Nigeria not ready to tackle Ebola resurgence – Oyewale Tomori

Oyewale Tomori flaunts more than three decads researching viruses and how to rein them in from causing pains to societies around the world. So the Virology Professor knows when a system is armed to confront afflictions such as the Ebola Virus Disease. And in this interview with GBENGA OGUNDARE, the erstwhile President of the Nigeria Academy of Science delivers an unflattering verdict on the potential of Nigeria to contain a fresh wave of the deadly EVD…

The EVD is lurking around the corner again. Can we get lucky this time around if it strikes?

It will not be TOTALLY correct to say that our performance in controlling the 2014 Ebola outbreak in Nigeria was a matter of luck. It is essential to place the 2014 Ebola outbreak in its true perspective, so we can learn a lesson or two for the future. The 2014 Ebola outbreak in Nigeria, was a combination of both fortuitous circumstance and an eventual commendable but rare performance of our national disease control system. The “luck” element was that the Ebola case came in so sick to Nigeria, that he was rushed to a private hospital straight from the airport, and not a public hospital. Our public hospital system was paralyzed on the strength of our doctors’ strike. If he had not been so sick, the Ebola case from Liberia, would actually have passed through our border control system and gone on to Calabar, the site of his meeting. Just imagine the number of people that could have been exposed if he had gone to Calabar! Even, given the limited scope of exposure, we still had 20 cases and 8 deaths, before we brought the disease under control. This “small” outbreak compared to  the situation in Guinea, Liberia or Sierra Leone, resulted from a combination of factors – the laboratory confirmation of the case as Ebola Virus Disease, the rapid declaration of an emergency by the government, the setting up of an emergency operation center and the aggressive tracing of contacts. So to your question. Can we get lucky this time if it strikes? I will like to ask a more appropriate question. If Ebola strikes in Nigeria, can we rapidly and effectively control it as we did in 2014? My answer is more a No than a Yes.

Isn’t that an indictment on our disease control system?

If the source of the infection is from outside the country, and we detect it early, then I believe we will rally round and get it contained as soon as possible. We must commend the government for taking, so soon after the announcement of the outbreak in D R Congo, the first step by monitoring ALL travelers coming into Nigeria through our international airports. This is a right step to take, and the stuff preparedness is made of. However, I do hope that the check on travelers entering Nigeria is not limited to the international airports. We must extend such monitoring of travelers entering Nigeria, to our land borders, especially the seme border. I say No, because internally our disease surveillance is still not up to par. If there is an indigenous Nigerian case, that is originating from Nigeria, or an Ebola case should slip through any of the international borders and end up in a location far removed from our urban centers of Lagos and Abuja, then we could have a case occurring and not detected early enough before we have an outbreak or epidemic in our hand. The problem is with the poor state of our disease control system – detection, reporting, sample collection, laboratory diagnosis. It be appreciated that the National Center for Disease Control (NCDC) is making strenuous efforts to correct this national disaster. However it will take additional support, funds and political commitment, to repair the years of damage we have inflicted on our disease surveillance system

The fear is that the Emergency Operations Centers (EOC) that tackled the last episode might be caught unawares again.

This is a genuine fear. You will remember, that soon as we were declared free of Ebola, we folded up the Ebola EOC located in Yaba. We packed our bag and baggage, we closed shop and went to our different homes. Go to the place now, and see neglect in shambles. So complacent did we become that when Lassa fever came calling in 2015,it raged from August 2015 to April 2016, with 268 cases and 147 deaths in 23 states of the federation. Currently, we are battling with meningitis. Again according to the Nigeria CDC, we have recorded as of 17^th May 2017,    14,005 cases of meningitis with 1,114 deaths, since the epidemic started in December 2016. Data from our weekly epidemiological report show that we recorded 1176 cases of meningitis and 81 deaths in 2014. The figures for 2015 and 2014 are 2709 cases/130 deaths and 831 cases /43 deaths respectively. These figures tell us that our ability to control Ebola was more of a “one-shot-lucky-irreproducible” experience. We have not yet institutionalized what we need to bring any disease under control. Therefore, we may not be as successful in another episode of Ebola as we were in 2014. I want to believe that the fear of Ebola may ginger us to a more rapid response than we now have for Lassa fever and meningitis, two diseases that are now so regular in their occurrence that we have a national disdain and lack of respect for.

The Health Minister said there’s no budget for Ebola emergency. How will money not become a factor now that we are preparing–and when it eventually happens?

I have been out of the country for some time, and did not actually hear the Honourable Minister say that. If he did, he must be correct. However I know that, somehow we always have money for any emergency, from Ebola to flood disaster and from meningitis to cholera. We even have a penchant for making emergency preparation for the Olympic Games, even though we were given a four year notice. This is the wrong way to organize our life. What we need is money for PREPAREDNESS to avert disease epidemics. Preparedness is the insurance we have against the occurrence of disease outbreaks. The cost of preparedness is much less than the emergency money we often allocate to contain a raging epidemic. Most of such emergency funds end in wrong hands and pockets and not often used for the intended purpose. Preparing to control an epidemic rather than preparing to prevent an epidemic is much more damaging to our economy and the very life of our citizens. How much is the cost of each of the life of those 268 citizens who died of Lassa fever in 2015, or the 1,114 (and still counting) Nigerians who have already died of meningitis this year. If instead of locking up local and foreign cash in millions in buildings and apartments, we rather provide a percentage to the NCDC or NPHCDA or other agencies that work for disease prevention, our country will be a better place and we will not be running all over the place in panic, at the mention of the outbreak of a disease in any part of Africa, or the world.

ALSO SEE: World prepares as Ebola returns

Has Nigeria been doing anything by way of research and development since the last outbreak?
My answer to that question is… “For where?” As a nation, we have forgotten the disaster of Ebola, as we soon forget the disaster of meningitis (at least until next year). Therefore tell me who does research and development on the forgotten? Who cares about research and development on matters that affect the poor, the vulnerable, and the discarded and displaced populations of Nigeria? Who wants to spend money in such unimportant issues as the health of the masses, when such money can be looted and stored in air conditioned apartments for the use of the privileged leaders of our great country? Who cares about the health of the ordinary Nigerian?  Who cares about who dies, so long he or she is not an honourable and rich representative of the poor. Ebola, Lassa fever, and ordinary meningitis are diseases of the poor, the neglected and suffering populations of Nigeria. It is below the consideration and distinguished and esteemed leaders of Nigeria to think of doing something positive about them. Who really cares? Yes, we do have a few centers and research institutes in one or two of our universities and in private set ups, that are conducting research on Ebola and other disease agents, but they are almost completely funded by external grants and funds. Nigerian government contributions to such ventures is best described as insignificant. Do I sound angry at such a simple question on what we are doing about research and development? No, not at all, I am just INCENSED and INFURIATED!

Is the VSV-EBOV vaccine available in Nigeria–or the FG team will wait until it strikes here and WHO decides to send it?

The vaccine is not available in Nigeria. There is an Ebola vaccine that is approved for use under a clinical or research trial protocol and emergency use licensure. It is important to note that bringing the vaccine to the market usually takes at least 7 years. However, because of the severity of  Ebola disease, bringing the vaccine to the market is being accelerated, but still may take more than 1 to 2 years. Therefore should there be an Ebola emergency in Nigeria, we will have to approach the WHO for a decision on the use of the vaccine in Nigeria.

Remember the polio outbreak. Nigeria was close to being declared polio free by theWHO, then we had more polio cases. Isn’t this frustrating?
It was certainly frustrating. But we were responsible for our frustration. We allowed the political class to dabble into what was out of their sphere of authority. We allowed then to prematurely announce that Nigeria was ready to be declared free of polio. For political gains, they added to the “Ebola” success, a campaign announcement that Nigeria was now ready to be declared free of polio, as another dividend of democracy. At the time of the announcement, Nigeria still had two more years of zero wild polio reporting to go. In addition, we had a part of our country of which we had no information of what was going on there, because it was inaccessible for health interventions- vaccination and surveillance. All attempts to correct the error failed. So we rode on the complacency of false zero polio report, as many of our Governors and LGA, under the illusion of polio freedom, refused to provide the political commitment and financial support needed to complete the job of polio eradication. So naturally, polio came back, and we are now back in the league of polio endemic countries, and our partners are Pakistan and Afghanistan!We have on several occasions, in many of our activities, celebrated victory before the final whistle is blown. Was I frustrated, yes, but not because polio came back, but that we failed to convince our leaders that the polio end game was not yet in sight for Nigeria. I had predicted that polio would resurge, and my greatest surprise would have been if we did not get polio after our false declaration. . Even now, no one can tell when Nigeria will eventually be polio free. That will be determined by when we have access to all, each and every part of Nigeria, and we can vaccinate our children and conduct reliable surveillance. We will require the military to render those parts of the country accessible for health intervention. We will also require the sustained and vigorous commitment of our leaders at the executive and legislative levels to know that Nigeria is NOT yet polio free and provide what we need to complete the job of polio eradication.

What would you say about conspiracy theorists and medical doctors who believe the rich developed the germ to reduce the population of the world’s poor people, especially that Ebola and Lassa fevers research is being funded by the rich?

I will say it is all NONSENSE. We are doing our best to reduce our own population by not taking care of our health, by letting diseases – measles and other preventable diseases – kill millions of our children, by killing our mothers at child birth, by ending the life of many of our citizens on the bad roads, by our leaders, the custodians of our natural and human resources. They turn our country in automatic teller machines (ATMs) where they and their offspring, take and steal money, without the need for a PIN.  These are what we should be worry about and not some conspiracy theories initiated by the very same people who are looting our resources. It is unfortunate that we are in the same planet with those who are funding research on Ebola and Lassa. I am sure they wished we were in our ownseparate planet, where Lassa, Ebola can decimate our populations, unhindered. Because we live on the same globe, those who are funding Ebola and Lassa research are doing it, also for their own benefit – to ensure that should Ebola or Lassa stray into their own countries, they have the needed drug and vaccine to combat it. They are also trying to protect their economy and the source of raw materials for their industries. Will you send your national airline to a country where Ebola is raging?  Will your national company continue to extract crude oil or essential minerals from the mines of an Ebola infected country? So let us forget all these garbage about conspiracy theories and find solutions to our self-inflicted problems.