GLOBAL HEALTH SECURITY: WHERE DOES NIGERIA STAND?

BY

ANYASORO STEPHANIE UJUNWA

FUNAI/B.Sc/16/3798

COURSE CODE: MCB 401

A SEMINAR PRESENTED

TO

THE DEPARTMENT OF

BIOLOGY/MICROBIOLOGY/BIOTECHNOLOGY

FACULTY OF SCIENCE

ALEX EKWUEME FEDERAL UNIVERSITY NDUFU-ALIKE IKWO,

(AE-FUNAI), EBONYI STATE.

IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE AWARD OF

BACHELOR OF SCIENCE (B.Sc.) DEGREE IN MICROBIOLOGY

SEMINAR SUPERVISORS: PROF. M.N ALO, MR. UCHENNA I. UGAH

JANUARY, 2020
ACKNOWLEDGEMENT

Most importantly, I want to acknowledge God Almighty for his infinite love, mercy and

favor, also for his gift of life towards me.

I also owe a debt of gratitude to my lovely parent that supported me all the period of writing

this report, for their financial and moral support, can’t thank them enough, and my siblings

that stood by me and kept encouraging me.

I will not forget to acknowledge my Head of Department, Dr. Ihuoma, my seminar

supervisors, Prof. M.N Alo and Mr. Uchenna Ugah, and all the staff of biological sciences

for their effort and advice in ensuring that this report was successful.
 DEDICATION

I want to dedicate this report firstly to God Almighty who in his infinite mercy guided and

protected me throughout the period of writing this report. Special dedication goes to my

Parent Mr. Francis Anyasoro, for his numerous sacrifices in making me get to where I am

today, and to my supervisors, Prof. M.N Alo and Mr. Uchenna Ugah for ensuring this report

was successful.
 TABLE OF CONTENTS

Title page

Acknowledgement ………………………………………………………………………i

Dedication ……………………………………………………………………………….ii

Table of contents

Abstract

CHAPTER ONE

1.0 INTRODUCTION.................................................................................................1

1.1 MEANING OF GLOBAL HEALTH SECURITY ………..........................................1

1.2 THE NIGERIAN CENTRE FOR DISEASE CONTROL (NCDC)………………..2

1.3 CDC GLOBAL HEALTH IN NIGERIA………………………………………………6

1.3.1 CDC IMPACT IN NIGERIA…………………………………………………………7

1.4 WHAT CDC IS DOING IN NIGERIA………………………………………………7

1.4.1 HIV AND TUBERCULOSIS…………………………………………………………7

1.4.2 MALARIA…………………………………………………………………………8

1.5 NATIONAL PUBLIC HEALTH INSTITUTES……………………………………8

1.6 NIGERIA TOP TEN CAUSES OF DEATH…………………………………………9

CHAPTER TWO

2.1 NATIONAL ACTION PLAN FOR HEALTH SECURITY IN NIGERIA

………….......10

2.2 HIV/AIDS AS A SECURITY THREAT IN NIGERIA ………………………………15

2.3 NON-COMMUNICABLE DISEASES AS A GLOBAL HEALTH SECURITY

THREAT…………………………………………………………………………….17

2.4 NON-GOVERMENTAL ORGANIZATIONS WORKING IN GLOBAL

RESEARCH….20

2.4 .1INTERNATIONAL ORGANIZATIONS…………………………………………….20

2.4.2 SCIENTFIC ORGANIZATIONS ……………………………………………………21

2.4.3 ADVOCACY/POLICY ORGANIZATIONS………………………………………….23

CHAPTER THREE

3.1 MEDICAL COUNTER MEASURES FOR NATIONAL SECURITY…………………23

3.2 GLOBAL PUBLIC HEALTH ISSUE IN NIGERIA…………………………………24

3.3 NIGERIAN NATIONAL HEALTH POLICY AND ITS SHORT COMINGS…………27

CHAPTER FOUR

4.1CONCLUSION…………………………………………………………………………..28

4.2RECOMMENDATION………………………………………………………………….28

REFERENCES
 ABSTRACT

Global health security is defined as the activities required in minimizing the impact and danger of acute
public health events that endanger the health of people living across geographical regions and
international boundaries. The weakened healthcare system and capacity in Nigeria have failed to tackle
the contemporary Global and public health issues in the country. The various health programs aimed at
health Improvement has not yielded much improvement in our health status as a nation. These paper
highlighted the major public health challenges Nigeria faces which are infectious diseases (like Ebola,
Lassa fever, Yellow fever, malaria, HIV/AIDS), Environmental pollution, improper waste disposal and
inadequate access to quality healthcare services. This paper therefore recommends that the Nigerian
Government should improve its plan on how to tackle the major Public health issues in the country,
provide adequate funding for Global Public Health research and be committed to achieving the
Sustainable Development Goals in Nigeria.
 CHAPTER ONE

1.0 INTRODUCTION

1.1 MEANING OF GLOBAL HEALTH SECURITY

Our health is exposed to a number of natural and man-made risks and hazards, and newly emerging

contagious diseases, native disasters, the cost of climate change, environmental pollutions and chemical

and nuclear accidents. The term “Global public health security” is defined as the activities required in

minimizing the danger and impact of acute public health events that endanger the collective health of

populations living across geographical regions and global boundaries. Nigeria is the most populous

country in Africa with about 200 million inhabitants divided into six geopolitical zones. Nigeria is a

realm of over 250 ethnic groups and very rich in diverse culture, tradition and religious beliefs. Health

problems in Nigeria are challenging but addressing them using public health principles is necessary to

support stability in this important area of the world (Centre for Disease Control (CDC), 2013).

According to Faisal et al. (2017), the foremost public health challenges Nigeria faces are infectious

diseases, maternal mortality, infant mortality, poor sanitation and hygiene, disease surveillance, non-

communicable diseases and road traffic injuries. In spite the shared labors of the Nigerian Government

and various Non-Governmental Organizations to provide efficient and effective health care delivery in

Nigeria, contemporary problems render this effort much less than desired. A few of these problem or

challenges include emerging and re-emerging health problems such as HIV/AIDS pandemic, infectious

diseases (like Ebola, Lassa fever, Yellow fever, and malaria), insufficient payment of health recruits

salaries, and poor quality of care, inequitable health care services and irrational appointment of health

workers among others. A new global burden has revealed that malaria and HIV are still the leading

cause of death in Nigeria killing more than 190 thousand and 130 thousand citizens respectively.
According to the World Health Organization Constitution, “the health of everyone is fundamental to the

attainment of peace and security and is dependent upon the fullest co-operation of individuals and

States”. Pandemics, health emergencies and weak health systems not only detriment lives but pose

some of the greatest risks to the global economy and security faced today. Further, universal health

coverage and health security are two sides of the same coin: improved access to health care and

strengthened health systems provide a strong defense against emerging threats, whether natural or man-

made. All countries have a responsibility to keep their people safe. WHO’s mission is to help all

countries fulfill their duty of safety and care to their citizens, especially to the poorest and most

vulnerable. The goal of global public health security is to demonstrate how collective international

public health action can build a safer future for humanity.

A more secure world that is ready and prepared to respond collectively in the face of threats to global

health security requires global partnerships that bring together all countries and stakeholders in all

relevant sectors, gather the best technical support and mobilize the necessary resources for effective and

timely implementation of international health regulations (IHR (2005)).

To make the world safer and more secure from infectious disease threats, the Global Health Security

Agenda (GHSA) was launched in 2014. While Nigeria is not a formally participating GHSA partner,

the country has agreed to meet the requirements stated in the International Health Regulations. CDC

works with the government of Nigeria and other partners to achieve these requirements by focusing on

workforce development, emergency response, surveillance, laboratory, and border health/point-of-entry

interventions.

1.2 THE NIGERIA CENTRE FOR DISEASE CONTROL

The Nigeria Centre for Disease Control (NCDC) was established in the year 2011 in response to the

challenges of public health emergencies and to enhance Nigeria’s preparedness and response to
epidemics through prevention, detection, and control of communicable diseases. Its core mandate is to

detect, investigate, prevent & control diseases of national and international public health importance.

To achieve CDC-Nigeria’s vision of “Public Health Excellence for Healthy Nigerians” the office

supports the Nigerian federal and state Ministry of Health (MOH) in the development, implementation,

& evaluation of disease rejoinder labors and programs that adds to strengthened public health

infrastructure and service delivery models in Nigeria (CDC, 2013). The centre for disease control and

Prevention (CDC) (2013) reported that communicable and infectious diseases are the major health

problem. Also, cases of malnutrition, accidents, food poisoning are also public health issues which can

be controlled and prevented. However, these health issues are the leading cause of mortality in Nigeria.

Only a few African countries like Ethiopia and Mozambique have long standing National Public Health

Institutes (NPHI). However, since the large 2014–2016 Ebola virus disease (EVD) outbreak in West

Africa, many African countries have been setting up NPHI (NPHIL 2018) to optimize the consumption

of scarce resources to prevent, detect and respond to infectious disease threats. The Africa Union and

the Economic Community of West African States (ECOWAS) have also set up regional disease control

centers (Nkengasong, et al. 2017)

The Nigeria Centre for Disease Control (NCDC) was conceived much earlier in 2007 as an attempt to

establish an institution that can effectively mobilize its resources to respond to these outbreaks and

other public health emergencies. Modeled after the US Centre for Disease Control and Prevention

(CDC), Atlanta, the first formal step to establish NCDC took place in 2011 when units of Federal

Ministry of Health—the Epidemiology Division, the Avian Influenza Project and its laboratories—and

the Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) were moved to form the

nucleus of NCDC.
Detecting and responding to infectious disease outbreaks has lengthy presented a major public health

challenge in Nigeria, given its size and complexity. Several large infectious disease outbreaks have

been reported in Nigeria, including the yellow fever outbreak in 1986 and 1987 that affected 9800 and

1249 people, respectively, the large meningitis outbreak in 1996 with 109, 580 cases and 11, 717

deaths, cholera outbreaks in 2001 and 2004 and more recently, the meningitis outbreak in 2017(WHO,

2017).In between these was the much acclaimed triumphant rejoinder to the outbreak of EVD in

September 2014(Otu et al, 2017)

Nigeria’s public health challenges continue to grow—rapid population growth, increasing movement of

people and destruction of infrastructure in the North East of Nigeria following the ‘Boko Haram’

insurgency and outbreaks from new and re-emerging pathogens. The year 2017 saw an increase in the

rate of infectious diseases like Lassa fever, yellow fever, monkey pox, cholera and new

strains/subtypes/serotypes of existing pathogens like Neisseria meningitis serogroup C in Nigeria(WHO

2017). In addition, Nigeria has had to address emerging public health threats, such as increasing

antimicrobial resistance, and increasing incidence of non-communicable diseases and high maternal

mortality rates (Hogan et al, 2010).

The establishment of NCDC is indeed more justifiable at this instant than when it was conceived in

2007. The value of the NCDC to the country became most obvious from its role in the coordination of

the response to the 2014 EVD outbreak in Nigeria, Oleribe et al., (2015) and coordinating the support

that Nigeria provided to the Governments of Sierra Leone and Liberia during the EVD outbreak in

those countries. This outbreak and the need for strong, country-led coordination become the basis for

further growth of the NCDC. Notably, NCDC now takes the front seat in preventing and preparing for

public health emergencies, and in managing the surveillance and reference laboratory architecture for

Nigeria. NCDC has strong partnerships with the WHO and the US CDC, which support various
activities at the Centre through grants and technical assistance to support disease surveillance,

establishment of reference laboratory systems, outbreak response activities and others.

Together with the African Field Epidemiology Network, NCDC also manages the delivery of the

Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP). The NFELTP is a 2-year

in-service training in applied epidemiology and laboratory practice within the NCDC/Federal Ministry

of Health and Federal Ministry of Agriculture. The programme also offers basic epidemiology training

to health workers at Local Government levels to improve surveillance and response to priority diseases

(NCDC, 2018). The NFELTP is modeled after the US-CDC Epidemiology Intelligence Service and has

been replicated in more than 80 countries around the world. In Nigeria, NFELTP has developed a pool

of Field Epidemiologists and Laboratory experts with skills to gather critical information and turn it

into public health action, and it is a major public health asset within Nigeria’s national public health

institute (Nguku et al., 2014).

The NCDC also has a very strong relationship with the new ECOWAS Regional Centre for Disease

control which is also the regional hub for the Africa Centre for Disease Control. Other partnerships that

the Centre has recently developed include with the University of Maryland, Baltimore, the Robert Koch

Institute, the Global Outbreak and Response Network and Public Health England, all focusing on

specific aspects of its mandate.

The NCDC has strengthened its focus on prevention and preparedness, stockpiling and prepositioning

of supplies for outbreak response in the states, development of guidelines and checklists for emergency

preparedness; and generally increasing its role in supporting the States. NCDC also provides guidance

and support to other professionals and sub-national government public health organizations and

officials.
One way that NCDC has been able to coordinate preparedness and response activities is the

establishment of its Incident Coordination Centre. This serves as a location to review outbreak reports

and decide on preparedness and response activities. Dashboards are available to display data from the

sub national level, which provides a snapshot of disease trends in the country. The Incident

Coordination Centre is also tasked with daily intelligence gathering and risk analysis of public health

events to identify potential threats. It serves as an Emergency Operations Centre during outbreaks, with

an incident manager leading the response, bringing together the various pillars of outbreak response

working in a command and control structure.

The NCDC is also the focal point for the implementation of the International Health Regulations (IHR),

which is a global legal agreement that aims to prevent and respond to the spread of diseases and to

avoid their becoming international crises. A Joint External Evaluation was carried out in June 2017 to

assess Nigeria’s capacity to prevent, detect and respond to treats of public health importance. Several

areas of strength were highlighted as well as areas requiring an improvement in capacity(WHO,

2017). Subsequently, a National Action Plan is being developed to strengthen areas of weakness.

The journey of NCDC shows that building NPHI takes clarity of vision, perseverance, commitment and

a strong legal mandate. Achieving a legal mandate will demonstrate Nigeria’s commitment to providing

a strong scientific focus for ensuring the health security of Africa’s most populous nation. Over the

next 5 years, the NCDC’s mission is to work in partnership with other arms of Government and

partners to protect the health of Nigerians. This will be accomplished through integrated disease

surveillance; a linked and connected public health laboratory network within the country and the sub

region; and the coordination of emergency preparedness and response activities.

NPHI help to concentrate a country’s resources for the prevention, detection and response to infectious

diseases in a single organization. Nigeria’s experience of setting up its NCDC can inform similar

efforts in other African countries.

1.3 CENTER FOR DISEASE CONTROL AND PREVENTION (CDC) GLOBAL HEALTH IN

NIGERIA

The Centers for Disease Control and Prevention (CDC) established an office in Nigeria in 2001. CDC

works with federal and state ministries of health to address HIV, tuberculosis, malaria, and

immunization for vaccine-preventable diseases as well as on strengthening laboratory, surveillance, and

workforce capacity to respond to disease outbreaks.

1.3.1 CDC Impact in Nigeria

CDC supported the population-based HIV/AIDS household survey in Nigeria. The Nigeria HIV/AIDS

Indicator and Impact Survey (NAIIS) reached approximately 250,000 respondents in 90,000

households. The data will guide activities toward HIV/AIDS epidemic control in Nigeria. Over 800,000

people received PEPFAR-supported antiretroviral therapy and achieved 82% viral load suppression in

2018. The Centre for Disease Control supported ten (10) polio campaigns that administered over 140

million doses of polio vaccines to children less than 5 years of age in 2018.
1.4 WHAT CDC IS DOING IN NIGERIA:-

1.4.1 HIV AND TUBERCULOSIS

HIV is a leading cause of death and a health hazard to millions worldwide. As a key implementer of the

U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC provides technical assistance to

help the federal and state level ministries of health (MOHs) implement effective, efficient HIV

programs. This support has contributed to saving the lives of men, women, and children through HIV

treatment services and a robust combination prevention strategy. Using a data-driven approach, this

strategy is tailored to the unique characteristics of the local epidemic for maximum health impact.

Working closely with the MOH, CDC supports the scale-up of high-quality HIV prevention

interventions including HIV treatment, and prevention of mother-to-child transmission services. Other
key activities include improving and expanding HIV counseling, testing, and tuberculosis (TB)/HIV

integrated service delivery. Health system strengthening support includes building capacity in the areas

of workforce development, operational research, epidemiology, surveillance, health information

systems, and program monitoring and evaluation to assess program performance and make adjustments

to respond to local epidemic.

Specific laboratory capacity building efforts have included the expansion of laboratory services to

support the rapid scale-up of HIV treatment services as well as the establishment of a national reference

lab capable of performing diagnostics for TB and other infectious and noninfectious diseases. CDC is

also providing support for Phase II field evaluation of HIV rapid test kits and the development of the

National Medical Laboratory Strategic Plan.

1.4.2 MALARIA

Malaria is a leading cause of death and disease in many countries, and young children and pregnant

women are the groups most affected. Under the U.S. President’s Malaria Initiative, CDC has assigned a

resident advisor to the malaria-endemic country of Nigeria to support the implementation of malaria

prevention and control interventions. CDC support includes:

 Developing the framework for a routine health information system in select states and local

government areas.

 Strengthening entomological monitoring and exercise in the CDC bottle bioassay and World

Health Organization (WHO) tube techniques.

 Strengthening diagnostic capacity by developing a quality assurance framework and using dried

tube specimens for quality control of malaria rapid diagnostic tests.

1.5 NATIONAL PUBLIC HEALTH INSTITUTES

CDC supported the African Union to develop and launch the Africa Centers for Disease Control and

Prevention (Africa CDC). CDC provided technical assistance for the establishment of five Africa CDC

Regional Collaborating Centers. The West African Regional Collaborating Centre for the Africa CDC

is located in Nigeria. Africa CDC and the regional centers, with assistance from CDC, establish the

Surveillance and Response Unit, and develop workforce capacity.

Vaccine-Preventable Diseases

Vaccines prevent an estimate of 2.5 million deaths among children under 5 five years of age. Still, one

child dies every 20 seconds from a disease that could have been prevented by a vaccine. CDC provides

technical and programmatic expertise to eradicate or control vaccine-preventable diseases through

immunizations. In collaboration with partners, CDC supports the polio eradication and measles pre-

elimination activities in Nigeria. Field activities include campaign planning, monitoring and

supervision, acute flaccid paralysis surveillance, outbreak investigations, outreach to nomadic

populations, special projects, research, and data management support. Recently, the National Stop

Transmission of Polio Program expanded to improve the delivery of routine immunization services

across northern states. CDC responded to numerous outbreaks of vaccine-derived polio and other

vaccine-preventable diseases.

Gender Equity and Response to Gender-Based Violence

Gender norms, inequalities, and violence increase vulnerability to HIV, due to multiple socio-cultural

factors. These dynamics may encourage high-risk sexual behaviors, and make it more difficult to get

tested, disclose HIV status, and access HIV treatment due to fear of violence or abandonment. CDC,

through implementing partners, promotes gender equity and equality in HIV programs by addressing
with teens and adults norms and behaviors that contribute to the HIV epidemic. CDC also supports

comprehensive health services and referral linkages to survivors of gender-based violence.

1.6 NIGERIA TOP 10 CAUSES OF DEATH

 Lower respiratory infections

 Neonatal disorders

 HIV/AIDS

 Malaria

 Diarrheal diseases

 Tuberculosis

 Meningitis

 lschemic heart disease

 Stroke

 Cirrhosis
 CHAPTER TWO

2.1 NATIONAL ACTION PLAN FOR HEALTH SECURITY IN NIGERIA

The National Action Plan for Health Security (NAPHS) is a comprehensive multi-sectoral plan that

integrates multiple work plans including REDISSE, NCDC Strategy Plan, AMR Action Plan, and

immunizations plans, addressing the major gaps identified by the Joint External Evaluation (2017) and

Performance of Veterinary Services (2010) assessments, and prioritizing them by national strategies

and risks. As such, the NAPHS is an “overarching” plan and can be used to create linkages and monitor

progress of major health security initiatives. The NAPHS is intended to provide:

a) A clear roadmap for implementation over a 1‒2-year period, allowing for annual revisions to the

plan based on capacities gained and actions implemented; and

b) A menu of coated activities for future years, which can easily be incorporated into annual

implementation plans and integrated into partner activities.

As such, this document is complemented by internal products including individual work plans

developed by the individual technical areas and an overarching NAPHS tracking platform that will be

used for mutual accountability. Critical financing gaps remain; advocacy, resource mobilization, and

coordination between relevant stakeholders will be critical to implement activities to keep Nigerians

safe.

Public Health Risks

Over the past 2 years, Nigeria has been confronted with several outbreaks of epidemic-prone diseases,

including measles, yellow fever, cerebrospinal meningitis, cholera, Lassa fever, and monkey pox. In

response to some of these disease outbreaks, public health workers have conducted vaccination
campaigns, while also provided infection prevention and control training to health workers, established

new laboratory testing capacity, and conducted communication and engagement activities to

communities. NCDC, which serves as the National Focal Point for the International Health Regulations

(2005) (IHR NFP), is responsible for surveillance and response to these outbreaks, and works closely

with the National Primary Healthcare Development Agency (NPHCDA) when a vaccination response

is needed.

Unfortunately, the number of zoonotic and epidemic-prone disease outbreaks is unlikely to subside. A

recent modeling study of risk for viral hemorrhagic fevers identified LGAs in Nigeria have a high risk

for having an index case for Ebola virus disease, Crimean-Congo hemorrhagic fever, and Lassa fever.

Furthermore, models of epidemic and pandemic potential based on local and international connectivity

showed that LGAs in Nigeria are some of the highest potential in Africa for the global spread of viral

hemorrhagic fevers. A recent strategic risk assessment conducted by Nigeria and facilitated by the

WHO identified the risk of meningitis, cholera, yellow fever, Lassa fever, and terrorism as both “almost

certain” in likelihood with a critical impact. An assessment of Nigeria’s capacity to prevent, detect, and

respond to these public health threats, called the Joint External Evaluation (JEE), was conducted in

June 2017, in addition to recommendations from the 2010 Performance of Veterinary Services (PVS)

assessment. The JEE identified that Nigeria has substantial room to develop its health security

capacities. Priorities identified in the JEE Executive Summary included:

• Passage and implementation of the NCDC Bill;

• Establishment of a multi-sectoral One Health coordination mechanism at Federal, State, and LGA

levels;

• Strengthening of laboratory capacity;

• Scale up implementation of the integrated disease surveillance and response (IDSR) program;

• Development and implementation of a comprehensive public health workforce strategy

• Enhancing the EOC/incident management system at the federal level and strengthening sub-national

rapid response teams

• Designation of points of entry

From Crisis to Opportunity: Alignment of Planning Processes

The external evaluation team lauded Nigeria’s progress in surveillance for vertical diseases such as

polio, TB, and HIV/AIDS, but highlighted that further efforts must be developed to strengthen

horizontal disease surveillance programs, improve transportation of laboratory specimens, and

implement a clear public health workforce strategy. A financed multi-sectoral plan for health security

can help to develop critical capacities to prevent, detect, and respond to public health threats, utilizing

resources and capacities that Nigeria has already developed. For instance, Nigeria is one of only three

countries in the world, including Pakistan and Afghanistan, with endemic wild poliovirus (WPV).

Security challenges in the North East have compromised the ability to immunize children and conduct

routine acute flaccid paralysis (AFP) surveillance (Bolu et al., 2018). However, there have been no

documented WPV cases since September 2016, and planning for the transition of polio resources has

begun. The role of polio resources (human and otherwise) in surveillance capacity and outbreak

response in Nigeria cannot be understated. The polio program alone funds approximately 23,000 public

health personnel in Nigeria at an estimated annual cost of $90m USD. Disease surveillance and

notification officers who investigate disease outbreaks and collect specimens utilize funds from polio

eradication efforts to ensure that other epidemic-prone disease specimens are transported to the correct

facilities. In addition to the scaling down of polio activities, the Nigerian public health system faces a
double threat, as Nigeria has begun the Gavi graduation process (cutoff: per capita gross national

income [GNI] >$1,850). Gavi will transition resources away from Nigeria and its co-financing

requirements will increase over the next 5-7 years. It is critical that the polio and Gavi transition

strategies are planned and leveraged to ensure sustainable capacity is developed for communicable

diseases in general.

Development of the National Action Plan for Health Security (NAPHS)

With crisis comes opportunity. In 2018, Nigeria developed a National Action Plan for Health Security

(NAPHS). The NAPHS describes objectives, strategic activities, costs, and focal points for filling in the

gaps identified by the JEE. The activities were prioritized based on the country-specific risks, the

potential or existing resources available, and the strategic plans of the participating MDAs. The

NAPHS was developed by linking existing national plans, including the National Health Sector

Development Plan II (NHSDP II), NCDC Strategy and Implementation Plan 2017‒2021, Nigeria

National Action Plan on Antimicrobial Resistance (AMR), Infection, Prevention, and Control (IPC)

Action Plan, and NSIPSS as they pertained to health security. The planning process was coordinated by

NCDC as the IHR NFP and included stakeholders from many relevant sectors. The full list of

participants is available in Annex 4:

• Federal Ministry of Agriculture and Rural Development

• Federal Ministry of the Environment

• Federal Ministry of Finance

• Federal Ministry of Health

• Federal Ministry of Mines and Steel Development

• Ministry of Defense

• Federal Ministry of Transport

• Federal Ministry of Science and Technology

• Federal Ministry of Justice

• Federal Ministry of Information

• Ministry of Interior

• Office of the National Security Adviser

• National Emergency Management Agency

2.2 HIV/AIDS AS A SECURITY THREAT IN NIGERIA

The human immunodeficiency virus and the Acquired Immune Deficiency Syndrome (HIV/AIDS)

pandemic constitute one of the most pressing threats known to mankind. HIV, which causes AIDS, is a

retrovirus that infects cells of the human immune system destroying or impairing their functions,

resulting in infected persons becoming susceptible to other opportunistic infections (W.H.O, 2009).

HIV/AIDS has become a major source of death in the world today, especially in sub-Saharan Africa.

Not only is it the leading killer of youths and adults in Africa, it is also further entrenching poverty,

weakening the productive capacities of countries, overwhelming already over-extended healthcare

systems, and threatening both national and continental security. However, contrary to widespread

belief, HIV/AIDS is not at all confined to sub-Saharan Africa. Every region of the world currently has a

significant number of people living with HIV/AIDS. As noted by Garret (2005), the scale and

geographic scope of the HIV/AIDS pandemic has only two parallels in recorded history: the 1918 flu
pandemic and the Black Death in the fourteenth century. According to the 2013 UNAIDS report on the

global AIDS epidemic, globally, an estimated 35.3 (32.2–38.8) million people were living with HIV in

2012, with Sub-Saharan Africa being home to 70% of all new HIV infections in that year. In 2012, an

estimated 1.6 million people in the region became newly infected; and an estimated 1.2 million adults

and children died of AIDS, accounting for 75 percent of the world’s AIDS deaths in 2012 (UNAIDs,

2013). Nigeria, which is the most populous country in Africa, is one of the worst hit by the HIV/AIDS

scourge. The Director-General of the National Agency for the Control of AIDS (NACA), Prof. John

Idoko recently disclosed that about 3.4 million Nigerians are living with HIV/AIDS, identifying

Nigeria as having the second-largest population of people living with HIV globally (Ogunmade, 2013).

South Africa is believed to have the highest number of people living with the virus. In January 2000 the

United Nations Security Council (UNSC) held its first ever session to examine HIV/AIDS as a security

concern, the first occasion in which the UNSC had specifically discussed a disease. Before then,

HIV/AIDS had primarily been considered a public health issue at the international level. UN secretary-

general Kofi Annan told the Security Council: The impact of AIDS in Africa was no less destructive

than that of warfare itself. By overwhelming the continent’s health and social services, by creating

millions of orphans, and by decimating health workers and teachers, AIDS is causing social and

economic crises which in turn threaten political stability. In already unstable societies, this cocktail of

disasters is a sure recipe for more conflict. And conflict, in turn, provides fertile ground for further

infections’ (UN press release, 2000). At the same Security Council meeting, the president of the World

Bank, James Wolfensohn pointed out that AIDS was not just a health or development issue, but one

affecting the peace and security of people in Africa. While life expectancy in Africa had increased by

24 years in the last four decades of the twentieth century, the continent’s development gains were

threatened by the AIDS epidemic and life expectancy gains were being wiped out. According to him,

“In AIDS, the world faced a war more debilitating than war itself. Without economic and social hope,
there could not be peace, and AIDS undermined both. Not only did AIDS threaten stability, but a

breakdown in peace fuelled the pandemic” (Wolfensohn, 2000). Subsequently, the UNSC adopted

Resolution 1308 highlighting the potential threat that the epidemic poses for international security,

particularly in conflict and peacekeeping settings, and encouraged a series of efforts to respond to

HIV/AIDS in this context. According to the resolution: The HIV/AIDS pandemic is exacerbated by

conditions of violence and instability, which increases the risk of exposure to the disease through large

movements of people, widespread uncertainty over conditions, and reduced access to medical care. If

unchecked, the HIV/AIDS pandemic may pose a risk to stability and security. Therefore, the

intervention of the Security Council in 2000 was a critical move in securitizing HIV/AIDS, presenting

the disease as something extraordinary which demanded international attention and action. The claims

made by the Security Council set the agenda for the subsequent debate on HIV/AIDS as a security

issue. Its intervention provided the legitimization necessary for HIV/AIDS to be considered a security

issue as well as the arguments for the development of an advocacy consensus.

2.3 NON-COMMUNICABLE DISEASES AS A GLOBAL HEALTH SECURITY THREAT

Protecting health against potential risks such as epidemiological risks that determine disease outbreaks

and pandemics, safety risks associated with poor quality of care and financial risks derived from paying

for care, will ensure health security (Frenk, 2009). However, health security can have different

meanings. Health security can be understood as securing health at the individual, national and global

levels, but may also be understood as the effect of health on security. The latter is a traditional approach

that focuses mainly on national security and the protection of sovereignty, borders, people, and private

interests and property (Holsti et al., 2013). The discrepancy in meanings has caused confusion and

mistrust between and among Member States (Aldis, 2008). In this paper, we discuss securing health

from non-communicable disease at the individual, national and global levels.

A recent Lancet editorial noted that non-communicable diseases are not garnering the attention they

deserve and suggested that such diseases should be considered as a global health security

issue. A Lancet editorial discussing the 2007 World Health Report called for leadership from the World

Health Organization (WHO) to ensure that global health security is achieved.

The impact of non-communicable diseases on public health is well known. In 2010, 34.5 million out of

a total of 52.84 million deaths were attributed to non-communicable diseases, and most of these

occurred in low- and middle-income countries (Lozano et al., 2012). In 2011, the General Assembly

adopted a resolution on the prevention and control of non-communicable diseases. This political

declaration was largely an acknowledgement of the burden of non-communicable diseases and the role

of governments and other stakeholders in preventing and managing this burden. Non-communicable

diseases have also been included in the sustainable development goals with a specific target.

Despite many efforts by WHO and the international community, however, funding for the prevention

and control of non-communicable diseases has lagged. Of the total 37.6 billion United States dollars

(US$) in development assistance for health for 2016, 29.4% was allocated to maternal, newborn and

child health, 25.4% to human immunodeficiency virus (HIV), 6.6% to malaria, 4% to tuberculosis and

1.7% to non-communicable diseases (Dieleman et al., 2016). The scarce funding for non-

communicable diseases is a possible indicator of their low priority on the global health agenda. Here we

argue that this situation is in part due to the failure to recognize non-communicable diseases as a global

health security threat.

For example, in contrast with non-communicable diseases, HIV, an epidemic of global significance, has

attracted considerable funding. The security concerns associated with HIV were so pressing that the

issue reached the United Nations Security Council. HIV is considered a national security threat because
of the impact on strategically important population groups, such as soldiers and peacekeepers and

because of its potential to destabilize states.

Non-communicable diseases can affect personal security in many ways: they are chronic conditions

and therefore have a long-lasting impact on health and on the perception of one’s personal security and

well-being. Evidence suggests that non-communicable diseases contribute to personal poverty, because

of their chronic nature, their impact on productivity and their direct and indirect costs. However, it is

the scale of the premature mortality due to non-communicable diseases, with its impact on individuals

and families that mainly threatens personal security. The WHO Global status report on non-

communicable diseases 2014 showed that in 2012, 42% of all deaths caused by non-communicable

diseases occurred before the age of 70 years and 82% were in low- and middle-income countries

(WHO, 2014). Non-communicable diseases clearly have an impact on individuals; however, they also

represent an economic burden to governments, and therefore are a health security challenge at the

national level.

The global dimension of non-communicable diseases as a health security issue refers to the health of

all the people and efforts to reduce health inequity. The Lancet Commission on Global Health 2035

foresees that the threat of pandemics, antimicrobial resistance and non-communicable diseases will

represent the greatest threats to global public health in the future. Antimicrobial resistance and

pandemics have a high priority status in the global agenda and their threat to global health security is

largely unquestioned. The West African Ebola outbreak prompted the creation of a global health

security agenda. Interestingly, the initiative did not come from the public health community, but from

the highest political levels. In 2014, the United States of America, with initially 40 partners from

around the world, launched the global health security agenda with the aim to prevent, detect and

respond to infectious disease threats globally (Frieden et al., 2014). The urge for a rapid response to
infectious diseases is not surprising, as fear of contagion is strong; non-communicable diseases do not

pose such a threat and are therefore not perceived as threatening (Alleyne et al., 2011).

We propose that the magnitude of the epidemic of non-communicable diseases, their increasing

prevalence, global costs, potential to overwhelm the response capacity of low-income countries and

their contribution to the inequality of health, make non-communicable diseases a global health security

threat. For example, the increased burden of non-communicable diseases on low-income countries that

have inadequate health systems might increase global inequality and instability.

The attention given to a public health issue mainly depends on how the issue is framed. For non-

communicable diseases to be understood as a global health security issue, perhaps they need to be

framed not only in terms of data on morbidity and mortality, or on their economic costs. Leadership to

advocate for non-communicable diseases as a global health security issue is a whole-of-society

responsibility, but those who can push for this are intergovernmental organizations such as WHO, and

increasingly nongovernmental organizations with global reach such as the Non-communicable diseases

Alliance.

We support the proposal that we should avoid the reductionist approach that limits health security to the

control of outbreaks (Frenk, 2014). It is time that non-communicable diseases is recognized as a threat

to global health security

2.4 NON-GOVERNMENTAL ORGANIZATIONS WORKING IN GLOBAL RESEARCH

2.4.1 INTERNATIONAL ORGANIZATIONS: -

 The Global Fund to Fight AIDS, Tuberculosis and Malaria - An international financing

institution that invests the world's money to save lives.

 Joint United Nations Programme on HIV/AIDS (UNAIDS) - An innovative partnership that

leads and inspires the world in achieving universal access to HIV prevention, treatment, care

and support.

 World Bank - A vital source of financial and technical assistance to developing countries around

the world to fight poverty, including making investments to improve health.

 World Health Organization (WHO) - The directing and coordinating authority for health within

the United Nations system, responsible for providing leadership on global health matters,

including shaping the health research agenda.

2.4.2 SCIENTIFIC ORGANIZATIONS: -

 American Association for the Advancement of Science (AAAS) - An international non-profit

organization dedicated to advancing science around the world by serving as an educator, leader,

spokesperson and professional association.

 Science and Diplomacy - This quarterly publication from AAAS provides a forum for rigorous

thought, analysis and insight to serve stakeholders who develop, implement and teach all

aspects of science and diplomacy.

 American Society for Microbiology (ASM) - A membership organization for microbiologists

working to advance the microbiological sciences as a vehicle for understanding life processes

and to apply and communicate this knowledge for the improvement of health and environmental

and economic well-being worldwide.

 American Society of Tropical Medicine and Hygiene (ASTMH) - A worldwide community of

researchers, clinicians and professionals dedicated to advancing global health through

collaboration, education and career advancement in tropical medicine.

 American Thoracic Society (ATS) - An international society committed to improving global

health - particularly regarding tuberculosis diagnosis, treatment and control - and is a forceful

advocate for tobacco control and smoking cessation.

 Coalition for Epidemic Preparedness Innovations (CEPI) - A global coalition seeking to

outsmart epidemics by developing safe and effective vaccines against known infectious disease

threats that could be deployed rapidly to contain outbreaks, before they become global health

emergencies. CEPI will initially target the MERS-CoV, Lassa and Nipah viruses.

 Consortium of Universities for Global Health (CUGH) - A consortium of colleges and

universities that builds collaborations and exchange of knowledge and experience among

interdisciplinary university global health programs working across education, research and

service. It is dedicated to creating equity and reducing health disparities, everywhere.

 CRDF Global - An independent nonprofit organization that promotes international scientific and

technical collaboration through grants, technical resources, training and services.

 The Global Health Network - A collection of websites and online communities supporting

global health researchers by facilitating collaboration and resource sharing.

 Infectious Diseases Society of America (IDSA) - Represents physicians, scientists and other

health care professionals who specialize in infectious diseases. IDSA's purpose is to improve the

health of individuals, communities, and society by promoting excellence in patient care,

education, research, public health, and prevention relating to infectious diseases.

 International Society for Infectious Diseases (ISID) - Supports health professionals,

nongovernment organizations and governments around the world in their work to prevent,

investigate and manage infectious disease outbreaks when they occur, especially in countries

that have limited resources and that disproportionately bear the burden of infectious diseases.
  International Diabetes Federation (IDF) - An umbrella organization of over 200 national

diabetes associations in over 160 countries.

 Planetary Health Alliance - A consortium of universities, NGOs and other partners supporting

the growth of a rigorous, policy-focused, transdisciplinary field of applied research aimed at

understanding and addressing the human health implications of accelerating change in the

structure and function of Earth’s natural systems.

2.4.3 Advocacy/Policy Organizations: -

 Center for Strategic and International Studies (CSIS) Global Health Policy Center - Bridges

foreign policy and public health communities by creating a strategy for U.S. engagement on

global health.

 GBC Health - A coalition of companies and organizations serving as a hub for business

engagement on the world’s most pressing global health issues.

 The Earth Institute - Columbia University's resource that brings together the people and tools

needed to address some of the world's most difficult problems, from climate change and

environmental degradation, to poverty, disease and the sustainable use of resources.

 Global Alliance for Chronic Diseases (GACD) - An alliance of research funders to support clear

priorities for a coordinated research effort that will address this growing global health crisis.

 Global Health Council - The leading membership organization supporting and connecting

advocates, implementers and stakeholders around global health priorities worldwide.

 Global Research America Global Health R&D Advocacy - Information about the U.S.

government Health Technologies Coalition (GHTC) - A group of more than 30 nonprofit

organizations working to increase awareness of the urgent need for technologies that save lives

in the developing world.

  Kaiser Family Foundation (KFF) U.S. Global Health Policy - An online gateway for data and

information on the U.S. role in global health.

CHAPTER THREE

3.1 MEDICAL COUNTERMEASURES FOR NATIONAL SECURITY

Governments are becoming more deeply invested in pharmaceuticals because their national security

strategies now aspire to defend populations against health-based threats like bioterrorism and

pandemics. To counter those threats, governments are acquiring and stockpiling panoply of 'medical

countermeasures' such as antiviral, next-generation vaccines, antibiotics and anti-toxins. More than

that, governments are actively incentivizing the development of many new medical countermeasures

principally by marshaling the state's unique powers to introduce exceptional measures in the name of

protecting national security. At least five extraordinary policy interventions have been introduced by

governments with the aim of stimulating the commercial development of novel medical

countermeasures:

(1) Allocating earmarked public funds.

(2) Granting comprehensive legal protections to pharmaceutical companies against injury compensation

claims.

(3) Introducing bespoke pathways for regulatory approval.

(4) Instantiating extraordinary emergency use procedures allowing for the use of unapproved

medicines.
(5) Designing innovative logistical distribution systems for mass drug administration outside of clinical

settings.

Those combined efforts, the article argues, are spawning a new, government-led and quite exceptional

medical countermeasure regime operating beyond the conventional boundaries of pharmaceutical

development and regulation. In the first comprehensive analysis of the pharmaceuticalization dynamics

at play in national security policy, this article unearths the detailed array of policy interventions through

which governments too are becoming more deeply imbricate in the pharmaceuticalization of society

(Elbe et al., 2015).

3.2 GLOBAL PUBLIC HEALTH ISSUE IN NIGERIA

According to Bolaji 2016, Nigeria faces many public health problems and challenges. The health issues

that Nigeria faces are infectious diseases, sewage disposal, health insurance, water supply, air

pollution, noise pollution, environmental radiation, housing, solid waste disposal, disaster

management, control of vector some diseases, doctor-population ratio, population-bed ratio, population

per health facility, payment system/methods, utilization of care, access to care, improper coordination

of donor funds, maternal mortality, infant mortality, health financing, poor sanitation and hygiene,

incessant doctors strike, disease surveillance, smoking of tobacco, brain drain, rapid urbanization, non-

communicable diseases, alcohol abuse, environment degradation, road traffic injuries etc.

According to the statistics by CDC (2013), the top 10 causes of death in Nigeria are as

follows:

 Malaria (20%)

 Lower Respiratory Infection (19%)

  HIV/AIDS (9%)

 Diarrheal Diseases (5%)

 Road Injuries (5%)

 Protein Energy Malnutrition (4%)

 Cancer (3%)

 Meningitis (3%)

 Stroke (3%)

 Tuberculosis (2%)

According to a report by Elvis et al., (2015), Nigeria has 2.9 million people infected with HIV/AIDS.

This is the largest number in the world after India and South Africa. The HIV/AIDS pandemic, which

has already left at least 930,000 children orphaned in Nigeria. This corroborated the findings of the

United State agency for International development (USAID), who stated that Nigeria has the second

largest number of people living with HIV globally and accounts for nine percent of the global HIV

burden. The U.S. Government, through the President’s Emergency Plan for AIDS Relief (PEPFAR),

currently assists more than 600,000 Nigerians with life-saving HIV therapy, which is 90 percent of the

people living with HIV/AIDS in the country. More than one million children orphaned and made

vulnerable by HIV receive care and support through these programs. USAID (2018) further stated that

Nigeria still has the highest burden of malaria globally which remains the top cause of child illness and

death. We support effort to decrease the number of malaria-related deaths in pregnant women and

children each year by increasing access to and availability of treatment, insecticide-treated bed nets,
and re-treatment kits. Between 2010 and 2015, malaria interventions through them resulted in a 36

percent reduction in malaria parasites found in the blood of children under age five, per the Malaria

Indicator Survey. Nigeria has scaled up malaria control interventions and since 2014 has

distributed 22 million mosquito bed nets, 14 million malaria rapid diagnostic test kits, over 48

million treatments courses for malaria, and eight million doses of medication to prevent malaria in

pregnancy.

Bolaji (2016) stated that the National Emergency Response and Preparedness Team were constituted

by the Federal Ministry of Health (FMOH), Nigeria in recognition of the importance of disease

prevention & control. But having the department of public health which is responsible for public health,

emergency preparedness and response as well as disease prevention and control under the FMOH has

not helped matters besides the mission of public health as defined by the Institute of Medicine (IOM)

which is “fulfilling society’s interest in assuring the conditions in which people can be healthy” has

not been achieved by the department of public health under FMOH. Every year Nigeria record an

outbreak of different disease which kill innocent Nigerians in their thousands. Despite this yearly

occurrence of an outbreak, there has not been an effective and efficient emergency response and disease

prevention system in Nigeria. That is why the department of public health under the FMOH needs to be

upgraded into an agency with or as part of the FMOH that will focus on emergency planning and

preparedness; disease prevention and control; and promotion of the health of Nigerian people while

the FMOH focus on other issues. Cholera outbreak in Nigeria estimated as 3 to 5 million cases

annually and 100,000 to 150,000 deaths yearly. It was the worst outbreak in Nigeria in recent years.

The number of cases was three times higher than that of 2009 and seven times higher than in 2008.

According to UNICEF, UN &WHO, women and children account for four out of every five cases

(Elvis et al, 2015).

3.3 NIGERIAN NATIONAL HEALTH POLICY AND ITS SHORTCOMINGS

The national health policy is not sufficiently helping the public’s perception of the revised national

health policy is unknown. The issue of equity, accessibility, affordability, quality, effectiveness and

efficiency which are the overall policy objectives of the revised national policy is still persistent. Since

independence in 1960, Nigeria has had a very limited scope of legal coverage for social protection

leaving over 90% of the Nigerian population is without health insurance coverage, despite its launch

in 2005, the National Health Insurance Scheme (NHIS) cover up to 10% of the Nigeria population

leaving the most vulnerable population at the mercy of health care services that are not affordable. This

means that the most vulnerable populations in Nigeria are not provided with social and financial risk

protection (Bolaji, 2016). Patrick (2015) listed the constraints identified by the National Health Policy

as follows;

 Disease control and other health programs being implemented within a weak health system.

 Inefficient and non-functional referral system between levels of care.

 Erratic supply and non-availability of essential drugs and materials.

 Ineffective and inefficient management of the nation’s limited health resources.

 Culture of corruption and promotion of self-interest.

 Poor coordination of donor fund.

 CHAPTER FOUR

4.1 CONCLUSION

With rare exceptions, threats to public health are generally known and manageable. Some

public health emergencies, however, such as outbreaks of AIDS, dengue and other infectious

diseases, could have been prevented or better controlled if the health systems concerned had

been stronger and better prepared. Global public health security depends on all countries

being well-equipped to detect, investigate, communicate and contain events that threaten

public health security whenever and wherever they occur.

No single country, however capable, wealthy or technologically advanced – can alone

prevent, detect and respond to all public health threats. Global cooperation, collaboration and

investment are necessary to ensure a safer future . This involves not only cooperation

between different countries but also between different sectors of society such as

governments, industry, public and private financiers, academia, international organizations

and civil society, all of whom have responsibilities for building a global public health

security.

4.2 RECOMMENDATION

To make global public health security possible, the following recommendations should be

considered:

 There should be Global cooperation in surveillance and outbreak alert and response

between governments, United Nations agencies, and all stakeholders.

 Open sharing of knowledge, technologies and materials, including viruses and other

laboratory samples, necessary to optimize secure global public health.

 Countries need to strengthen their own systems so that they can predict and respond

to any emerging dangers. In addition, nations need to help improve the public health

infrastructure of all countries.

 Cross-sector collaboration within governments: The protection of global public health

security is dependent on trust and collaboration between sectors such as health,

agriculture, trade and tourism.

 Increased global and national resources for the training of public health personnel, the

advancement of surveillance, the building and enhancing of laboratory capacity, the

support of response networks, and the continuation and progression of prevention

campaigns.
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