In a few days, the Nigerian government will remove the requirement for international travellers to conduct PCR tests before arriving in Nigeria and will instead begin testing travellers at the airports using rapid diagnostics tests (RDTs). While I am an advocate for increased testing, including the use of RDTs, I would describe the recent decision by the Nigerian government to introduce these tests at airports for all passengers as a ticking time bomb.
Earlier this year, I wrote about why Nigeria must bring COVID-19 testing closer to the people. There is no doubt that the rate of testing has declined in the country; some say this is partly due to access and others say it’s due to the low-risk perception. However, there are risks associated with testing a high number of people within airports that could be more detrimental than beneficial.
The removal of the requirement of PCR tests for travellers could mean more people will be exposed at airports for a test that can miss infections. Rapid antigen tests aren’t as effective in detecting low levels of the virus at the beginning or tail end of someone’s infectious period. This less accurate testing could allow new and unwanted strains of COVID-19 to make their way across borders.
Removing the PCR requirement will reduce the financial burden for passengers, who currently spend at least $100 to register for a post-arrival travel. A lower cost of travelling with the relaxation of travel restrictions is likely to lead to higher passenger volumes. This could be disastrous in a country where the average number of travellers is currently about 3,000 daily.
At airports, queues themselves could become points of transmission if someone happens to be infectious. Bringing travellers together in one room or area to collect their samples for a COVID-19 test could provide higher risk for transmission. In my experience, and based on internal reviews that I have been privileged to be part of working on COVID-19 response at national and global levels, the international airports in Nigeria do not have sufficient space or logistics that will enable appropriate physical distancing for sample collection until the receipt of results.
A second concern is that as the health system in Nigeria has been severely strained by the pandemic, there may not be sufficient human resource capacity at airports for a seamless process of testing passengers. In addition to the response to the pandemic, the country is also grappling with a Lassa fever outbreak that has killed about 45 health workers in three months and in a race against time to reach the 70% vaccination target. All of these require extensive human resources and an increase in responsibilities without a commensurate increase in human resource capacity will lead to gaps in healthcare delivery.
There is also the question of responsibility for those who test positive, especially at a time where most isolation centres in Nigeria are now poorly run with tales of unpaid health workers and poor maintenance. In December 2021, my friend who tested positive for COVID-19 had to grapple with rats in the isolation centre where he was admitted in Abuja.
Of course, the biggest problem with this policy change is that Nigeria’s vaccination coverage remains one of the lowest in the region and globally with less than 5% of the population fully vaccinated. This leaves the country at risk of continued surge in cases and emergence of variants. The UK where I am currently based has higher vaccination coverage with 85% of the population fully vaccinated but is still seeing an increase in cases as restrictions are lifted. Undoubtedly the same could happen in Nigeria if more caution is not taken.
As a public health professional working on COVID-19 responses, I strongly believe that COVID-19 testing no longer provides the protection it did previously. Thus, in making its policy decisions, the Nigerian government must remember that testing is not a fully preventative measure. The safest approach is to stay at home if you have any symptoms or get tested before staying in an enclosed space. With testing at airports, there is both the logistical problem and an epidemiological problem that could lead to a surge in cases rather than prevent them.
If testing must be a strategy, then instead of testing travellers at the airport, it is more effective for the Nigerian government to introduce pre-travel rapid tests done at countries of departure within 6-12 hours of departure. For those who are unvaccinated and therefore at higher risk of infection, the pre-arrival PCR test which is more accurate at detecting cases should be continued.
But ultimately, it may be better and more effective to now respond to symptoms rather than to test. This does not mean passengers should be willingly exposed to the virus but I struggle to see the benefit of detecting cases among people who have been in an enclosed space already. Instead, passengers with known COVID-19 symptoms should be denied boarding to protect others.
Oyebanji, a Nigerian public health professional and 2021 Aspen New Voices Fellow, is the Strategy Coordinator at the Coalition for Epidemic Preparedness Innovations. She worked as an analyst at the COVAX Strategic Coordination Office from April to November 2021
