ANALYSIS: Ebola is back — but how prepared is Nigeria to prevent an outbreak?

James Mbom has been in Nigeria since mid-2018 when he fled his hometown in southern Cameroon following the violent conflict between the government and rebel forces. He is now settled in Cross River state alongside more than 5,000 Cameroonian refugees — but he visits home frequently.

“We don’t have any issues travelling, except the payment we often make to the security (agents) at the border. The only thing they check is your refugee ID card and sometimes you are asked to wash your hands but not always,” he told TheCable.

These frequent and unchecked movements through the border by Mbom and others are now issues of health safety concern.

From Djoum, Mbom’s hometown in Cameroon, it takes just a day’s journey to get to Congo which borders the Democratic Republic of Congo (DRC) where the Ebola virus has killed four persons out of the 11 infected in a fresh outbreak.

Elsewhere, in the north-east, Nigeria is just two countries away from Guinea where the virus has proven to be deadlier and spreading faster, killing eight persons out of the 13 confirmed cases.

The fresh outbreak started in DRC on February 7 after the last Ebola health crisis had ended in 2020, killing 11,000 persons out of the 28,000 infected. Before then, one of the previous outbreaks had crossed into Nigeria but the country responded adequately.

HOW PREPARED IS NIGERIA THIS TIME?

During visits to Nigeria’s border with Cameroon in Cross River state; with the Niger Republic in Sokoto and Katsina states; and with the Benin Republic in Lagos, TheCable found out there are no adequate measures in place to ensure that any carrier of the virus is immediately detected.

When TheCable visited Jibia LGA of Katsina about two weeks ago, the border is so porous that you can easily enter the country from Maradi, the closest territory in the Niger Republic, with little or no restriction.

Apart from the main entry point where a few security and health operatives are stationed, there are many other routes, including the bushes, where people leave and enter the country from — and no single disease surveillance measure is in place.

The situation is slightly better at Ikom in Cross River which is about 40 minutes to Ekok, the closest Cameroonian community.

TheCable observed that there is no strict enforcement of health protocols such as temperature checks, while the officials seemed to have much of their attention focused on security checks.

In Lagos, not a single health official was manning the border with the Benin Republic, with the government staff deployed in the area focusing on just the neighbouring communities.

A resident who had just arrived in Nigeria through the border spoke about his experience. “Nobody is manning the border at all. The health officials are not immediately close to the border,” he said.

WHY NIGERIA SHOULD BE VERY WORRIED

Chidi Nwakanma, an epidemiologist based in Cross River, told TheCable that epidemic preparedness is not just about a country and that Nigeria can only be as safe as its neighbours.

He explained that with the current situation, Nigeria might miss the warning signals regarding any Ebola outbreak from the neighbouring countries, especially Cameroon.

He said: “The pandemic has greatly improved the situation from what it used to be but we still have a long way to go. Here (in Cross River), you see these Cameroonians coming in and leaving as if there is no official border and most of them, especially those seeking refuge, do not go through proper checks from the port health services.”

According to Prevent Epidemics, a project used by Vital Strategies to track epidemic preparedness globally, Nigeria recently moved from ‘Not Ready’ to the ‘Work to Do’ category after “sustained investments Nigeria has made in their systems to find, stop, and prevent epidemics”.

It, however, added that the country still has gaps in preparedness, which include “monitoring systems that can spot unusual health reports from local clinics or trained disease detectives who can rapidly deploy when a new health threat is reported”.

But even with a poor epidemic preparedness ranking of 46 out of 100, Nigeria is ahead of its neighbours —  including Cameroon (38), Benin (34), Niger Republic (34) and Chad (29) — all featuring under the ‘Not Ready’ category.

“This means that we are even at greater risk,” said Ugwuanyi Emmanuel, an Abuja-based public health expert. “The low level of preparedness in neighbouring countries means we have a lot of work to do at our borders to be able to detect any health emergency.”

Both the Nigeria Immigration Service (NIS) and the federal ministry of health could not be reached for comments on the extent of Nigeria’s preparedness to detect and prevent the Ebola virus as well as the country’s capability to adequately secure its borders.

Boss Mustapha, chairman of the presidential task force (PTF) on COVID-19, had said at a recent briefing that the federal government is “enhancing surveillance at points of entry” to respond to Ebola outbreaks in the neighbouring countries.

According to the Nigeria Health Watch which advocates for better funding for epidemic preparedness through its #PreventEpidemicsNaija project, funding for the best health crisis is “no longer an option, but a necessity”.

The organisation recently advised that “public and private sector stakeholders must collaborate to ensure funds are available to protect the health of Nigerians” — especially after the COVID-19 pandemic “has shown epidemics do happen and can take nations unaware”.