Book Review

The Imperfect Storm: A Pandemic and the Coming of Age of a Nigerian Institution by Chikwe Ihekweazu, with Vivianne Ihekweazu

This 263-page memoir, published by Masobe Books and launched in Abuja on August 8, 2024, is a compelling, firsthand account of transforming Nigeria’s public health landscape. Co-authored by Dr. Chikwe Ihekweazu (former Director General of the Nigeria Centre for Disease Control and Prevention, NCDC) and his wife Vivianne Ihekweazu (a health communications expert), it blends personal reflection, institutional history, and a gripping narrative of Nigeria’s COVID-19 response.

In January 2018, after an exhausting year marked by recurrent outbreaks and mounting public-health challenges, Dr. Ihekweazu circulated an email to partners acknowledging their support and expressing optimism for the year ahead. Sensing that something genuinely transformative was underway at the NCDC, I responded with the hope that he would someday document the experience — even offering, half-seriously, to serve as his editor. This book fulfils that promise.

I’m glad he finally found the time to write this book. If you want to read the story of how a cohort of Nigerian public health workers were motivated and inspired to do great things, this is the book for you. This is the story of how one man took a fledgling public institution by the forelock and made it soar against all odds.

In a style reminiscent of Ngozi Okonjo-Iweala’s Reforming the Unreformable: Lessons from Nigeria, it pulls you straight into the heart of the matter and doesn’t let go until the very end. It is the story of a patriotic believer in the crazy thought that a public institution can be made to work. He made young people believe in their abilities to perform, and they excelled. He groomed and mentored young people and made them leaders.

Upon Dr. Chikwe Ihekweazu’s appointment at the NCDC, the agency saw significant improvements: it established a functional website, activated institutional email addresses, and the National Reference Laboratory commenced testing for pathogens of public health importance. The Emergency Operations Centre was equipped and functioning in no time. A strategic plan was soon developed to provide a firm framework for the operations of the health protection agency. Technical Working Groups focusing on diseases of public health importance were up and running. Several guidelines, manuals, and tools to support disease prevention and control activities at the sub-national levels were developed and made available for users.

The defining event in Chikwe’s stewardship at the NCDC — which rightly takes up much space in this book — was the agency’s response to the COVID-19 pandemic. The agency was constantly on-air communicating risks and educating Nigerians on how to protect themselves while things changed quickly as the world updated its knowledge on a novel virus. The agency partnered with local and international organisations to deploy personnel to support the states in all aspects of the response.

NCDC became a household name — blamed for all the problems but also taking the credit for the successes. But it also exposed the staff to international organizations — Africa CDC, WHO — who snapped them up as the pandemic waned and opportunities blossomed.

But the story also highlights Nigeria’s chronic reliance on foreign and intergovernmental organizations for technical and financial support. It’s hard to see how Chikwe could have led NCDC to achieve what it achieved with the systemic failures and the meagre funding provided by the government.

Several paragraphs express the depth of gratitude to the intergovernmental organizations like the World Health Organization, UNDP, UNAIDS and UNICEF; national institutions of the usual donor countries like the US Centers for Disease Control and Prevention — either directly or through its implementing partners like Georgetown University, the University of Maryland, Baltimore, the African Field Epidemiology Network, Germany’s Robert Koch Institute, and the UK Health Security Agency; or private foundations and other non-governmental organizations like Resolve to Save Lives, the Tony Blair Institute, and the Bill and Melinda Gates Foundation.

The major player that the author forgot to mention is the World Bank which made available credit that funded components of the National Action Plan for Health Security through the Regional Disease Surveillance Systems Enhancement (REDISSE) project.

It is a painful reminder that the best implemented public-health programmes in Nigeria are often those supported by foreign agencies and organisations — an indication of our persistent neo-dependency and reliance on the resources of wealthier countries to fund activities essential to protecting the health of Nigerians.

As Soji Adeyi has observed, “Africa’s health systems are financed, organised, and in many cases even conceptualised as if they were temporary projects rather than permanent national institutions.” The success of the NCDC under Ihekweazu, paradoxically, both confirms what is possible and exposes the structural fragility beneath it.

But Chikwe didn’t have a choice. He understood what needed to be done and harnessed the available opportunities. For an agency saddled with the huge responsibilities of protecting the health of millions of Nigerians, he had to leverage the resources and linkages at his disposal to get the system working.

It is also a story that rings with gratitude to the men and women who supported the author in building and running the national public health institute, an agency essential to the security of the health of Nigerians.

Since Chikwe moved on, many of the best epidemiologists at the NCDC have moved on to the WHO, Africa CDC, and other global health organizations and foreign institutions without replacement.

This exodus of critical expertise and the drying up of the World Bank REDISEE funds have sapped the momentum of the fledgling but vital public health agency. It has slowed down to almost where Chikwe picked it up from. This needs to be addressed post-haste.

The enduring challenge remains sustainability: how to fund institutions with domestic resources, and how to retain the human capital required to grow them with reduced dependence on external charity.

Chikwe’s feat lay in galvanizing people out of the lassitude of ‘business as usual’ to run an institution which has been touted as an example to other African countries. Not everybody has the vision and capacity to attract and leverage the technical support that these organizations have to offer.

Vivianne Ihekweazu’s contribution adds a vital dimension. She provides glimpses into the domestic and emotional context within which institutional reform unfolded, and she herself joined the COVID-19 response, applying her expertise in health communication. The book quietly affirms a truth often overlooked: that professional success is frequently underpinned by personal stability and partnership.

The memoir is well-written, uncluttered with medical jargon. It is an incredibly readable book, racy and unputdownable — a veritable page-turner. It is highly recommended for anyone interested in public health, leadership, Nigerian history, or global pandemics — it’s a must-read for understanding what “coming of age” truly means for a national agency in crisis.

As reforms are rolled out under the current administration, the present leadership of the NCDC must confront the twin imperatives highlighted by this memoir: retaining critical expertise and securing sustainable funding for an agency charged with protecting the health of over 200 million Nigerians.

In recognition of his work, Dr. Ihekweazu has since risen to global prominence at the WHO, where he now serves as Executive Director of the Health Emergencies Programme, following earlier roles leading the WHO Hub for Epidemic and Pandemic Intelligence in Berlin and serving as Acting Regional Director for Africa. His trajectory underscores both the calibre of leadership Nigeria can produce — and the cost of failing to retain it at home.