On April 11, 2018, Dr Tedros Adhanom Ghebreyesus visited the Nigeria Centre for Disease Control (NCDC). This was his first visit to Nigeria since assuming the role of Director General of the World Health Organisation (WHO). It was the first time the NCDC would be hosting such a high-level visitor from the United Nations. This was an extremely significant event for us. I remember my encounter with him in May 2017, the night he was elected Director General of WHO. I was part of the Nigerian delegation that attended the World Health Assembly (WHA) in Geneva. For the first time, an African was elected to serve as the Director General of the WHO. It was a moment of pride for many of us. Of course, it was not just that Dr Tedros (as he is fondly called) is African, but that he came with a great pedigree of achievements at the national and international level. Yet, we knew that he came into office with extremely high expectations, especially in a post Ebola world. We were elated by the African spirit of brotherhood and unity, and discussed within our circles, what his election meant for the region. For me, it meant an increased responsibility to rise to the challenge of health security issues in Nigeria. I felt an additional burden of responsibility to our new leader in global health, not to let the continent down. The year that followed would be very challenging, as we managed outbreaks of Lassa fever, monkeypox, Cerebrospinal Meningitis (CSM) and others in Nigeria. However, more than ever before, I was confident of the support coming from the WHO, as it supports a national institution that is itself growing in capacity and confidence.
Sometime in March 2018, I received a call from the country representative of the WHO in Nigeria, Dr Wondi Alemu, informing me of the choice of Nigeria to host the WHO global policy group meeting. This meant the country would host the Director-General, Deputy Director-General, six Regional Directors including, critically the Director of the new WHO Emergencies Programme – Dr Peter Salama. In the same week, we would host a historic meeting to launch the ‘Ending Yellow fever Epidemics’ strategy for the African region. He also informed me that Dr Tedros had chosen NCDC as one of the few places he wanted to visit in Nigeria. While it seemed like a lot of pressure at the time, it illustrated the strategic position Nigeria and the NCDC had begun to take, in the global health space. Our preparations to host the delegation started in earnest.
There is great mutual benefit in the partnership between the WHO and national public health institutes in Africa. WHO’s long-term mandate of providing strong technical assistance to national response structures was best demonstrated in the Nigerian-led response to the Ebola outbreak in 2014. We demonstrated how strong political leadership and a team of field epidemiologists was the perfect receptacle for WHO support. Years after the outbreak, Nigeria continues to take proactive steps in strengthening its national public health institute; increasing its preparedness and response capacity to similar outbreaks. I was therefore very proud that the Director General chose to visit the NCDC. Despite a longstanding prior appointment, I had the pleasure of welcoming Dr Tedros to the NCDC and showing him and his colleagues how far we had come since 2014.
Joint NCDC/WHO Rapid Response Team during one of our outbreak response activities
Dr Tedros’ visit to the NCDC also served in drawing global attention to the unique challenges of a country the size of Nigeria and the work being done at the NCDC. It showed that we not only play a strong role for Nigeria, but also for the global community. In the last two years, our work has been at the centre of many health security discussions. The re-emergence of yellow fever and monkeypox in 2017, as well as the unprecedented outbreak of Lassa fever in 2018, has elicited several discussions globally. In response to all these outbreaks, the WHO has been a strong partner, supporting the national institution with the responsibility for leading the response.
NCDC Incident Coordination Centre Lead introduces activities of the ICC to Dr Tedros and his delegation
Dr. Tedros’ visit served to encourage many members of the team that had spent many weeks in the field, often with WHO colleagues. “There has been a Nigeria CDC in existence for many years, but what we now have is an agency with the capacity to respond to outbreaks. Thank you for all you do”- these were the encouraging words of the WHO Regional Director for Africa, Dr Moeti Matshidiso, who has herself been an inspiration to all of us. There is no doubt that the visit of the Director General and his delegation was very motivating to the staff of the NCDC, who continue to work tirelessly to protect the health of Nigerians. Often, the focus of success (or absence of it) is in the leadership of the organisation. However, at the NCDC, most of our success has come from the hard work, diligence, dedication and commitment of my colleagues – from the drivers to the directors who have led from the front. For these colleagues, the visit of the DG was exciting and a reminder of the important role they play. This was obvious in the push for selfies with the global health leaders who came visiting.
Group picture with the WHO DG, DDG, 6 Regional Directors and the NCDC Team
As part of the Director General’s visit, I had the privilege of traveling to Borno State together with Dr Tedros and his delegation. Despite some scepticism about the security situation, Dr Tedros showed great leadership and commitment by insisting on this visit to the North East of Nigeria. In Borno, the WHO has gone above and beyond its normal call of duty in supporting the rebuilding of the state health system, since the insurgency began. In 2017, we worked with WHO to support the state in responding to an outbreak of cholera, mostly affecting internally displaced persons. In collaboration with our sister agency-the National Primary Healthcare Development Agency (NPHCDA), we implemented the first oral cholera vaccination campaign in the country. At present, we are working closely with the WHO in North East of Nigeria to strengthen our capacity in disease surveillance and outbreak response. It has not been an easy journey but the strength in collaboration has made a difference.
At this year’s World Health Assembly, Dr. Tedros reflected on his visit to Borno in 2017, in his message to health leaders from across the world
There is no doubt that the challenges we face in ensuring health security in Nigeria are daunting. However, the support from the WHO at the global, regional and country level has proven to be a valuable asset to us. For us at NCDC, where we have a small team of dedicated colleagues, the Director General’s visit to the NCDC has created a greater sense of purpose that is hard to describe. Dr. Tedros’ leadership has been very inspiring and we will push to make this a progressive era for health security in Nigeria, changing the narrative about outbreak response and ensuring that the NCDC demonstrates a heightened level of preparedness to disease outbreaks.
Chikwe Ihekweazu is an infectious disease epidemiologist and Chief Executive Officer of the Nigeria Centre for Disease Control