Strengthening Health Security through Field Epidemiology — Key messages from the 2018 NCDC/NFELTP Conference
Since 2016, the Nigeria Centre for Disease Control (NCDC) and the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) have every year, hosted an annual conference- the largest gathering of field epidemiologists and public health professionals in Nigeria.
This year, the conference held from the 4th to the 6th of September, at the Transcorp Hilton in Abuja. The theme- “Strengthening Health Security through Field Epidemiology” was fully explored in the exciting programme which combined renowned keynote and plenary speakers, scientific presentations with thought-provoking discussions, ending with a grand celebration marking the 10th anniversary of the Nigerian Field Epidemiology Training Programme.
Apart from the formal programme for the conference, there was also a lot of networking with keynote speakers, staff of NCDC, and graduates and current residents of the NFELTP engaged in fervent discussion outside the formal sessions. The conference also provided an opportunity to recognise organisations and individuals that have played a key role in the NFELTP since its inception in 2008. In addition, the most recent graduates of the programme, as well as the delegates with the best presentations were formally recognized.
Dr. Chikwe Ihekweazu, Chief Executive Officer (CEO) of the Nigeria Centre for Disease Control (NCDC), said the conference provided an opportunity to celebrate success, identify challenges and strengthen commitments and partnerships, especially in light of the tenth anniversary of the NFELTP programme.
“This conference is to evaluate where we are with the opportunities we have in defending ourselves, what the future holds, bringing these together, inspiring & stimulating new ideas that would take us forward as we fight against the bugs that threaten our existence as a human race,” he said.
A number of important messages from the Conference emerged that should inspire us as a nation to think deeply about our health security, our preparedness for epidemics and the importance of these field epidemiologists, the front line “disease detectives” in safeguarding Nigeria.
Some of the key messages and questions that arose were:
- Does Nigeria have the capacity to diagnose enough of our emerging and re-emerging diseases
This was an important highlight from the first day of the conference. Professor Iruka Okeke, a Professor of Pharmaceutical Microbiology at the University of Ibadan, drew attention to the limited diagnostic capacity in many African countries and its impact on global health security. She said the common belief that some diseases disappear closer to the equator might not mean that they did not occur but could also mean that those diseases are less diagnosed closer to the equator. For her, this is worrying and she said: “We cannot have a secure world if we cannot have pathogens and diseases diagnosed in the areas where they emerge”.
Drawing attention to the important role of capacity, she highlighted that effective diagnosis can only happen if the right people have the right capacities. She also raised the potential of genomic surveillance as a leapfrog technology that can transform public health in the country.
However, she warned: “What we need urgently is not just structures and equipment, but the ability of the technicians to read the sequences”. Noting that there are numerous open-source and easy to access online resources that can teach genomics and how to read results of genomic sequences she indirectly issued a call to action for laboratory scientists in Nigeria.
- The importance of leveraging technology for disease surveillance
Dr. Peter Nsubuga focused on the Integrated Disease Surveillance and Response (IDSR) framework and how technology can help scale it. The IDSR is the WHO recommended framework which illustrates the functions, activities and skills required to implement a coordinated, comprehensive surveillance and response system. He said Nigeria is not doing enough in public health informatics on the continent and this needs to improve given many opportunities we can leverage on. Linking the importance of capacity development and the NFELTP programme to disease surveillance, Dr. Nsubuga said, “IDSR or surveillance cannot work itself, it needs people who are well trained.”
The NCDC has recently begun the rollout of SORMAS, a digital surveillance tool that enables surveillance officers and epidemiologists to detect diseases based on real-time health facility data and automatic notification.
- Collaboration, Collaboration and even more Collaboration
The importance of multi-sector, multi-country collaborations to help strengthen health security was not only reiterated but clearly demonstrated at the conference. The conference had representatives from the Federal Ministries of Health, Agriculture and Rural Development, Environment, media and academia. Key development partners, including the World Health Organisation (WHO), UNICEF, the Japanese JICA, and the German GIZ, held important sessions during pre-conference workshops on September 3rd, ahead of the Conference. Given the importance of cross-border collaborations for regional health security, the presence of Tolbert Nyenswah, the first Director General of the National Public Health Institute of Liberia, was significant. He shared how Liberia is faring with a presentation titled: “Is Liberia Ready for the Next Ebola Outbreak: Standing Up an Effective and Functional NPHI in Liberia.” Noting that while preparing for potential and emerging health threats is vitally important, he emphasized that strengthening global health security must start by protecting people from the diseases they face today.
Dr. Patrick Nguku, Regional Technical Coordinator of AFENET Africa for Nigeria and West Africa believes that while working together had its challenges, it remains the best way to go for a greater good of the public. “It is difficult to move together but you move farther when you do,” he said. The benefits of multi-sectoral collaborations on national development were highlighted by Dr. David Shamaki, Director of the National Veterinary Research Institute Vom, Plateau State, who thanked Dr. Ihekweazu for breaking the gap between the veterinary and medical profession. “The more we work together the stronger we are. 60% of diseases that affect man come from animals so there is need to work together because when the population is healthy, we spend less on diseases and spend more on development,” he said.
Dr. Joshua Obasanya, Chairman of the Conference Planning Committee, reiterated at the end of the conference: “We can do more through multi-stakeholder collaboration. The use of skilled workforce is a key to attaining health security and that was apparent throughout the conference.”
- Training and funding as key drivers of a resilient epidemiology programme
Dr. Okey Nwanyanwu, Senior Executive for Africa at the Global Health Services Network, spoke on “Securing Nigeria’s Public Health Future Through NCDC: People, Knowledge, Money,” at the Conference. He spoke about the NFELTP’s origins 10 years ago, and the importance of discussing solutions that would drive future interventions, especially how to make resources available to those who ensure Nigeria’s health security from epidemics.
“Public health security in Nigeria is the responsibility of Nigerians. Its future can only be secured by Nigerians through a coordinated and integrated effort organised locally and sustained organically,” he said, adding that “Given the population of Nigeria, it is estimated that we need to train and sustain 1,000 epidemiologists to be able to meet epidemiologic challenges. To date 367 are in training and another 58 have been selected for the next class for a total of 425.”
He commended the residents of NFELTP, pointing out that, “You guys are appreciated because while everyone else is running away from an epidemic, you are running towards it.” Of the 367 residents completing or currently in the NFELTP programme, 60% are physicians, 18% are veterinarians and 23% are laboratory scientists.
He noted that Nigeria needs to develop a plan for training, research and knowledge management that includes NFELTP, and implement a tiered public health workforce development plan. He also emphasized the aspect of funding for NFELTP. “Money is important. It’s not only NCDC that should be funding NFELTP. Other ministries should be contributing funds. States, NGOs and the private sector must be involved. But we need to have a plan to raise these funds. We need to have a way to keep them engaged,” he said, advocating for the creation of an NCDC Foundation as a fundraising arm for the NFELTP.
Moving forward; An NFELTP that is stronger and sustainable
While there were many positive signals from the conference, it is important to highlight the key concerns raised by speakers. These need to be addressed if Nigeria is to chart a meaningful course for training in epidemic preparedness.
Dr Nwanyanwu in summarising the integral role of the NFELTP Programme said: “The FELTP Epidemiology programme is only sustainable if it is well integrated in the national public health institute. It must be owned by Nigeria, managed by Nigerians and should collaborate with other sectors and ministries. It must be funded by the Nigerian Government,” he said, adding that “The US CDC will cut by 80% current efforts to present global disease outbreaks. We cannot stop disease outbreaks without money.” He said Nigeria must not only train its fellows but also ensure that its neighbours are able to access training. He ended on the positive note that as trained epidemiologists, “We are not afraid of any epidemic. We are Nigerians, we are Africans… we will always do the best that we can do.”
Prof, George O. Akpede of Irrua Specialist Teaching Hospital who spoke on “Indigenous Initiative and the Control of VHFs: The Lassa Fever Control Model of ISTH” noted that the turnaround in the treatment of Lassa Fever came when the Institute for Lassa Fever Research and Control, a specialized facility for detection, case management, prevention and control of Lassa Fever was set up. Pointing out some of the gains of the Institute, he highlighted a “significant reduction in the case fertility rate with the commencement of reliable laboratory diagnosis and improved capacity in lab diagnosis and clinical management.” He admitted that Viral Haemorrhagic Fevers like Lassa Fever have become an acknowledged threat at sub-national, national, regional and global levels to global health, which is closely intertwined with global security. “Rising to the challenge is really an issue of raising the standard of clinical care of infected persons, particularly those with severe infections, in endemic countries,” he said.
At the close of the conference, Dr. Chima Ohuabunwo, Executive Director for AFENET reminded the residents that the programme has come a long way in the past 10 years. He echoed the NCDC CEO’s challenge that residents who have presented abstracts should push ahead to publish them. “The best way to drive public health change is to publish your work. We support member countries and all the programmes to publish. We co-sponsor the Pan African Medical Journal and it is free for graduates to publish.” He announced that AFENET will be launching another Journal; the Journal of Interventional Epidemiology and Public Health, “to publish the work that we and our graduates and residents do.” He ended by encouraging cohesion amongst the Programme’s residents. “As residents and graduates, we have formed a core of professionals that will keep working together to ensure that public health emergencies, wherever they occur in Africa, are contained if they cannot be prevented,” he said.