Tackle diphtheria now

A previously obscure disease, diphtheria, caused by bacteria infection, has taken the centre-stage in Nigeria’s public health concern for about nine months now. Prevalent in about 114 local government areas in 21 states, among them, the Federal Capital Territory (FCT), as many as 8,406 cases of diphtheria have been confirmed by the Nigeria Centre for Disease Control (NCDC). According to data released by NCDC, the epicentre of the disease is Kano State, with about 7,188 cases, accounting for 86 per cent of the infections in the country. Other states affected include Yobe (775); Katsina (232); Bauchi (20) and Kaduna (17). Many of the affected states recorded single digit infections. Though these figures may sound alarming, the World Health Organisation (WHO), which is monitoring the spread, has argued that the outbreak may have been under-reported in several parts of Nigeria.

Diphtheria, though preventable, is very contagious and causes sore throat, fever, breathing and swallowing difficulties, barking cough and even swelling in the neck. According to the NCDC diphtheria is caused by the bacterium called Corynebacterium species. Those who are mostly at risk of contracting diphtheria are children and adults who have not received any or a single dose of the pentavalent vaccine (a diphtheria toxoid-containing vaccine). Also, people who live in a crowded environment, in areas with poor sanitation, and healthcare workers who are exposed to suspected or confirmed cases of diphtheria. The disease spreads easily among people through direct contact with infected people, droplets from coughing or sneezing and contact with contaminated clothing and objects.

It is not the first time that Nigeria would experience an outbreak of diphtheria in recent times. In 2011 and 2022, the country suffered from waves of the bacterial infection. However, the outbreak in 2023 has become more severe than previous outbreaks, as the country has suffered from two waves in a single year. The first wave occurred between January and May 2023, with a break in June. The second outbreak began in July and has persisted as at September 2023.

To deal with the situation, the federal government has set up a task force to combat the disease. The task is being coordinated by the Chief Executive Officer of the National Primary Health Care Development Agency (NPHCDA), Dr Faisal Shuaib. At a recent meeting, chaired by Professor Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare, the task force said it would liaise with the governors of the affected states to work out measures to roll back the spread of the disease. Some of the measures include persuading governors to release their counterpart funding for vaccination, ownership and mass mobilisation and sensitisation of the people on how to prevent the spread of the disease.

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The singular reason for the outbreak and spread of this disease, said to have been forgotten in many parts of the world, is not far-fetched: inadequate or lackadaisical approach to the vaccination of children in many parts of Nigeria. An effective routine immunisation of children against childhood diseases, among them diphtheria, would have prevented the pains many children, parents and families have been experiencing since the beginning of the year. In Nigeria, the procurement of vaccines has been outsourced to international charity organizations. Even when these vaccines are donated to Nigeria, state governments fail to take the relay baton from that point by ensuring that children are actually vaccinated. The primary access to vaccines is at the nation’s Primary Health Care Clinics. However, out of about 30,000 PHCs in Nigeria, barely 5,000 are functional. Children born in the remaining 25,000 dysfunctional PHCs are exposed to diphtheria. It is, therefore, not surprising that the infection rate is persistent and mounting.

All agencies of the three tiers of government must come together to engage in emergency measures to combat the spread of the disease. First is to wet the country’s PHCs, general and even tertiary hospitals with vaccines, so that all newly born children and those below the age of five are vaccinated without delay. Even children who may have been vaccinated should be given booster doses of the anti-diphtheria vaccine as a way of preventing their chances of being re-infected. To cover more potential victims of the disease, it has become necessary to provide vaccines to privately owned health institutions as well, as many Nigerians actually patronise private hospitals.

We must avoid the kind of health emergency that diphtheria has brought upon Nigeria by taking vaccination of children and even adults for preventable diseases seriously. The authorities must not outsource the responsibility of providing vaccines for its populace to international health Non-Governmental Organisations (NGOs) who are not under obligation to pay Nigeria’s health bills. Nigeria’s health research institutions should be funded to locally produce vaccines for preventable diseases that are prevalent in Nigeria. Only measures like these would forestall another outbreak of diphtheria or any other preventable disease in a couple of years after this outbreak is fought to a logical conclusion.