Bill Gates: Nigeria Should Invest in PHC, Disease Surveillance, Immunisation

Bill Gates is the co-Founder, Bill and Melinda Gates Foundation and the driver of the Goalkeepers Report, an initiative that tracks yearly progress made on Sustainable Development Goals across the globe. In this exclusive interview with Martins Ifijeh, he spoke on the need for Nigeria to invest in Primary Health Care, disease surveillance, and expansion of internet access for e-learning among children unable to get classroom education due to the COVID-19 pandemic. Among other sundry issues, he also spoke on the need for Nigeria to continue campaigns on immunisation against wild polio virus, emphasising that relapse on vaccination could result in resurgence of the virus in the country. Excerpts:

Every year, the Goalkeeper’s Report celebrates global progresses against poverty and diseases, but it appears in 2020, the progresses have stopped, especially in low and middle income countries like Nigeria where indices for poverty and diseases are worse off. What should Nigeria do to mitigate the impact COVID-19 is having on these important two areas?

It is true that the 2020 Goalkeepers Report is a less optimistic one than in a typical year-by-year report where progresses are made on literacy and child survival. Although these progresses are gradual, they are often very important.

We get to highlight the countries that are doing the best, so that other countries can adopt those practices and make their own progresses. But this is not the case for the 2020 report.

Here, we felt it was super important to highlight, not only the direct impacts of COVID-19 in terms of the deaths, but also the indirect effects, including on the health systems, such that progresses made in areas like vaccination rates have started going down. Sadly, we will see far more deaths from the disruption to the health system in Africa for other diseases than we will see for COVID-19 directly.

Exact policies on things like vaccination will have to be set by countries, and in some cases regions within countries. This will help put vaccination services back into place so that even children that are missed will get some of those vaccines.

The COVID-19 pandemic is forcing governments to make tradeoffs. This is a good reason for every country to make case for its primary healthcare and prioritise spending there. It’s also a time to make sure the spending is going to health workers doing the job. People say it is politically hard to get rid of waste, but the COVID-19 pandemic may provide people the strength to say ‘no, let’s focus on the funds on health workers doing the job; let’s focus on the location where these services are being provided; and let’s make sure all the monies are focused on health at this critical time.

Many countries are going into recession due to the catastrophic impact of COVID-19. What long-term measures should countries like Nigeria adopt if they must meet sustainable development goal by 2030?

Well, sadly, the world was not ready for this pandemic, and so the speed at which we are able to do the testing and come up with drugs and vaccines is much slower than it would have been had we invested in that preparation. Many of those preparations could have been done at a global level so that countries like Nigeria does not need to invent new vaccine platforms which should be funded by rich countries and then provide capacity to the entire world.

Nigeria should have good disease surveillance and understanding on how to get testing capacity ramped up, in case another pandemic comes along. The good news for Nigeria is that basic investment in the primary healthcare system is ongoing. That is there are locations where mothers can take their kids to for vaccination, and money is being targeted on primary healthcare, and many African countries have only managed to achieve this.

Is achieving the SDGs by 2030 still feasible considering what the COVID-19 pandemic has done?

Well, the SDGs have a lot of different targets. Our foundation was involved in making sure that the health targets, like the child mortality, neonatal mortality, maternal mortality, were set at a realistic level, although they were set before the pandemic.

So even if there is a challenge over the next two years due to the pandemic, countries like Nigeria must put health services back in shape particularly in the North where over 10 per cent or in some cases 15 per cent of children die before they clock five years. This really shouldn’t be the case if investment in primary healthcare is modest enough. This should not be like funding for hospitals where the funding is small and the impact is very high.

If we renew commitment to primary healthcare the right way, we will be able to see dramatic improvements, particularly in Nigeria, even if we fall short of the specific SDG goal.

Through the support of your organisation, Nigeria has been able to defeat polio. Do you fear for a relapse should government slow down on interventions, on immunisations and other measures against the virus?

It is a huge achievement that Nigeria got rid of wild polo virus. It required amazing work. In all the states, health workers went out to deliver vaccines.

You know, Aliko Dangote was a huge help to our Foundation, and was very generous in making that happen, just like he is doing with the Coalition against COVID-19 (CACOVID), but you are right that we are not done yet. We have a form of the virus called the vaccine derived polio that is in Nigeria and other African countries.

We have to do campaigns against that, and we have to make sure that the wild polio virus still existing in two other countries – Pakistan and Afghanistan – does not find its way back into Nigeria. Nigeria needs to make sure it has enough immunisations so that should it find its way into the country, it won’t spread very quickly.

So, we will, for some years to come, have to keep doing these campaigns; targeting both the vaccine-derived and this wild polio type 1 that is still in those two countries. State governors really need to think about primary healthcare and polio activities. These are key parts of the priorities.

Countries are going digital for school learning due to the COVID-19 pandemic.

But for a place like Nigeria where internet access is limited, and with over 10 million children already out of school even before the start of the pandemic, what other options do we have to ensure children are kept in school despite the COVID-19 situation?

Well, the educational interruption is tragic all over the world, and it will be very hard to catch up on that. For children up to 10 to 12 years, e-learning may not work so well, so classroom learning is still desirable. Even for the kids who are older than that, without internet with high quality connection on a large screen, they are still disadvantaged. Phone screen doesn’t work for a lot of e-learning.

So, in Nigeria, the availability of internet connections for the number of kids who have that type of compactible device is small. Even if we get the content right, which we need to do, and even if we train teachers, which we need to do, the portion of the students that can be reached with e-learning is still pretty small in Nigeria. So Nigeria needs to expand internet access to cover I do believe in e-learning. I think it’s very important.

It should expand, but mostly we need to end this pandemic through the use of the vaccine so that we can mostly go back to normal school activities, and simply where e-learning is an extra complement for some of the courses, where you can access a teacher who might have expertise that the local teachers do not have.