Community "social mobilizers" played a critical role in halting Nigeria's Ebola outbreak (Photo: CDC Global)
By Denis McClean
GENEVA, 11 October 2016 - Nigeria has been Ebola-free since it narrowly avoided being sucked into the escalation of the highly contagious haemorrhagic fever outbreak which devastated its neighbours, Guinea, Liberia and Sierra Leone resulting in the loss of over 11,000 lives.
WHO has commended the Nigerian Government for its strong leadership and effective coordination of the response that included the rapid establishment of an Emergency Operations Centre headed by Dr. Faisal Shuaib, an advisor to the Minister for Health, who was at the centre of the country’s efforts to eradicate polio.
Dr. Shuaib said: “The Government’s quick action and deployment of the necessary resources was key to averting a disaster. The circumstances were hugely challenging but we hit the ground running and there was good collaboration across all sectors involved. We were also fortunate in that Nigeria has a first rate virology laboratory affiliated with the Lagos University Teaching Hospital.”
The West Africa Ebola outbreak was the worst since the virus was first identified in 1976, and influenced the drafting of the Sendai Framework for Disaster Risk Reduction which emphasizes the need to enhance the resilience of national health systems and to integrate disaster risk management into health care.
Poverty, lack of preparedness and risk information, combined with inadequate health resources, made West Africa especially vulnerable, driving up exposure and fueling the spread of the virus from March 2014 to January 2016 when WHO declared Liberia to be Ebola-free.
There was major alarm when the first case was reported in the sprawling Nigerian capital Lagos in July 2014, home to over 20 million people. A diplomat who had been caring for a relative who died of Ebola in Liberia, and was already ill with the fever, managed to board a commercial fight to Lagos with the intention of visiting a faith healer.
He was admitted to a private hospital where he had to be physically restrained by a brave female doctor as he tried to flee the isolation unit. Both he and the doctor died. Matters were further complicated when another case was identified in the bustling oil centre of Port Harcourt.
Dr. Margaret Lamunu, a veteran of WHO’s work on disease control in humanitarian crises, saw her family once during the 15 months she worked on the Ebola crisis. She was re-deployed from Sierra Leone to support the response in Nigeria when the news broke of the first case.
Commenting on the experience, Dr. Lamunu said: “There was a huge difference in response capacity in Nigeria and what was possible in Guinea, Sierra Leone and Liberia where you can almost count the numbers of doctors on one hand.
“In Nigeria we had people with Masters degrees doing the tracing work and there was no shortage of qualified medical personnel and lab facilities. All the resources necessary were mobilised quickly. The national Government, the public, partners, and the global community were concerned about it getting out of control.
“There was great detective work in tracking down hundreds of contacts and the Nigerian Federal Ministry of Health, CDC (US Centre for Disease Control and Prevention), Médecins Sans Frontières, the Nigerian Red Cross and many other partners deserve much credit for how they managed to contain the risk of a major health disaster.”
A total of 894 contacts were linked directly to the original case. A further 526 contacts were linked to a health care worker who died in Port Harcourt. Altogether 18,500 face-to-face visits were carried out to check for fever and other symptoms. The high rate of literacy in the general population made it easier to carry out information campaigns by comparison with Guinea, Sierra Leone and Liberia.
By the time Nigeria was declared Ebola-free in October 2014, there were 19 infected individuals in addition to the index case from Liberia, 7 of whom died. These included eleven health care workers, 5 of whom paid the ultimate price for their courageous and successful efforts at containing the epidemic.
Dr. Chadia Wannous, UNISDR health focal point, noted: “The experience of Nigeria when contrasted with that of other affected countries underlines how important it is to enhance the capacity of low-income developing countries to manage not just emergencies and disasters but the underlying risks. This requires resilient health systems with trained personnel, risk information and risk communication systems, logistics and supply chain structures, financing mechanisms and solid health governance as we have seen in Nigeria.”
She also highlighted the significant role played by the community, with teams of "social mobilizers" reaching thousands of households with health information and facilitating understanding so that fear and mistrust do not hinder mounting an effective response.
UNISDR is currently collaborating with WHO, UNDP and other partners to implement a project in Ebola-affected Sierra Leone, Liberia and Guinea to “accelerate the implementation of the Sendai Framework with risk-informed health systems”.
The project, funded by the government of Japan, aims to enhance collaboration between disaster risk management and health authorities and integrate health into disaster risk management structures and at the same time integrate risk management into the health sector. By doing so, it is expected that the project will further contribute to reducing mortality due to health emergencies and other types of disasters.
Reducing global disaster mortality is the theme of this year’s International Day for Disaster Reduction, October 13.