Another year, another epidemic. Now, don’t panic. There isn’t an outbreak—not at the moment, at least. But one could be lurking around the corner. They come in seasons, so much so the Nigeria Centre for Disease Control (NCDC) speaks of preparing for the “next epidemic season.” And they can be relentless and weird.
Take Lassa fever, named after the Borno town of Lassa where researchers first described the disease nearly 50 years ago. Ironically, in all that time, Borno has never reported an outbreak. The last confirmed outbreak there was in 1969, according to the World Health Organisation. But it is endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria—alongside other West African countries where it has left thousands dead in its wake.
And then Ebola. For years, outbreak seasons were confined to East Africa. In 2014, the virus behind the deadly haemorrhagic fever shifted path and ended up in West Africa. Sierra Leone, Liberia and Guinea were worst hit. The virus killed more than 11,000 people across the three countries, crippled health systems across the West Africa region and battered economies dependent on service and tourism.
Nigeria was already in a tizzy long before the virus came flying into one of its two major international airports. Quickly emergency operations went up—based on a central-command model it had been using to mop up the last vestiges of poliomyelitis. Time would later see Ebola recede, after up to 20 people were infected and eight dead.
Also, meningitis. For all the frenzy around Ebola, cerebrospinal meningitis seems tame. It comes around in a cycle or “season” almost yearly—and researchers have the season neatly mapped to a T. Its outbreak even gets prediction mention weeks before it comes around. Despite its predictability, meningitis is a top epidemic killer. In Nigeria alone, between December 2016 and June 2017, more than 1,100 people have died from it —in just six months, compared with only eight from Ebola in two years. A total 14,518 suspected cases reported from 25 states, a total 1,166 dead.
Again, the central-command model of disease response came in handy: the NCDC was command, every other health agency and institution fed into it. The emergency operations centre began to wind down in June after it declared the meningitis outbreak over. Reason? Deaths from the disease had been declining in the final eight weeks of the outbreak. In the last four, no local government area reached the threshold designated for an outbreak alert. A major dip in mortality occurred in May.
But overall response and attitude to disease outbreak leave many gaps and potential risks to public health. NCDC feels spick and span, with new leadership—and tacking on all the bells and whistles of 21st-century response to disease outbreak. The @ebolaalert handle it used to stay in touch with the public has morphed into @epidalert; its website holds a list of weekly epidemiological report tracking a handful of diseases, and the centre has managed to keep sanity in the face of threatening outbreak.
Except for one caustic blunder this year when the governor of Zamfara State, Abdulaziz Abubakar, made furious headlines for ostensibly saying Nigeria’s latest meningitis outbreak was divine wrath brought on by a life of sin. The word “fornication” got wide mention, an irony for a disease affecting mostly 5-to-14-year-olds.
A little clarification. Yes, the latest outbreak of meningitis was weird. Different serogroups of the meningitis bacteria cause the disease. For years, Nigeria has had outbreaks caused by A or B. Then the NCDC’s laboratory tests confirmed more than 80% of cases undergoing testing showed serotype C. The country had never had it, hadn’t vaccine for it, wasn’t prepared for it. Such circumstances could have prompted the “punishment from God” statements from the governor. “What we used to know as far as meningitis is concerned is the ‘type A virus’ which had been tackled through vaccinations by the World Health Organisation (WHO), the governor said. “However, because people refused to stop their nefarious activities, God now decided to send Type C virus, which has no vaccine.” Zamfara was the epicenter of the outbreak, and it seemed to be crying for help.
The backlash came from all quarters: NCDC said no science linked meningitis to God’s wrath. HRH Sanusi Lamido Sanusi, Emir of Kano, one of the largest northern cities said in a tight-lipped response to Yari’s comments: “If you don’t have vaccines, say you don’t have vaccines.” In a what-I-actually-said comeback, Yari later would say his comments were twisted to “ridicule” him. All that succeeded in shifting attention from the outbreak itself to who said what and why.
NCDC itself came under a joint external review for its preparedness to respond to disease—a requirement of International Health Regulations. The review, voluntary and collaborative—with help from the US Centre for Disease Control—accessed NCDC’s capacity under IHR. It found lots of “red lights”. But the country’s health minister Isaac Adewole said, “I am proud that we have been able to go through this process to ensure Nigeria will not be left behind. I am confident that we will get it right despite the work to be done in strengthening our capacity to prevent, detect and respond to emergencies.”
It has taken the Ebola epidemic to show Africa how health is inextricably linked to economy, trade, travel, social and security issues. It sped up action to set up an Africa Centre for Disease Control and Prevention. It has strategic priorities to strengthen health-related surveillance systems and set up disease intelligence hubs to impact public health decisions and actions. It will also strengthen information systems to collect and analyse health information across the continent—which should help, especially if it is timely.
It will also work to improve workforce competency and quality assurance by working with networks of clinical and public health laboratories. It will also help African states develop “effective public health emergency preparedness and response plans”.
The point is: whatever comes knocking around in the next epidemic season. Africa will be prepared. Or won’t it?