Disease Smuggling Poses Real Threat to Ghana’s Public Health, UG’s Prof. Kenu Warns, Calls for Stronger Surveillance and Capacity Building

A Professor of Medical Epidemiology at the University of Ghana School of Public Health, Prof. Ernest Kenu, has warned that Ghana’s public health security could be undermined if the country fails to strengthen surveillance systems, laboratory capacity, sanitation and outbreak preparedness.

Delivering his inaugural lecture on the topic, “Disease Smuggling”: The Unseen Cargo in Global Health Security - Lessons from Cholera and COVID-19 in Ghana, Prof. Kenu explained that infectious diseases often move silently through people, communities and weakened systems before they are detected.

He described “disease smuggling” as the silent and unintentional transport of disease-causing germs across geographical, ecological and behavioural boundaries. According to him, these pathogens do not always present themselves at checkpoints or ports of entry. Instead, they may move through contaminated water, crowded buses, funeral practices, overwhelmed treatment centres and surveillance systems that detect outbreaks too late.

“Disease smuggling is not a border patrol problem but a system failure,” Prof. Kenu stated. He explained that the real danger lies in unsafe water, poor sanitation, weak infection prevention practices, delayed laboratory results and public health systems that are unable to detect and respond to threats quickly.

Using Ghana’s cholera history as a key example, Prof. Kenu recalled that the country’s first documented cholera case in 1970 was linked to a Togolese traveller who collapsed at the Accra International Airport. He noted, however, that the wider outbreak was traced to a more complex chain of transmission involving a corpse brought from Togo for funeral rites along the coast.

He explained that the incident showed how disease can move through cultural practices, mobility and systems that are not adequately prepared to detect and interrupt transmission.

Prof. Kenu also referred to Ghana’s 2014 cholera outbreak, noting that Greater Accra alone recorded 20,199 cholera cases, with nearly 80 percent of index cases across the country linked to prior travel to the capital. He added that during the 2016 Cape Coast outbreak, visiting a cholera treatment centre was associated with a twelvefold increase in the chance of infection, a finding he said demonstrated how treatment centres can amplify outbreaks when infection prevention and control practices are weak.

Turning to COVID-19, Prof. Kenu said the pandemic revealed similar lessons about silent disease movement. He explained that COVID-19 entered Ghana “not through physical cargo but in the lungs of travellers” and that among the first 17,763 confirmed infected persons, nearly 80 percent showed no symptoms.

He said this finding demonstrated the danger of silent transmission and the importance of early detection, timely testing, community cooperation and effective surveillance.

Prof. Kenu further observed that although Ghana introduced several response measures during the pandemic, including enhanced surveillance and testing around confirmed cases, public behaviour did not always match public health policy. He noted that his team’s observations in public spaces showed hand hygiene adherence at 12.3 percent, while nearly 60 percent of individuals wore face masks incorrectly.

He stressed that handwashing with soap and running water remains one of the most effective and cost-efficient ways of breaking the chain of transmission. He added that handwashing programmes can reduce diarrhoeal-related illnesses and deliver strong returns on investment when uptake and adherence are high.

Prof. Kenu cautioned that the next disease threat may come in the form of an antimicrobial-resistant cholera strain, a new coronavirus variant, Ebola or an unknown pathogen from the forest belt. He said Ghana cannot build walls high enough to keep such threats out but can build systems strong enough to detect and stop them early.

He called for increased investment in the Ghana Field Epidemiology and Laboratory Training Programme, decentralised laboratory capacity, community-based surveillance and the integration of digital surveillance platforms into a real-time early warning system. “The next smuggled disease is coming. Will Ghana stand ready?” he asked.

The Vice-Chancellor, Prof. Nana Aba Appiah Amfo, who chaired the lecture, commended Prof. Kenu for his contribution to public health research, teaching, mentorship and service.

She noted that the lecture was timely, as it drew attention to the hidden pathways through which diseases move and the importance of research in strengthening national and global health security.

Prof. Amfo stated that the lecture invited the University community and the wider public to reflect deeply on how diseases move through systems, behaviours and environments. She observed that disease transmission is a border issue and a system failure linked to unsafe water, poor sanitation, weak surveillance, delayed diagnosis and overwhelmed treatment centres.

She further noted that the relevance of Prof. Kenu’s scholarship extends beyond Ghana, particularly at a time when many African countries continue to confront infectious disease outbreaks.

The Vice-Chancellor added that the University of Ghana remains committed to scholarship that addresses societal challenges and informs public policy. She said Prof. Kenu’s work demonstrates how rigorous research can shape practice, influence decision-making and contribute to healthier, safer and more resilient societies.

Prof. Amfo also highlighted the University’s recent recognition in the QS World University Rankings 2027, where UG was ranked first in Ghana and West Africa. She said the achievement reflects the work of researchers and scholars such as Prof. Kenu, whose research addresses urgent local and continental challenges while contributing to global knowledge.

Earlier, the Registrar, Mrs. Emelia Agyei-Mensah, underscored the importance of inaugural lectures as a vital part of the University’s academic calendar. She explained that the lectures provide an opportunity for the University to honour academics who attain the rank of full professor and give them a platform to share their research journey, scholarly insights and contributions with the wider public.

She congratulated Prof. Kenu on attaining this important academic milestone and commended him for his distinguished service to the University, the health sector and the country.

Prof. Kenu is the Head of the Department of Epidemiology and Disease Control at the University of Ghana School of Public Health and Programme Director of the Ghana Field Epidemiology and Laboratory Training Programme. His research spans HIV/AIDS, tuberculosis, cholera, meningitis, yellow fever, Lassa fever, rabies, polio, avian influenza, COVID-19 and global health security.

He has authored and co-authored more than 240 peer-reviewed publications and mobilised over US$22 million in research and health systems funding to support workforce development, laboratory strengthening, disease surveillance, emergency preparedness and public health training across Ghana and the sub-region.