Nigeria is now Free of Ebola Virus Transmission

The lines on the tabular situation reports, sent to WHO each day by its country office in Nigeria, have now been full of zeros for 42 days. WHO officially declares that Nigeria is now free of Ebola virus transmission. This is a spectacular success story that shows that Ebola can be contained. The story of how Nigeria ended what many believed to be potentially the most explosive Ebola outbreak imaginable is worth telling in detail. Such a story can help the many other developing countries that are deeply worried by the prospect of an imported Ebola case and eager to improve their preparedness plans. Many wealthy countries, with outstanding health systems, may have something to learn as well.

The complete story also illustrates how Nigeria has come so close to the successful interruption of wild poliovirus transmission from its vast and densely-populated territory. Earlier this year, WHO confirmed that Nigeria had eradicated guinea-worm disease – another spectacular success story. When the eradication initiative was launched, Nigeria was the epicentre of this disease, with more than 6,50,000 cases reported each year.

When laboratory confirmation of the country’s first Ebola case, in Lagos, was announced on 23 July, the news rocked public health communities all around the world. Nigeria is Africa’s most populous country and its newest economic powerhouse. For a disease outbreak, it is also a powder keg. The number of people living in Lagos – around 21 million – is almost as large as the populations of Guinea, Liberia and Sierra Leone combined. Lagos, Africa’s largest city, is also characterized by a large population living in crowded and unsanitary conditions in many slums.

Thousands of people move in and out of Lagos every day, constantly looking for work or markets for their products in a busy metropolis with frequent gridlocks of vehicular traffic. With assistance from WHO, the US Centers for Disease Control and Prevention (CDC), and others, government health officials reached 100% of known contacts in Lagos and 99.8% at the second outbreak site, in Port Harcourt, Nigeria’s oil hub.

Federal and State governments in Nigeria provided ample financial and material resources, as well as well-trained and experienced national staff.  Isolation wards were immediately constructed, as were designated Ebola treatment facilities, though more slowly. Vehicles and mobile phones, with specially adapted programmes, were made available to aid real-time reporting as the investigations moved forward.

The Nigerian response to the outbreak was greatly aided by the rapid utilization of a national public institution (NCDC) and the prompt establishment of an Emergency Operations Centre, supported by the Disease Prevention and Control Cluster within the WHO country office. Another key asset was the country’s first-rate virology laboratory affiliated with the Lagos University Teaching Hospital. That laboratory was staffed and equipped to quickly and reliably diagnose a case of Ebola virus disease, which ensured that containment measures could begin with the shortest possible delay. In addition, high-quality contact tracing by experienced epidemiologists expedited the early detection of cases and their rapid movement to an isolation ward, thereby greatly diminishing opportunities for further transmission.

WHO country team of epidemiologists, clinicians, logisticians and administrators have identified a number of specific lessons that may be useful for other countries facing their first imported Ebola case or preparing for one. They have also carefully documented a large number of “best practices” for containing an Ebola outbreak quickly.

The most critical factor is leadership and engagement from the head of state and the Minister of Health. Generous allocation of government funds and their quick disbursement helped as well. Partnership with the private sector was yet another asset that brought in substantial resources to help scale up control measures that would eventually stop the Ebola virus dead in its tracks. Health and government officials fully appreciated the importance of communication with the general public. They rallied communities to support containment measures. House-to-house information campaigns and messages on local radio stations, in local dialects, were used to explain the level of risk, effective personal preventive measures and the actions being taken for control. On his part, the President reassured the country’s vast and diversified population through appearances on nationally televised newscasts. The full range of media opportunities was exploited – from social media to televised facts about the disease delivered by well-known “Nollywood” movie stars.

Nigerian government and health officials, including staff in the WHO country office, are well aware that the country will remain vulnerable to another imported case as long as intense transmission continues in other parts of West Africa. The surveillance system remains on guard, at a level of high alert.