What it’s like to lead the Covid-19 response in Africa’s most populous country

In late April, as cases of the coronavirus began to rise in Nigeria, Dr Chikwe Ihekweazu realised that he had a problem. The director general of the Nigeria Centre for Disease Control (NCDC) knew that the country needed to sharply increase its testing capacity — but that it did not have enough of the specialised equipment and supplies to do so. And with the whole world competing for those same supplies, sourcing more was proving difficult.

So, he took to Twitter. “We’re desperately looking for more RNA extraction kits as we expand #Covid19 testing,” he wrote, and then braced himself for the criticism that he knew would come — after all, it’s not often that Nigeria’s top infectious-disease expert publicly admits to the country’s shortcomings.

Sure enough, the criticism came. But so did the supplies. “I put out that tweet and in an hour, I had the supplies I needed … help comes in surprising ways.” Ihekweazu told the Mail & Guardian in a telephonic interview from Abuja. It’s nearly 10pm at night in Nigeria’s capital, and he’s still in the office.

‘The perfect place for micro-organisms to grow’

The 49-year-old physician got the call from the presidency to lead the NCDC in 2016. When he accepted the position, he had no idea what to expect. The agency, established in 2011, was still in its infancy — it did not even yet have a legal mandate to operate as an autonomous government institute. On his part, Ihekweazu had not worked in Nigeria since 1999.

In most other respects, however, Ihekweazu was a perfect fit. He had just finished a five-year stint as co-director of South Africa’s Centre for Tuberculosis (during which time, he read this newspaper every Friday; “I have a soft spot for the Mail & Guardian,” he said). Before that, he had spent time at what is now Public Health England and the Robert Koch Institute, Germany’s public-health agency. He had vast experience with epidemiology.

Ihekweazu also took over an agency that was brimming with confidence after its much-lauded handling of the 2014 Ebola outbreak. “Nigeria’s response to the 2014 Ebola outbreak was really what put NCDC on the map,” he said.

Ihekweazu went about harnessing that energy and enthusiasm to rapidly grow the agency, doubling its staff size in just two years, and making sure he got the most out of his workers. He has successfully attracted Nigerians in the diaspora as well as those in well-remunerated, private-sector jobs, often with little more than an appeal to their patriotism.

“You see, young people sometimes not doing a lot in government organisations and you think that they don’t have the capacity to do more. So I push people to do a lot more, I enable them opportunities to travel, to present at conferences and suddenly confidence and capabilities grow,” he said.

The NCDC staff also get plenty of hands-on experience with disease outbreaks. Many Western nations are facing their first significant outbreaks in recent memory, but Nigeria has never been afforded such luxuries. Since Ihekweazu took over, the NCDC has dealt with the worst outbreaks of Lassa fever, yellow fever and cholera in a decade. In 2017, Nigeria had to confront monkeypox, 40 years after the last confirmed cases.

“One thing we don’t have lacking in Nigeria, unfortunately, are infectious disease outbreaks. We have a high population density, bang in the middle of the tropics. It is a perfect place for micro-organisms to grow,” Ihekweazu said. 

In 2018, the agency’s status was formalised by President Muhammadu Buhari, which gave Ihekweazu greater authority over data, budgets and hiring. But even the most determined organisation needs financial resources to succeed. The NCDC has an annual budget of just ₦1.76 billion (about R84-million). That’s about half of the operational costs of the presidency alone, according to BudgiT, a civic organisation tracking government spending. 

The coronavirus has exposed years of chronic underinvestment in diagnostic laboratories, Ihekweazu said. And, considering that fighting the disease depends on widespread testing, that’s a major worry.  “We haven’t invested enough as a country in building enough molecular labs to help us with this across Nigeria. We didn’t have the physical footprint and that’s definitely one challenge,” he said.

A long road ahead

Nigeria has recorded 2 801 cases of Covid-19, with 83 deaths, as of May 5. Testing capacity is ramping up but Nigeria still had conducted less than 20,000 tests in total by May 5. There are 18 laboratories around the country testing for the virus, but these efforts suffered a setback in the northern city of Kano, where a contaminated laboratory had to be shut down. A raft of unexplained deaths has led to questions and tensions in the city.

“We rushed to get a lab fully functional in Kano and, because of the rush, there was a breakdown in the process at some point, so we had to close it down to restart it. The testing process wasn’t as smooth as it should be,” Ihekweazu said. “The lab is back up and running. What I can tell you is that the situation is improving. Once we’re able to get the flow of testing, isolation [and] contact-tracing going, then we can focus on the broader epidemiological questions relating to Kano.”

But observers such as Human Rights Watch have called for greater transparency from Nigeria’s health officials regarding the situation in Kano. The rights organisation claims there are fears of a wider outbreak of Covid-19 that exceeds the publicly available data, citing concerns by the doctors’ union and a local university.

“Official data from Kano state ministry of health reports 342 confirmed Covid-19 cases and eight deaths as of May 3, but residents fear that the outbreak may have caused far more devastation. Authorities should act quickly to ensure accurate public-health information is available and accessible to all,” the organisation said.

The Kano situation illustrates the scale of the challenge that is facing Ihekweazu and his young team at the NCDC. “The mood is okay, but this is a hard problem because the end is not in sight. It becomes really difficult to keep everyone motivated. The people haven’t given up. Across the country, some of our staff have become infected themselves,” he said. “You’ve got to work with all of that, but I think there’s a great sense of mission right now. Never have I seen the entire country almost closed down and watch the public-health workforce do its work. There’s so much attention on us.

Ihekweazu, who has a Nigerian father and a German mother, says he had his sight on further expanding the organisation’s capabilities. having worked in similar organisations in Europe and South Africa. “I had a view of where I wanted the NCDC to go and knew what was needed to get it there,” he said. But it wasn’t plain sailing at the start. “I had to navigate a very challenging political and government landscape in Nigeria that I’d never really worked in.

Nigeria’s civil service is vast and plagued with multiple allegations of corruption. The state oil agency, the Nigeria National Petroleum Corporation, has long been seen as an avenue for public officials to siphon money into their own pockets. And there is a perception that people working in government are lazy and uncaring about their duties. Ihekweazu says his experience at the NCDC has been vastly different from conventional wisdom. The key, he says, has been a focus on encouraging young people to do their best work for their country, even without the lure of massive financial reward.

Aanu Adeoye is a Media Fellow with Germany’s Konrad Adenauer Stiftung.

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