Containing Ebola in Nigeria: Lessons Learned and Recommendations

Nigeria’s Response to the Ebola Outbreak

When Nigeria’s first Ebola case, Sawyer, was confirmed in Lagos on July 23, it shocked public health communities around the world. In a city like Lagos, where the population swells and ebbs daily, contact tracing seemed impossible.

But Nigeria’s rapid response prevented an explosion of cases, and world-class epidemiological detective work linked every case to direct or indirect contact with the index patient.

What Happened?

The Ebola outbreak has impacted many lives, communities and systems in West Africa. Nigeria was able to contain the disease swiftly and was declared free of Ebola by the World Heath Organization in October 2014.

The rapid response by public health officials and the government was aided by an extensive social mobilization strategy that included teams conducting face-to-face visits within specific radii around suspected cases, using RT-PCR testing on two blood samples taken at least 48 hours apart to confirm symptom development (Ebola Virus Disease; EVD) and identifying contacts. These contacts were then followed with a 21-day follow up unless they became laboratory confirmed cases of EVD or died.

The impact of the Ebola crisis on the economy was significant and broad based across sectors. Many companies reported loss of revenue, increased operating costs and missed business opportunities as a result of meetings being rescheduled and employees avoiding travel to Nigeria out of fear. Health care providers suffered a particularly heavy financial burden due to reduced patient volume.

What We Learned

One of the reasons Nigeria was able to contain the outbreak so quickly is that it took advantage of existing infrastructure. Health officials had a database of health care workers that could be called upon to identify new cases and track contacts, and this was used.

When the index patient died, experts were able to generate a list of 898 potential contacts. This shows how important it is for authorities to be vigilant, especially because of the long incubation period.

However, Nigeria also suffered from fear-based aversion behaviour from both HCWs and health care seekers. Consequently, hospitals experienced reduced utilization and revenue. This was a major challenge for the health sector. While previous studies have looked at the direct impact of Ebola on health sector, this paper is unique in capturing the downstream economic effects that could not be measured with traditional quantitative methods. The paper also highlights the importance of addressing these indirect impacts.

Recommendations

The Ebola outbreak in Nigeria was largely contained by rapid implementation of public health measures. These included isolation, contact tracing and monitoring of contacts, quarantine and ring vaccination.

Health officials and other stakeholders should continue to strengthen the systems they have in place to respond to public health emergencies, including through capacity building and training. This should include a focus on epidemiology and One Health, a key element of which is using digital data rather than paper records that can be easily lost or destroyed.

The rapid deployment of the Nigeria Centre for Disease Control (NCDC) was a key factor in curbing the spread of the outbreak. In addition, seeding the Ebola EOC with staff from the National Polio EOC was a crucial step to demonstrating both national and state commitment to the response. This is a model other African countries should consider adapting to their local contexts. This would help to speed up the implementation of a robust response to future public health threats, including EVD.

Conclusions

The Ebola outbreak in Nigeria provided a rare opportunity to test a wide range of public health and private sector responses to an epidemic. The Nigerian government acted swiftly and coordinated the response using existing structures adapted from its polio eradication experience. It also established a clear political priority and established a political leader accountable for the response, alongside technical managers who were accountable to national task forces and the President.

Despite the success of these efforts, many challenges remain. A number of these could be addressed through enhanced preparedness planning for future public health emergencies.

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