Nigerian lesson

Print edition : November 28, 2014

A teacher demonstrates to pupils washing procedures to prevent the spread of the Ebola virus at a school in Lagos on October 8, 2014. Photo: PIUS UTOMI EKPEI/AFP

FOR 42 consecutive days, which ended on October 19, the situation reports on the Ebola outbreak from the Nigerian government displayed only a string of zeros. That is when the World Health Organisation (WHO) officially declared Nigeria to be Ebola-free in accordance with its recommendation.

The 42 days represent twice the maximum incubation period for the Ebola virus disease, or EVD (21 days). This 42-day period starts from the last day that any person in the country had contact with a confirmed or probable case. This last day is defined as the day when the last patient in the treatment centre tested negative for EVD, using a real-time reverse transcriptase polymerase chain reaction (RT-PCR).

Nigeria is Africa’s most populous country, and the population of the city of Lagos alone (21 million) is almost as large as the combined populations of Guinea, Liberia and Sierra Leone, the countries hit worst by Ebola.

A large section of the population of Lagos, the largest city in Africa, is urban poor, living in crowded and unsanitary conditions in slums. And thousands move in and out of the city every day in search of work or markets for their products. So for a disease like Ebola that spreads through contact with the infected, the setting was a powder keg.

When the first Nigerian case was confirmed on July 23 in Lagos, the United States Consul General in Nigeria, Jeffrey Hawkins, is reported to have said: “The single juxtaposition of ‘Ebola’ and ‘Lagos’ conjured up images of an apocalyptic urban outbreak.” But that did not happen.

The containment of Ebola by Nigeria is a “spectacular success story that shows to the world Ebola can be contained”, in the words of the WHO’s Nigerian representative, Rui Gama Vaz, while addressing the press after Nigeria was declared Ebola-free.

It was only early this year that the WHO confirmed that Nigeria had eradicated the guinea worm disease, which is another remarkable success story. With 650,000 cases of the disease reported every year, Nigeria was the focal point for the disease before the eradication initiative was launched.

So when Ebola struck, the state knew that it had the capacity to contain it if the effort was made in mission mode. Lessons from its polio-eradication drive also proved helpful. With the assistance of the WHO, the U.S. Centres for Disease Control and Prevention (CDC) and others, government health officials and the state’s public health institutions undertook a coordinated approach to trace all the contacts of the infected. In Lagos, they achieved 100 per cent and at the second outbreak site of Port Harcourt, Nigeria’s oil hub, 99.8 per cent.

Federal and State governments provided ample financial support and trained medical and paramedical staff from public institutions. Contact-tracing involved 18,000 visits to check the temperatures of the 898 primary and tertiary contacts, who were all linked to the one initially infected patient. One nurse had ended up infecting at least 21 people as she travelled over 500 km after having treated a patient in Lagos.

The government also quickly built isolation wards and designated Ebola-treatment centres. A large number of vehicles and modern communication technologies were pressed into service to enable real-time reporting of the investigations. And all identified contacts were physically monitored on a daily basis for 21 days.

Calestous Juma, Professor of the Practice of International Development and Director, Science, Technology, and Globalisation Project at Harvard Kennedy School, Harvard University, wrote in The Guardian: “Ebola is rolling back years of economic effort in Liberia, Sierra Leone, and Guinea. It is also exposing the limitations of development models that ignore the importance of building state capacity. A major lesson from the outbreak is that there is no substitute for effective public institutions in protecting the public interest.”

There is clearly a lesson in this Nigerian story for India’s public health system as well.

R. Ramachandran

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