Policy and Governance of Disease Surveillance Systems in Nigeria: Addressing Emerging Microbial Threats

Abstract

This comprehensive review critically examines the state of microbial epidemiology, disease surveillance policies, and public health response mechanisms in Nigeria. As Africa's most populous nation, Nigeria faces a significant and evolving burden of infectious diseases, including epidemic-prone diseases (cholera, Lassa fever, meningitis), vaccine-preventable outbreaks (diphtheria), and global threats like Antimicrobial Resistance (AMR). The national framework is anchored on the Integrated Disease Surveillance and Response (IDSR) strategy, coordinated by the Nigeria Centre for Disease Control and Prevention (NCDC), which collects and analyzes data to detect outbreaks and inform policy. Despite notable strengths developed through responses to major outbreaks like Ebola and COVID-19, including workforce development and the establishment of a national reference laboratory network, systemic weaknesses persist. These include fragmented data flow, critical gaps in diagnostic and laboratory infrastructure, especially at sub-national levels, inadequate funding, and weak integration of One Health principles. The review highlights promising innovations, such as the launch of Nigeria's first national AMR survey and explorations into wastewater-based epidemiology (WBE). It concludes that while policy frameworks are largely robust, transformative progress hinges on sustained investment in laboratory capacity, digital data systems, antibiotic stewardship, and equitable implementation of surveillance from the national to the local government level. Strengthening these areas is imperative for Nigeria to achieve its health security goals, effectively combat AMR, and build a resilient public health system capable of preventing, detecting, and responding to microbial threats.