In July 2014, Ebola virus disease found its way into Nigeria after an infected Liberian Government official named Patrick Sawyer arrived in Lagos.
Though he was prevented from further interacting with members of the public by officials of a Lagos based hospital, who diagnosed him, the disease still found its way to several parts of the country, killing at least eight people out of the 20 affected.
Minister of Health at the time, Prof Onyebuchi Chukwu, recalls some of the major steps taken by the Goodluck Jonathan administration in fighting and defeating Ebola in Nigeria.
How did you receive the news on July 20, 2014 when it was announced that Ebola had found its way into Nigeria?
I had actually travelled to Melbourne, Australia, to represent President Goodluck Jonathan at the World AIDS/HIV conference at the time the announcement was made.
It was on my way back, at the stop-over in Singapore, that I switched on my phone, which was always roamed and noticed that I had a text message from the then Chief Executive Officer of the Nigeria Centre for Disease Control, Prof Lasidi. The message said, “Honourable Minister, finally, Ebola has landed in Nigeria.”
It was a terrible news for me at the time because it was the least I was looking forward to hearing.
Given the anxiety and uncertainty at that time, what was the first step the government took in dealing with the disease?
The first step was that even in my absence, the Minister of State for Health had already directed the NCDC to immediately proceed to Lagos. When I returned to Nigeria, I had a meeting that same day with President Jonathan who just arrived from an overseas tour. From then on, it was action.
Were there times you lost sleep in the first few days after Ebola found its way into Nigeria?
I lost sleep throughout that period not because I did not know what to do but because there was always something to do.
Throughout the period, my average sleep time was three hours and I doubt if President Jonathan himself had as much sleep back then because there were times he would call me around 200am to get the latest update from me.
How quickly was a plan to tackle the disease drawn after the news hit the airwaves?
Actually, Nigeria started preparing for Ebola as soon as we got wind of the outbreak in Guinea. Mind you, the authorities in Guinea did not tell the world on time about the crisis in their country because the outbreak occurred in December but was announced officially in January, making the situation complicated.
But from that time, we started preparing even though the only difference was that there was no doctor that had ever managed Ebola virus disease In Nigeria back then. Even as the Minister of Health. I had never seen a case of the disease other than on the television or what I read in books.
So, we had started preparing long before Ebola finally found its way into Nigeria.
As head of the health ministry back then, who were the first set of people you reached out to in coming up with a strategy to combat the disease?
The first set of people I contacted were these in the NCDC, they were the technical people responsible for controlling disease outbreak and they were already on ground before I returned to Nigeria from Australia that period.
I was briefed by them upon my return to the country, I asked them questions, spoke to the World Health Organisation for help. I spoke to the then Director-General of WHO, Dr Margaret Chan, and she graciously sent us a doctor, who was already experienced in treating cases of Ebola virus in East Central Africa and this proved to be critical in our success of controlling the disease.
Also, I spoke with the then Governor of Lagos State, Mr Babatunde Fashola, the Lagos State Commissioner for Health at the time, Dr Jide Idris. I was always in touch with President Jonathan, briefing and debriefing as was expected. The President also constituted a multi-disciplinary, multi-sectoral presidential committee on strategy and communication because it was a disease that affected the entire Nigerian people.
I also met with a lot of media houses because we needed them to educate and enlighten Nigerians on what the disease was all about and how to prevent it. The media was very active and played a vital role in that success story.
With the way Patrick Sawyer, the index case, entered Nigeria at that time, do you think it could have been prevented if our borders had been more secure?
It was not necessarily a case of porous borders. From the evidence we had, there might have been a collusion in Monrovia, Liberia, to get the guy into Nigeria by all means because CCT footages from Monrovia Airport showed that Sawyer was already very ill at the time he was waiting to board the flight to Nigeria. He was already throwing up. I have copies of the footages.
His sister had died as a result of the virus at the time and he had very close contact with her. He knew he was in a critical situation. We gathered that he was heading to a church in Lagos for spiritual cure but we thank God he didn’t get to the place before he was discovered. If he had reached that church, it could have been a bigger disaster for us.
I believe there was a collusion in Monrovia to get him to Nigeria by all means because even when the flight had a stop-over at Lome, Togo, and he was throwing up, they could have removed him from the aircraft but he was allowed to remain and make his way into Nigeria.
I have been on air many times and pilots would always be decisive once they are near the vicinity of an airport to evacuate a sick person because it is more difficult to make an emergency landing in an unknown place than where you are sure you already know the facilities on ground.
So, why they allowed that man to fly from Monrovia to Nigeria are questions we need to find answers to. Sawyer used the excuse of attending the ECOWAS conference in Calabar, Cross River State, to enter Nigeria as a senior Liberian Government official.
You said he was going to a church, which church was that?
He had a different reason, you can always use an official reason for travelling at any time but you use that opportunity to solve some of your personal problems.
So, officially, he was headed to Calabar. That was why he was met at the airport by ECOWAS officials, who came to pick him up. That was not where he originally wanted to go, he wanted to actually get some healing for his ailment at a church.
Which church was that?
By what we were told, I think it was Synagogue Church of All Nations headed by Pastor T.B. Joshua.
Do you think Sawyer did what he did on purpose?
It is difficult to say. He had a legitimate official reason for being in the country. But having spoken to different sources including his relatives, there were suggestions that he actually came to seek spiritual healing in Nigeria.
Did the Nigerian government make any official communication to the Liberian authorities over what Sawyer did?
Of course. Once Sawyer knew the result of his diagnosis at the hospital where he was first taken to in Lagos, he made attempts to run away. Some doctors were infected in trying to physically restrain him from running away and then lodged a complaint with the Liberian Embassy.
The Liberian ambassador at the time demanded that his body be released to him and in fact the hospital had to contact me over the matter.
We engaged the Liberian ambassador and told him there was no way we could allow Sawyer’s body to leave Nigeria given the diagnosis he had.
So, even to get permission to cremate his body, we needed the Liberian Embassy to send information to his family to consent to it before we could go ahead with the plan.
Would you say the free movement between ECOWAS member countries contributed to Sawyer’s burdensome entry?
No. Even if he had a visa, it could still have happened. I do not think that had to do with free movement, in fact that gives us more work to do and we are equal to the task.
So, we cannot put the blame on free movement of persons within the ECOWAS region.
What were some of the bottlenecks your ministry encountered while trying to work with the Lagos State Government and others to prevent the spread of the disease?
In the course of working with Lagos Government, we indeed encountered few hitches. Once in a while, you had personality clashes but the attitude I adopted was that Ebola virus disease was not an opportunity to play politics.
If you recall, Lagos State was under the All Progressives Congress and the Federal Government was under the Peoples Democratic Party and there was always the tendency of actors on either sides to score cheap political points but I remained purely professional as a doctor and that encouraged everyone to cooperate with the Federal Government.
At what point did you get help from the international community?
Initially, much help was not coming except from the WHO. Ebola was one disease Nigeria took charge of right from the beginning. Unlike in other cases where the outside world would lead and we’ll be tagging behind, on Ebola, we decided the pace, we were in charge and told them what we wanted from them.
So, the WHO, right from the outset, was with us. There was hardly any day that I did not communicate with the then country representative of the organisation.
The United Centre for Disease Control and Prevention was also very helpful to us. Almost every day, I was on the telephone with Dr Thomas F. who was the then Director of the organisation based in Atlanta, Georgia, United States. As a result of the time difference, our conversation usually took place between 3:00am and 4:00am Nigerian time because he wanted to be sure that he had concluded the routine job he had in his office before sparing time for us to discuss over the phone.
When the outbreak spread to Rivers State, the Doctors Without Borders came in. Even though they had officially disengaged from Nigeria at the time, they felt the need to return to help us fight Ebola virus outbreak. They were very helpful in Rivers State where we worked with them.
Also, the UNICEF contributed their bit. But of course, we worked with other people including the late Nigeria’s High Commissioner to Canada, Chief Ojo Maduekwe. He was extremely helpful. He linked me up with a lot of Nigerians working with the Canadian Government and companies in the area of disease control. We related with them and they offered their pieces of advice which were useful.
What sort of scepticisms did your ministry deal with in trying to curb the spread of the disease?
Initially, there were scepticisms and people were cynical given the fact that the perception was that Nigeria had never been able to manage its affairs so well especially when it involved government leading the line.
So, even the international community was a bit sceptical, they were not sure we could handle the situation. Failure is an orphan and if we had failed, nobody would have come to us. But success has several parents. That was what happened.
Once people saw we were succeeding, they started associating with us. My office received countless foreign visitors because of how we were able to contain Ebola virus disease. Nigeria gained the trust of others due to how it handled Ebola.
Was there a timeframe fixed to defeat the disease and was that achieved?
Our target was to contain the disease and ensure that no other persons aside those initially affected contacted it. Even though other people later contacted the disease, we ensured that it didn’t spread further.
Our objective was stop further spread, contain it, and if we did that, we believed to a timeframe would come naturally. That was our belief and we achieved that.
We learnt that President Jonathan was to announce Stella Adadevoh, the doctor who diagnosed Sawyer, as a national hero at a point but dropped the idea at the last minute, what really happened?
The details will come in my memoirs. It is true because I had written to President Jonathan that even though we had not been declared totally free of the virus, he should make a national broadcast and use that opportunity to give commendation and if possible declare some heroes and heroines of the struggle.
He bought the idea and asked Dr Reuben Abati to draft a speech while I supplied the technical details. The two of us spent hours carrying out that assignment.
But when the President addressed the nation the following day, that aspect wasn’t mentioned. The truth is that politics in Nigeria tends to affect a lot of things and this was one clear case.
Do you agree with those who feel that was a huge setback for Jonathan’s government?
I would not put it that way. It was not a setback but it would have given the administration more appeal in the eyes of the public.
When Dr Adadevoh stopped Sawyer, it was by impulse that she did that. It was not as if she went out of her way to touch him after suspecting that he had a contagious virus. But I think for her to have sacrificed her life in such a dedicated service, she deserved a national commendation.
I attended her funeral to show concern to her family. She was a professional colleague but more importantly as a Minister of Health, I felt it was very important we sympathised with the family at such devastating moment.
As a medical practitioner yourself, didn’t you feel slighted that a colleague who laid down her life for us to defeat the disease was not given due recognition by the Federal Government at the time?
I did not feel slighted. Was I given due recognition for the role I played? Do I have any national honours? I do not.
We did not do it actually to work for national honours. We did it by way of responsibility in terms of the offices we were occupying and the Minister of Health is the one that coordinates measures against the outbreak of disease in any country. It just happened that I was the Minister of Health at that time, I guess if any other person was in that position, he or she also could have done well.
We still have the names of those who played important roles in containing Ebola in Nigeria and if at any time government feels like honouring them, they are available at the Ministry of Health.
What do you think would have happened to Nigeria if Adadevoh had not stopped Sawyer from going into the society to interact with more people?
More people would have been exposed to the virus and this could have meant more work for us but we would have controlled it.
Before the index case, did the Ministry of Health have any knowledge of the disease or been working with other African countries to prevent a spread?
There had not been such collaboration for Ebola virus disease. It was just that the way we tackled it was home grown. It came from our understanding of what Ebola virus was all about. It came from the commitment of everybody, right from President Jonathan down to the media, everybody was committed to Nigeria controlling and containing Ebola virus disease.
What we now established became the new world standard in combating Ebola. It had not been done like that before anywhere in the world. The WHO said we had established a new standard for handling disease. Other countries now copy our model. We even sent people to Liberia and Sierra Leone to help them control their own outbreaks of the disease. That was how effective our strategy was.
Some people regarded Ebola as a spiritual attack, did the government at any point contemplate approaching it from a spiritual angle?
No. It was purely a health issue and that is why the matter rested with the Ministry of Health and its agencies. Nobody in government saw it as a spiritual problem or advised that we tackled it from that perspective.
Financially, how much would you say it cost the Federal Government to finally defeat Ebola in Nigeria?
It is difficult to say. I have never sat down to put the cost. For the work plan handled by the Federal Ministry of Health, N1.9bn was estimated. Much of the things we proposed were the things that was to be put in place. By the time I left the ministry, we had committed at least three quarter of that money.
We got support from the WHO and private organisations in Nigeria, so to calculate the cost would be tough. At a point, we gave the Lagos and Rivers state governments N200m each to battle the scourge. To arrive at the total figure is not something I can just sit down and dish out alone.
What structures did your ministry put in place to ensure that the disease did not find its way back into Nigeria after the country was declared free of it?
By the time I left office, we knew that the journey to the NCDC becoming a totally independent parastatal was closer to being achieved. There were lots of people who were opposed to the establishment of NCDC but after the Ebola virus crisis, they began to appreciate the essence of the agency more. That alone is a huge strategy in terms of dealing with any disease outbreak, not only for Ebola.
The second thing we did was to reorganise the port health services because they are the ones that stay at the point of entry. Part of the money we got went into buying operational vehicles for this purpose. Nigeria has so many land borders, so we equipped the immigration officials to function well and do proper health checks for those coming in.
We also established more laboratories for the NCDC so that diagnosis could be done fast. With this, we were sure it would be difficult for the disease to find its way back into Nigeria.
Dr Adadevoh died on August 5, 2014, how did you receive the news of her death?
I was sad upon hearing the news of her death. Apart from the family, I was probably the earliest to receive the news of the death as the Minister of Health. I felt sad because we had hoped she would survive. I did not know her in person but knew her younger sister who was my senior in the medical school.
I felt very sad. As Minister of Health, I was always saddened to see people lose their lives as a result of avoidable deaths.
On October 20 of that year when the WHO certified Nigeria to be free of Ebola, did you celebrate the news in any special way?
I think God used the Ebola virus disease to lift me up as a person. God decided to use the opportunity to make, rather than mar me.
I lost colleagues in Sierra Leone. They were sacked because things went wrong. If things had gone wrong in Nigeria, I would have been sacked as the Minister of Health by the President.
So, I thank God that under my watch, Nigeria was declared free of the disease. It was indeed a huge moment for me.
What was your most memorable moment during that crisis?
It was the day we were certified free. It was a day of joy for me considering all that we had passed through in trying to achieve success.
Initially, it was hard to get volunteers to work with Dr David whom the WHO sent to us. Everybody was afraid of being infected by the disease. After I contacted the Chief Medical Director of the Lagos University Teaching Hospital, he put out notices including through social media, asking doctors to volunteer. When some doctors, about 35 of them, eventually showed up, we were happy. But on the day we were to move them to Yaba for training and begin the work, 30 of them ran away out of fear. By the time the training ended, only three of them remained. It was these people together with Dr David that carried out the work.
Even as Minister of Health, my family was always telling me to be careful. They would warn me not to enter everywhere. My wife called me once and said that somebody told her that I entered the mortuary where those who died from the disease were kept. She was angry with me but I had to assure her that I was safe.
So, there was pressure on everybody but we tried to take necessary precautions to keep everybody out of danger.
Do you recall the toughest decision you took at that time?
Yes. One of the toughest decisions we took then was to appoint a much younger person to head the emergency operations centre. Today, the young man is the Chief Executive of the National Primary Health Care Development Agency.
At that time, he had many seniors who were working for us. He was actually being paid by Bill and Melinda Gates Foundation but he was working for National Primary Health Care Development Agency in the polio control centre in Abuja.
When I got information from many sources that the team we put together in Lagos were not doing well, I started to scout. I called many people to nominate people to head the team and when his resume got to me and I went through it, I was impressed. I invited and interviewed him in the night around 8:00pm in my office. After I finished interviewing him, I was convinced that he was the person I needed to do the job at hand.
But being much younger, he faced a lot of opposition when he got to Lagos. I advised him to be diplomatic in dealing with those who were his seniors. I gave him all the support he needed and that gave us the result we needed. It was one of the best decisions I took in our fight against Ebola.
People seem to give more credit to Lagos State government on how the outbreak was managed; do you think this is fair on the FG?
Everybody should take credit. I was the leader of the team, so I marshalled out the orders of what should be done and what should not be done. I controlled things, so it was a double-edged sword.
All the three commissioners of health in the three affected states were good. Nigerians cooperated a lot during that crisis and should all partake in the credit. What is important is that we achieved our objective by containing the disease. – Punch.