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Leveraging investments in AIDS, TB and Malaria to fight COVID-19 pandemic outbreak in Nigeria, CCM at the frontline

Nigeria has a large population estimated at 200 million (the largest in Africa), with about 70% of people living below $1 per day. On 27th February 2020, the country confirmed its first case of COVID-19. As at 23rd April 2020, Nigeria reported 980 confirmed cases, 197 recovered cases and 31 deaths, with Lagos State, the country’s commercial capital with a population of about 20 million people, as the epicenter of the pandemic. The pandemic has been reported in 24 states out of 36 states and in the Federal Capital Territory (FCT). The pandemic has transitioned from containment phase to community transmission, thus prompting an adjustment of strategy.

CCM supporting NCDC to develop COVID-19 response plan for Global Fund support

On December 31st 2019, when the Wuhan Municipal Health Commission, China, reported a cluster of cases of pneumonia in Wuhan, leading to the eventual discovery of the novel coronavirus, little did China and the world expect what was coming. In another 30 days (30 January 2020), the Director-General of World Health Organisation (WHO) accepted the recommendation of the Emergency Committee and declared the novel coronavirus outbreak (2019-nCoV) a Public Health Emergency of International Concern (PHEIC). At this point, Heads of Governments and indeed the global population accepted that we are all threatened by a clear and present danger which WHO named COVID-19. From Asia to Europe, from America to Africa, from Australia to South America, COVID-19 has taken over territories, killedtens of thousands and stretching even the most resilient health and economic systems beyond elastic limit. As at 24th April 2020, the world recorded 2,668,135 cases of COVID-19, including 190,236 deaths. It overwhelmed the world with fear and panic, even the bravest was no exception. In a frantic bid to control the wildfire-like spread of the virus and the deaths it left in its trail, the rarely used word ‘lockdown’ became the most used word by world leaders.

Nigeria has a large population estimated at 200 million (the largest in Africa), with about 70% of people living below $1 per day. On 27th February 2020, the country confirmed its first case of COVID-19. As at 23rd April 2020, Nigeria reported 980 confirmed cases, 197 recovered cases and 31 deaths, with Lagos State, the country’s commercial capital with a population of about 20 million people, as the epicenter of the pandemic. The pandemic has been reported in 24 states out of 36 states and in the Federal Capital Territory (FCT). The pandemic has transitioned from containment phase to community transmission, thus prompting an adjustment of strategy.

Driven by compassion anddetermination to save the citizens from the rampaging pandemic, Nigeria’s President, Muhammadu Buhari,on March 17,inaugurated the Presidential Task Force on COVID-19 to coordinate a multi-sectoral response to the pandemic. The Task Force, chaired by the Secretary to the Government of the Federation, is saddled with strengthening the national response strategy, particularly in the areas of testing, containment and management of coronavirus and building awareness among the populace.The Task Force has as members the Ministers of Health, Foreign Affairs, Interior, Aviation, Humanitarian Affairs Disaster Management and Social Development, Education, Information, Environment and Minister of State for Health. Others are the Director General Department of State Services, Director General National Centre for Disease Control and World Health Organization Representative in Nigeria.In support of the Task Force, UNAIDS and UNDP facilitated the establishment of the COVID-19 Basket Fund. The Basket Fund, launched on April 6, 2020, serves as the one COVID-19 financing and investment platform for diverse stakeholders to channel their financial support to ensure an efficient, effective and impactful response to the coronavirus pandemic.The UN and the European Union have contributed to this basket fund thus far.

Nigeria has high burden of HIV and tuberculosis, and malaria, anda high prevalence of non-communicable diseases including diabetes and chronic lung diseases. Evidence suggests that older people and persons with pre-existing morbidities are at higher risk of COVID-19. In view of the high burden of diseases, poverty level and Nigeria’s weak health system, the impending COVID-19 epidemic, if not promptly and adequately responded to,will most likely jeopardize and reverse the gains already made by government of Nigeria and her development partners, including the Global Fund, through their investments in the health sector.

The Global Fund, recognizing the potential negative consequences of COVID-19 on existing programs it supports in countries, issued a guidance note and encouraged countries to consider and take prompt action to mitigate the potential impact of COVID-19. In this regard, countries were requested to reprogramme not more than 5% of their existing grant to support response to COVID-19 with focus on the following intervention areas: epidemic preparedness assessment; laboratory testing; sample transportation; use of surveillance infrastructure; infection control in health facilities; and information campaigns.Nigeria is currently implementing a Global Fund grant worth about $660,000,000 which will end on 31st December 2020. Following this guidance, the CCM Nigeria immediately requested the Principal Recipients to conduct a risk assessment of COVID-19 on their grants implementation and develop a mitigation plan and submit same for consideration. This proactive step by the CCM was further reinforced by the Global Fund Country Team through an official communication to the Principal Recipients.

The earliest COVID-19 threat to Nigeria’s Global Fund programme was that it jeopardized the finalization of our Funding Request to the Global Fund for 2020-2020 allocation cycle. All international consultants were withdrawn and requested to return to their countries of residence. Gathering of people for any purpose was also banned by the government of Nigeria. The CCM had to quickly resort to use of virtual platform to facilitate the finalization of the Funding Request and submitted on schedule i.e. 23rd March 2020. Technical teams through the Resource Mobilisation Committee (RMC) of the CCM worked through one week to respond to clarifications and additional submissions requested by the Access to Funding team at the Global Fund. Nigeria’s Funding Request submissions for HIV, TB, Malaria and RSSH are now accepted for Technical Review Panel (TRP) review for window one.

The Principal Recipients have also developed risk mitigation plans and have received approval from the Global Fund to implement these plans using grant funds. Given that this is the last year of the grant implementation period, the CCM has also scheduled a web-based meeting of the Resource Mobilization Committee (RMC) and the Principal Recipients to review grant financial status and reprogramme funds as necessary to ensure grant outcomes are achieved even in the face of COVID-19 threat. The proposed RMC meeting will also involve wider stakeholders, including the Nigeria Centre for Disease Control (NCDC) to explore areas of potential additional support to the country’s COVID-19 response. Some of the risk mitigation interventions adopted by the Principal Recipients are use of virtual platforms to hold technical review meetings and provide oversight to grant implementation thereby ensuring that quality of care is not compromised as a result of COVID-19 situation. They also provided for personal protective equipment (PPEs) to the frontline health care workers at the facilities and communities.

Relying on the Global Fund guidance note on COVID-19 response, the CCM supported the NCDC and Federal Ministry of Health (FMOH) to develop a COVID-19 proposal for Global Fund support, using existing grant funds. This proposal essentially drew from the 3-month National COVID-19 Outbreak Incident Action Plan to articulate high impact interventions that will contribute to significant improvements in case finding and prevention of new infections. The strategic thrust of this $6 million dollar proposal was decentralization of COVID-19 testing to all 36 states and FCT using the existing TB diagnostic instrument -the GeneXpert Machine.

The proposal will repurpose at least one GeneXpert laboratory used for TB diagnosis to conduct COVID-19 testing. Critical components of this strategy include improving biosafety capacity of these laboratories to level 2; provision of the Xpert Xpress SARS Cov-2 cartridges for COVID-19 testing; provision of sample collection kits; and provision of personal protective equipment for frontline health care workers. This proposal has been approved by the Global Fund and implementation just commenced. It will support testing of 170,670 COVID-19 tests in 12 weeks.

The proposal aligns with the “National Strategy to Scale up Access to Coronavirus Disease testing in Nigeria”which is built on three prongs namely: (i) Expand Existing NCDC Laboratory Network with Molecular RT-PCR; (ii) Leverage Capacity within the HighThroughput HIV Molecular Testing Laboratories; and (iii) Repurpose Point of Care Tuberculosis Testing GeneXpert Machines for COvID-19 Testing. The strategy was developed by NCDC with support from WHO, US-CDC, Resolve to Save Lives and the CCM. Prong two of the strategy is being activated using high throughput PCR platforms used for HIV viral load and early infant diagnosis (EID) testing. The prong three of theCOVID-19 testing strategy will increase national testing capacity by about 30%. Existing infrastructure for logistics and information management supported by the Global Fund grant for HIV and TB are also being leveraged to support the COVID-19 response, especially at sub-national levels.

As Nigeria, Africa and the Global community grapple with the COVID-19 pandemic, no matter what happens at the end of this, the world will never be the same post COVID-19. The concept of resilient health system has been proven to be at best a relative concept as countries with supposedly strong health system watched their system collapse in the face of the ravaging COVID-19pandemic. Global supply chain system became somewhat comatose, with countries and sub-national entities left to scratch around for the needed health commodities to fight the pandemic. The workplace has been redefined as one without borders. Social interactions have been redefined by the concept of social/physical distancing. As we mark World Malaria Day, we are constantly reminded that COVID-19 should not be a barrier to sustaining the tempo against the three killer diseases of AIDS, TB and malaria, which still kill more people than the dreaded coronavirus.Investments in the three diseases should be efficiently leveraged to combat COVID-19.

By Dozie Ezechukwu

Executive Secretary

Country Coordinating Mechanism of the Global Fund

Nigeria