Lessons learned during the COVID-19 pandemic in Nigeria
Come February 27, 2025, we will likely awaken to our customary daily responsibilities, engagements, and endeavors – whatever it is that sustains our motivation. Undoubtedly, it is a privilege to have the opportunity to advocate for a noble cause, provide care for a loved one, or strive towards an ambitious objective.
Thursday, February 27, 2020, was also expected to be routine for many of us. Or perhaps not, certainly not for me. We were confronted with the distressing announcement of Nigeria’s inaugural COVID-19 case. Indeed, that was significant! I immediately recalled my personal experience with the 2014 Ebola outbreak in Nigeria. I had just returned to Lagos from Port Harcourt on that fateful Friday evening in late August 2014, when my colleague called me from Port Harcourt: Oga, the Port Harcourt index case was a doctor who treated an Ebola-suspect patient covertly at that hotel where you stayed! Panic seized my heart. I experienced a profoundly disturbing moment when I realized that I may have been exposed to the virus. Consequently, for the subsequent two weeks, I had to navigate the challenges of personal quarantine and monitoring my vital signs. Fortunately, I survived the scare, and the rest is history.
Five years ago, the COVID-19 virus arrived in Nigeria. The first confirmed case involved an Italian national who traveled from Milan to Lagos. At that time, the virus had been declared a global public health emergency of international concern by the World Health Organization, yet no established treatment protocol for the infection existed. As of February 27, 2020, over 82,000 cases had been reported across 45 countries, resulting in 2,801 fatalities. Just one day prior, seven countries – Brazil, Georgia, Greece, North Macedonia, Norway, Pakistan, and Romania – had also reported their initial cases. COVID-19 was an unyielding inferno, ravaging regions and eluding containment.
As of January 26, 2025, COVID-19 has resulted in 777,348,321 cases and tragically taken 7,084,010 lives, according to the World Health Organization. The statistics for Nigeria are more challenging to ascertain, but the most recent reliable data indicated that there have been at least 267,188 cases and 3,155 deaths as of April 13, 2024. Fortunately, cases have now diminished in number and frequency, yet the embers of COVID-19’s flames continue to smolder. Hence, what lessons has COVID-19 imparted to us as a nation, and what actions must we continue to undertake to implement these lessons?
First, it has been established that public health emergencies necessitate the foresight of our health authorities to prepare for potential new and re-emerging infectious diseases. Over the past 20 years, the global community has experienced a series of pandemics, although it is acknowledged that none have reached the magnitude of COVID-19. Health authorities must remain vigilant regarding the possibility of another pandemic occurring in the future. Notably, Nigeria instituted the Nigeria Centre for Disease Control and Prevention in 2018. The NCDC has played a crucial role in Nigeria’s response to COVID-19 over the past five years. The NCDC embarked on pandemic preparedness initiatives one month prior to the confirmation of our first COVID-19 case, which included strengthening surveillance at our international borders and broadening our diagnostic testing capabilities. These essential measures facilitated the identification of the first case and the implementation of a contact tracing protocol, resulting in the identification of a second case approximately 200km away – a Nigerian citizen who had contacted the Italian national.
It is also significant that the Nigerian government promptly established a high-powered Presidential Task Force on COVID-19 on March 17, 2020. The PTF was chaired by the Secretary to the Government of the Federation and included members at the cabinet level from 13 relevant ministries, departments, and agencies. The WHO Country Representative was additionally involved with the PTF. Due to its high-level political engagement, the PTF formulated the National COVID-19 Pandemic Multisectoral Response Plan. This plan was designed to coordinate multisectoral national and subnational frameworks to mitigate the spread of COVID-19 and lessen its impact on the social, economic, and health infrastructure. Despite the challenging landscape posed by political tensions and misinformation on social media, stakeholders deemed that the PTF had performed commendably. In April 2021, the PTF transitioned to a Presidential Steering Committee on COVID-19, with reduced bureaucracy and responsibilities.
Conversely, the initial phases of the COVID-19 pandemic were characterized by the evident hesitance of the government to close its international borders in order to avert the importation of the virus. With the advantage of hindsight, we now understand that the mere closure of borders was insufficient in mitigating the prevalence of COVID-19 in Nigeria. Nevertheless, Nigeria's relatively delayed closure of its international airports and land borders may have contributed to the rise in cases following the identification of the first case. The majority of instances within the first 30 days of the initial case involved travelers returning from other countries. A more rapid response, coupled with rigorous quarantine protocols, could have potentially decelerated the transmission of the disease within Nigeria. Considering that international travel in Nigeria is frequently associated with the wealthy and politically prominent, and given that most of the initial cases impacted the elite, many Nigerians initially contended that COVID-19 affected solely the affluent. This standpoint substantially obstructed the initial public health strategies implemented by the government. However, the local transmission of the disease ultimately disseminated throughout the community, transcending class divisions. We must enhance our response to territorial defense against impending pandemics.
Secondly, we have learned that fostering public trust is vital for effectively maintaining the effort against a novel infectious disease. The Nigerian government declared a two-week complete lockdown commencing on March 30, 2020, which was later extended to May 15, 2020, in the majority of urban areas before being relaxed. All non-essential services were suspended. Public health initiatives were initiated to inform citizens regarding the virus, its symptoms, and preventive strategies. The initiatives underscored the significance of handwashing, social distancing, and mask-wearing. However, when the first substantial wave of the pandemic commenced in early July 2020, the formidable challenge of managing the virus became evident. The escalation in daily reported cases was propelled by community transmission and heightened testing. Nonetheless, adherence to non-pharmaceutical interventions grew increasingly difficult due to misinformation, pandemic fatigue, and economic strains.
As the surge of COVID-19 cases extended into November 2006, the healthcare system experienced an increasing strain, resulting in difficulties in delivering adequate care for all patients. Despite the government's implementation of stricter measures, including lockdowns in high-risk areas, curfews, and limitations on gatherings, adherence to these measures gradually diminished. This reduction in compliance was closely associated with the public's diminishing confidence in government authorities. For instance, earlier in the year, the private sector and international donors, via the Coalition Against COVID, contributed substantial funds and food items to assist the government's response to the pandemic. Nonetheless, subnational governments exerted limited efforts to distribute palliative support to the less privileged. Consequently, a pervasive atmosphere of mistrust led to widespread looting of government-owned warehouses of palliatives throughout the country, further distancing the government from the populace. The public is more inclined to comply with public health measures when they perceive the government as transparent during future pandemics.
Furthermore, it has been learned that resources can be optimized to achieve tasks more efficiently. During the pandemic, a shift towards online learning occurred, as the extended closure of schools and universities disrupted the education of millions of students. The healthcare sector observed innovations such as telemedicine and mobile health clinics aimed at reaching underserved areas. These innovations assisted in managing the heightened demand for healthcare services. Virtual court proceedings also began to establish themselves, with reforms and guidelines facilitating adjudication with minimal delay. The federal civil service experienced revitalization with the onset of e-administration. Although a significant journey remains to fully realize the digital transformation of public service delivery, Nigeria is on a positive trajectory if it maintains its progress. However, the lingering question pertains to whether the public healthcare delivery system has improved since the onset of COVID-19. At its 63rd annual meeting in 2023, the National Council on Health noted that the COVID-19 pandemic intensified the challenges of limited manpower and capacity, inadequate infrastructure, and insufficient equipment afflicting Nigeria’s public healthcare delivery system. The council recognized the necessity for a resilient health system capable of enduring future outbreaks. Two years after the council’s meeting, what is our current status? We can no longer afford mere lip service to the health sector regarding the construction of more hospitals, upgrading clinical and diagnostic facilities, enhancing local production capacity for
