the national coordinator of the PTF.

Apart from the local and international support Nigeria received, one response many Nigerians paid attention to was the philanthropic donations by big companies, organisations and individual Nigerians.

As of May, 2020, about N36.3 billion had been raised.

This was considered a noble gesture in response to the outbreak prompting public scrutiny on how the money would be spent.

The Accountant-General of the Federation, Ahmed Idris, last September stated that over N30 billion, representing 84 per cent of the N36.3 billon, was expended between April 1, 2020 and July 31, 2020, leaving the balance of N5.9 billion.

The accountant-general was responding to the Freedom of Information (FOI) request dated August 10, 2020, and sent to him by Socio-Economic Rights and Accountability Project (SERAP) and Connected Development (CODE).

He said the PTF spent N22 billion, and 36 states spent N7 billion to support their COVID-19 initiatives.

Unsatisfied with the response, the groups in a statement said, "we also note that the documents sent to us do not contain other significant details as indicated in our FoI request... including details and breakdown of the number of Nigerians who directly or indirectly have benefited from the spending, and details on plans to spend the balance of N5.9 billion... "

While the subsequent response is being awaited, another group, a youth-led NGO, Follow the Money, wrote 57 FOIs to 27 state agencies, requesting how the COVID-19 funds they received was spent.

Only six states provided "sparse information, assuring that palliatives were distributed accordingly, even though there were no details of distribution and evidence of the same", the group said in a statement that came with a throve of documents.

Reports of lopsided distribution of palliatives based on political and sectional prejudices were further exposed in the aftermath of the #ENDSARS protests in October 2020, when warehouses piled with palliative were discovered and raided by hungry Nigerians.

Weak enforcement of safety protocols

Despite the announcement of mandatory safety protocols to prevent the spread of the virus, many Nigerians violated them and enforcement was lax among law enforcement agencies.

Lock down restrictions were partially lifted in May 2020 and with the economic downturn, job losses, rise in domestic violence and health emergencies, people started seeing the pandemic as a lesser threat.

Safety protocols such as wearing of facemasks, maintaining social distance, hand washing and cleaning routines were not adhered to. The #EndSARS protest erupted across the country with thousands of youth trooping out in defiance to repeated calls by the NCDC and health experts to avoid mass gatherings.

Two governorship elections were held amid the outbreak last year and large political gatherings held without social distancing and the use of face masks.

There were mass travelling and gatherings during the holiday period last December amid the resurgence in infections officially declared the second wave.

Health experts traced the spike in cases to the violation of safety protocols and community transmission.

With the resumption of international flights in Nigeria on September 5, 2020, weak enforcement of COVID-19 testing protocols in Abuja and Lagos airports also aided the resurgence of the disease, a PREMIUM TIMES check revealed.

Poor testing

While Nigeria's national COVID-19 strategy is being centrally developed, it relies heavily on individual state governments to localise and enforce national guidelines.

The states are solely in charge of the coronavirus management and response while the country's infectious disease outfit, NCDC, supports and receives daily infection information from them.

The daily infection update is then published by the NCDC, which ultimately serves as the yardstick by which Nigeria's COVID-19 outbreak is measured.

However, the reliability of these figures is in doubt due to several loopholes and challenges, including states not turning in enough test samples.

For example, Kogi has only conducted a meagre 3,370 tests, which is less than one per cent of the state's 3.5 million population, according to the latest weekly general fact sheet published by the NCDC.

On April 28, 2020, the Nigerian government announced its target of testing at least two million people within the next three months. Almost a year later, Nigeria has yet to conduct two million tests.

As of Saturday evening, Nigeria has conducted 1,489,103 tests.

With that figure, Nigeria has conducted nearly 7,000 tests for every one million of its population, according to data from worldometer.info.

This pales in comparison to South Africa, which has tested 146,751 samples for every one million citizens -- or Morocco at nearly 150,000 per one million, the highest of any African country, according to worldometer.info data.

There are over 80 testing labs in the country, according to the NCDC director, Chikwe Ihekweazu, but many citizens say getting a coronavirus test has been a challenge.

While testing is free in state-owned laboratories, there are few of these facilities and they are in major cities and those seeking to be tested would wait in long queues for days, a PREMIUM TIMES check revealed.

Also, many Nigerians are also unwilling to get tested for the disease and there are concerns that people are self-medicating and self-managing their symptoms at home.

Sketchy preparation for COVID-19 vaccination campaign

Nigeria wants to vaccinate as much as 50 per cent of its population against COVID-19 to achieve herd immunity.

Authorities are expecting to receive "anytime soon", the first batch of the 16 million doses of the AstraZeneca COVID-19 vaccines through COVAX, a World Health Organisation-backed programme set-up to divide about two billion doses of vaccines across 92 low-and middle-income countries.

Nigeria will also get millions of doses of vaccines from other arrangements such as that put in place by the African Union.

However, what has remained sketchy is an actual plan for a massive vaccine roll out.

Vaccine hesitancy, poor roads and storage infrastructure especially in rural communities as well as insecurity present significant barriers to the successful distribution of vaccines, health experts say.

Results from an ongoing survey by PREMIUM TIMES is already showing that many Nigerians could reject the vaccines due to misconceptions about the jabs and the disease.

"By now, there should be an ongoing massive awareness campaign to disabuse minds and enlighten the people on why it is important to take the vaccine", Nzube Ezeh, a public health researcher said.

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