Nigeria risks public health catastrophe as drug resistance rises — Expert

By Kareem Islamiyat

“We are one failed antibiotic away from a public health catastrophe,” declared Dr. Ifeanyichukwu Samuel Ike, silencing the room at the Lagos Doctors’ Forum, where physicians, public health officials, and medical researchers had gathered at the Lagos State University Teaching Hospital on November 8 for a meeting on emerging threats in infectious disease.

In a presentation that drew sustained engagement from an audience of Nigerian medical practitioners, Dr. Ike, a Nigerian-trained physician and public health epidemiologist now based in Illinois in the United States, laid out what he described as a converging public health emergency that Nigeria is institutionally underprepared to confront, despite carrying one of the heaviest infectious disease burdens in the world.

“The science is the same everywhere,” he told the audience. “The organism does not care whether it is in Atlanta or Aba. What differs is the capacity to detect it, respond to it, and contain it. And on that front, Nigeria cannot afford the delay it is currently operating under.”

His argument addressed three intersecting threats — HIV, sexually transmitted infections, and antimicrobial resistance — and the increasingly thin line between them. Drawing on his clinical experience at the University of Nigeria Teaching Hospital and his current work in U.S. public health surveillance, Dr. Ike argued that the systems Nigeria needs to put in place to confront these threats are well understood, internationally documented, and within reach. What is lacking, he said, is the political urgency to build them at the speed the situation requires.

He turned first to antimicrobial resistance.

“Neisseria gonorrhoeae, the organism responsible for gonorrhea, has developed resistance to every antibiotic class previously recommended for its treatment,” he said. “Penicillin. Tetracycline. Fluoroquinolones. All gone. Ceftriaxone is the last reliable first-line treatment we have. Resistance to ceftriaxone is already being documented in multiple countries. When we lose it — and at the current trajectory the question is when, not if — we will have a sexually transmitted infection with no effective oral treatment option anywhere in the world.”

The implications for Nigeria, he argued, are particularly severe. Gonorrhea is endemic across the country. Antibiotic dispensing is poorly regulated. Self-medication is widespread, often driven not by ignorance but by the simple economic reality that accessing a physician for every infection is beyond the reach of most Nigerians. The result is a population-level pressure on antimicrobial resistance development that exceeds the conditions in most high-income countries.

“The CDC has designated multidrug-resistant gonorrhea an urgent threat,” Dr. Ike said. “The United States is treating this as a national priority through frameworks like the National Action Plan for Combating Antibiotic-Resistant Bacteria. The question Nigerian health authorities have to ask is whether we have an equivalent national framework, with equivalent enforcement, addressing the same crisis. At the moment, we do not.”

He pressed the same argument across HIV. Nigeria carries one of the largest HIV burdens in the world, with PEPFAR-funded treatment programmes serving millions of patients across the country. But the gap between national-level data and community-level response, he argued, remains the single greatest weakness in the Nigerian HIV response.

“The data exists,” he said. “NAIIS surveys, NASCOP reporting, PEPFAR programme data. We have more information about Nigeria’s HIV epidemic than ever before. But the gap between what that data shows and what actually happens in a primary healthcare centre in rural Benue or a community health post in Zamfara is enormous. The intervention design at the community level remains largely top-down. Programmes are built by policymakers who may never have sat with the communities they are designing for. That is the failure point. That is where the response is breaking down.”

He pointed to the United States as a cautionary example rather than a model. Despite hundreds of millions of dollars in federal investment through the Ending the HIV Epidemic initiative, congenital syphilis cases in the United States have surged by 700 percent over the past decade. Black and African American communities continue to account for approximately forty percent of new HIV diagnoses despite representing thirteen percent of the population. The systems failure in the United States, he argued, is a warning rather than a reassurance.

“If the United States, with all of its resources, is failing on congenital syphilis and on HIV equity, then Nigeria has to treat these issues as the emergencies they are,” he said. “Antenatal syphilis screening is standard of care. The science is decades old. The fact that congenital syphilis remains a significant cause of stillbirth and neonatal death in Nigeria today is not a knowledge problem. It is a delivery problem. And we know how to fix delivery problems if we are serious about doing so.”

Dr. Ike argued that the three threats — HIV, sexually transmitted infections, and antimicrobial resistance — cannot be addressed in isolation, and that the failure to act on one accelerates the failure on the others. The drug-resistant gonorrhea crisis, he said, is not separable from the broader STI surveillance gap. The HIV response cannot succeed in communities where the same patients are being failed by every other layer of the public health system. The antimicrobial stewardship problem cannot be solved without addressing the systemic conditions — economic, regulatory, infrastructural — that drive antibiotic misuse in the first place.

“We often discuss these issues separately,” he said. “HIV in one conversation. AMR in another. STI surveillance in a third. That separation is convenient for policy briefs but it is dangerous in practice. These threats are biologically connected. They are epidemiologically connected. They share the same failure points in the system. They have to be addressed together.”

Dr. Ike closed his presentation with a direct address to the policymakers and senior medical professionals in the room. Nigeria, he said, has the clinical workforce, the institutional knowledge, and the international relationships to mount an effective response to these converging threats. What it lacks is the urgency.

“Three things have to happen,” he told the audience. “First, Nigeria needs to invest in a workforce of public health professionals who can combine clinical depth with data analytics capability — people who can read a surveillance report and understand what it means for a patient in Kano or Aba or Port Harcourt. Second, intervention models have to be designed with communities, not delivered to them. The trust that government programmes often lack already exists in our community health structures, our traditional leadership, our religious networks. Those structures need to be genuinely integrated into HIV and STD intervention design, not treated as a checkbox. Third, we need a national antibiotic stewardship framework with real enforcement. Every course of antibiotics used inappropriately in Nigeria today is a contribution to the resistance crisis that will kill Nigerians tomorrow.”

He concluded with a warning the room appeared to take seriously.

“The organism does not wait,” he said. “Nigeria does not have the luxury of waiting either.”