Meningitis outbreak, nation at loss


The recent outbreak of meningitis which has affected 17 states and claimed no fewer than 438 lives is a very sad reminder of the shambolic healthcare delivery system across the country. The outbreak also advertises a certain poverty of ideas on the part of those who rule even in matters that are supposedly routine. It also signposts the absence of an emergency medical preparedness plan that should have been activated to mitigate the current disaster. It is indeed embarrassing to note that this epidemic has taken the country unawares. Coming on the heels of an earlier outbreak, the frequency of occurrence is indicative of a huge shortfall in human development index and a failure of leadership in the country. This is a shame to a nation that should have outgrown primary healthcare challenges.

According to reports, Zamfara and the neighbouring states of Sokoto, Katsina, Kebbi and Niger have been hit hardest by the epidemic. Imo has recorded its first case and there are fears the disease might spread to other areas if unchecked. Most of the dead are children aged five to 14 because their immune systems are not well developed. Nigeria is facing a major shortfall in vaccines to contain the outbreak and the government announced last Friday that it had ordered 800,000 emergency vaccines from Europe. The head of the Nigeria Centre for Disease Control (NCDC), Chikwe Ihekweazu, said the country was in the middle of a significant response in each of the affected states, but disclosed that the Cerebrospinal Meningitis (CSM) aka Meningitis C strain responsible for the outbreak was not common in Nigeria and the worldwide stock of vaccine to cure the disease was limited. understands that the World Health Organization (WHO), which manages the stocks, has delivered 500,000 doses for a vaccination campaign to start in Zamfara on April 11. But this is very insignificant as it is estimated that about three million doses will be required in Zamfara alone. The government has a team working to determine the actual number of doses required to contain the spread of the disease, which has hit 17 of the nation’s 36 states and the Federal Capital Territory. It is however disheartening that medical doctors under the aegis of the Nigeria Medical Association (NMA) have condemned the government’s handling of the epidemic. NMA President, Prof. Mike Ogirima, told a press conference in Abuja that the association condemned in strong terms the reactive measures by the government on the epidemic. “The delayed immunization of the citizens against an infection that is already established is ineffective based on the epidemiology of the disease. For immunization to be effective, it must have been administered around three months before the period of clinical manifestation due to the latent period,” he said.

He urged the NCDC and other government agencies to be more proactive in the approach to such emergencies in the country and advised that early release of budgetary provisions for health programs should be part of the change mantra of the Buhari administration. Ogirima also took strong exception to a statement ascribed to Zamfara Governor, Abdulazeez Yari, that the meningitis outbreak was a curse from God for the people’s fornication and adultery, explaining that CSM was caused by the Neisseria meningitides bacteria and rampant with overcrowding and transmissible through coughs and sneezes, and facilitated by cramped living conditions and close contact. The illness causes acute inflammation of the outer layers of the brain and spinal cord, with the most common symptoms being fever, headache and neck stiffness. The fatality rate is usually very high if left untreated, especially among children and infants. Deaths can also occur in adults in a matter of hours after initial presentation.

Nigeria lies in the so-called “meningitis belt” of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east, where outbreaks of the disease are a regular occurrence. More than 13,700 people were infected and over 1,100 died in an outbreak in Nigeria and neighbouring Niger in 2015. In Nigeria, meningitis has been recurrent for decades; and as far back as 1975 research showed the various epidemics of CSM as to the type of strains involved and it is embarrassing again to note that this epidemic has taken Nigeria unawares. The country lacks progress in human development indices in this 21st century. People living in shacks urinate and defecate in the open, increasing the propensity for contamination in the north due to the scorching heat. Also, poor ventilation, desert encroachment leading to dry and dusty wind, climate change, and poor hygiene are worsening the situation.

Despite these known facts, there have been several outbreaks still. So, the question is: what is this nation ever prepared for? Nigerians are left to the vagaries of life while the leaders do nothing. Not even enough work on preventive health! It is worth recalling that various epidemiological studies conducted in the past on CSM trend indicated it is somewhat a yearly ritual. As such Nigeria should be on the alert. The National Program on Immunization (NPI) should make meningitis vaccine as part of the free routine immunizations, while parents should also take personal responsibility for their health and those of their children by ensuring that all members of their families are immunized against meningitis.

Way back in 1947, Nigeria produced its own vaccines to fight epidemics like small-pox. Seventy-years after, Nigerians are dying from meningitis and seeking vaccines from abroad. This is unacceptable. As an urgent national imperative, the federal government should immediately resuscitate local vaccines production (LVP) at Yaba and expand the scope of LVP at the National Veterinary Research Institute, Vom. Since 1991, the Yaba vaccines production laboratory has been all but abandoned and this to say the very least, is embarrassing. The pharmaceutical industries should be challenged and supported to produce the country’s consumables and this should be the new order instead of budgeting huge sums of money on importation of vaccines and other consumables.

The latest meningitis outbreak, once again, presents a challenge to the authorities to address basic social amenities that make for improved living conditions for the average Nigerian. The times call for a rapid response team with members from the affected states, health officers and stakeholders to curtail the outbreak. Anti-meningitis interventions should be holistic, targeting short-term measures and long-term improvement in human development indices.