Chikwe Ihekweazu, Director-General, Nigeria Centre for Disease Control (NCDC)

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On working with the private sector to fight Covid-19 and strengthen health care infrastructure 

What challenges has the NCDC been able to overcome in terms of testing capacity, and what are the main obstacles ahead? 

CHIKWE IHEKWEAZU: The outbreak of Covid-19 exposed pre-existing weaknesses in Nigeria’s diagnostic capacity. Historically, testing has not developed as rapidly in Nigeria as in other countries because its importance has not been prioritised, leading to diagnostic insufficiency in the health sector. We were therefore left in a very vulnerable position at the beginning of the outbreak – we were in a period of global shutdown but needed to respond. The countries that were able to rapidly scale their diagnostic capacity already had functioning molecular labs and simply moved from testing one virus to testing another, whereas in Nigeria we had to build the labs from scratch. 

We had three goals in mind in terms of testing. The first was proximity: Nigeria is an incredibly vast country and we needed to bring testing closer to people to increase confidence in the system. The second was to scale up the number of tests done in specific centres, particularly in areas with a high number of infections, such as Lagos. The initial strategy was to look for any lab in the country – whether in a university or hospital – that had some existing molecular diagnostic capacity and try to scale that up as quickly as possible. We also had the opportunity to convert some of our equipment used for tuberculosis and HIV testing. The third goal was to focus on the future. We were not just looking for short-term solutions to this particular problem, but to ensure that we have infrastructure that will last. We are now present in all but five states, and we are working with the private sector to increase capacity and develop more robust molecular diagnostic services.

To what extent has the public sector collaborated with the private sector since the outbreak of Covid-19? 

IHEKWEAZU: Prior to the pandemic, the private sector’s interest in supporting health services was very limited. However, the outbreak led to the formation of a group known as Cacovid, led by the Dangote Foundation, which brought together key corporate players in Nigeria. Rather than trying to compete and work individually, these businesses pooled their resources and helped us deliver on our most important priorities, by procuring personal protective equipment and laboratory supplies, for example. Going forward, many companies are working to establish relationships with the states they operate in. For example, Shell has supported labs in public hospitals in Rivers State. We are collaborating with these companies to provide expertise and specifications of what needs to be done. 

We have also received a lot of support from tech companies and small start-ups, which have been particularly helpful to our call centre given the influx of calls since the pandemic hit. There will be more opportunities for these firms to play a part in the response to Covid-19 as companies are forced to streamline their operations and embrace technology to improve efficiency. Other small-scale businesses such as restaurants also helped by providing public workers with meal deliveries. 

How would you evaluate the private and public sector’s capacity to produce and distribute vaccines, and do you have a timeline for their rollout? 

IHEKWEAZU: Nigeria’s vaccine distribution mechanism is one of the most efficient aspects of the public sector. Vaccination campaigns to protect against polio and other diseases have required fairly sophisticated distribution infrastructure linked to strategic locations across the country. We have confidence in our ability to distribute, and I do not think we will have much hesitancy towards the Covid-19 vaccine as has been predicted in other parts of the world. The main question now is how quickly we will have access to a vaccine, given that we do not currently have the capacity required to develop our own. This is a deficit that has become very apparent to us and we are determined to do something about it moving forward.

Looking at Nigeria’s current health care infrastructure, what areas are in need of additional investment? 

IHEKWEAZU: The pandemic has highlighted the need for investment across the entire health sector. High-level discussions are under way to identify how we can restructure funding for health care services going forward, as we currently have a very mixed and inefficient model in place. Nonetheless, many Nigerian expatriates are involved in the European health care sector and are returning to Nigeria to invest in major clinical and hospital projects. The missing link is to identify how to mobilise the resources of the middle class, as many who can afford to seek treatment abroad often do so. The travel restrictions imposed by the pandemic have further highlighted the need to invest more in improving domestic health care infrastructure.

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