We must start from the standpoint that right now that we do not have a clue about the spread of the disease, which is why we need active and coordinated governance to do the epidemiological research and tests to know where we are, so that we can plan rapid action.
I was really shocked when the Nigerian government announced that henceforth all Federal Executive Council and National Council of State meetings are postponed due to the COVID-19 pandemic. NO! NO!! NO!!! – they must keep meeting daily. Precisely because the pandemic is developing to be one of the greatest threats to the existence of Nigerian society, and by implication, the Nigerian state, this is the time for governments to be meeting daily to avert the looming disaster. Of course, social distancing is an important part of the survival story, but thanks to technology, virtual meetings are easy to organise. The important point to make is that every public health crisis is in reality a governance challenge about how best to plan and use resources to address the health concern.
As I write this column, the number of affected individuals announced by the National Council for Disease Control (NCDC) is only 51. There are reports, however, that we have tested only a couple of hundred people whose itineraries and health conditions indicate strong possibility of infection. This means we are testing those we think are already infected. This might be because we have very few kits dashed to us by international organisations. We thank the Chinese billionaire, Alibaba’s Jack Ma for sending us more test kits and masks a couple of days ago, so hopefully, we can expand testing. The issue is that precisely because we have done so little testing (because we do not have the kits to do so), we do not know how quickly and widely the epidemic is spreading. Governance is necessary to build scenarios and plan and act on what to do in the days, weeks and months ahead.
The problem with COVID-19 is that it is one of the fastest spreading viruses seen by humans and our approach to seeking how it is spreading is based on the success story of what we did during the Ebola outbreak – contact tracing of the index case. It takes two to three weeks to find most of the contacts and that worked well for Ebola, which was much less contagious and needs direct contact with body fluids to infect persons. COVID-19 is a different story and some of the contacts that were located after three weeks might have been infected but could have had mild or asymptomatic attacks and might have spread it to hundreds of people while appearing to be well. We must start from the standpoint that right now that we do not have a clue about the spread of the disease, which is why we need active and coordinated governance to do the epidemiological research and tests to know where we are, so that we can plan rapid action.
There are lots of governance issues around social distancing that have to be addressed daily and significant resources need to be leveraged to make social distancing work. In Nigeria, we do not have a functional local government system to address these issues.
Nigeria has developed a governance framework to address epidemics. It is known as the “Three-Ones” strategy, which was devised to coordinate the resources and the diverse national, local and international players involved in the fight against HIV/AIDS in 2004. In 2006, it was used to address the Avian Influenza epidemic and subsequently the H1 N1 and Ebola viral epidemics. It promotes the coordination of resources and players on the following core principles: One agreed action framework that provides a basis for coordinating the work of all partners; One national coordinating authority with a broad-based, multi-sectoral mandate; and One agreed country level monitoring and evaluation system. This is the structure that is led by the National Centre for Disease Control (NCDC) and which is now governed by an enabling law. It provides a structure that can deliver and coordinate the implementation of a “technically sound” action plan that benefits from consultation with leading professionals across all areas of intervention – including the private sector, civil society and of course public actors. It avoids duplication and conflict through a process of consultation with all stakeholders that clarifies the roles of all players at all levels and puts in place mechanisms to support them to fulfil such roles. It does not, however, provide key political decisions on the most effective governance strategy to use in addressing the problem.
South Korea has been one of the most successful countries in tackling the COVID-19 pandemic, on the basis of an elaborate strategy of widespread mapping and testing of the spread of the disease. The country with a population of 51 million today tests 20,000 people daily in 600 centres. It produces 100,000 test kits daily and is today making money from selling the kits. This did not happen by accident. On the day the index case in the country was found, the government met with the pharmaceutical industry and gave them a guarantee to pay for their investment in developing and providing the test kits at whatever price. The strategy of mass testing and mapping had already been simulated before the pandemic and the government provided the political and financial support to make it happen. Some richer countries like the United States, Italy and Spain were capable of doing the same thing but their governments were asleep and hoping and praying that the disease would go away and are today paying the heavy price for their foolishness, as they beg South Korea for kits to buy. The Nigerian government has already lost a lot of time and must meet daily and act to find a handle on what we can do to address our own COVID-19 crisis.
We have, for example, reached a consensus as most countries have done, on social distancing as a very important practice in slowing down the spread of the virus so that health systems are not swamped. That is fine. The question then becomes how you implement social distancing in countries with large urban populations, who live in over-crowded slums and must go out and work every day to earn what they will spend for their daily bread. Today in India, the masses are telling the government that starvation induced by social distancing will kill them before they get the COVID-19 virus. They have no money to buy food, the markets are closed anyway and they cannot buy food, even if they are given money. In addition, transport systems promote extremely close contact, as such lifting the transport ban could provoke a spike of cases. There are lots of governance issues around social distancing that have to be addressed daily and significant resources need to be leveraged to make social distancing work. In Nigeria, we do not have a functional local government system to address these issues.
The real governance issue is that we have to beg for help today because we have allowed our health system to collapse, as our elite became completely reliant on foreign systems and today they cannot go abroad as everyone is in crisis. We must plan our way out of this crisis with a renewed commitment to rebuild our health and educational systems…
Another problem is that as the federal government is not exercising effective leadership, state governments are taking over but many are working at cross purposes. The Abia State governor has proudly announced that his State is in the Bible and cannot be infected, so he does not need to do anything. Kano, Rivers and Kogi State governments are closing their state boundaries against foreigners and other Nigerians who might bring in the disease. Others are taking sane and sensible measures. All these tells us that we cannot close governance at any level and expect to survive this epidemic. As I said last week, we are Africans, therefore we hoped and prayed that our continent will be spared the COVID-19 virus because the weather is too hot and, in any case, we were not ready for it (as if the virus cares). The damn virus did not heed our prayers and it came nonetheless. We must govern ourselves out of the crisis.
As the PREMIUM TIMES‘ latest editorial argues, we are in dire need of help — for testing kits, to health care workers, to hospitals fitted with the right equipment including ventilators, to protective gear for our healthcare professionals, to cash transfers to our most vulnerable populations. Jack Ma’s 20,000 test kits would barely be enough for a day if we are to really tackle this scourge headlong. We must plan, act and govern our survival out of the crisis. The real governance issue is that we have to beg for help today because we have allowed our health system to collapse, as our elite became completely reliant on foreign systems and today they cannot go abroad as everyone is in crisis. We must plan our way out of this crisis with a renewed commitment to rebuild our health and educational systems, so that we can survive the uncertain future that is arriving. Today, the political leadership in the United States and the United Kingdom are considering allowing COVID-19 to wipe out most of the population over sixty to reduce the depression that is wiping out the profits of their capitalists. That is the highest level of depravity imaginable. We could take another approach of seeing this crisis as a guide leading us to build a more inclusive society in which the interests of all dictate public policy choices.
Picture credit: The PUNCH.