Responding to Disease Outbreak

In a country prone to disease outbreaks due to poor healthcare and its corollaries – high mortality rate, late reportage of cases, and poor diagnosis of illnesses – there seems to be a glimmer of hope as the Nigeria Centre for Disease Control commences the establishment of State Public Health Emergency Operations Centres in 18 states of the federation. Martins Ifijeh writes

It is common knowledge that Nigerians are exposed to countless severe conditions that are largely politician-made. As they say, in Nigeria, when it rains, it pours. This is what plays out during disease outbreaks in the country, resulting in high level of casualties.

For instance, during the worst Cerebrospinal Meningitis (CSM) outbreak in the history of Nigeria between 2016 and 2017, at least 14,542 suspected cases were recorded, leading to 1,166 deaths. Of these cases, only 1,006 samples were tested, which highlights a very low sample testing capacity in the country. Also, 37 local government areas reached the epidemic threshold at the time, thereby showing several gaps in preparedness and response to CSM, and other infectious diseases.

In the same vein, in February this year, Nigeria recorded what could be described as the biggest Lassa fever outbreak its history, with a total of 2,845 persons placed on red alert, while at least 317 laboratory cases were confirmed. Between January 1 and February 28, 2018, the outbreak spread to 18 states, killing 72 persons, according to figures released by the Nigeria Centre for Disease Control (NCDC).

Public Health Emergency Centres
Global health experts believe one of the ways to address death and high incidence of disease outbreak is effective public health emergency response, as seen in many developed countries of the world.
Thus, with the recent plan by NCDC to establish Public Health Emergency Operation Centres (PHEOC) in at least 18 states of the federation, there is hope of changing the narrative; a strategy that will strengthen the capacity of states to respond to disease outbreaks more effectively while NCDC remains a supportive and coordinating point for the centres.

Specifically, the 18 centres will serve as facilities for multi-agency incident command and control structures which will help NCDC streamline the coordination of disease outbreaks and response to incidents and events of public health importance.

Bayelsa PHEOC Kicks Off
NCDC has kicked off the planting of the centres, starting with Zamfara, the Federal Capital Territory and Bayelsa, with the hope that within the next six months, other centres in the country will be fully active and ready to any combat disease outbreaks head on.

Speaking during the commissioning of the PHEOC in Bayelsa State, Chief Executive Officer, NCDC, Dr. Chikwe Ihekweazu, said the idea behind the establishment of the centres was to strengthen disease surveillance, response and coordination across the country, adding that this will aid in reducing deaths occasioned by outbreaks of CSM, Lassa fever, Cholera, Monkey pox and Yellow fever.

According to him, “In 2017, Nigeria faced one of its largest outbreaks of CSM caused by a relatively new sero-group. At the time, the epicentre of the outbreak was in Zamfara State where late reporting and detection of cases had contributed to high morbidity and mortality from the disease. Subsequently, the country has experienced outbreaks of Lassa fever, cholera as well as a resurgence of yellow fever and Monkeypox.

“A pivotal foundation for outbreak response activities is coordination. Unfortunately, many states across the country have performed below par in responding to disease outbreaks, including coordinating activities at various levels of government and partners.

“Against this background, the NCDC has begun a project to establish state PHEOCs. These centres will serve as facilities for multi-agency incident command and control structures during outbreaks. Our goal is to streamline the coordination of outbreaks and response to incidents and events of public health importance. With these centres, states have a strengthened capacity to monitor, detect and respond early to disease outbreaks in the country.”

Extension

On plans for extension, Ihekweazu noted that since the start of the project in January 2018, state EOCs have been established in Zamfara, FCT and Bayelsa State, adding that over the next few months, this will be extended to 16 other states in the country. He said NCDC’s priority currently was in states without EOCs, adding that with an increased risk of infectious diseases, it is very important for every state government to take ownership of coordinating its outbreak response activities.

“Each state EOC is networked to the NCDC Incident Coordination Centre and a weekly coordination call is held to ensure communication lines are always open. By the end of 2018, we hope to have reached 18 states in the country and built a stronger health emergency preparedness and response capacity in Nigeria,” he added.

Ihekweazu explained that the role of NCDC in enhancing Nigeria’s preparedness and response to communicable diseases outbreaks is aimed at reducing adverse impacts of predictable and unpredicted public health emergencies. Adding that national strengthening of this capacity requires inclusive and collaborative approach with state public health departments as a major stakeholder.

According to him, a number of strategies have been put in place at the national, including instituting multi-agency incident command and control mechanisms during outbreaks, setting up diseases specific technical working groups and providing strategic capacity building opportunities for personnel.

“At the states level, there are varying emergency response capabilities both in terms of burden of diseases, manpower availability and the readiness to act in a coordinated manner when required,” he added.

On his part, the Team Lead, PHEOC, Dr. Everistus Aniaku, says establishment of the centres will be in phases, noting that the first phase which must have been commissioned by NCDC by the end of July this year includes six priority states, which are; Zamfara, FCT, Bayelsa, Cross Rivers, Enugu, and Ebonyi State.

He stated, “We have fully established and commissioned three centres now which are the Zamfara, FCT and Bayelsa. In two weeks’ time, we will be commissioning that of Cross River, then Enugu and Ebonyi will follow almost immediately.
“The second phase which is already been put together for commissioning includes the PHEOCs in Kebbi, Nassarawa, Ondo and Lagos state. Our CEO, Dr. Chikwe is very passionate about addressing all issues regarding disease response and coordination in the country, hence we are optimistic that he will lead us into establishing all 18 PHEOCs by the end of this year.”

According to him, for each centres established and commissioned, NCDC will not only equip the facilities, but trains the PHEOC staff on capacity building, while also supporting with other structures needed to run an effective and functional PHEOCs.

With the proposed establishment of EOCs across the country, Nigerians are hopeful they will no longer lose their loved ones to the incessant outbreaks in the country.