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
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.
“On behalf of the Government of Nigeria, we thank you for the support from Public Health England and the UK Public Health Rapid Support Team, in establishing diagnostic capacity for the novel coronavirus (COVID-19) at the NCDC National Reference Laboratory (NRL).
Following your kind support, we have been able to establish and validate capacity at our NRL. This has been extended to two other laboratories in Nigeria.
We are grateful for the reagents, supplies and training support from your institution.
Thank you for the strong partnership we have.”
Director General of Nigeria CDC (2/2020)
Nigeria rapidly moved from having no COVID-19 diagnostic capacity to repurposing and activating an initial five laboratories within its network of Lassa Fever laboratories to conduct conventional Real-Time PCR diagnosis for COVID-19. This has now been scaled up to 28 laboratories across the country (and counting) inclusive of private laboratories. This increase in capacity has been in part facilitated through the IHR Project’s support, which was commended by NCDC’s Director General, Dr. Chikwe Ihekweazu in February 2020 (see quote from Dr. Ihekweazu above).
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;