A leading Ghanaian epidemiologist has warned that the country cannot rely on border checks alone to keep deadly diseases out and called instead for a network of fast, decentralised, and technology-driven health systems capable of detecting outbreaks before they spread.
Professor Ernest Kenu, the Head of the Department of Epidemiology and Disease Control at the University of Ghana's School of Public Health, said disease smuggling would not stop at passport control but would end only when systems functioned effectively at every level.
He added that the situation would end when every hand was washed, every leaking pipe was sealed, every treatment centre was infection prevention and control (IPC) compliant, every region had a ready laboratory, and every citizen became a sentinel.
He consequently called for more robust smart systems to tackle the next outbreak.
Prof. Kenu, who made the call last Thursday while delivering his inaugural lecture, recommended decentralising laboratory capacity across all regions, with diagnostic results linked directly to emergency dashboards.
He also called for training community members — including market women, food vendors, teachers, drivers, and religious leaders — as frontline disease surveillance "sentinels," integrating digital surveillance systems into a single real-time dashboard with automatic signal detection, and for mandatory infection prevention and control audits at treatment centres.
Lecture
The lecture, organised by the school, was the fifth for the academic year.
It was on the topic: "Disease Smuggling: The Unseen Cargo in Global Health Security — Lessons from Cholera and COVID-19 in Ghana".
Prof. Kenu argued that what he termed "disease smuggling", the silent, unintentional transport of pathogens across borders and communities, was fundamentally a system failure rather than a border patrol problem.
"The smuggler is not the problem.
The contaminated pipe-borne water is.
The unregulated street vendor is.
The overwhelmed treatment centre that amplifies infection is.
The system that detects the disease too late always carries the blame," he said.
He said the next threat was already en route in some form, be it as an antimicrobial-resistant cholera strain, a new coronavirus variant, hantavirus, Ebola, or an unknown pathogen from the forest belt.
"Ghana cannot build walls high enough to keep them out, but it can build a system that is smart enough to stop them early," he added.
Tracing the history of diseases in the country, Prof. Kenu said Ghana recorded no cholera cases before 1970, when a Togolese traveller collapsed and died at Accra International Airport in the country's first documented case.
He said the airport, however, was merely "the spark, not the source".
The true vector, he said, was a Ghanaian fisherman who had died of cholera in Togo.
His body was brought home for burial, and traditional funeral rites — washing, dressing, and communal mourning — allowed the bacteria to spread silently through coastal communities.
"Cholera arrived in Ghana in a coffin, not in a car, not in an aeroplane," he said, describing it as "a disease disguised as dignity".
He said the late Prof. Gilford Ashitey of the University of Ghana Medical School had, before this, even contemplated deliberately smuggling cholera into the country from India to force sanitary reforms, inspired by Edwin Chadwick's 19th-century sanitation movement in England.
History rendered the experiment unnecessary, Prof. Kenu said, as the disease arrived on its own terms in 1970.
Since then, Ghana has recorded more than 15 distinct cholera outbreaks, with cumulative cases exceeding 130,000 and over 2,000 deaths.
He cited the 2014 nationwide outbreak, in which nearly 80 per cent of index cases across the then 10 regions were linked to prior travel to Accra, and the 2016 Cape Coast outbreak, where visiting a cholera treatment centre was associated with a twelvefold increase in infection risk — what he called a return of the "ghost" of 19th-century hygiene pioneer, Ignaz Semmelweis.
COVID-19
Turning to COVID-19, Prof. Kenu, who played a key role in the management of the pandemic, said the virus entered Ghana in March 2020 through travellers from Turkey and Norway, prompting swift government action, including lockdowns and a novel contact-tracing strategy that tested all individuals within a two-kilometre radius of a confirmed case.
He explained that the radius was deliberately chosen because everyday community life — markets, churches, schools, and barbering shops — typically occurred within that range, allowing health workers to isolate and treat cases early.
He disclosed an unexpected outcome of the pandemic response: between 2021 and 2023, his team ran a Phase II clinical trial for a new cholera treatment, importing investigational drugs from Hungary after securing regulatory approvals.
The trial ultimately closed without enrolling a single cholera patient.
"COVID-19 prevention measures, especially hand washing and improved hygiene, had interrupted the cholera transmission," he said, describing it as "the bitter irony of disease smuggling, where one cargo had eliminated another smuggled cargo."
Research
In her remarks, the Vice-Chancellor of the University of Ghana, Prof. Nana Aba Appiah Amfo, said the lecture underscored the university's commitment to impactful research with policy relevance, stating that it came at a time when the institution had been ranked first in Ghana and first in West Africa in the QS World University Rankings 2027.
She described inaugural lectures as more than ceremonies marking the attainment of full professorial rank, calling them platforms for "reflection, engagement and knowledge sharing" that aligned with the university's strategic priority of impactful research.
Prof. Amfo said the lecture's subject matter showed how diseases "move silently through our systems, our behaviours and our environments", and commended Prof. Kenu's scholarship for addressing challenges with both local and global relevance.
