Background

On February 27th 2020, the Nigerian Federal Ministry of Health (FMOH) confirmed its index coronavirus disease 2019 (COVID-19) case in Lagos State, its commercial capital with a population of over 16 million. Following the successful establishment and management of the Emergency Operations Centre (EOC) during the Nigeria Ebola Virus Disease outbreak of 2014, the Nigeria Centre for Disease Control (NCDC) set itself the goal of establishing Public Health Emergency Operations Centres (PHEOCs) to serve as epidemic intelligence hubs across the country,  to enhance coordination of emergency responses to public health events, and for effective communication and efficient resource management during any incident. By December 2019 NCDC had established PHEOCs in 22 out of its 37 States

Practice Development

NCDC set up a Coronavirus Preparedness Technical Working Group (TWG) on January 23, 2020, which developed a Pre-incident Action Plan as a readiness measure. PHE’s IHR Project was not just a member of the TWG together with other stakeholders, but also worked in collaboration with UK-PHRST to help develop initial diagnostic capacity for COVID-19 in the country.

The NCDC Director General (DG) was a member of a 25-member panel of experts on the WHO-China Joint Mission on COVID-19. The learning from this visit was shared with stakeholders (including the IHR Project) and senior NCDC management by the DG.

NCDC with the support of WHO Nigeria subsequently planned and conducted a Table-Top Exercise on 27th-28th February 2020, to test the Pre-Incident Action Plan, with participation of the IHR Project. Following the confirmation of the index case, the Preparedness TWG was stood down and a multi-sectoral Emergency Operations Centre (EOC) was activated at Level 3 – the highest emergency level in Nigeria – led by NCDC, on 28th February 2020.

The IHR Project continues to actively participate in the National EOC meetings and general COVID-19 response activities with specific input into multiple areas, including coordination, laboratory diagnosis, human resources, epidemiology, psychosocial support, Laboratory Biosafety and Infection Prevention and Control, providing strategic support to the Incident Manager and membership of the DG Support Group.

The recognition of increasing number of confirmed cases across the country, signifying a change from clusters of cases to community transmission, led to the conduct of a Mid-Action Review on March 9 2020, with PHE IHR Project’s Senior Health Adviser for Nigeria as a member of the planning team. The outcome of this was a revised Incident Action Plan at national level.

As of 23 September 2020, a total of 494,577 laboratory tests have been conducted with a cumulative 57,724 confirmed cases in all 37 States in the country and 1,102 deaths, with a Case Fatality Ratio of 1.9%%. Nigeria is participating in the WHO Solidarity Trial of COVID-19 Therapeutics and is also interested in vaccine clinical trials. The country has established a research consortium with membership from local and international stakeholders and organisations including UK PHRST.

Key Learning

There are several lessons learnt from the pandemic so far which the IHR strengthening Project can use to identify future opportunities for engagement and collaboration with NCDC on, these include the following;

• The relatively late closure of Nigerian international Airports compared with other African countries may have contributed to the spike in cases in Nigeria, after the discovery of the index case. A faster response may have slowed the spread of the disease in Nigeria.
• The total lockdown deployed in Wuhan and some other countries was not possible to implement without modification given the context in Nigeria where a significant proportion of the population depend on daily livelihoods without recourse to a robust social protection system.
• The familiarity with the IMS system which is enshrined in the Integrated Disease Surveillance and Response (IDSR) Strategy and technical guidelines in the country was very useful in terms of launching and building on COVID-19 preparedness and response activities across the country.
• Nigeria is footing the testing, isolation and treatment bills of COVID-19 patients which helps greatly with a public health emergency management in a country with significant out-of-pocket expenditure for health services.
• The private sector quickly rallied around the government with the creation of the Coalition Against COVID (CACOVID) raising over 27 billion Naira to support the government response highlighting a strengthening of the realisation of the need for Public-Private Partnerships not only in developing the public health sector in Nigeria, but also in emergency response in the country.