In 2014, Nigeria experienced an outbreak of Ebola virus disease. In our country where warm greetings are the norm, Ebola changed our reality as people no longer shook hands or hugged. Several businesses and schools closed down, organisations (banks, etc.) that stayed open had buckets of water and hand sanitisers for their customers. Most people lived in fear of the unknown.
The number of infectious disease outbreaks in the world has increased significantly over the past 30 years. As global trade and travel increases, so does the international spread of disease – and so does the economic impact of outbreaks. Nigeria’s tropical climate, population density and the porous borders means that our collective vulnerability to the societal and economic impacts of infectious disease crises is increasing. We could be one flight away from the next pandemic.
Since the 2014 Ebola outbreak, Nigeria has experienced other large outbreaks of infectious diseases such as Lassa fever, meningitis, yellow fever, measles and cholera. More recently, Nigeria has again been in the news for ‘exporting’ monkeypox cases to the United Kingdom. This highlights how our interconnected world leaves us all at risk of the next Ebola outbreak in Nigeria.
Although Nigeria’s response to the Ebola epidemic in 2014 was described by many as “robust and decisive – attracting commendations from several international partners”, yet, we can not afford to be complacent as we are actually not as prepared as we need to be across the totality of our health systems.
In 2017, a Joint External Evaluation (JEE) of International Health Regulations, an internationally accepted evaluation tool for health security, showed that Nigeria’s level of readiness stood at 39%. The same process carried out in 2019 showed an improvement in the score to 46%. Despite clear evidence that prevention is more cost effective than response, we remain trapped in a cycle of panic and neglect. We tend to spend money to respond to outbreaks when they occur but fail to sustain investment in preparedness when the panic subsides.
During the 2014 Ebola outbreak in Nigeria, several private sector players showed a keen interest and support for health security. From paying for staff time at Emergency Operations Centres (EOCs) to procuring vehicles and donating Personal Protective Equipment, the private sector rallied around to support efforts of the Government of Nigeria. Infact, Nigeria’s highly acclaimed successful response could not have been possible without the critical role of the private sector. Historically, our response to infectious disease outbreaks has been reactive with limited private sector engagement, and it appears that since the crisis ended, we have all gone back to sleep. We must however realise that we can do much better and must not wait for the next Ebola outbreak.
The Government of Nigeria seems to have increased its own engagement in contending with Public Health Emergencies through the agency of the Nigeria Centre for Disease Control (NCDC).
In 2018, NCDC led the development of a National Action Plan for Health Security. This is a comprehensive multi-sectoral plan that established a projected cost of 81 billion naira to ensure Nigeria builds the capacity to prevent, detect and respond to infectious disease outbreaks over five years. In 2019, NCDC’s budgetary allocation was only one billion naira only. In the unlikely case that this was multiplied by ten, the country’s national public health institute would still not have the funds required to protect us from outbreaks. This further highlights the need for public-private partnerships.
It is very obvious that private sector and businesses are at a high risk of severe losses when there is a major outbreak. Therefore, the private sector needs to be proactively engaged in building a strong and resilient health security structure, and not sit on the fence. Investment in issues such as roads and bridges are seen as more viable that in vulnerable health systems. The private sector has a critical role to play in response to outbreaks.
Trust can be improved between the public and private actors. Improving cooperation and mutual learning provides a long-term approach to trust building. NCDC has begun to do this through the establishment of the Alliance for Epidemic Preparedness and Response (A4EPR), and I was privileged to have anchored the Public Launch of the A4EPR Platform in Lagos, in 2018. The A4EPR is a platform set up in collaboration with the Private Sector Health Alliance of Nigeria to ensure transparent engagement by the government and private sector for disease outbreak control.
Building bridges, buildings and roads bring obvious gain such as visual recognition and popularity. However, we must also change our mindset and see the benefits in proactive investment in health security. We can think of this in three ways.
By addressing known challenges such as weak surveillance and laboratory systems, we build mechanisms before a crisis strikes to facilitate a rapid, well-coordinated response. The private sector can be more involved in supporting agencies like NCDC to strengthen preparedness. We do not know what or when the next pandemic will be. However, all countries including Nigeria remain at risk of this and we must be better prepared.
There is value for money and life when there is investment in health security. Given the primary goal of profit making for several businesses, investing in outbreak preparedness and response is also an investment in business growth and continuity.
Investment in health systems creates a high level of trust among community members, which could be a potential cause of conflicts during large outbreaks. The Ebola outbreak in the Democratic Republic of Congo is a clear example of how mistrust can exacerbate outbreaks. By working closely with the government, the private sector builds the potential to gain increased trust in communities.
As NCDC works with intensity to build key capacities to strengthen national health security, the private sector needs to actively and sustainably get involved, in order for Nigeria to make the much needed progress in this vital area of our national life.
Adeseun, head of public health in Africa at IQVIA, is based in Lagos. Email: remi.adeseun@iqvia.com
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