 Welcome back to the Breakfast here on PLOS TV Africa. Earlier, one of the stories that we spoke about in the news, the president, Mohammad Abouari, of course, I was quoted as asking that other nations do better with COVID-19 or support to developing countries. And of course, that includes with vaccines. And of course, that brings us to the conversation on how prepared Nigeria was and is and will be in case there is another pandemic or medical emergency or health emergency in the future. This morning, we're speaking with Dr. Bolaji Obadeyi, who is a member of the governing board, League of State Primary Health Care Agency. Good morning, Dr. Obadeyi. Thanks for joining us. Good morning. It's my pleasure to be here. Great to have you on the program. I'll start with, you know, let's go back to, you know, how we have fared with regards to our response to COVID-19. Do you think or would you say that, you know, League of State and of course Nigeria as a whole has done well enough, you know, with our response to COVID-19 so far? Thank you for that question. I think one can say that relative to the resources that we have, the technology that we have and the manpower, health manpower that we can boast of, I would say that Nigeria and League of State especially have done very well, commendably well with regards to responding to the COVID-19 pandemic. If you recall, last year, 2020, it was completely unexpected and precedent. But somehow, as soon as the news broke in December of 2019 in China, from about January of 2020, League of State through the Commissioner for Health has been mobilizing resources, getting ready, thinking it through, and we're able to put up a good response to the pandemic. If you look at the structure of the pandemic in Nigeria, League of State is the epicenter for this pandemic followed by Abuja and then other hotspots in the country. So if we're able to contain the pandemic in League of State, which we have, then it means that we have done creditably well. We have also received commendation from other international bodies in our ability to prevent the COVID-19 pandemic from spreading across our country and the sub-region. So I would say with the little resources that we have as a developing country, with the manpower constraints that we have also, we've done very well. There's always room for improvement in any enterprise. Yeah, but Dr. Bade, I want you to clarify because I think one thing that we still didn't get to talk about in the period that we've been dealing with COVID-19 is what exactly the reason is that the virus didn't spread as far and didn't become as deadly as other nations had projected for Africa and for Nigeria. Some people would say we probably were lucky. There was even people who said maybe it's the weather here. The weather is too hot for it to survive and some of all of that. But we've never really been able to answer the question as to what made COVID-19 not as deadly as was expected here in Nigeria. Yeah, thank you so much. I think that's a million dollar question. It's a question of many parts. I would say that it's a question that needs to be answered with evidence and science from research. We don't want to postulate and say maybe it's this and maybe it's that. COVID-19 is a disease that's barely two years old. It's going to be two years old this December. So all the research and the knowledge and the evidence base and the data that we have about COVID-19 is all two years, 24 months old. And that's a very short time to begin to make pronouncements about any disease at all, polio, measles and the others go back up to about a hundred years. So this is something a disease I think we need to build data and evidence about and the research is ongoing. There is a research plan within the legal state response system that looks into the evidence and data that is evolving locally from the COVID-19 response. And I'm sure that all over the country in other states as well as the federal level is a lot of research and thinking going on. I would say though that the public health measures we put in place across Nigeria were quick. They were decisive. And I think that's a small part of why the COVID-19 pandemic did not spread as much as it did. Nonetheless, there's still a lot of research just as you say to look into genetics, to look into the effect of the weather, to look into the effect of cross immunity from other diseases that are endemic around us. What for example is the role of our immunity, long-standing immunity to malaria in protecting us against COVID-19. These are all hypotheses. So research I think in the coming years will confirm definitively what are the reasons why the pandemic has not spread. Okay, so let's go back in time now. Looking at the time when we had the Ebola outbreak now we have COVID-19. Do you think that we have done better? Because some people have the opinion that we practically managed the Ebola outbreak than the COVID-19. What are your thoughts? I think those are two different templates. The Ebola virus and the pathophysiology of that disease is different from that of COVID-19. But where we have similarities I will tell you. I think the similarities that we have with Ebola and COVID-19 is that in both instances we had extremely strong leadership and governance. In the case of Ebola when that happened the government in the first case was in legal state. The government immediately kicked into action. The governor for the state came back from a trip. The commissioner on the ground was all over the place doing what needed to be done. And again with COVID-19 I think leadership has been strong in this particular health crisis with the commissioner and with the governor taking charge immediately and working there tonight to ensure that things went well. So while those two diseases are not exactly comparable, the case fatality for Ebola is much higher than the one for COVID-19. The means of transmission is different. The approach to prevention and control is also slightly different. So while there are different diseases you know with any emergency at all or any outbreak or any biosecurity threats leadership is extremely critical. Governance is extremely critical and in both instances I think we have been very lucky with leadership and governance. But another issue that is very strong is the issue of acceptance and that has to do with awareness because if you remember the time of the outbreak of Ebola we found out that the awareness was very strong compared to that of COVID-19 and then we had different conspiracy theory of how to stop the Ebola issues. Now let's go back to what you mentioned. You talked about the Nigerian government acting in December. I'm thinking that we started taking action in March. That's when we started seeing deliberate steps in action. So yes it broke in December you know in China there were about January we were a little bit not too you know strong with our policies and action February up until March and that's when we started having the shutdown and lockdown across spot. So what is do you think that in terms of awareness we're creating enough awareness you know with the pandemic's you know situation and in the nearest future what are we going to do to create awareness? Excellent you know the key word there is visibility there is a lot of action good technical action going on in the background that the public might not be privy to in terms of what protocols can we develop what handbooks do we have? Where do we mobilize resources from? What are the what-if scenarios? What if this happens? How do we respond to that? What if that happens? How do we respond to that? Constituting the several pillars of the COVID-19 response those are things that were going on the background that the public was not involved in for at least two months before at least a clear month before the first case we had in Lagos state with COVID-19. In looking at communication for the two diseases comparing Ebola and COVID-19 you know with Ebola it's a more dramatic disease that that you don't need to tell anybody do you really want to get this because there's bleeding from the earifices there's fever it's toxic the person dies rapidly with COVID-19 we even had so many asymptomatic cases if you recall and that means that for the average Nigerian or the market woman when you say asymptomatic the understanding is not there the person's understanding of asymptomatic is zero infection whereas in public health we know that asymptomatic means you carry the virus you are able to infect all that people even though you are not showing any symptoms so that's that's where risk communication we need to improve our skills as medical professionals as sociologists as psychologists how we communicate the risk of these various different diseases to people so they have understanding that while it's not like Ebola where there's bleeding and there's death and you're very ill COVID-19 if you are not serious if you get infected it can kill you as well so that's an important part in terms of preparedness we often talk about the three aims we talk about money we talk about materials and we talk about mom power those three are pre-kable for Nigeria in how we prepare for future biosecurity threats these are biological emergencies this is that I'll call as a result of changes in our ecosystem in the climate change the rising temperature the fact that there's urbanization which means we're now in close proximity to animals that we never used to relate to it so I think there will be future pandemics there will definitely be more epidemics in Nigeria we're dealing with about five different epidemics as we speak it's not just COVID-19 there's LASA fever there is a yellow fever there are breaks of cholera there's cow pox quite quite a basket of things that we're having to respond to and so I think we need to have a strategy as a country in terms of how we want to this is the new normal and it's not it's not a very comfortable normal how do we move forward as Nigeria so money manpower materials that's conventional the non-conventional tool to add will be technology digital technology vaccine technology and of course lastly leadership and governance we often forget that I say governments because when you look at how we were able to mobilize against COVID-19 um we can have the ministry at the Secretariat can have the federal government in Abuja we still need other traditional lower government structures to reach our people the market management governance the local government health authorities the local government chairman will leverage all of these platforms platforms in communicating to people about what to do against COVID-19 so I think in preparing for future pandemics the three conventional ones morning we can't avoid that materials we need to invest in our health system manpower we need to develop new streams of healthcare workers more public health practitioners more molecular biologists more epidemiologists more people in the area of testing which we have to rapidly expand capacity and so on we also need to invest in technology this technology e-health invest in vaccine technology possibly producing our own vaccines ourselves here in Nigeria and of course we need to strengthen leadership and governance that I think is the way to good fabric with this unseen enemy oh dr buddy it's um well I'm not sure when we will get to that stage where we start to you know prepare our own vaccines here in Nigeria might take a while you know seeing our investments in healthcare from the national level and on the state level also but I want you to break down the you know the discussion and preparedness you know in layman terms if possible um to understand better what needs to be done because um the thing with pandemics and health crisis is you can never really tell if it's going to be one that attacks blood cells or one that attacks you know the respiratory system or one that attacks the gastrointestinal tract you can never really tell um and and so they have to be systems that are put in place that would be you know the quick response you know that you know that the the the state would you know would put in into action um in case there is a pandemic like that so what have you seen that we still lack here in Lagos and across Nigeria that you believe must be immediately um properly invested in um to prepare ourselves for another pandemic if if if need be okay um that's a very broad question but I will come at I will approach it from the angle of what I do I'm a health economist so I will focus for example on financing health financing by the way we used to produce vaccines in Nigeria in the past and I think we can do it again if we just get dedicated government support the UK government as soon as the COVID-19 pandemic broke provided I think 10 billion pounds dedicated to just developing the vaccine so that's the kind of approach we need to have before cost and um and put our money where our mouth is okay on visual financing just that alone there's government financing of health which needs to improve that is the amount of money that government invests in health not just that government also needs to look at um a performance-based financing what are we getting for the money that we're putting in health that is are we putting money in the right places even more important and there to my heart is the issue of health insurance that is now household financing or personal financing okay if we say government has done his best government cannot do more there's no more money government can spend more can individuals spend more can we spend that money in a strategic way can we rather than pay out of pocket which means in the pandemic you have your money under your pillow and you're waiting for when you're in and then you just put together what you have and go to the hospital which is unlikely to be love because nobody keeps money for sickness so in terms of the layman that is what can I do I would say individual Nigerians should begin to look more at EPA schemes at having a basic health insurance package that is subscribing to whatever you can afford in the various options which are available to us now whether government health insurance or private health insurance subscribing to one to such an extent that if there's an outbreak of a pandemic or an epidemic and it affects your family you can access health care you simply go there with your electronic card you don't need to look for money at that time so that's where we an individual or a family can prepare for a pandemic having some kind of cover that gives them access to health care services not on the basis of ability to pay but on the basis of their need so when I pick up my card I go to the hospital and there are various prepaid schemes which are available now that are quite affordable so in terms of financing that's one thing we can do breaking it breaking it down again in terms of human resources and manpower we need to take care of what we have frankly I don't know how we can do that to prevent our doctors and nurses from going abroad but not everybody's living because of money some people are living because they're not fulfilled because they can't practice what they've learned so if we invest more in the health system our doctors and nurses perhaps those who just want to who have an altruistic motive will stay and and do their bills we also need to train more a country of 220 million people uh one of our former professors professor what they talk about Lucas god bless his soul used to say that our problem is not brain drain is that we're not training enough nurses and doctors he thinks that as a matter of fact we are able to export even if we trained enough like the Philippines like Cuba and other India and other countries are doing so we need to train more and more help manpower of the right cater what everybody needs to be a doctor you can be a community health worker if that's a level of education that you have you can be a nurse you can be a pharmacist there's so much of the real skaters that we need so I think those are simple areas where the the regular man can be the average Nigerian can begin to think about how to prepare my family for another different outbreak of disease which I think will happen everybody should have some form of cover some form of insurance cover yeah it's a lot it's a lot of work obviously it's um it will take a while before we get there all right but let's also uh look at the basic structures you know I know that you've mentioned that money is very important and of course money would answer to some of you know the things that we will need including the structures themselves but let's assume that we have the money what should we be channeling the money to I mean we're talking about structures now for instance uh when we had the COVID-19 outbreak we started battling and grappling with the issue of isolation centers in a lot of states that really there was no provision for isolation centers and then state governors started you know seeing how to pump monies and you know create isolation centers so my question now is what basic infrastructures do we need as a country across the 36 states including the FCT you know in case there's a pandemic there's an emergency what basic infrastructures do we need across the entire country thank you so much that's a question we need to ask ourselves from time to time there are three tiers of the health system the base the foundation of the health system is the primary health care system that's the entry level that's a touch point for more than 70 percent of Nigerians that's the one that is closest to most Nigerians is the place where you can get the the fastest health care possible above the primary health care level is the secondary level whatever can be handled at the primary health care level goes to secondary level what can be handled at secondary level goes to tertiary level I think if that's the way that the pyramid is built the investment into the health sector should go to the base you don't build the house and put all the money on the roof we build the house and ensure that the foundation is strong enough and that's the same approach we should have to strengthen our health care system investing in the place where 70 percent of Nigerians access their health care from making sure that the primary health care system works making sure that the primary health care system has the approach that is preventive the public health approach clinical medicine attends to one person at a time if you go to see your specialist your gynecologist or your new surgeon there can be ten of you in the room is one person at a time public health is population health it's the branch of medicine that looks at the health of groups of people in terms of preventing diseases and controlling the outbreak of disease that's another area that we need to invest our money in ensuring that we have a strong public health system that our epidemiological skills and knowledge is strengthened so that when we have these outbreaks which we have all the time cholera here and there yellow fever outbreak here and there we have the right manpower to respond to those outbreaks what we see unfortunately is that we invest in the roof we invest in the tertiary system we should don't get me wrong we should have inacular rituals we should have MRI machines we should have CT scans but if you decorate the roof and the foundation is crumbling what we've seen is what we're going to continue to see so I think we need to look at the allocative efficiency of our health system where should we put more money it's the base it's the foundation and showing that there is a health post health center that is functional well-staffed well-equipped has drugs that is close to everybody so that if an epidemic breaks we are not then as you say asking ourselves where do we put these people they simply go to their nearest functioning health center when we have a designated isolation bed at least one or two in each of those places where we can put people who have a bit kind of condition but if we don't have that then what we're going to see is the last village effort to quickly set up isolation centers having said that let's be credit to all the state governments every single one of them COVID-19 has brought out some of the best in us I think that every state has cannot boast of at least one if not two or three designated isolation centers that those things were not there two years ago so I think we're moving in the right direction we simply need to institutionalize the COVID-19 response to ensure that the capacity is spread broadly across the health system using of course the primary health care system as the beast Dr. Balaji Obadeyi a member of the governing board lego state primary health care agency very very interesting conversation and I will say thank you for your time this morning thank you for chatting with us wish you a beautiful weekend ahead thank you very much thank you for having me it's a pleasure and that's where we'll be saying goodbye this Friday morning thank you very much for being with us all the way since seven o'clock in the morning uh if you missed out on any parts of our conversation remember where to catch up it's simply at plus TV Africa of course on facebook and instagram and of youtube as well plus TV Africa and we wish you a very great weekend I am messy and I am a