Nigeria’s Ebola crackdown is an example to the world

An information board on Ebola in the Obalende district of Lagos, Nigeria.
Photograph: Pius Utomi Ekpei/AFP/Getty Images

Persistence, rigorous enforcement of quarantine and disinfection of premises contribute to a success story for Nigeria










The public health crackdown on Ebola in Nigeria, which has been declared free of the virus, serves as a model for the rest of the world.

The outbreak began in Nigeria when a Liberian man, Patrick Sawyer, who had been to the funeral of his sister who died from Ebola, flew to Lagos on 20 July, against medical advice. At the departure airport, he was visibly very ill, according to the World Health Organisation (WHO), lying on the floor of the departure lounge. “He vomited during the flight, on arrival and, yet again, in the private car that drove him to a private hospital. The protocol officer who escorted him later died of Ebola,” said WHO, but he was treated for malaria because he insisted he had not had contact with any Ebola patients.

It took three days, during which time nine medical staff nursing him became infected, of whom four died, before Ebola was diagnosed and he was placed in isolation. Sawyer died two days later.

But as soon as the virus was confirmed, a massive public health effort began. Containment has been key to ending every Ebola outbreak in Africa in the past. Every person who may have been exposed to the virus has to be found, monitored and isolated if they develop symptoms. Even though that involved hunting through crowded buildings in streets without door numbers, Nigerian teams managed to trace everybody who had been in contact with Sawyer and everybody who had contact with those who later developed the disease.

In total, 19 people became ill in Nigeria, seven of whom died. It could have been so much worse in Nigeria’s densely populated cities: there are 21 million people in Lagos. The US consul general in Nigeria, Jeffrey Hawkins, said at the time: “The last thing anyone in the world wants to hear is the two words ‘Ebola’ and ‘Lagos’ in the same sentence.” That juxtaposition, he added, conjured up images of an “apocalyptic urban outbreak”.

But Nigeria set up a centralised emergency operations centre, staffed with many public health experts who work on the polio eradication effort. It also had a first-class virology laboratory affiliated to the Lagos University teaching hospital which turned around testing and diagnoses in 24 hours. Generous government funds were allocated and quickly disbursed, says WHO. TV broadcasts by movie stars and social media were used to reassure and inform people. More than 150 people were sent out to look for contacts of people who had become ill and GPS systems in place to counter polio were used for tracking Ebola contacts. It was, said WHO, “world-class epidemiological detective work”.

According to a paper written by some of those involved, in the journal Eurosurveillance, the list of contacts reached 898 and they were not all in Lagos. A nurse who became infected travelled more than 310 miles (500km) to Enugu, finding at least 21 contacts. But the biggest crisis was caused by one of Sawyer’s contacts, who had been infected, fleeing to the oil capital, Port Harcourt, where he infected a doctor. That doctor, who died, was linked to 526 contacts, including many members of his church who carried out a healing ceremony for him involving the laying on of hands.

In total, the contact tracers made 18,500 face-to-face visits to check on people for raised temperature, which can indicate the onset of symptoms, – not easy given the stigma around the disease. Their persistence – anybody who fled the monitoring teams was tracked down and returned to medical supervision – and disinfection of premises paid off.

The authors of the paper say: “No country is immune to the risk of Ebola virus disease in a globally connected world, but … rapid case identification and forceful interventions can stop transmission.”