Strengthening Nigeria’s local foundations for global health security

The world is still reeling from some of the aftershocks of the COVID-19 pandemic. In its wake, several other health emergencies have also emerged, calling up the need for national, regional, and global health systems to neutralise their impacts on public health and safety and the course of national economies.

If there is anything the past few years have taught us, it is this: the interconnectedness of our world today makes it impossible to view any health threat as a local affair. Health security must now always be viewed as a global concern. The health of one is the health of all.

Last week, health professionals from across Nigeria and even beyond converged in Abuja to deliberate on this subject. Convened by APIN Public Health Initiatives as the second edition of its annual symposium themed “Securing our Future: Strengthening Global Health Security in Nigeria,” it was an opportunity to x-ray key challenges at the Nigerian level militating against the provision of health security and proffering solutions that would help the nation navigate these challenges and ensure the provision of health security at the national level and plugging this into the global health security framework.

Focusing on global health security is important for several reasons. For one, it builds the systems required for the prevention of pandemics: Global health security helps prevent the spread of infectious diseases across borders, reducing the risk of pandemics. It also establishes that protection for vulnerable populations from infectious diseases, such as the elderly, children, and those with compromised immune systems, is available.
These help to reduce the economic burden that infectious diseases can have on trade, tourism, and the economic stability of nations and increase productivity through ensuring the availability of a healthy workforce.

However, the basis for this rests on national systems, and this was the crux of the keynote address by Dr. Chikwe Ihekweazu, the assistant director general in the Division of Health Emergency Intelligence and Surveillance Systems, World Health Organisation. He pointed out that investment and strengthening of domestic institutions and health systems, respectively, would engender a better understanding of health crises and also drive progress. This was easily illustrated using his experience as the DG of the Nigerian Centre for Disease Control and how steps taken in the preceding years to the COVID-19 pandemic eventually played key roles in ensuring the NCDC was effectively positioned to help Nigeria manage the pandemic.

Without a doubt, global health security depends on local health security, and local health systems depend on local institutions. His emphasis on the dependence of this on local interconnected systems is profound because it highlights some of the gaps that countries like Nigeria sometimes take for granted. The ability to save lives depends on the capacity of the institutions we are building. If the Nigerian Centre for Disease Control had not upgraded its systems and elevated its approach to its mandate beyond what was inherited in 2016, Nigeria’s COVID-19 response would have left much to be desired. This need for improved systems can also not be limited to one or two agencies.
When you consider this in the context of Nigeria’s N1.2 trillion health budget for 2024, a mere 4.47% of our total expenditure (or N1.5 trillion when including other provisions related to health, such as the Basic Health Care Provision Fund), our ability to build and sustain effective local health systems that equip us for national health security is brought to question. It’s worth noting that this allocation falls short of the 15% Abuja Declaration commitment.
Where a state government for instance is unable to create a framework that enables different but related health systems operating in the realms of either detection, data collection, prevention, innovation or logistics to function as single interwoven units of health service delivery, it becomes impossible for them to provide the concerted efforts that coalesce into a complete system that can deal with public health threats when they occur.

And so, Dr. Ihekweazu had to rightly emphasise the need for governments to invest in domestic institutions to be able to create the necessary paradigm shift that will set Nigeria firmly on the path of effective local health security, which plugs competently into driving the agenda for global health security.

In doing this, the federal government has to take the lead. There is substantial investment in our health systems as a country that is of foreign origin. These have played very instrumental roles in building our capacity to deal with shocks and emergencies, but the true measure of our capacity can only be measured by the investments we make ourselves.

External partners can support, but leading the process of Nigeria’s health security should rest closely with those at the heart of the problems—us!

The Federal Government, supported by local health partners, must be deliberate about investing in efforts to protect and strengthen health systems against unexpected public health threats because these local health systems serve as the first line of defence against health emergencies. Strengthening these systems enables countries to prevent, detect, and respond to health threats more effectively. Today we are dealing with Mpox and Lassa fever. Who knows what threat lies just beyond the horizon?

Planning and future preparation are key. We cannot contribute effectively to much-needed global health security if we have a reactive mindset, particularly in today’s world, where infectious disease outbreaks and epidemics are increasing in severity and frequency.