Submission by the Honourable Minister of State for Health, Dr. Olorunnimbe Mamora at the University of Ibadan Physiology Students' Association, Distinguished Personality Lecture

INTRODUCTION AND OPENING
• I start on note of gratitude by saying a big “thank you” to the University of Ibadan Physiology Students’ Association for graciously inviting me to deliver this guest lecture at your Annual Association Week.
• I am very honoured to be speaking to you, students and young people, as we look to you all to build the world that our children and grandchildren will inherit
• I recognise that speaking about the battle against coronavirus in Nigeria is extremely important, as this pandemic will shape the world for a very long time to come. Therefore, it is very appropriate that we start now to understand where we have done reasonably well, where we have not done well, or where we have out rightly failed and what we can do better starting tomorrow, if not today.
• As requested by the organisers of this lecture, I will reflect on key lessons that we have learned from the COVID-19 pandemic, and how this is preparing us for future pandemics, as it is certain this will not be the last pandemic!

BACKGROUND
• I thought it best to set the stage with an understanding of the risks that we face in terms of infectious disease outbreaks in Nigeria.
• In the last decade, Nigeria has faced several public health challenges. In 2014, Nigeria responded to an Ebola outbreak that affected four other West African countries. We did this with relative success that was recognised globally. In 2017, we recorded the first monkey pox cases, forty years, after the last case was reported in the country and have continued to learn from this. In the same year, the first yellow fever cases were reported 21 years after the last case in the country. Over the last four years, there has been an increase in Lassa fever cases in the country. Almost every year, we record outbreaks of Lassa fever, cholera, meningitis, measles and yellow fever.
• What all these tell us, is that we are no strangers to large infectious disease outbreaks; our population is estimated at about 200 million people, the tropical climate we have, and the high rate of travel and trade to Nigeria put us at risk of the spread of infectious diseases.

COVID-19 PREPAREDNESS
• When our first COVID-19 case was detected in February 2020, we had begun to prepare but we did not have all the resources we needed in place.
• This was the same case in nearly all other countries of the world, for significant reasons – the world was faced with a pandemic caused by a new pathogen that had never been detected previously, hence was referred to as “novel corona virus”. We did not fully understand how the virus spread, we did not have vaccines, we did not have therapeutics to treat cases and had only begun the development of diagnostics to identify the pathogen.
• At the beginning of the pandemic, various epidemiological models predicted a doomsday scenario for Nigeria and other African countries. This was linked to our weak health systems, compared to countries in other regions; high population density, notably in informal peri-urban settlements; prevailing conflicts and humanitarian crises in a number of countries; and the contending burden of other diseases such as HIV/AIDS, tuberculosis, malaria and even the neglected tropical diseases(NTDs) we continue to grapple with in Africa.
• Yet, till date, Nigeria and other African countries have reported far fewer cases and deaths compared to other regions in the world. However, we must remember that we are not out of the woods, hence, it is not yet Uhuru!
• Prior to the confirmation of Nigeria’s first case on the 27th of February 2020, NCDC began monitoring the COVID-19 outbreak in China and conducted several risk assessments of the threat to the country. The initial risk assessment revealed significant gaps in critical areas including surveillance, points of entry monitoring, case management, laboratory, infection prevention and control (IPC) and logistics.
• On the 22nd of January 2020, more than a month before the first COVID-19 case was confirmed in Nigeria, the first public health advisory was published and widely disseminated using traditional and social media. We started our risk communication very early.
• The Federal Ministry of Health through the Nigeria Centre for Disease Control established a multisectoral National Coronavirus Preparedness Group (NCPG) to ensure a cohesive and effective coordination of the country’s preparedness efforts. This later transitioned to the National Public Health Emergency Operations Centre.
• Before Nigeria’s first case was confirmed, testing capacity was established at the NCDC National Reference Laboratory, and three existing laboratories within the NCDC molecular laboratory network - Virology Laboratory of Lagos University Teaching Hospital, African Centre of Excellence for the Genomics of Infectious Diseases (ACEGID) Laboratory at Redeemers University Ede, Osun State and the Nigerian Institute of Medical Research (NIMR), Lagos, followed immediately.
• The NCDC also began working with the States and tertiary hospitals to map out and establish isolation and treatment centres for managing COVID-19 cases. In addition to this, NCDC began training health workers across all the states of the Federation, on case management, infection prevention control (IPC), surveillance, risk communication and other areas of epidemic preparedness and response. The agency began to preposition medical supplies such as personal protective equipment (PPE) to all States of the Federation and FCT, Abuja. Importantly, NCDC developed preparedness guidelines and plans that incorporated an all-inclusive ‘One Health’ approach while adapting global regulations to Nigeria’s context.
• The NCDC worked with the Port Health Services of the FMoH to institute Point of Entry surveillance at international borders, introducing thermal screening, compulsory self-isolation, and contact tracing.
• In summary, we were not as prepared as we wanted to be, but we had made enormous efforts to establish testing, case management, risk communications and other components of the response.

LESSONS FROM THE COVID-19 PANDEMIC
• In the next few moments, I will share five key lessons from Nigeria’s COVID-19 response activities.
1 The first is on leadership and coordination: Nigeria’s COVID-19 response has had strong leadership provided by the Presidential Task Force on COVID-19 (PTF) established by His Excellency, President Muhammadu Buhari. The PTF coordinated multi-sectoral inter-governmental efforts to contain the spread and mitigate the impact of the COVID-19 pandemic in Nigeria. This was especially important as the COVID-19 pandemic was not a health problem alone. Although the PTF has now metamorphosed to a Presidential Steering Committee (PSC), the PTF served as a coordination hub for Nigeria’s COVID-19 response, with leadership at the highest level of government, chaired by the Secretary to the Government of the Federation, Mr Boss Mustapha. By having a multi-sectoral group at the highest level of leadership, we were able to coordinate strategic decision making for the country such as school closures, restriction on commercial flights, movements, public gatherings and others. The NCDC continued to provide scientific evidence and data to guide decisions by the PTF. Many states also set up their state task force for multi-sectoral response. Nigeria recognised the need for multi-sectoral coordination early, and this made a huge difference in our response activities.
2 The second key lesson learnt is how much stronger we are, when we work together (“Stronger Together”) It has been a demonstration of strength that lies in unity. I recall early in this pandemic, the DG, WHO, Dr Thedros enjoined the countries of the world to work together in the spirit of global solidarity and national unity. Nigeria adopted these words of wisdom. Prior to the COVID-19 pandemic, Nigeria had built strong partnerships with UN organisations, regional health institutes like the Africa CDC and West Africa Health Organisation (WAHO), other institutions like the US-CDC, the media and several other groups. One collaboration that has stood out very strongly is with the private sector. Following the confirmation of Nigeria’s first case, businesses and organised private sector through the Private Sector Coalition against COVID-19 (popularly called CACOVID) began to provide additional support to the Government. We have benefited immensely from their resources, expertise, and network in both the public health response and overall response to COVID-19 pandemic.
3 The third lesson is on transparency and trust. We knew early in the day that we had to be transparent with Nigerians, and build the trust needed for the public to work with us in controlling the pandemic. We have worked very hard to be clear and transparent about what the government is doing. Since the first case was announced, NCDC has announced a daily update of the situation every single day and published a weekly situation report. We have provided several avenues for communication to Nigerians. We recognised that where there was a breach in trust, there was limited adherence to public health and social measures. Being transparent is extremely important in risk communications and promoting behavioral change.
4 The fourth lesson was reliance on science, data and evidence. The lesson here is that in making decisions during a pandemic, we must be guided by science, data and evidence. There is no room for guess work.  The NCDC has continued to work very hard with states to improve the accuracy and completeness of key datasets that we use in making our decisions. Even when under immense pressure, we have refused to fly blindly and remain guided by science and evidence. As physiologists in training, you will recognise the critical importance of scientific rigour.
5 The fifth lesson is in investments in health security. As I shared earlier, we were not as prepared as we would have loved to be at the beginning of the pandemic. But the resources we had were based on previous investments in health security by NCDC. The first set of laboratories that began to test for COVID-19 in Nigeria had been established years earlier to test for Lassa fever. The States where we had Public Health Emergency Operations Centres had received support from NCDC between 2017 and 2019 to establish these laboratories. You will agree with me that we must do better in investing in health security and the Federal Government of Nigeria has begun to work on this, such as through the Basic Health Care Provision Fund, a provision in the National Health Act of 2014, where NCDC will be provided with 2.5% of the 5% of the funds earmarked for health emergencies.
These five lessons l have just shared with you, essentially tell the story of our modest achievements, the challenges we have faced, and the prospects we have in the battle against COVID-19 in Nigeria.

PREPAREDNESS FOR FUTURE PANDEMICS BASED ON LESSONS FROM COVID-19
• The COVID-19 pandemic has been unprecedented in several ways. It has affected lives, the economy of our country, travel, and social interactions. These have required a complete redirection of our public health resources to fight one disease. We were cognisant of the need to strike a delicate balance between lives and livelihoods.
• While building during a pandemic has led to the achievement of several milestones, there is no doubt that the world could have been better prepared if we invested more in pandemic preparedness. Therefore, we are seizing this moment of disruption to build more sustainable and resilient systems for health security in Nigeria
• And as hard as it might be to focus on a future crisis while we’re still faced with COVID-19, the World Health Organization (WHO) estimates we face a pandemic threat every 5 years. So, we must be better prepared, and we have begun that process in Nigeria.
• The world has been faced with a huge challenge of inequitable access to COVID-19 vaccines, with Africa bearing the brunt of it. While countries in Europe and the Americas have fully vaccinated as high as 50% of their population in less than one-year, African countries are still around 1% and faced with a scarcity of the vaccines. The doubts and controversies trailing the vaccines have further compounded the issue of vaccine hesitancy. Vaccine hesitancy has been fuelled by deliberate misinformation, disinformation, outright falsehoods and myths that have continued to spread through social media. These myths vary from the weird to bizarre!
• The pandemic has created a sense of urgency around vaccine development and manufacturing in the African region. In Nigeria, we are taking advantage of this opportunity to fully establish our capacity for vaccine manufacturing. We have been working closely with Biovaccines Nigeria Limited, a joint venture between the Federal Government of Nigeria, and May & Baker Nigeria Plc.
• We are strongly aligned with the Africa CDC’s target that by 2040, Africa should move from manufacturing 1% of the vaccines it uses to manufacturing at least 60% of its vaccine needs. Our country has the market size and the commitment required for this.
• Beyond vaccine manufacturing, we have leveraged on the COVID-19 pandemic to strengthen our health security. In about one year, NCDC has established at least one molecular laboratory in every State in Nigeria, completely digitised our infectious disease surveillance system, scaled up the establishment of State Public Health Emergency Operations Centres in nearly all States, started the establishment of about 12 standard infectious disease treatment centres across the States of the Federation, in December 2020, with six of these completed and fully equipped.
• In terms of funding, we continue to advocate for more funding to NCDC as the country’s public health institute, but also to other agencies of the Federal Ministry of Health, for us to strengthen our primary health care system, medical research, pharmaceutical research and development, regulatory affairs, and other components that we need to be better prepared for the next pandemic
• The responsibility is not with the Federal Government alone. We continue to appeal to State Governments to invest in the health security of their respective States – investing in preparedness is a wise choice!

CONCLUSION
• Mr Vice Chancellor, Dear friends, colleagues, distinguished ladies, and gentlemen, in the last fifty minutes or thereabouts, I have taken you through the battle against COVID-19 in Nigeria, enumerating our achievements, challenges and prospects. We have earned commendation from the WHO as opposed to the “Armageddon” earlier predicted for Nigeria!
Apparently, when we are better prepared, we will be able to do things differently and do it better – we are learning from COVID-19 pandemic to build back better.
• The pandemic is not over yet and we continue to learn lessons. Today is a great opportunity to reflect on the role that you, young persons, will play in building and sustaining Nigeria’s health care system. A popular saying in our country is “the young shall grow”; but hasten to add the old will surely fade away. This is the natural process.
• I would like to emphasize at this point that a significant part of our COVID-19 response in Nigeria has been driven by young people. They are at NCDC, National Primary Healthcare Development Agency (NPHCDA), across our State EOCs and even in the treatment centres and the laboratories spread across the country.
• As young people, you have the energy, the innovation and the “vibes” that we need to sustain our response – use your networks and skills to share the right information, support your family members and friends in accessing the COVID-19 vaccine to protect us all. The vaccines are safe. I urge you to think of innovative ways that you can contribute to the pandemic response activities.
• We remain very grateful for the support from Nigerians in keeping the COVID-19 numbers low. We cannot afford to give up now, as it is not over until it is truly over. We are not unaware of “pandemic fatigue” as our people are eager to go back to the old normal. But the reality is that we must first carefully manage the new normal.
• The work that we are doing at the Federal Ministry of Health and our Agencies is extremely important. But even more critically, our preparedness for the next pandemic starts immediately and building your contribution, as young people, to this, should start not even today but right now!
I thank you, for your kind attention.

FMOH Agencies

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