Making Nigeria safe from common diseases

The fact that Nigeria has been good at reporting outbreaks, mortality, and morbidity from diseases instead of promoting prevention engaged our attention the other day. And the follow-up today should be that there is a need to make the country safe from common diseases. 

Again, while Save the Children Ambassador, Cuppy Otedola (a.k.a. DJ Cuppy), has promised that the over N5.1 billion raised recently at a gala night would be given to Save the Children to tackle malnutrition and pneumonia, which WHO defines as an inflammation of the lungs caused by bacteria, viruses, and fungi.

Accordingly, the disease claimed the lives of 162,000 Nigerian children in 2018, the highest number of pneumonia deaths globally; with India 127,000, Pakistan 58,000, Democratic of Congo 40,000 and Ethiopia 32,000 deaths. This is despite the fact that available data also approximate that 1.35 million children’s lives have been saved by Hib and pneumococcal vaccines in Nigeria since 2000, and currently, Hib and pneumococcal vaccines are on Nigeria’s immunisation schedule for children. It was introduced in 2014 by the Federal Government through the National Primary Health Care Development Agency (NPHCDA).

The agency introduced the Pneumococcal Conjugate Vaccine (PCV) and Pentavalent1 into the routine immunisation schedule. While PCV protects against pneumococcal disease, an infection caused by the bacteria Streptococcus pneumonia, which can lead to pneumonia and meningitis; the Pentavalent vaccine is a combination of five vaccines-in-one that prevents diphtheria, tetanus, whooping cough, hepatitis B and Hib, all through a single dose.

The significant role of NPHCDA in the introduction of Hib and PCV into the routine immunisation is acknowledged, but it mainly addressed the supply side, which may account for why Nigeria still contributes to child deaths from pneumonia and meningitis. Therefore, NPHCDA and other relevant stakeholders should step-up strategic healthcare interventions to promote optimal health-seeking behaviour by under-5 caregivers, including creating demand and increasing uptake of Hib and PCV, particularly through social mobilisation and mass media communication strategies. 

It is also important that media campaigns expose caregivers to the timetable for vaccines; and the need to complete the recommended doses, with the first dose administered at the sixth week of birth – Hib 1 and PCV 1, which protects the child against influenza and partially protects against most causes of pneumonia and meningitis including blood and lung infections and brain damage respectively. At 10 weeks of age, a child is vaccinated against Hib2 and PCV 2; 14 weeks of age, Hib and PCV 3, which prevents influenza and prevents pneumonia and meningitis including blood and lung infections and brain damage. 

Similarly, communities should be inspired to take action to prevent pneumonia by demanding for Hib and PCV from duty bearers; while civil society organisations (CSOs) and professional bodies should educate caregivers on their responsibilities in bringing down the prevalence of pneumonia; and also mount public enlightenment campaigns to raise awareness in the communities. Wives of public office holders, community leaders, faith-based organisations and kinship associations should raise awareness, especially on the uptake of Hib and PCV.  Also, individuals should practice quality sanitation, increased personal hygiene, especially those that are handling under-five children. Thus, citizens should imbibe the culture of hand washing, especially critical times (after using the toilet and before cooking food for these children). People should ensure they parboil water before drinking; and avoid cooking food inside house, so that smoke will not damage the children’s lungs.

Finally, for a total eradication of pneumonia, Nigeria should serve every child who is vulnerable to the disease and ensure that high-quality treatment is available to all who need it. So, the human resource challenges that the health system face (in terms of staff numbers and skills); and the monitoring and evaluation systems should be addressed to strengthen the supply side of the equation.

On containing YF, although, the National Yellow Fever technical working group (TWG) activated the national Incident Management System (IMS) to coordinate the response activities, on September 5, 2019; Nigeria should focus on prevention rather than rapid response to outbreaks, because YF is completely a vaccine preventable disease; and vaccination is the most important means of preventing the disease. The vaccine is free in Nigeria, when given as part of a childhood routine immunisation schedule and one shot protects for life. Anyone nine months or older should be vaccinated against Yellow Fever. So, every family should ensure that children receive all their childhood vaccines.

Although, one dose of Yellow Fever vaccine provides long-lasting protection, during outbreaks, those vaccinated against yellow fever 10 or more years ago, should get a booster dose of the vaccine. This may account for why during outbreaks or preventive campaigns, the target age group of nine months to 44-year-olds is given a shot since it is not known whether they had it. Also, for those who travel to YF risk areas, the vaccine should be administered at least 10 days before travel. Specifically, hikers, park visitors and people engaged with activities in the wild areas are encouraged to be vaccinated against Yellow Fever.

On vaccination, it would be recalled that in 2018, the World Health Organisation (WHO) pledged a yearly donation of 20 million doses of vaccines to eradicate yellow fever in Nigeria; which was aimed at assisting the country in achieving the total vaccination of the populace, in line with the global Elimination of Yellow Epidemics (EYE) by 2026.

However, reports have revealed that only 10 out of the 36 states have already been covered with YF vaccines, with persons aged nine months to 45 years vaccinated within the past two years, and about 35 millions Nigerians out of about 200 million vaccinated since the YF outbreak started in September 2017, through reactive and preventive mass campaigns. This implies that WHO’s donation of YF vaccine is a drop in the ocean.

This could partly account for why adult Nigerians cannot access the supposedly free preventive vaccine at health centres; making YF outbreak in Nigeria a recurrent annual decimal and Nigeria a high-risk country. So, while the Yellow Fever vaccine intervention by WHO is commendable; it is important to point out that WHO is only giving fish to Nigeria, instead of teaching Nigeria how to fish.

Obviously, a fact that adult Nigerians cannot access the YF vaccine is a deficit that requires credit to fill the account. Therefore, at the moment, that should be a major concern not just to Nigeria, but the global health body – WHO, since containing YF lies in prevention. Hence, instead of focusing on just donating vaccines for YF in Nigeria, WHO should also lead a vaccine and treatment research and fund the same, particularly since the Federal Government in 2018 said Nigeria is set to resume local production of vaccines after 27 years. This is aimed at having home-grown solutions that are sustainable, which will in turn help in curtailing outbreaks and protecting against the spread.

Besides, strategically preventing of YF requires collaboration between town and gown. As such, the Federal Ministry of Health (FMoH) should set evidence-based and contextual health agenda while working with multilateral organisations, as they work based on cooperation with national governments. 

Therefore, FMOH should engage WHO with the issue of local production of vaccines as the nation’s health agenda. Again, the Federal Ministry of Health; Centre for Disease Control (CDC) in Nigeria; Nigerian Institute of Medical Research; Institute of Human Virology, Nigerian; Research and Development units of health-related organisations such as pharmaceutical companies and universities, especially the graduate students, should reach out, collaborate and engage in a well-coordinated manner to search for solutions through research.