The COVID-19 pandemic has caused significant disruptions to the health and economy of nations, including Nigeria. As at today, Nigeria has tested 1.3m persons for COVID-19, with 10% (131,242) of these confirmed positive. Compared with the global and Africa’s Case Fatality Rate (CFR) of 2.2% and 2.5% respectively, Nigeria has fared better with a CFR of 1.2%.
Six States (Lagos, FCT, Plateau, Kaduna, Oyo and Rivers) have contributed 70% of confirmed cases, with Lagos the commercial nerve of the country contributing about 40% of total burden.
Data indicates that men appear to be disproportionately affected accounting for 69% of the confirmed cases. Most cases occur in people aged 31-40 years.
Although the impact of the pandemic was relatively mild in the first wave, the virulence and mortality seen in this second wave appears to have increased significantly. With increased demands for hospital bed space and oxygen requirements necessitating an increase in spending on health services both by federal and state governments.
On the economic front, the country was only gradually recovering from the 2015-16 recession before the pandemic struck. So, it was unsurprising that our GDP contracted by 3.5% in 2020. Given the impact of the second wave of the pandemic it is unlikely that we see GDP growth recovery to pre-pandemic levels in 2021.
These macro-economic challenges coupled with double digit inflation and falling per capita income have real life implications on lives and livelihoods and are of concern to us as a government.
Our primary responsibility as a government now focuses on minimising the disruptions to population health and economic growth.
What we have done so far
Nigeria was very pro-active in handling the first wave and continues to remain so. Prior to the confirmation of the first case on the 27th of February 2020, the country actively monitored events around the world, with a public health advisory published by the Nigerian Centre for Disease Control (NCDC) a month before the first confirmed case in the country.
A presidential task force was established to coordinate multi-sectoral response to the pandemic while a public health emergency operation centre was established under the NCDC.
In March 2020, the country’s airports were closed with the exception of essential flights and inter-state movements restricted in order to minimise the spread of the virus.
On the health front, about $20m was made available to support the Nigerian Centre for Disease Control (NCDC) at the outset to scale its capacity to adequately respond to emerging issues.
The private sector in Nigeria harnessed their strengths to establish the Coalition Against COVID-19 (CACOVID), which launched in March 2020 to support the Government’s control efforts.
Raising more than $75m, CACOVID has provided medical supplies and equipment, tests, isolation and treatment centres for individuals with COVID-19. In addition, under its food relief program, essential food materials were donated to vulnerable persons to cushion the effect of the lockdown.
States also followed suit, responding to the pandemic by addressing the health and economic impact. In Ekiti for instance, COVID-19 taskforce was established as early as March 2020 and prior to the detection of the first case in our State. Eminent citizens of the State under the Rapid Response Mobilisation Committee (RRMC) have helped raise about $3m and deployed the same to fund some of the critical infrastructural and social needs to support the State’s fight against the pandemic.
As a State government, recognising the impact of the shocks created by the pandemic on our revenues, in 2020, we revised our budget mid-year with capital expenditure for a number of budget lines re-prioritised to enable us channel resources to health and social-welfare for the vulnerable. Renumerations for top government functionaries were also reduced by 50%.
In my capacity as Chairman of the Nigerian Governors’ Forum, we quickly developed a communications and collaboration plan for all State Governors. We recognised early on that no state is Nigeria is safe, until every state is safe. We have met regularly with the NCDC since the beginning of the pandemic, we set up internal committees within the Forum to ensure engagement across various sectors of the response. Our voices as State Governors are very important, especially when thinking about social challenges like stigma and vaccine hesitancy. We have continued to participate in risk communications activities, to address these challenges and more.
Current response
Our strategy as a nation can be grouped into 3 thematic areas – Prevention, Treatment and Economic.
On prevention, we continue to communicate and inform the public on the need to adhere to safety protocols and provide the necessary information to improve awareness about the disease. Both at Federal and State levels, messages to increase awareness about the pandemic, safety protocols to be taken and how/where to get treated are constantly published on print and electronic media.
We recognise that as with many other countries, we are battling an infodemic alongside the pandemic. A critical component of risk communications activities has been the development of information education communication (IEC) materials based on the evolving situation and social media chatter. Materials were developed at the national level and adapted by states, to local needs and languages.
We are also on the offensive with respect to ensuring people comply with the safety protocols in place.
Only last week, Mr President signed the COVID-19 Health Protection Regulations, which provided guidance on gatherings, operations in public places, mandatory compliance with treatment protocols, penalties and enforcement.
When Nigeria reported its first case in late February 2020, only four laboratories in the country could test for COVID-19. By October 2020, testing capacity had expanded to over 70 laboratories across the 36+1 States. The scale up of laboratory services was important given the size of the country and the need to rapidly obtain results for suspected cases.
As at December 2020, more than 45,000 health workers have been trained across the country on infection prevention and control measures.
These preventive actions are important given that a major priority in the country’s response is to break the chain of transmission individually and collectively through adherence to public health and social measures.
Our treatment approach includes adequate care and management of positive cases. For persons with asymptomatic or mild symptoms, self-isolation and home-based care is approved if such persons have completed a risk-assessment by the State Ministry of Health and meet all requirements.
In the instance where hospital care is required, isolation centres across the country are now equipped to handle critical cases. Each State now has at least one isolation centre, with States like Ekiti, having up to three.
Also, we are working with the Federal Government to ensure we have vaccines available in the country. Just last week, the NGF invited experts to brief Governors on vaccine procurement and administration. We had a National Economic Council (NEC) meeting, where the National Primary Health Care Development Agency (NPHCDA) shared the plans around vaccines procurement. We expect about 80m doses of vaccines would be available in 2021 to cover 40% of the population, while another 60m doses is being planned for 2022. Beyond government’s procurement of vaccines, we at the NGF are also strong proponents of the utilisation of public-private partnerships in vaccine procurement as a means of closing the gap between what is available and what is necessary to achieve herd immunity.
As we already know, vaccines themselves are not cost effective, but rather immunisation is. To ensure people are immunized, State Governments have a role to play in supporting the logistics and ensuring people get the vaccines.
Using the Vaccines Readiness Assessment Tool (ViRAT), I have encouraged my colleagues to revisit and strengthen their vaccines cold chain and logistics, step up demand creation and communication and map out priority persons to receive vaccines amongst other things. Plans must also be comprehensive enough to address other areas that could create a logistical nightmare such as storing vaccines, reaching out and ensuring people come back to receive their second doses. We have considerable experience on this, having handled polio vaccination which actually led to the eradication of wild polio virus in Nigeria.
On the economic front, our major priority is to secure livelihoods. National monetary and fiscal policy reforms must align to support improvements in household income. Working with the Federal Government, a number of employment creation programs have been created and currently being implemented. The Central Bank of Nigeria (CBN) has played an important role here and we must commend them. Intervention funds have been made available with interest rates below inflation, in the hope that we can stimulate growth of small and medium scale businesses. Similarly, institutions such as the Bank of Industry and Bank of Agriculture have also given moratoriums on existing loans to ease the burden of payment.
Looking forward
With discoveries of new strains of the virus, it’s too early to predict the impact. However, we now have about a year’s experience in fighting this.
Crises have consequences, often unknown at the outset. In the aftermath of the Second World War, the Bretton Woods institutions were created to help rebuild a shattered economy and promote international economic cooperation. Like the Second World War, the COVID-19 pandemic defines an era.
As we look forward to recovery from the impact of the COVID 19 pandemic, our approach must shift from emergency response to strengthening the resilience and sustainability of our health system. We must task ourselves and rethink existing assumptions and facts around financing and delivery of health care in a manner that guarantees we build back better.
This requires adequate funding of the health sector. We have begun to advocate for increased investment in health security and public health emergencies by State Governments. In Ekiti State for example, our capital budget for health in 2021 increased by 250% above 2020 figures. Our new four-year strategy for the health sector has public health security as a major priority. At the NGF, we are recommending that states begin to think about establishing their own Centres for Disease Control.
In the medium to long term, we must begin to think strategically about the future of public health security and therefore explore the potential of in-country manufacturing of approved vaccines, following technology transfer. The pandemic is a good reminder of the implications of public health outbreaks on national security. We must take the leap and gain a better level of independence, in the area of vaccine research and development but also science generally.
Another key point to note is ownership. Public health is not for the health sector alone as is popularly practiced in countries including Nigeria. The COVID-19 pandemic is perhaps our biggest lesson around this, as the pandemic has affected all spheres of the economy. Nigeria now has a National Action Plan for Health Security (NAPHS) that includes a multi-sectoral approach to prepare for and respond to disease outbreaks. Every sector must now contribute to ensuring health security and this is not limited to the provision of funds alone. Many of the determinants of health are outside the health sector, and so we must have multi-sectoral leadership and response to public health emergencies.
*Fayemi, governor of Ekiti State and chairman, Nigeria Governors’ Forum, delivered this paper at Chatham House, London on Tuesday.
