The Nigerian Centre for Disease Control is mandated to coordinate some of the nation’s health responses and intervention activities. In this interview with Winifred Ogbebo, the Director of the centre, Prof Abdulsalami Nasidi speaks on how the centre is supposed to prevent the frequent emergencies and outbreaks the country is grappling with, and also, control the spread of diseases.
How far has the centre gone in achieving this?
So far the centre has been established under the directive of the president, which is situated in Abuja, and presently, the centre is conducting activities like manpower development. We are training people to get masters in public health. The programme is ongoing because we are collaborating with the University of Ibadan and Ahmadu Bello University (ABU).
We are now enhancing our epidemic response activity. We are making it more timely, coordinated and assisting the state to reduce all the response time to our emergencies.
We play the key role in all these emergencies, in the bomb blast crashes and our aim is to provide Nigeria with a system that can reduce the impact of all these emergencies, prevent them if possible, and mitigate their impact and of course, empower the country to respond faster and improve the efficiency of our response activity.
What are the challenges to our prompt response to epidemic?
First is our ability to detect those epidemics. So we are now working to strengthen our surveillance system to detect them early and nip them in the bud. That is one hurdle, working to improve the system of surveillance and response.
Two is our ability to diagnose, to ascertain what exactly the nature of the epidemic is like. Let’s say, this is lassa; we should be able to say it is the same kind of virus that was causing lassa before. So we should be able to tell the government that this outbreak is caused by this pathogen and what we need to do.
Thirdly, we should be able to provide the country with effective health intervention programmes, and which will be most desirable in the circumstances.
We should be equipped to tell the government, for instance, which HIV/AIDS treatment is working or not and if it should be changed, improved upon or something like that.
The NCDC will be carrying out operational research to improve our health intervention activities. We should be able to conduct research on pathogens causing the diseases. We should be able to monitor the HIV/AIDS virus, lassa fever virus, bacteria that cause TB to know if it’s the same or its changing.
We are not inventing the will to develop or manufacture new drugs, but rather do research to see if the drugs already developed are really working in our own environment.
We should also be able to monitor research institute and see how we can assist them to do the right thing, check their protocol, design and then work with some of these ethical groups to ensure that nobody actually comes into this country to start doing research without doing the right thing. We should be able to protect our research findings, and protect our materials. For instance, someone can just come into Nigeria, gather materials, take it abroad, do research and there is no follow up.
Now with NCDC, no one can do research in health without coming to us, and then we sign what is known as Nigerian transfer agreement, and do the research together or any findings you have there, we share the benefits. So we have to position our scientists and workers in the area of health to compete with their counterparts abroad, work with them, and any outcome from such research must be shared, not that they will just take the benefit away and we will have nothing.
We should be able to position centres to raise funds. CDCs do raise funds for researchers. We are supposed to be working with the minister of health, science and technology to raise funds to fund our researchers in the various universities and research centres to conduct specific research into areas of public health we think we want to improve.
Lastly is in the area of manpower. All CDCs work so hard to develop appropriate manpower for specific responsibilities. For instance, with the Dana crash, we should be able to do DNA matching and we should be in a position to offer such services. We are not reinventing the will, but what we are doing is pulling together all those activities that are done haphazardly into this centre, coordinate them and provide the country with better services.
Are we equipped to handle detection and diagnosis of virus, or a specific epidemic, especially when we consider the lead poisoning detection done abroad?
This is because when it occurred, the people that actually detected the lead poisoning are ministry of health workers of Zamfara themselves, before calling the MSF,and all the MSF did was to take the sample to test and confirm that its lead poisoning. But it was Zamfara State ministry of health that confirmed that the outbreak was associated with the mining, but they did not know which of the heavy metal was causing the outbreak. So you can see that in the real sense, it is a joint effort, but unfortunately, it is not seen like that and it is portrayed that only one side has done it.
We have equipment to test for lead and heavy metals in Nigeria, but they are all scattered and nobody has that information, so now CDC is now to coordinate, and get a coordinating centre where people can get information on where to acquire services, like where they can get DNA sequences, give information on where to get quality assurances and how these things are being done, and develop standard operation procedures on how centres can do these things.
What is the latest on the Zamfara lead poison situation?
The president established a committee which is made of the ministries of mines and steel, health, science and technology, labour and environment which met last week. This committee is tasked with how to get this N850 million out. The minister has realized that we cannot leave these to foreigners to handle, but that we need more money, so we have submitted proposal to the president, to the government and in return, they have created an office, and the secretary to the government of the federation, has directed that the health response aspect be handled by NCDC. So we already have a focus to handle that issue. The mining aspect is going to be handled by the ministry of mines and steel, now there is a presidential directive that it must be coordinated.
So the lead poisoning is a continuous activity because the mining will not stop, rather, it is now expanding as people are now aware that they can get gold from Zamfara. Before the area was limited but now its widening, resulting in continuous poisoning. So we have to definitely roll out a short, medium and long term strategy on how to protect not only the children but the people in Zamfara, and other mining areas in Nigeria from these metal poisoning.
We intend to do remediation which is removing the surface that is already contaminated and replacing it or relocation or use the money to provide drugs to treat those already affected.
What is responsible for the delay in the release of the funds meant for the remediation exercise?
This is one of the issues that the five ministers will be discussing when they meet next week, and we will conclude on how to get the money out without any more delay, especially as more people will continue to die.
What is your take on giving monies to the communities to do their own remediation instead of companies who will charge more?
One of the major objectives of establishing the NCDC is to encourage local efforts and empower communities to do what they can do, that is already ongoing, the states are already doing the remediation, the local government are participation. We want to empower the state to start treatment of these patients themselves, because kelation, which is getting the lead out of the body, is mostly done by MSF, but we want the state and local government to start doing it within the next two months or so, and that is what that money is going to be used for because currently, all the monies used for kelation is provided from abroad which is unfortunate. Nigeria government has now come in and they have directed that monies should be released, and we are going to ensure that it gets out.
In the area of surveillance and alerts on epidemics and outbreak, how equipped is the centre in that, especially since the country is experiencing resurgence in TB and other Tropical diseases?
There are several centres that do TB in Nigeria, those who concentrate on purely TB issues. We have the TB centre in Zaria which is the leading centre. We have the Institute of Medical Research, and various aspect of the TB response. So TB is not a new outbreak but an upsurge in areas where you have increased levels or incidences of HIV/AIDS or hunger, where you have people with reduced immunity. These things happen where you have poverty. With HIV/AIDS positive person, you will get the upsurge of TB, so it is not new that this is what is happening. All we need to do now is how do we identify these areas where we will have these upsurges, try to prevent such an upsurges, and where it is already happening, to mitigate the impact to reduce the number of people dying from the upsurge.
So the NCDC functions is not to actually report these upsurges but to identify areas where we might have such upsurges and come up with health interventions that would mitigate impact and if possible, prevent it from happening.
So our laboratory in Zaria, under the NCDC, is a sophisticated P3 laboratories worldwide capable of doing the Multi Drug Resistance TB research, and also capable of monitoring such MDR in the population, and stop it.
Because before you ensure such an alert, you must do so properly. You must have base line data and information which we are gathering, but we need funding to facilitate the process. The MDGs office is helping and we are getting regular funding, so very soon these alerts will begin, and we will commence public health education to alert people on what they need to do to prevent TB under our communication health strategies.
When will these alerts begin?
Presently, we are concentrating on manpower development, but soonest these alerts will begin and we will be collaborating with the media to carry out these functions.