Dr. Gani Enahoro is Vice President, African Veterinary
Association and former President of the Nigerian Veterinary Association of
Nigeria. He bares his mind on the solution to Lassa fever outbreak.
“Luckily, there has been a preponderance of
circulating “Facts on Lassa Fever” in the social media, since this current
outbreak that has affected 94 patients and killed 43 in 10 states (up to 63 fatalities in 17 states as press time) as at 13th
January 2016, resulting in a Case Fatality Rate of 44%. This statistic
and precautionary measures all trace their source to the press release by the
Honourable Minister of Health, Prof. Isaac Adewole. A man I admire so much,
since I had close encounters with him during Alumni reunion programmes two
years ago as Vice Chancellor of University of Ibadan.
“This
public document included the listing of symptoms to watch out for, GSM numbers
to call, e-mail addresses for the internet savvy, pathogenesis and epidemiology
of Lassa fever, tracing its origin to rats of Mastomys natalensis- the hairless tail, multi-mammate rat, which is
prevalent in West Africa, as the hosts or reservoirs of the Lassa fever virus.
It also has an incubation period of 6-21 days with multi system failures that
would eventually lead to death.
“The
objective of this volume of information is laudable and meant to increase
awareness through public education by warning and sensitizing people, but they
could sometimes also frighten the citizens about the dangers of Lassa fever.
Thanks to the advent of the social media, for making information dissemination
very easy, cheap and just a single click away.
“However,
beyond this hype and fears, there are fundamental issues and several questions
that need to be addressed going forward, if we must conquer the scourge of
Lassa fever, and by extension other viral haemorrhagic fevers.
“There
must be a change in the past strategies employed by the health authorities,
that has failed to stop the recurrence of this deadly zoonotic viral
haemorrhagic fever, tapping from the experience of Ebola that we have just
recovered from, and which seems to be our lot in West Africa and the successful
experience in taming the Highly Pathogenic Avian Influenza popularly called
Bird Flu.
“Lassa
Fever has been with us since 1969 and is still regrettably being talked about
with more frenzy today with a case fatality rate almost thrice the 15% that WHO
considers a very bad situation. The reason could be that old and current
strategies deployed have been the same and ineffective. As a nation, we must
come out of the box and design a new and sincere approach to dealing with a
disease that is quite endemic in our region, rather than continue with the fire
brigade methods of raising alarm, daily blow-by-blow ministerial updates of
deaths on television, setting up one-sided committee, begging for international
donations and building professional silos around the outbreaks, as if an island
exist around diseases. At best, what those steps have given us was to unfairly
concentrate every effort in post infection management of patients and contact
tracing of those who related with infected people, rather than a holistic
multi-disciplinary approach that is more efficient, prudent and sustainable,
when all hands are on the deck.
“The
animal-human interface that makes elimination of rats and rodents critical in
the case of Lassa fever has been completely ignored or played down, when the
committees are formed and when funds are deployed. No expert in that area of
competence has ever been found worthy of membership of Lassa Fever Committees,
even when an unwieldy number of 26-man omnibus committee of solely medical
doctors was formed in 2012.
“The
failure of such one-sided panel beating of a very deadly situation is now
steering us in the face today with the current recurrence. It sounds more
logical that we should worry as much, if not more about the source of the
disease and how to control it alongside the care for those already infected, in
the hope that we could nip in the bud, exposing more people that could have
been infected in future. This is the missing link, which could be traced to
pecuniary benefits that may surround the funds that would be provided, under
emergency, to deal with the disease. I hope we are all learning from
Dasukigate, the infamous arms fund deal that has confirmed that blood money
does not stink in some people’s pockets, no matter their status in the society.
“For
every student of public health, the first lesson was that no dividing lines
exist between human and animal medicine, because more than sixty-five percent
of infectious diseases in man are traceable to their animal origins. It then
means that collaboration between these two specialties must be promoted at all
opportunities for the overall interest of the general public. I must appreciate
that just the one time this collaboration was tasked, Nigeria got better for
it, and that was during the two major outbreaks of Bird Flu in 2006-2008 and
recently last year, the vestiges of which we are still dealing with today.
“The
trust in the competence with which the Veterinarians handled the animal
component of the disease has currently saved the public an almost equal hype that
Lassa has generated. As at January 13, 2016, it was reported that poultry farms
in Bayelsa, Plateau, Lagos, Kano and the FCT recorded severe mortality rates
due to bird flu. With all modesty, the bio-security and bio-safety measures,
introduced by the veterinarians kept the disease away from man in all the
cases. It should never be forgotten that person-to-person transmission of
mutated strains of HPAI virus is a possibility, with a case fatality rate (CFR)
up to 60-70%. This is a more deadly situation than the worst of Lassa
hemorrhagic fever outbreak known to history.
“At
the peak of bird flu scourge in 2006-2008, what helped most was, that early
recognition of animal and human components and the engagement of effective
communicators at the Federal Ministry of Information who managed the
information desk, and weighed the messages that should be passed to the public
through the electronic and print media. Relevant jingles and posters were all
over. Why can’t we replicate this beauty of multi-disciplinary intervention
when Lassa fever is concerned?
“A
more concerted effort is required inter-ministerial from the Federal Ministries
of Health, Agriculture, Environment and Information, if we sincerely wish to
deal with this scourge. The Pest Control Services section has always been
domiciled in the Federal Ministry of Agriculture, just like the Department of
Veterinary Services, and not anywhere else. There are Veterinary institutions
like the National Veterinary Research Institute (NVRI), Vom in Plateau State,
which can boast of diagnostic facilities of a similar Bio-Safety Levels (BSL 3
or 4) that is available at Irrua, which can confirm Lassa or possibly Ebola
Viruses, such that samples from patients in Taraba would not have had to be
transported all the way to Irrua Specialist Hospital in Edo State for
confirmation.
“This benefit can only come
from effective inter-disciplinary collaboration.”
Newspaper Interview
