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COVID-19 and cancer: Nigeria’s unique quadruple jeopardy

The Covid-19 pandemic has created several tragi-comic double jeopardies which are peculiar to Nigeria – the politician or elite who previously felt too “big” to attend local hospitals, but is now forced to either eat humble pie or die; the doctor whose job puts him at the greatest risk of contracting the virus and so cannot enjoy an “I told you so” moment to underline the irresponsibility of a government which chronically under-funds the health sector; the pastorpreneur who has invested heavily in a new church auditorium, but now has only his nuclear family as the sources of tithes and offering; and a government which must now provide welfare for a restless population under lockdown, in the face of plummeting oil prices.

Dr. Osagie Ehanire  COVID-19 and cancer: Nigeria’s unique quadruple jeopardy Osagie Ehanire
Dr. Osagie Ehanire, Health Minister

A few weeks ago, nobody could have imagined any of these scenarios. Nigeria’s most “versatile” prophets and future-tellers have been caught napping. Real life has become stranger than the most creative Nollywood plot. Don Jazzy, one of Nigerians foremost celebrities, alluded to this unfortunate situation in his social media post reported on March 25, 2020, wherein he mocked, “Build hospitals build hospitals una no hear, now go abroad for treatment,”. Patrick Okigbo also addressed this issue in his article of the same day, titled, “Nowhere to run: When wealth, made or stolen, provides no refuge”.

However, in the case of Nigerian cancer patients, Covid-19 has put them not in a double jeopardy, but in a four-dimensional (quadruple) jeopardy.

The virus responsible for the coronavirus disease 2019 (Covid-19) was first identified in China on December 30, 2019. The outbreak of Covid-19 soon became a pandemic and exactly a month ago (on February 27), the first case of Covid-19 was confirmed in Nigeria. This pandemic has rightly precipitated a series of remedial actions and reactions both globally and at all levels of society, given the contagious and acute nature of the disease. Thanks to the sustained media awareness and advocacy campaign!

The pandemic took the whole world unawares such that the robust health infrastructures of even the most developed countries became overwhelmed. This has caused widespread fear of what will become of developing countries like Nigeria if they get hit with the magnitude of the infection currently seen in these advanced countries. At the moment almost all countries in the world are currently on lockdown.

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As at March 26, 2020, there were 468,577 cases of Covid-19 globally and 21,185 deaths with an overall mortality rate of 4.5%. Most of these deaths occurred in the elderly and people with pre-existing noncommunicable diseases, especially cancer. In fact, in Italy, the country with the highest mortality, the earliest data showed that 20% of patients who had died from Covid-19 were cancer patients. When Nigeria reported its first coronavirus-related death which occurred on March 22, 2020 the casualty was a cancer patient who had returned from the UK where he had gone for chemotherapy treatment.

Whilst it is imperative for all to do everything RIGHT and BENEFICIAL to check the spread of the dreaded Covid-19; it must not remove our attention from much bigger and much deadlier public health problems, especially the BIG WAR Against Cancer. We must also keep up the relentless fight against other conditions which are risk factors for cancer, including human papillomavirus (HPV), HIV/AIDs, hepatitis virus, malaria, hypertension, diabetes and others.

Noncommunicable diseases (NCDs) are now responsible for majority of global deaths, with cancer being a leading cause of death and the single most important barrier to increasing life expectancy in every country of the world in the 21st century. According to the International Agency for Research on Cancer (IARC), there are over 18 million new cancer cases globally and 9.6 million cancer deaths every year. Cancer kills 26,000 people daily – more than the global death toll of Covid-19 in 85 days!

In fact, cancer is a bigger problem in Nigeria than other better publicised problems, including militancy, kidnapping, armed robbery and pipeline explosions.

Covid-19 is known to have a single digit mortality rate of between 0% and 9% of those infected with the virus (about 4.5% globally). Meanwhile, the global mortality rate of cancer is 53%. In Nigeria, over 100,000 new cases of cancer are diagnosed annually out of which about 70,000 die – a death ratio of two in Three.

Whilst the cancer patients in developed countries have a double jeopardy in that they are worse hit by the Covid-19 crisis, our nation’s cancer patients are faced with a UNIQUELY NIGERIAN QUADRUPLE JEOPARDY – firstly, the increased susceptibility of cancer patients to Covid-19; secondly, the dearth of infrastructure for cancer care; thirdly, restriction on medical tourism due to the lockdown; and finally, the diversion of the few resources available locally towards addressing the Covid-19 crisis.

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But the danger looms not only for cancer patients, but for all of us. This is because there is a direct relationship between the baseline capacity of a nation’s health sector to care for cancer patients and its preparedness to tackle unexpected health emergencies such as the novel Covid-19 pandemic. In fact, many nations are currently converting their existing robust health systems to adapt to the present realities. In contrast, a nation like Nigeria which is ill equipped to prevent, diagnose and treat cancers finds itself totally prostrate, when faced with unexpected health crises.

A Comprehensive Cancer Centre (CCC) is a tertiary health institution focused exclusively on cancer care in all its departments. It is a shame that whilst India has over 200 Comprehensive Cancer Centres, Nigeria has none. In addition, Nigeria currently has less than ten radiotherapy machines to cater for its teeming population, against the WHO recommendation of at least one radiotherapy machine for every one million people. To make matters worse, most of the machines available in Nigeria are either outmoded or non-functional.

Rather than addressing the problem, Nigerian politicians and elite pride themselves on the fact that they can arrange for medical tourism for themselves and their relations. Consequently, Nigerians spend over $200 million annually for treatment abroad, an amount that is enough to set up three Comprehensive Cancer Centres in Nigeria every year. Sadly, most Nigerians who travel abroad still end up dying because of late presentation.

Covid-19 serves as a wakeup call for all to support the BIG WAR Against Cancer, a campaign of ↑↓GivingTide International which is operated by the nongovernmental National Cancer Prevention Programme (NCPP) of mass medical mission.

The aim of ‘the BIG WAR’ is to make cancer care accessible to all, by establishing three levels of infrastructure, viz:

  • Nigeria: At least one Mobile Cancer Centre (MCC) in each state
  • Nigeria: At least one Comprehensive Cancer Centre (CCC) in each of the six geopolitical zones
  • Global: At least one radio-chemotherapy facility for every million people (a United Nations goal)
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These goals are easily achievable, if we would apply the kind of concerted effort that has been deployed to tackle Covid-19. However, Nigeria must not expect the international world to address its local cancer challenges, because cancer is not contagious. Rather, we must look inwards. This is not a WAR that can be left to the government alone.

Already, significant strides have been achieved in the BIG WAR Against Cancer through the concerted support of some public-spirited Nigerians – philanthropists like Jim Ovia, Modupe and Folorunso Alakija, Winifred Akpani, and Tonye Cole. Through their generosity, the pilot phase of the Mobile Health System is now ongoing and transforming the lives of Nigerian masses.

The relentless and sacrificial effort of mass medical mission has contributed to a reduction of cancer death in Nigeria from 240 deaths daily to 193 deaths daily between 2008 and 2018 (WHO data). There is an urgent need to escalate the reach of this project and to establish the first Comprehensive Cancer Centre in Nigeria, for the optimal care of confirmed cancers. In future, the CCC could always be adapted to fight unexpected health crises, like Covid-19.

In this regard, there are various successful models around the world that we could emulate. For example, in 1994, Imran Khan, (then a cricket superstar), built the first Comprehensive Cancer Centre in Pakistan, a memorial to his mother who died of colon cancer. At this centre, 75% of patients are treated free. To raise the funds needed to set up the CCC, over 50 events were organized. Imran Khan later developed acute intestinal obstruction (a condition not related to cancer) and had to undergo emergency surgery at the same Centre he established; that operation saved his life. He later went on to establish the second CCC in Pakistan.

Imran’s story should inspire us to heed the call by GivingTide to set up local infrastructure for cancer care. We never know whose life could be saved, for while it may be our privilege today to give, it may be our necessity to receive tomorrow.

According to Bill Gates, “You do not need to be the chair of a large foundation to have an impact on the world. Risk takers need backers. Good ideas need evangelists. Forgotten communities need advocates. And whether your chief resource is volunteer time or hard-earned dollars, for a relatively small investment catalytic philanthropy can make a big impact.”

Without concerted effort, the vision of stemming the contemporary scourge of cancer and its related diseases cannot be achieved. It is in our enlightened self-interest to rise in support of the BIG WAR Against Cancer.

By Dr Abia Nzelu, PinkCruise (Mobile Health Outreach of National Cancer Prevention Programme), info@givingtide.org

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