In this interview with Eniola Akinkuotu, the Minister of Health, Prof. Isaac Adewole, speaks about the recent threat of another outbreak of Ebola virus and other health issues.
The World Health Organisation has declared an outbreak of Ebola in Congo, describing it as a public health crisis of international importance. What is your ministry doing that can assure Nigerians that the government has the situation under control?
Well, since 2014, when we were able to put Ebola under check, we have not let down our guards. If you visit any international airport, you will discover that we routinely screen passengers who come in and I was there (at an international airport) on Monday to ascertain the level of preparedness and to ensure that we are still actively doing what we ought to do. I just went to reassure myself. I have travelled out a couple of times and I know those thermal screeners are working. What we have decided to do is to set up an Ebola working group, led by the Nigeria Centre for Disease Control. We have also invited representatives from the Ministry of Information and Culture so that we have a broad-based committee to handle response. We have also alerted the commissioners of health to manage any form of haemorrhagic fever with the seriousness it deserves. I have advised them to be careful when there is a case of any fever that is not malaria and not responding within 48 hours. So, I think we are on top of the situation.
After the last Ebola outbreak, it seemed the campaign for personal hygiene dropped and we returned to our usual way of doing things and the Ministry of Health also stopped its awareness on hand washing and so on. Why was that?
I’m not sure the campaign stopped. I think it is always normal, when an outbreak goes down, for people to lower their guards but to be honest, we didn’t stop in Nigeria. We continued to screen passengers at the airports and we regularly reminded Nigerians about the value of personal hygiene. Many of the personal health challenges can be resolved with good personal hygiene.
The last Ebola outbreak started from Lagos. It is believed that the state government was able to do a lot because it is more developed and urbanised that other states and than things could have been worse if it were another state.
That is to some extent very correct because Lagos had a very responsive administration. They have a strong health system.
If Ebola starts from a state like Zamfara, which is already experiencing an outbreak of Meningitis, how will the Federal Government curtail it?
One of the fallouts of the Meningitis outbreak is that we are strengthening the health system in all the states and we are reemphasising the need for the revitalisation of the system. I have engaged the Governor of Zamfara State, Abdul’aziz Yari, about the need to engage more health workers and he has promised to engage more nurses and doctors within the states so that we can be up to task. But may I also inform you that Ebola importation will have to come through a border route. Ebola is not native to Nigeria, there must be an airport or a land port or a seaport. If we maintain vigilance at all those positions, it will not get to Zamfara State.
Are you saying the Federal Government is more prepared to deal with Ebola than it was in dealing with diseases considered to be less frightening like Meningitis and Lassa fever which resulted in many deaths, even if it starts from a place like Zamfara?
Yes. Certainly. This is because an importation of a disease will be picked up by our public health workers easily and these are federal workers who have been trained and stationed at the ports.
Between August 2015 and Sept 2016, about 280 persons were afflicted by Lassa fever and 154 deaths were recorded. Would you say that government did well given the fact that even a corps member died last week of Lassa fever in Cross River?
We have done well in managing Lassa fever. We have done well really in creating awareness among the populace. We have not done well as individual health care workers. We have alerted times without number at meetings with Chief Medical Directors. I just informed the health commissioners that it is unacceptable for someone to have a fever for two weeks and for them to be unable to treat it. The beauty of Lassa fever is that it is treatable. It is not even like Ebola. When doctors diagnose Lassa fever, they relax because it is treatable. But then, what we must realise is that treatment must start early. If you don’t start early, you are likely to miss keeping the patient alive.
Some experts have blamed the situation on a poor disease surveillance system. How are you planning to improve that?
It is not poor surveillance but a poor or weak health system. If the health systems are working, things would be different. Like I told the commissioners, one case of Meningitis should create a health alert. The Meningitis outbreak started in Zamfara State during but we didn’t get to know until three months later. That is unacceptable; just like we had Lassa fever in Niger State in 2015. We had 17 deaths in one local government without anybody telling us. That is the result of a weak or poor health system and that is why this administration is committed to rebuilding the health system. This is because when you have a strong health system; it takes care of all your challenges.
Why does it appear that the handling of Lassa fever and Meningitis have lacked the zeal the Ebola outbreak inspired even though Lassa fever and Meningitis occur more frequently?
The thing about it is that Ebola kills more rapidly and there is no treatment. And so, for us in the health sector, such a disease must be taken more seriously. There is no treatment and so the solution to Ebola is prevention. There is treatment for Meningitis. Meningitis is susceptible to antibiotics so it should not kill anyone. As a medical student, I managed Meningitis. All you need to do is have a health care professional who is trained to make a diagnosis of Meningitis. Once you make the diagnosis, you will do a lumbar puncture, you will check the fluid and you can confirm Meningitis and you treat it. That is not the same for Ebola which has no treatment. And so, we just must keep it away because we cannot treat it. Lassa fever is treatable so Ebola is not on their level.
So, how is it that since 2016, over 700 persons have died from Meningitis outbreak in the country? Is it due to the sloppiness of health care providers?
It is due to poor surveillance in the states. The states have a poor health system. The states should notify the Federal Government. If they fail to notify us, we can’t really help them. So, that is why we are sending messages across the states so we can know what their problems are. They should not hide it. We tell them, it is not your fault if there is Meningitis because it is treatable. Just alert us and we will move in there. We have a team on standby and we have constituted a 10-member team for Ebola ready to move to any part of the country.
Governor Yari said Meningitis outbreak was God’s punishment to the people for fornication. Do such a statement from political office holders and such mindsets affect your performance?
I suspect the governor must have been misquoted because I didn’t hear this directly from him but I think the problem of Meningitis got compounded in Zamfara because of heavy metal poisoning and because it was unusual, which was type C. They did not realise on time that they were dealing with an epidemic.
Some experts said there was shortage of vaccines to fight meningitis. How is the government making sure we never run out of stock again?
The vaccines for type C were not freely available. This country did a nationwide campaign against type A some years back so everybody went to sleep believing that Meningitis was no more. But then in 2013, we started seeing sporadic cases and this year, we had the worst outbreak of type C we have ever seen in this country and our job is to ensure that we prevent further outbreaks.
Some government agencies like the Primary Health Care Development Agency have not been attracting enough foreign grants because of mismanagement of funds. Last year, Global Fund also said it would not be releasing funds to tackle HIV because millions of dollars were diverted. How are you dealing with corruption in government agencies?
That is not completely correct. What Global Fund said was that they would put additional safeguards in Nigeria for those organisations that were found to be deficient. Global Fund said they would not give them money directly but will continue to fund Nigeria. And what Global Fund did was to appoint new principal recipients, including Catholic Relief Services. CRS to manage Malaria while the other is to manage HIV portfolio. And so, funding continues. But I can tell you today that one of the organisations that was found to be deficient, NACA (National Agency for the Control of AIDS), has now been cleared and it is now ready to resume. I hope that with time, National Malaria Elimination Programme, as well Department of Health Planning, Research and Statistics, will also be cleared.
Some persons were arrested over the diversion of millions of dollars donated by Global Fund for HIV. Why has no one been prosecuted?
They have refunded money and the Economic and Financial Crimes Commission will soon charge them to court and I can assure you that immediately the infraction was discovered, we moved the officials out of their desks and we wrote them letters of query and set up a panel to look into the matter. So, as far as this administration is concerned, there will be no cover-up
Three Queens College of Lagos pupils died from an epidemic in the school recently and the school and its old students association said they wrote to the Federal Ministry of Health. Have you investigated the matter and brought anyone to book over the tragic incident in the school?
Three students died as a result of drinking contaminated water. Queens College is not under me and I have not received any official communication. I was in Lagos for another assignment and on my way to the airport, I got a call and an alert on my Twitter handle about some unusual situation in Queens College and then I turned around and went to the school. However, when I got to the school, the students were on vacation, so people should put things in proper perspective. When students are on vacation, you cannot see any sick child. There was nobody to see but in spite of that, I asked the principal about the state of things and the principal said ‘we don’t have a problem’ but because I went with the CMD of Lagos University Teaching Hospital, Idi-Araba, and representatives of the commissioner of health in Lagos, I decided to set up a team to investigate and look round and in the course of that, we discovered that truly, there was an outbreak of diarrhoea and vomiting, which was linked to the water system. I wrote a report, which a committee submitted and was given to the Minister of Education. And I can tell you that Lagos State came to the rescue along with those in LUTH and things are back to normal.
This government claims to be improving on the health care system but why is it that every senior public official travels out of the country for treatment?
That is very unscientific because it is not all of them. How many travel out?
The President travels out for medical attention and even last year, the Minister of Women Affairs was in the United States for a leg surgery.
What you need to know is that health is a personal issue and there is also a doctor/patient relationship. I had a difficulty at the UCH (University College Hospital, Ibadan). Some of my patients, up till today, don’t want to see any other doctor. They still call me. One of them even called to say he wanted to come and see me in Abuja, but I said no, let my colleagues look after you and so I referred him to two doctors. So, that is the issue about health. There is this bond between a doctor and a patient that is very hard to break. If I was seeing a doctor in the United Kingdom before becoming a minister, being a minister now does not necessarily mean I should detach myself from the doctor. I may want to continue with the doctor until it is over and then if I have subsequent complaints, I can call on a new physician in Nigeria. Sometimes, even your doctor in Nigeria can ask you to seek a second opinion if you are in doubt. It is allowed in medicine for you to have a second opinion.
You revealed recently that $3.2m worth of HIV drugs expired in storage. How did that happen?
It happened during the previous administration. The issue is that the drugs expired because of some challenges in the system and we are trying to put that behind us. We are now putting together a network of logistics supply system. We have two excellent facilities in Abuja and Lagos which we call ‘Warehouse in a Box’. The one in Abuja is called Premium Medical Supplies Store and everything there is computerised and with that kind of computerised system, there will be no more expired drugs because we will be able to monitor them electronically. It will be a system of first in, first out and we will also be monitoring expiry dates. What we are also trying to avoid in the country is a situation where we take drugs that are about to expire. When you pick drugs that have short shelf lives like six months, they can expire easily.