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Chikwe Ihekweazu is worried about access to future COVID-19 vaccines, but says, “We are also not just sitting quietly and doing nothing.”

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‘It’s a tricky thing.’ COVID-19 cases haven’t soared in Nigeria, but that could change

Sciences COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

So far, sub-Saharan Africa has not faced the extreme numbers of cases and deaths from the novel coronavirus some public health experts feared would occur. Nigeria, the continent’s most populous nation, has reported only 33,000 cases and just under 750 deaths among its nearly 200 million citizens. (The number of daily reported cases more or less stabilized in June, after an increase since April.) Like everywhere else, the true toll is likely higher—testing in Nigeria is scant—but the country hasn’t seen overflowing hospitals.

Yet the numbers across Africa are ticking up, and Chikwe Ihekweazu, director of the Nigeria Centre for Disease Control, is far from complacent. In Nigeria, implementing testing and control measures across the vast federation of 36 states is a tall order.

Ihekweazu spoke with ScienceInsider about the country’s approach to the pandemic, the role of the World Health Organization (WHO), and the challenge of securing a vaccine for the Nigerian population. This interview has been edited for clarity and brevity.

Q: What’s the current situation in your country?

A: We are seeing hundreds of new cases every day, with sustained community spread, in particular in Lagos. The epidemic is still increasing, but not exponentially. We are also not seeing the severity observed in other countries.

In the meantime, we are still increasing our test capacity. Testing is not being done enough for several reasons: There is stigmatization of people with COVID-19 and some states are not as proactively pushing testing as they should. There could be underreporting of deaths and severe disease, but at least we would see a part of it in the hospitals. It is a tricky thing because it could become very dramatic but so far it has not been.

Q: Do you have an explanation for the fact that it is not as bad as in some other regions of the world? Is it because a larger proportion of the population is young? Less favorable conditions for transmission?

A: There are many things you can point at, but anyone who says he knows the reasons is not honest to himself. And we are still in the middle of it. It could still change.

Q: What do current coronavirus regulations look like in Nigeria?

A: There is still a ban on gatherings of more than 20 people. There still is a curfew between 10 p.m. and 4 a.m. Domestic flights have resumed, and we lifted the restriction on interstate travel because people found ways around it. We still ask people to maintain distance, work from home, to wear face masks in public spaces. Most schools are still closed.

Q: Is it true that many Nigerians see COVID-19 as just another issue? That they don’t find it as overwhelming as people in other parts of the world?

A: Yes. That is not because of the virus itself but because of the reality of everyday life in Nigeria. People are used to a lot of difficulties.

Q: Does that make it harder to make people adhere to the restrictions?

A: Yes, this has been an issue in the beginning. We had difficulties imposing any of the restrictions, talking about a disease nobody knew, while most of the people testing positive were asymptomatic.

Q: There are rumors that because health care workers get bonuses for every case they find, people are registered as “cases” without actually being tested.

A: Well, there have always been stories, rumors going around. We have a good diagnostic test, the one that is being used all over the world. One thing is for sure: that anyone tested positive has been infected with the virus.

Q: You’ve taken part in the WHO-led mission to China in February. What lessons have you drawn there?

A: The biggest lesson was there are trade-offs. The Chinese government has more influence over its people. That has advantages. It gives them more leverage to enforce control when there is an emergency like this. I was amazed by the level of compliance to instructions and how people collectively bought into what was deemed necessary to stop transmission. There are other parts of the world, including Nigeria, where this is more difficult [and] it becomes exponentially more difficult to manage an infectious disease outbreak.

We have a very liberal society. Capitalism is seen as a way to grow and there is a lot of entrepreneurship. So, we don’t really have a government that controls. That makes it difficult when you do need government control and enforcement to make people do things that are not comfortable to do: Wear masks, not gather, keep distance from each other. The other thing is cultural. We are a people’s country; we talk, we laugh, we joke, we dance, we love music, sports, and all those things that bring people together. And all of a sudden, we can’t do any of those.

We’re 54 countries on the continent and we rely heavily on [the World Health Organization], both regarding technical advice and guidance on what to do.

Chikwe Ihekweazu, Nigeria Centre for Disease Control

Q: Many countries started off tough and after lifting restrictions the virus came back fiercely. Are you afraid that will happen in Nigeria as well?

A: These restrictions are going to be difficult for any country in the world to sustain over periods of time. It is true that people will adhere more when the situation becomes more serious. We saw that in Italy and Spain. It is a very tricky balance.

Q: Have you had a lot of interaction with WHO in recent months?

A: Yes, obviously we have direct contact with WHO all the time. They are the primary counterpart in all the infectious disease control work that we do. WHO is a close, critical, and important partner.

Q: What do you think of the international discussion about WHO’s role?

A: We are very surprised by the criticism. We’re 54 countries on the continent and we rely heavily on WHO, both regarding technical advice and guidance on what to do. My personal experience has been that they have always been very equitable and thoughtful. We’re human. Sometimes we don’t make all the right decisions. But I’ve never felt in any way that there has ever been any lack of integrity and diligence in their intentions.

Q: People are talking about giving WHO more teeth, in particular, to force countries to share information as soon as possible.

A: I agree. There should be teeth. But I don’t think they would have to be very sharp. They should only be used in extreme scenarios, like sending a mission to a region in an earlier stage to collect information. What we need to build is a much more collaborative context in public health, because many of the threats are much more subtle. In our part of the world, I’ve been talking a lot about access to public common goods. We don’t have sufficient diagnostic capacity to scale up as rapidly as we would love to. If we had that, if we could build more equitable access to diagnostics, therapeutics, vaccines, we would solve most of the world’s infectious disease problems.

Q: How can we reach that goal?

A: We have to define some things as a global common good that are best not left to commercial interests. The question of access to vaccines for COVID-19 is putting this on the table. We haven’t quite won the battle, because many countries are organizing themselves to purchase the vaccines ahead of time. And this is not just about COVID-19, it is about [human papillomavirus vaccines], it is about diagnostics and treatments for many other diseases. And our own governments have a role to play there as well, not to abdicate their responsibility.

Q: Are you worried the COVID-19 vaccine will not become available for a majority of the Nigerian population?

A: We are worried, but we are also not just sitting quietly and doing nothing. We are engaging as best as we can, seeing what we can do to ensure we have access. We’re also collaborating with our partners, led by the Africa Centres for Disease Control and Prevention and international organizations such as GAVI, the Vaccine Alliance, to make sure we have a seat at the table. We might not have the economic and scientific might, but we are definitely involved in the discussions.