Afri-Dev.Info Emergency Public Policy Brief: For National Assembly Meeting on Ebola In Nigeria – & 21 Preliminary Public Interest Questions

7. What of universities and other higher education institutions? Should academic and non-academic staff & student unions be trained and provided with similar equipment?

8. Have all 36 states of the federation and their local governments been involved in the proposed Education Ministry measures (including training, equipment, & monitoring committees) for Ebola management? Have the proposed monitoring committees  especially been set up? Have names of all 36 state ‘Ebola Desk Officers’ been forwarded to Abuja by September 1st as directed?

9. How much has been budgeted for the schools emergency measures – by Coordinating Minister of Finance & Economy? – By state Commissioners for Finance? And how much has actually been released?

10. Are teaching unions and associations satisfied – with overall emergency Ebola measures in schools and safety of students and teachers ?

Health Sector Concerns

11. Given the impact of just one Ebola case on First Consultant’s Hospital – private clinic where index case was treated (including weeks of closure) – have all hospitals public & private been provided with emergency Ebola response capacity? Isolation wards, disinfectants etc. What would be the impact of multiple hospital closures on other health issues, and overall mortality?

12. ‘Normal’ Nigerian non-Ebola related annual child mortality is already 827,000 (13% of global total). What would be projected mortality of a Liberia scale second wave Ebola outbreak i.e. on overall under 5yr’s population of 27.1 million; and under 18yr’s population of 79.9 million?

13. Have all 36 states of the federation and their local governments acquired the required human resources and technical capacity: e.g. numbers of ambulances and special vehicles/facilities for movement of blood samples, suspected cases to testing and isolation centers? etc

14. How many testing centers & isolation wards currently exist in Nigeria – where are they located, and what is the overall combined capacity – compared to the country population?

15. Given the inadequate density of doctors (4.1 per 10,000 – as against the global standard of 23 per 10,000) – will weak health systems be able to cope if premature re-opening of schools backfires – given Nigeria’s current disease burden?

16. Are key medical workers and associations (doctors, nurses, midwives, lab technicians etc) satisfied – with resources provided, and emergency measures in public, private hospitals and clinics – if any?

17. Ebola can still be transmitted in semen weeks after recovery – given lessons of historically weak investment in HIV prevention, treatment and care – what steps have been taken on sexual health education & commodities crucial to Ebola response?

18. Given that a strong immune system is key to possible survival of Ebola infection – what are the implications for estimated 3.2 million Nigerian living with HIV, including 400,000 children?

Disaster Preparedness & Planning Concerns

19. Learning from Liberia where for a combination of reasons – majority of victims are women – is there a gender based emergency response plan – for vital everyday health system responses such as child birth; role of women as nurses, carer’s in communities etc.?

20. Is there a child focused emergency response plan for vital everyday needs such as vaccinations etc.?

21. Learning from Liberia: where epidemic was worsened by 2nd wave of Ebola after initial outbreak subsided. What are overall short, medium and long term disaster preparedness contingency plans for: emergency medical supplies; food supplies; movement of persons; transport; law enforcement; fall out of possible economic meltdown etc? Given that only 58% of Nigerians have access to clean water; and only 31% have access to improved sanitation facilities – what are contingency and long term investment plans on social determinants of health?

Accompanying Summary Public Policy Brief

Afri-Dev commends the Lagos and Rivers State, and Federal Ministry of Health, on swift response to the Ebola outbreak especially given under funded and weak health systems.

Precisely because of this under funding and weak health systems, we welcome the House of Representatives response to calls by Afri-Dev and other stakeholders to look further into the wisdom of schools resumption on the 22nd of September before the outbreak can be declared over going by global health standards and protocols.

Afri-Dev believes firmly that Nigeria must proceed with extreme caution and learn from experiences of Guinea, Sierra Leone – and in particular Liberia where caution was relaxed too soon – and the country was hit by a second wave of Ebola after almost 21 days of no new case.

In the context of global health, the Ebola outbreak is a matter of grave public interest – not just to Nigerian’s, but also to the ECOWAS region, Africa and the world. Going by the current situation in Liberia – and considering Nigeria’s estimated population of roughly 170 million – (compared to Liberia Population of 4.1 million – the potential economic and social cost of a wrong decision in Nigeria is a nightmare that cannot be imagined.

The evidence from WHO and CDC and other experts is clear: To quote the Deputy director of US Center for Disease Controls National (Center for Emerging Zoonotic and Infectious Diseases):

“If there was no cases identified after today, we would still be committed to waiting 42 days from today to declare the outbreak fully over.  The concern is that the outbreak can be reseeded much like a forest fire, with sparks from one tree reseeding it.  That is clearly what happened in Liberia.

Liberia was a situation they did not have any new cases for more than 21 days in the first wave of the outbreak and they were reseeded by cases coming across the border.  Until we can identify and interrupt every chain of transmission, we will not be able to control the outbreak.”

Interrupting every chain of transmission depends on contact tracing and containment as the holy grail of stopping Ebola. Given Nigeria’s poor civil registration, poor urban planning, and inadequate rural infrastructure – contact tracing is almost certainly sure to fail if even a fraction of the school population is infected with Ebola.

For these reasons, we cannot afford to get it wrong. The decision on resumption of schools is too big to be left to  judgement and decision – of mainly the Minister of Education, and Commissioners of Education from 36 states whom with all due respect have never had the experience of managing a large scale epidemic amongst the school population.

Public officials are appointed to serve in the public interest – and their decisions are best informed by full consideration of potential impact of those decisions on all citizens. It is bad governance for public officials to dismiss legitimate public concerns as irrelevant. Rather, public officials should welcome and engage in transparent dialogue with citizens and all stakeholders to resolve issues.

On this basis we firmly believe that very important questions must be answered by the House of Representative special sessions, with the expert advice and evidence of key stakeholders including: World Health Organisation (WHO); UNICEF; Doctors Without Borders (MSF); US Center for Disease Control (CDC); Nigerian Medical Association; Association of Nurses & Midwives;  Red Cross & Crescent; Union of Teachers; Academic Staff Unions of Universities and Polytechnics; UNESCO, UNFPA, UNHCR amongst others.

While schools cannot remain closed indefinitely, and we cannot rule out a separate Ebola outbreak in the future – The situation in Liberia and Sierra Leone demonstrates (1) That waiting 21 to 42 days could make the difference between complete chaos, and a resolution of the present Ebola outbreak in Nigeria; (2) That considering Ebola outbreaks have become progressively worse over the past 40 years – long term multisectoral investment, policy and planning measures should be put in place now – to prepare for a possibly worse outbreak in the future.

Nigeria has so far been lucky – and this must be appreciated. All Ebola cases (so far) are linked to a single person who traveled from Liberia to Lagos on 20 July. A combination of lucky circumstances led to early detection of the first and subsequent cases – i.e. that health workers have been coincidentally involved at every stage – mainly the incredible courage of two brave women – a doctor and nurse (now dead from Ebola) – that identified the index case and restrained him; the fact that the person that deliberately escaped from surveillance in Lagos fled to Port Harcourt to seek private treatment (leading to death of another doctor); has so far ensured that – the transmission chain has been traceable and contained. The key to continued success is to give health officials (working with limited resources) and the entire country a better chance of surviving the current outbreak – by not prematurely re-opening schools – and adding millions of children, students and teachers to the equation.