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“We are Building for a Better Future” -NCDC Boss

The easing of lockdown in Lagos, Ogun and FCT starts Monday, May 4, what are your expectations?
Let’s find out what the purpose for the lockdown is. Four weeks ago when Mr. President instituted restriction of movement focusing particularly on FCT, Lagos, and Ogun States, there were three purposes. The one everybody remembers is that we wanted to reduce risks of transmission from one individual to another and we achieved that to some extent. Our modelling shows that we achieved 50 per cent reduction of where the number would have been if we hadn’t those lockdown versus where they are today. So there was some success there. There were two other objectives. One is to prepare the work that we were doing in collaboration with all the state governors across the country to enable public health response, case finding, identification, contact tracing, listing all the contacts and following them up and enabling the development and maturity of that process.

The third objective was to enable the health system all together to prepare for a completely new disease that had emerged in our landscape. That too happened. The objective was never aimed at stopping the transmission all together before we start our activities. We knew from the onset that that was not going to be possible in our context. So we needed something to prepare ourselves from the easing of these measures from May 4, and this is not complete easing rather, a very carefully calibrated easing of the measures, and we will collectively, not just the state or federal government – make sure we manage these measures as articulated by the PTF in order to keep ourselves safe and begin a new normal in Nigeria.

Living with COVID-19 is the reality and we can’t get out of that reality until we get a vaccine. Everybody in the global space is working towards that goal. Whether we do it today or push it up to one week or two weeks or three weeks, we will still come to that reflection point. So Mr. President made a very difficult decision on April 27. He literally weighed the pros and cons of all the data in front of him and he is telling us to start this process of relaxation very gradual, much calibrated in order for us to start living with this new reality and get to terms with it and start preparing ourselves, our communities and work places with this new reality. Ideally, that is the challenge all of us have from May 4.

Are you saying that community transmission that a lot of people feared had doused because looking at the graph as it relates to deaths… does it look good?
The trajectory of graphs is very difficult to interpret because death always lags behind cases to some extent. Remember, we have established there is community transmission in three major cities of FCT, Lagos and Kano. 75 per cent of cases in Nigeria still come from these cities. That is the reason why one of the measures that has been kept in place by Mr. President is the restriction of inter-state travel. The outbreak in Nigeria even though we show it in one curve is really not one outbreak. We are seeing three significantly large-city outbreaks in FCT, Lagos, and Kano. In almost all the states we have found introductions. Many of them have been managed and limited to a few number of cases. So what we are doing is to throw our resources into those states that have established transmission and try to limit spread in these states while preventing the virus from going to other states.

The virus doesn’t fly on its own to other states. The virus is carried by people – individuals that are travelling. And we have analysed our data and saw that most of the cases from other states emerged out of travellers from these high burden states. So what we are trying to do is to keep some of the most important restrictions such as inter-state travel, international travel, and large congregations and they will remain almost completely banned until subsequent weeks when Mr. President will evaluate the situation. Why we start easing some of our restrictions on work places is to make sure that some of our economic activities can start because economic activities are linked to livelihoods which are linked to life. These are the decisions that were made and in summary I would not read too much into the deaths, it’s an emerging situation. We will continue monitoring it very carefully but always make sure that Nigerians are well informed to the best of our ability on the status of the epidemic every evening with the data that we release.

Has the coronavirus case in the country peaked?
It is very difficult to say and I don’t think we have gotten to that point. You know what has happened over the last few weeks is that we have been building our testing capacity. You could remember that we got a lot of criticism of how many people we could test and how quickly. We took that criticism to work and every single day and every single night we were working hard to build up that testing capacity. Every single day the NCDC staffs have been working hard to increase our testing capacity. As we increase testing capacity across the country, we will see numbers rise but it is okay for them to rise because we are gaining visibility into what we were not sure about. And it is only by gaining visibility and understanding the scale of the outbreak, the distribution, the spread, that we can really mobilise the resources within government and outside government to respond appropriately.

The United States has adopted Remdesivir on the advice of the FDA for treatment of COVID-19. Is Nigeria adopting that line of medication too?
I am really happy you brought up this question because it’s a kind of victory for science. Over the last few days we have gotten an emerging evidence for the first drug that has shown evidence of efficacy. It’s a drug called Remdesivir. It came to prominence over a trial to use it for the Ebola virus where it didn’t really work. But it has long remained in our arsenal and we now try it in a clinical trial and we have seen that it does produce benefit to people. So I am actually happy that finally some clinical trial evidence has emerged about a new drug. What we now need to do is to gain access to this new drug. It is a difficult process at the moment but we have started the conversation to enable access to Nigerians. We will speak to NAFDAC to speed up the regulatory process so that we can make the drug accessible and available to Nigerians.

There is this NCDC Bill currently receiving conversations on the floor of the national assembly. What is your reaction to that?
It’s not an NCDC Bill. Nigeria Centre for Disease Control is well established by an Act of the parliament and passed in 2018 and we are very comfortable with that. This is a new infection disease bill. My understanding is that it was introduced by the House of Representatives. We were not part of the consultation process in bringing up the bill. Definitely there is the need to consider a new public health law and a legal aspect of public health. But I don’t think to be honest and in my view in the middle of a crisis is not the best time to do this. We need to get out this period, consult widely and then come up with decision that we can all really adhere to. What of the states and federal laws. Public health is very broad. A lot of responsibility does not lie with the federal government. They lie with the state and local governments to implement. So there is the need for wider consultations.

What would you say to those who think Nigeria is doing poorly in terms of our testing capacity especially when compared with Ghana and South Africa?
We have been building up our testing capacity every single day. We are hitting one thousand and two thousand heads a day and you will see those numbers go up quickly. With testing we are solving three problems. First we are trying to bring the tests closer to people. So the number of tests is not the only variable we are counting. Secondly, to increase the numbers that we can test in the high incident states of Lagos, FCT and Kano; and then to build for the future. We are trying to do these three things simultaneously. You know I worked in South Africa for three beautiful years before coming back to Nigeria. I understand the investments that they made over the past 50 years in building up the national health laboratory services in South Africa, and how that has now supported their response. I know what is going on in Ghana. They are using a slightly different approach to testing.

The one we have considered and ultimately decided at the moment is what is right for us because there is always a price to pay. We looked at that part Ghana took together with everyone involved in testing in Nigeria and then we decided that it wasn’t the path that was suitable for our circumstance. But we will continue to do what we are doing everyday – building on what we have, relying on the infrastructure we have at the moment while increasing incrementally. We have set for ourselves publicly a target of testing two million people in the next three months. That is the target we are working to and every day we are building up to that target. We know the importance of testing in enabling us to control this outbreak.

The Presidential Task Force has really backed us in terms of providing us with the resources and ability to meet this target. All our partners the United Nations, the United States government, everyone has come together to say listen, let’s build for the future and that’s what we keep doing every day and Nigerians will keep seeing the testing numbers increase, and that is one reason why we see our case numbers increase every night. We are building and I am confident that we will get to the goal that we would want to achieve. But sometimes, there is a price to pay for speed. We don’t want to be the quickest out of the starting blocks. We want to be the first to reach the finishing line. There are compromises to be made and we are making them while building better for the future.

Is Nigeria looking in the direction finding local solutions like the use of herbs like Madagascar in solving this problem?
I have heard about the Madagascar story and I received it with a lot of excitement. I have been trying to find a little more details of what exactly it is and how it’s being used and things like that. So we are working on finding more information. Until we really understand what is being given to people I can’t really recommend whether it should be used or not in our context. You know when I visited China a few months ago, Chinese traditional medicine is very much integrated into the care that was being provided the patients that had COVID-19 in China. My responsibility is to have a clear understanding of what works and what doesn’t work before I recommend to Nigerians.

This is a sacred responsibility for whoever that is leading an organisation like mine. I cannot really work and make decisions on anecdotes or whatsApp videos or whatever is thrown at me every day as the magic solution. We have to sit back, evaluate and make critical decision for Nigerians. By the time we say Nigerians use this, we can sit back and know that we have made the best possible recommendation for Nigerians. In my position, I have to be careful in what I recommend because it is not a personal opinion. It becomes the opinion of instituted authority. So we are looking very carefully at treatments, therapeutics, vaccines, diagnostics, and whatever works I will be the first person to push for its introduction into the landscape in Nigeria. But first we have to know it works. There is no short-cut. We have to know that something provides benefits before we introduce it into the Nigerian population no matter how popular it is on social media or other contexts.

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