The fight against Lassa fever: Will it prepare Nigeria for future epidemics?
It not unusual to talk about challenges and at the same time seek out available opportunities. Speaking about opportunities presented by Lassa fever can be likened to the biblical saying, “Can anything good come out of Nazareth?” Lassa fever is a disease that is endemic in Nigeria and has been a source of persistent outbreaks over the years. The largest and most recent Lassa fever outbreak was in 2018, and it witnessed about 90 reported deaths, including health workers.
But that is not the whole story about Lassa fever in Nigeria. It is impossible to say that nothing has been learnt from fighting the disease, since its discovery five decades ago. In 1969 when the viral haemorrhagic fever (VHF) was first discovered in the town of Lassa, Borno State, the arguments of the Minister of Health at the time, Alhaji Aminu Kano during the World Health Assembly was to protest the naming of the virus after the town of Lassa. The name of the virus was not reversed, but the case was made for the potentially counterproductive effect of naming places after new infectious agents. Today, the World Health Organization has developed best practices for naming new human infectious diseases.
What other lessons have been learnt in the 50 year consistent battle against Lassa fever? Can these lessons inform the fight against other infectious diseases in order to improve overall global health security? Are there solutions that can be replicated? What partnerships do we need to advance against the disease?
The Lassa fever International Conference, curated by the Nigeria Centre for Disease Control (NCDC) between the 16th and 17th January 2019 provided an opportunity to explore answers to these important questions. Participants from different parts of the world gathered in Abuja to have robust discussions, network and find answers to one of the global health threats that has so far been quite neglected.
President Muhammadu Buhari recently signed the NCDC bill into law in November 2018 and according to the Director General of the NCDC, Dr Chikwe Ihekweazu, this was an important milestone in the agency’s efforts to protect the health of Nigerians. The act which now establishes the NCDC not only gives the agency a legal mandate to operate with a dedicated budget line, but it also positions it as a science-driven organisation, a vision that Dr Ihekweazu said he and his team would strive to bring to reality.
A Historical Reflection on Lassa fever
Understanding the important role of building institutional knowledge, the organisers assembled plenary speakers and panellists who provided a rich historical perspective on the Lassa fever virus.
Professor Njidda Gadzama shared his rich understanding and personal connection with the Lassa fever index case, an American missionary who worked in the town of Lassa, Borno state. He challenged the notion that Lassa fever originated from Lassa town and called for further research in this area.
Professor of Virology, Oyewale Tomori, added to the history of Lassa fever by providing timelines of Lassa fever outbreaks between 1969, when it was first discovered and named. He encouraged more research into understanding the historical perspectives of Lassa fever, especially those Nigerians who were part of the disease’s early history. He said it was important for researchers to look beyond research focused on knowledge, attitude and practice (KAP) of the public towards infectious diseases. Insights and lessons from the 2018 Lassa outbreak were shared by Mrs Elsie Ilori, who led the Lassa fever response and helped set up the Lassa fever Emergency Operation Centre (EOC) set up in 2018. The case fatality rate during the outbreak was 27%, and Ilori said the strategic vision of the agency is to cut this down to 5% within the next 10 years.
Are we using all we have?
The need for country ownership of disease surveillance, detection and response came out strongly during the conference. Professor Oyewale Tomori, Chair of the National Laboratory Technical Working Group mentioned that “We have all it takes to control diseases with minimal assistance, but we have refused to take all we have.” He noted that the preference for foreign over local investments to solve Nigeria’s homegrown problems should be discouraged, as Nigeria should eventually be able to tackle its problems without international development partners’ support. Dr Daniel Bausch, Director, United Kingdom Public Health Rapid Support Team (UK PHRST) expressed excitement at what he saw as the new developments at the NCDC, stating that “they (NCDC) are providing African leadership for an African problem and building capacities not just for Lassa fever but many other diseases.”
Lassa: Nigeria’s New Research Frontier?
The push to fight back Lassa fever over the years has opened new frontiers in research. A rapid gene sequencing of Lassa fever developed by Redeemer’s University and Irrua Specialist Teaching Hospital in 2018 helped to confirm that the strain of the Lassa fever virus present in the country had remained unchanged.
The exciting work and possibilities in the area of metagenomics, championed by the African Center of Excellence for Genomics of Infectious Diseases (ACEGID) at Redeemer’s University, was shared at the conference by Professor Christian Happi. He mentioned that the technology had helped scientists better understand the evolution of the virus, known as the virulence. Deeper genomic knowledge of the virus is also helping with the development of more sensitive rapid diagnostics tests.
Vaccines are one of the best and most cost-effective public health investments that can save lives, as well as offering the public protection against infectious diseases. The new partnership between the NCDC and the Coalition for Epidemic Preparedness Innovations (CEPI), a public-private coalition that aims to derail epidemics by speeding up the development of vaccines, gave rise during the conference to exciting discussions around the development of a vaccine for Lassa fever. CEO of CEPI, Dr Richard Hatchett, said: “Lassa fever is a recurrent public health challenge and there is need to develop a vaccine that can be used as a preventative measure against Lassa fever”.
The hope now, is that the successful outcome of clinical trials will lead to the development of a Lassa fever vaccine. A positive development that could end the spread of Lassa fever within the next 50 years.
Key outcomes from the conference will inform response going forward because the virus and its mode of transmission, especially rodent to human, has not changed. Consequently, risk communications should be designed, taking into consideration the cultural and social nuances that influence public behaviour. Health workers need to have a high index of suspicion, maintain good infection, prevention and control practices to prevent outbreaks in hospitals. With the geographic spread of the Lassa fever virus caused by human and climate reasons, insights on disease burden will help preparedness and response efforts.
There are exciting times ahead in the fight against Lassa and other Viral Haemorrhagic Fevers. We must remain intentional about looking beyond the problems and finding opportunities in the fight, as Nigeria continues to rise to the challenge of beating infectious diseases in Nigeria.