How polio prepared Nigeria for Ebola outbreak

As the US confirmed the first case of Ebola outside Africa, world leaders and public health specialists are desperately scrambling to control the west African outbreak. One of the few bright spots is the success of Nigeria in controlling the disease, which could have spiralled out of control in Africa’s most populous country.

Ebola surfaced in Nigeria in July, but with the final patients under observation given the all-clear, the country is now officially Ebola-free. Nigeria was able to respond relatively quickly, and use its experience in tackling polio to do so. As we have seen in the US, all countries need to be better prepared, with plans in place in case Ebola is imported.

Nigeria’s outbreak started when Patrick Sawyer, a Liberian-American, flew into Lagos on 20 July. He was already seriously ill and later died. In total there were 19 confirmed cases and one probable case that stemmed from Sawyer’s. Eight of these cases resulted in death and the last case was officially detected on 31 August. Since then, no further cases have been detected.

Nigeria had a head start over other west African countries. As one of the last countries to still be polio-endemic, Nigeria has been waging a war against the disease. A strong polio surveillance system backed by an emergency command centre, which was built in 2012 by the Bill & Melinda Gates Foundation, has ensured agency coordination so that polio outbreaks can be identified quickly and stopped. A cadre of 100 Nigerian doctors trained in epidemiology by international experts, who have helped end polio in countries such as India, makes up the backbone of the rapid disease response team.

With only six cases of polio this year, Nigeria is tantalisingly close to ending polio and moving the world one step closer to global eradication. But as soon as the Ebola outbreak happened, it was imperative that Nigeria utilised the aces it had up its sleeve.

Before Sawyer was identified as having Ebola, he had already infected several people while travelling from the plane to the hospital. Having denied being in contact with Ebola, he was treated initially for malaria in a hospital with no infection control. A nurse treating him later died and it was only when malaria treatment failed that Nigeria’s first case of Ebola was identified.

Once that diagnosis had been made, Nigeria mimicked its own polio response and an Ebola emergency operation centre in Lagos was set up. From the polio response team, 40 of the Nigerian doctors trained in epidemiology were reassigned. This centralised hub coordinated the Nigerian health ministry, the World Health Organisation, Unicef, the US Centers for Disease Control and Prevention, Médecins sans Frontières and the International Committee of the Red Cross.

The response was flawed, it took two weeks for the first isolation ward to open and health workers were initially reluctant to work in it. However, 1,800 health workers were eventually trained, protective gear was provided, and safe wards with enough beds and access to chlorinated water were set up so that patients could be treated safely. In total, health workers made 18,000 visits to 900 people to check the temperatures of possible contacts. As with polio eradication, this wasn’t easy but it was imperative to stopping the disease in its tracks.

Nigeria and the US both made mistakes when Ebola first hit. It is important other countries learn from this and develop emergency plans to respond quickly to stop it spreading. Nigeria’s health system is fragile but the country is lucky to have a comparatively high number of specially trained health workers and a polio surveillance system, which helped prevent an exponential spread. Sierra Leone, Guinea and Liberia were less fortunate, the disease was allowed to get a head start and prosper in the remotest rural villages that had poor health infrastructure. But there is hope in all three countries.

As world leaders begin to break from their collective apathy, the lessons from Nigeria are clear. There needs to be enough trained health workers, equipment and facilities available to isolate those showing Ebola symptoms in well-equipped treatment centres. Accelerated action in west Africa, specifically educating communities about the disease, symptoms, treatment, contact tracing and how to bury the dead, can end this virus. There are no short cuts, and urgent international support is critical to building treatment centres and stopping Ebola.

Nigeria cannot afford to declare Ebola over. The first outbreak is but others may come. As with polio, until there are no cases of Ebola, no one is safe from the virus.

•Tomori, a professor of virology at the Nigerian Academy of Science, wrote this article for The Guardian of London