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Nine states responsible for 80% of cholera cases — NCDC DG

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The Director General of Nigeria Centre for Disease and Control, Dr Ifedayo Adetifa, in this interview with MATTHEW AGBAJE, outlines the agency’s plans to completely conquer COVID-19 and other diseases currently ravaging the country

Since you became the Director General of NCDC, can you briefly state what has changed or improved in the sector under your command?

I assumed office in October 2021. It is a bit difficult to tackle this question because when you say what has changed, it is assumed that I already have a history that can be compared. But I wasn’t here before and so I can’t make a comparison as to what has happened to this point. Instead, let me talk about the things that have not changed which are the current challenges to public health and are related to the fallout of the impact of the pandemic. While people may think the pandemic is on its way out, we are actually still battling with the consequences and damage done two years ago. But we have continued to respond, and government funding for the agency for this year, compared to previous years, has gone up by about 100 per cent in the approved budget and the actual money released compared to other agencies.

We successfully managed the Omicron outbreak that caused the third wave towards the end of last year, and also dealt with the worries or challenges about Marburg thankfully they haven’t arrived in the country but our level of preparedness is high. We have strengthened Lassa fever surveillance and increased the ability to test for Lassa fever. We are coping with the monkeypox outbreak with invested surveillance for that condition because of a significant increase in the number of cases recorded.

Has Nigeria conquered COVID-19, and is there going to be any new wave?

Nobody has conquered COVID-19 as it is still with us, though it is not like when it first broke out. It was fully unknown when it arrived with no idea of the new pathogen or how it will behave and prediction of massive deaths. Some predictions panned out and some did not, but the point is it is still very much with us with very low or less than the desired level of testing. Some countries are still experiencing either high or steady numbers of cases. The progress the world has recorded is a result of vaccination and population immunity from previous exposure, and there is now a disconnection between case numbers and the number of people who end up in the hospital, and who died.

Let’s not celebrate early as Nigeria has recorded about 3,200 direct deaths from COVID that we know which may be underestimated. If one thinks about some of the largest passenger aircraft that carry about 300 passengers, then it means what we have lost (to COVID-19) is equivalent to the crash of 10 aircraft. This type of tragedy will not be accepted in any part of the world if it happened like two years ago. So, the virus is with us but we now know a lot about it, although not everything.

As we all plan to return to normal, we are keeping an eye on the later part of the year when people will travel more, and if further waves are not recorded then we may be thinking that COVID is here to stay. This will help us to focus more on people with the highest risk, the elderly, people with hypertension, diabetes, cardiovascular disease, cancer, organ donor recipients and others.

A new wave is theoretically possible if a new variant that can avoid all the immunity emerges; otherwise we may cope if it stays the way it is.

What has Nigeria done right as a result of the pandemic?

The pandemic has caused us to invest for the future, but our answers will still be no when asked if we are ready for the next pandemic. That’s because we need to be humble. Even countries that seemed better prepared for public health treatment all struggled to cope. Nigeria has responded well to COVID, and we are now in a better place to deal with any new outbreak. We will no longer be starting from a situation where we have just three labs or where people have no idea about the pandemic. We have acquired new knowledge and skills, which will engender quicker action in response with better coordination even at the highest level. Our lawmakers’ performance is commendable by equipping all the necessary ministries, departments and agencies to respond to the outbreak.

Why is the country still battling cholera at this time?

It’s a personal embarrassment to me and even to the highest level of government. We are aware of everything that we need to know about it and the solution is to have potable water and safe disposal of sewage and avoid open defecation and so on. Sadly, there hasn’t been adequate investment in sanitation and hygiene. If potable water supply is provided to areas of cholera outbreak, cases will drop to nearly zero.

Governments at all levels need to invest in the safe water supply to the citizens and invest in sewage disposal and stop open defecation. Also, we need infrastructure development, which will ensure flood and waste water are properly channelled to avoid contaminating other water sources.

Talking about the high level of infection in the country, which states are the most affected by this disease?

About nine states at the moment are responsible for over 80 per cent of the current cases of cholera. They include Taraba, Cross River, Katsina, Borno, Kano, Ondo, Zamfara, Bayelsa, Bauchi and Adamawa for this year alone. There are more states in the North but other regions are not left out, especially where there are relatively under-served public amenities such as water. They tend to look for water from natural sources which are probably contaminated because of indiscriminate defecation.

Ghana is currently battling Marburg, does Nigeria stand the risk of the disease through its insecure borders?

Nigeria is at risk of any condition that is found in the sub-region or Africa, especially in countries with history or higher levels of travel. Flights from Ghana to Nigeria are on a daily basis with multiple options even through the land borders. The whole world is like a village. Ghana has successfully managed the outbreak. They now have a countdown of close to 42 days and the outbreak will soon be declared over if no new cases are recorded.

We have the capacity to diagnose Marburg in two laboratories; one in Abuja and another in the Public Health Network in Lagos Teaching Hospital. Among other pathogens, Marburg is what our technical group is keeping watch on, and visits have been made recently to some hospitals to identify the ones that can treat any possible cases.

Does the Nigerian economy affect the agency from carrying out its necessary preventive measures from neighbouring countries?

The government has been increasing NCDC funding since 2020 till date. Though it may not be enough to do all we want to do, there has not been a shortage of financial commitment to the agency. We are thankful to the executive and legislative arms for recognising the work we are doing towards the health security of Nigerians.

What are the causes of monkeypox and is it deadly?

There is only one cause of monkeypox, which is the virus called zoonotic. It is primarily found in animals. The virus has now adapted to humans and we now have human-to-human transmission. It is a self-limiting disease in most cases but is worrisome as it is in the same family of smallpox which has now been eliminated. The whole world will have to worry if it changes in any way that makes it cause smallpox virus.

It causes inconvenience and irritation for a while and one can recover but in the case of small groups, it can cause severe disease and prolonged hospitalisation and has led to death in some cases. We have had about seven deaths this year. It can be deadly if one’s immunity is suppressed by diseases or one is receiving cancer treatment following an organ transplant. It can also be deadly if one is suffering from both smallpox and monkeypox.

The treatment of smallpox has been licensed in some countries for monkeypox, which is not yet in Nigeria. Still, the NCDC is currently working with partners and manufacturers to purchase some doses of this really expensive drug that we can give to those people who are at the highest risk of diseases to prevent deaths in the country.

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John Oshioke

web developer, Content Writer

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