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The Threat of Eemerging Infectious Dideases: How Prepared is Nigeria
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n 1969 a disease characterized by high fever, muscle aches, mouth ulcers, and bleeding in the skin emerged in a village near Jos. Several people died and their was panic in the land. The causative virus was found to be harboured by a rat, Mastomys natalensis. It is spread to humans via the rat's urine in airborne droplets or contaminated food; however, the most feared means of transmission was by medical personnel treating patients in hospitals. This was later named Lassa fever, after the village in Nigeria where it first emerged.
Since then the emergence of HIV, Legionnaire's disease, Ebola haemorrhagic and several others where all warning signs to the world on the continuing threat caused by emerging infections, however it was the emergence of diseases like SARS, Avian Influenza and to an extent Anthrax after 9/11 that reawakened the consciousness of the world to the danger these pose. Since then countries have reacted with various levels of intensity to protect their populations.
Influenza pandemics have occurred regularly throughout the history of mankind. In the two pandemics in 1957 and 1968, the casualties were in excess of 6 million worldwide. The WHO and the wider scientific community believe that we are as close to the next pandemic as we have been any time in the past 37 years. The rapid spread of SARS from Asia to Canada, has shown that the ease of international travel and our own tendency to travel to all the nooks and corners of this world, makes Nigeria potentially an extremely fertile ground for the explosion of an infectious disease such as SARS.
The key to not being overwhelmed in the first wave of a global infection is to plan very carefully and thoughtfully while there is still time. European countries have been busy preparing pandemic preparedness plans, partly in response to this threat, by setting up a pan European Centre for Disease control in Sweden later this year. Several African countries including our neighbours Ghana have established Field Epidemiology training programmes, yet the silence in Nigeria has been deafening.
The question is: can we afford to ignore this threat. Since we are barely coming to terms with the financial and infrastructural requirements to deal with the HIV/AIDS epidemic, and only just being rescued from the quagmire into which we put the Global Polio Eradication Programme, should the threat of the emergence or re-emergence of infectious disease be a priority for health care resource allocation? I dare say that if we ignore the threat, we might yet pay a very high price.
With a population of more than 126 million, Nigeria is Africa's most populous country. With poor health care and millions already weakened by AIDS, the consequences would be devastating should such a virus spread here. Our response to the rumoured case of SARS in Nigeria in 2003 is a case in point. Lacking any central mechanism to deal with threats of this nature, the then Minister of Health quickly set up an "Inter-Ministerial Committee on the Prevention of SARS". Rumours made their rounds on the massive procurement of special masks, gloves, protective gowns, infrared digital thermometers, spray machines etc. if these things were indeed procured, where are they now?
Although actions like quarantine, isolation, port-of-entry screening are often the most visible tools used in controlling the spread of emerging infectious disease, the most important aspect of these is to plan ahead. As of today in Nigeria, there is no official technical agency, in the mould of the Centre for Disease Control (CDC) in the States or the Health Protection Agency with the human, technical and infrastructural resources to react to emerging infectious diseases. This responsibility is saddled on the technocrats in the Ministry of Health. Within the ministry is a Public Health Department that manages a series of vertical disease specific programmes. The only ones that can justifiably claim to be engaged in any visible activities are primarily driven by donor funds. No active coordination between the federal level and the states is existent. If tomorrow we had to vaccinate front-line personnel for an emerging epidemic, who would be decide what front-line personnel to vaccinate first and how many. Do we start with doctors, the police, or maybe the army? Who will manage and coordinate the process? A new "Inter-Ministerial Committee"?
In addition to the threat of emerging infectious diseases, outbreaks of cholera, cerebrospinal meningitis, measles, and yellow fever occur regularly in Nigeria. While we might have been socialized to believe that this is a normal part of life, this most definitely should not be the case. WHO reports that 250,000 new cases of tuberculosis detected were detected in Nigeria in 2001 and 120,000 have gone blind from onchocerchiasis. All these diseases combine to cause high morbidity and mortality in the population and the one thing they all have in common is that they are all entirely preventable by established means, and have been for several years.
In conclusion, while we invest considerable resources in the modernisation of our teaching hospitals, and in scaling up ARV treatment programmes for people living with HIV/AIDS, we need to remember the not so glamorous infectious diseases. Surveillance, outbreak investigation and control are public health functions representing the first link in a chain of activities aimed at countering infectious viral and bacterial agents. Prevention often involves simple means to interrupt the transmission process of an infectious agent. For these activities to be successful, we must think of them now, or our predisposition to panic reactions might make the aftermath of the Ikeja ammunition dump explosion seem like child's-play.
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The Threat of Eemerging Infectious Dideases: How Prepared is Nigeria
