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Surveillance without diagnostic capacity is like swimming in the dark

My priority area of intervention at NCDC is linked to the priority area of need, the one area that keeps me awake at night. If we were to have another case of Ebola in Nigeria, would we have the laboratory infrastructure to make a timely diagnosis to reco

A recurring question in my recent discussions with partners and even in my inflections is “What is your priority for the NCDC in 2017?” This question was again thrown at me by Dr. Christopher Elias President of Global Development at the Bill and Melinda Gates Foundation who we were pleased to host at the NCDC at the beginning of the year. The visit, in itself was inspiring because I had the privilege of listening to firsthand experiences from a man who has played a key part in the work towards polio eradication in our country. After discussions that were centered around polio strategies and practices we could adapt in our surveillance work at the NCDC, he asked the ever-recurring question: What is your priority?

My priority area of intervention at NCDC is linked to the priority area of need, the one area that keeps me awake at night. If we were to have another case of Ebola in Nigeria, would we have the laboratory infrastructure to make a timely diagnosis to recognise it and prevent a large outbreak? I keep pondering over the question – Do we have the laboratory network required to detect threats and respond effectively. The ability to effectively test samples to detect what diseases we are dealing with is an area that requires our urgent attention and definitely my highest priority for NCDC. In so many situations, we have been forced to treat diseases and control outbreaks based on clinical diagnosis without laboratory confirmation. For almost all our diseases of public health importance apart from polio, most cases are reported without a laboratory confirmation.

In the second week of January, I paid a visit to the Aminu Kano University Teaching Hospital, the NCDC Zonal laboratory as well as other laboratories in the region. I was excited to see a committed and strong team in the laboratory. Unfortunately, some of their activities had been crippled because of the absence of resources such as reagents and primers. This was also the situation I had encountered during my visit in November 2016 to the Central Public Health Laboratory in Lagos, and our laboratories in Port Harcourt and Enugu.

Towards the end of 2016, we were faced with an outbreak of febrile illnesses in Sokoto which several newspaper headlines highlighted as ‘RESISTANT MALARIA’. The term resistant malaria was adopted without any laboratory diagnosis, but on the simple assumption that the symptoms and subsequent treatment of malaria in the patients didn’t lead to them getting better. With the deployment of a NCDC team to Sokoto, an outbreak investigation was initiated and we found that it was unlikely to be malaria. It became clear that we were dealing with a disease that we had not confirmed. Samples had to be sent from Sokoto to one of the partner laboratories we support in Lagos via complex domestic transportation arrangements. A diagnosis was made in a few patients, but it was too late to collect samples from most of those affected. Thankfully it was not Ebola, but what if it was?

While the NCDC has a network of laboratories in different zones of the country, these laboratories work independently of each other and have not been supported to form a strong, mutually supportive network in the true meaning of the word. We have set up a small team, led by the erudite Prof. Oyewale Tomori to guide us as we seek to develop a strong NCDC laboratory network to harmonize the activities that each laboratory does and figure out how we can truly work together to meet some of our biggest challenges. We want to ensure that all the laboratories in our network have the capacity to diagnose diseases of public health importance and can share information between themselves and us at all times. If there is a laboratory confirmed case of Lassa fever in Edo state, the laboratory in Sokoto will be aware from the specimen collection process up until confirmation and other related surveillance activities.

We are privileged to be part of the Honorable Minister of Health’s Rapid Results Initiative (RRI). In recognising the urgency of the situation, he kindly authorised that we fast track the process to make our laboratories functional in the different regions of the country. With this initiative, it is our vision that our laboratories will be better equipped to perform diagnostic functions in and out of outbreak situations. We also received a mandate from the Honorable Minister to commence activities at the National Reference Laboratory in Gaduwa and we hope that by the end of March 2017, the laboratory will be operational. It will be a reference laboratory that will coordinate activities of our network of laboratories, provide special diagnostic, surveillance, and epidemiological testing. This will mark a huge step for the health sector in Nigeria and Africa as the Gaduwa laboratory is also expected to provide services to countries in the ECOWAS region.

There are a lot of areas where we have not been up to par in terms of laboratory functions and its relationship with disease control. This puts us in a situation where we may be dealing with something we do not know about. This cannot continue in Nigeria.

With the plans we have set for ourselves within the working group, the Honorable Minister’s RRI and our internal strategic plan at the NCDC, I am expectant and excited that we will be able to boast about robust public health laboratory capacity for Nigeria in the coming years. Our biggest department at NCDC is the laboratory division. Now is their time to deliver for Nigeria.

This answers the important question asked by Dr. Christopher Elias and forms my most important priority for the NCDC in 2017.