By Chioma Obinna
The bedrock of every National health system is a strengthened medical laboratory system, however, the laboratory structure in Nigeria is very weak because most of the recommendations in the National Medical Laboratory Science Policy 2007 are not implemented. Currently, Nigeria has 52 Federal Teaching Hospitals and 22 Federal Medical Centres but none of these facilities has any form of accreditation.
Nigeria is the 4th leading country in importation of laboratory equipment and consumables, and more than 90 per cent of consumables required to provide medical laboratory testing is all imported and this has led to various substandard products finding their way into Nigeria. Again, the testing laboratory at Yaba, Lagos, which former Minister of Health, Prof. Onyebuchi, facilitated, is yet to be put into full function. Recently, the country witnessed the resurgence of Yellow fever in Ebonyi State. While media reports say at least 17 people died, the Nigerian Centre for Disease Control, NCDC, put the number of deaths from a “strange ailment” at 20, but the Ebonyi State government insisted that two deaths were recorded. Good Health Weekly spoke to a renowned medical laboratory scientist, Dr Casmir Ifeanyi, who is the National Publicity Secretary, Association of Medical Laboratory Scientists of Nigeria, AMSLN. He stresses that unless Nigeria revamps its medical laboratory sector by building in-country capacity for local production of vaccines, the country will continue to lag in health indices. In this exclusive interview, he maintained that Nigeria’s inability to produce vaccines locally and the massive reliance on importation is the bane of effective containment of the outbreak of haemorrhagic fevers in the country. Excerpts:
Recent outbreak of Yellow fever
The outbreak of Yellow fever in Izzi in Ebonyi state that has resulted in the death of people is just one of the resurgence of the hemorrhagic fevers in Nigeria and I am sure you are conversant with Lassa fever and Ebola which I pray it does not come back to Nigeria.
I am also sure you are aware of Monkeypox all these belong to the hemorrhagic family and there are a few others including avian influenza.
The pathetic story about the yellow fever resurgence and recurrent outbreak now is almost to an endemicity in Nigeria is rather very worrisome.
It is worrisome because Nigeria medical laboratory scientists were producing yellow fever vaccine, I can spare us some names, Pa Nwachukwu, Chief Barrister Felix Nwabueze, Mr Mike Momoh, and persons like Prof B.E Agbolohor, these men and many more were producing yellow fever vaccines in Nigeria.
These are medical laboratory scientists. That was when indeed they had in full, the paraphernalia of their professional charter when they were allowed to carry out the very dexterity aspect of their functions as medical laboratory scientists.
They were doing that to the point that the World Health Organisation, WHO, contracted Nigeria to produce yellow fever vaccines that were used then to contain yellow fever outbreak beyond Nigeria and some parts of the West African sub-region. What has happened?
As we speak, we can no longer have the in-country capacity for this vaccine production because of a deliberate effort to under develop the medical laboratory practice in Nigeria.
It is worrisome because what we were leading globally, what we were producing locally for export and what WHO prequalified us and contracted us for production is what we now largely import.
So we now have a demographic change in the populace, people are becoming more vulnerable, the disease has become resurgence and the country no longer have capacity in-country to produce it and so the vaccines are not available. We do vaccination now for ceremonial purposes like if people want to get visas, they will go pay N2000 to Public Health and their cards are stamped as being vaccinated. All these cosmetic approaches are what have brought us to this level. Now the disease outbreak is worrisome. The use of emergency containment centres approach is not enough practice. We must step it up. We must revamp our laboratories. We must begin to build the in-country capacity of medical laboratory scientists as it was then to produce yellow fever vaccines in-country. So long as we continue to rely on imported vaccines we will continue to have the challenge of hemorrhagic fevers.
Why are we having this challenge?
This is because some of the vaccines imported were not derived from local strains of either the viral agents or the bacterial agents and this is worrisome. The country must get ready. We have done very well in complying with the international health regulation 2005, particularly, with the coming of Dr Chikwe Ihekweazu as the Director-General of NCDC.
We have done very well because the NCDC has become the headship of government driving the international health regulation but a lot needs to be done. We have joined external health valuation and we performed fairly well.
But then, we need to get our ass together and begin to deal with issues of a national action plan for health security and that will include in-country capacity for vaccine production and that will include in-country capacity for detection of this viral outbreak at zonal, regional or state levels. As we speak, we have only the NCDC reference lab, of course, it is not top-notch but it is a push forward.
What do we need to do in that direction?
We need to establish more of these labs in the South-East axis, particularly, in Ebonyi State. The Governor should drive the process of a zonal laboratory in the State. I have singled out Ebonyi State because it is the focal point for local outbreak of Lassa fever in the South East. Now it is also the focal point for Yellow fever outbreak in the South East, so it becomes very pertinent for the South-East Governors Forum to come together and put up a Zonal public health laboratory to deal with the issues of Lassa fever, issues of detection and diagnosis of yellow fever, monkeypox and all such hemorrhagic fevers that is beginning to rear their ugly heads.
Weak medical lab structure
The weak medical laboratory structure in Nigeria is something that we will continue to cry about. It is shameful that we still courier specimen to detect hemorrhagic fevers to smaller countries that are smaller than Kwara state in Nigeria, such countries like Cote Ivoire and Senegal. It is pathetic, it is shameful and when they have national disasters we will dole them the big brother support whereas, in-country, we are empty. We are like painted sepulchre. The present administration must begin to focus on revamping medical laboratories and must stop the rivalry in the health sector. It is the in-fighting and the plot by physicians to destroy the laboratory and take over that destroyed our capacity for vaccine production, capacity to do this minimal detection that we are able to do even before technology came.
Are we at the point of massive yellow fever vaccination?
Yes, we are almost there, particularly, where the outbreak is relatively becoming endemic. We must go there for mass vaccination but what is going to mitigate against mass vaccination? One is the availability of vaccines. Why is there paucity of vaccines? This is because we have to wait for certain processes, issues about importation and approval for production etc. And that will limit us but that is what we need to do.
With the current outbreaks and almost leading to a point of endemicity in some States, the media must up the game in public education. We can do more to educate our people first on how to prevent exposure to something like yellow fever vaccines. It is simply the same way you are going to prevent malaria.
If you stay off the bites of Aedes aegypti mosquito species, you would have helped yourself a lot. So we have to get the first principle which is the basic principles of hygiene and preventive healthcare. Can we afford to sleep under insecticide-treated nets? That is one good step to go. Can we reduce bushes as they grow around our place? The basic vector control processes that will apply to mosquito species that causes malaria parasite is what you also need to apply for yellow fever.
Availability of vaccines
Of course, the authorities at the Federal Ministry of health will tell you there are vaccines but what is the quantity of the vaccines against a population of 201 million people? What is the quantity of vaccines for a country that depends solely on importation, particularly for yellow fever that is not in the routine immunisation programme? The truth is that vaccines are not available in-country.
Quality of reagents
We have continued to complain about Nigeria being turned to a dumping place for fake reagents, fake chemicals, and diagnostic kits because the provisions of ACT cap M25LFM2004 regarding the validation of reagents, diagnostics and chemicals has remained dormant. It is dormant because unseen forces profiting from the dumping and the general management of laboratory in Nigeria have made sure that, that aspect is not activated. We have capacity in-country to validate, calibrate and therefore say that these reagents are fakes or can be used in our country but the laws providing for them are being frustrated from full-scale operationalization and that is where the worry is. You see the yellow fever outbreak in Ebonyi state would not largely be blamed on human resources. We have the human resource in the country to do this detection, unfortunately, these ones are not provided with the state- of- the- art equipment or facility to do this detection. For instance, in Ebonyi State we have a Teaching Hospital but what is the biosafety class of the laboratory in that teaching hospital? They were not issues in the past but they are issues today. It is shameful and it is worrisome.
The deaths recorded are unfortunate. It can be avoidable but the right thing has not been done. And as we speak, the right things are not even being done. While we commend the efforts of the Director-General of NCDC, Dr Chikwe Ihekweazu for being able to do much with little, that Agency needs support. The medical laboratory’s workforce in Nigeria requires training, empowerment, relevant laws, and relevant policies of government that had been approved for decades needs to be operationalised fully so that we can get back our medical laboratory capacity and that is the only way we will not become the weeping child when it comes to health indices.
The government of Ebonyi state should step up their game and not live in denial. The Governor has been able to develop the State and we are hoping he is also doing the same in the health sector.
The Governor must be in the driving seat and drive the process of building the healthcare professionals in Ebonyi state, particularly, the medical laboratory scientists and also the setting up of the state-of-the-art medical laboratory facility in the state so that the capacity for detecting these hemorrhagic fevers will be built in the state, living in denial is not an option and escapism is not an option.