One year after the Lassa Fever conference: Are we rising to the challenge?

About a year ago, nearly 700 people from 15 countries across the world gathered in Abuja, Nigeria, for the first Lassa Fever International Conference in Nigeria. The Nigeria Centre for Disease Control (NCDC) and our partners hosted this two-day event on the 16th and 17th of January 2019, to mark 50 years since the Lassa fever virus was first discovered in Nigeria. Given the significance of the discovery and outbreaks that have occurred mostly in Nigeria and West Africa, our theme for the conference was 50 Years of Lassa fever: Rising to the Challenge.

Since its discovery in 1969, several countries in West Africa have continued to record outbreaks of Lassa fever. In 2018, Nigeria recorded an unprecedented outbreak affecting 21 states. Although there were more cases of Lassa fever recorded in 2019, we also saw a decrease in the number of deaths among confirmed cases and fewer health care workers infected. This may be linked to improved awareness, patients presenting earlier and better case management. One year after the first Lassa fever International Conference, this is a good opportunity to review our progress in Nigeria and ask, “Are we really rising to the challenge?”

The Lassa fever International Conference presented an opportunity for the scientific community to reflect on what is known about the Lassa virus, identify gaps that exist and prioritise a research agenda for the control of Lassa fever. For us at NCDC, the conference was also an avenue to set targets for Nigeria’s prevention, preparedness and response to Lassa fever outbreaks and other public health emergencies.

Since the conference, we have been working very hard to strengthen our capacity for Lassa fever control. Significantly, our surveillance, data collection, analysis and management for Lassa fever has improved. We have developed a harmonised database, which did not exist previously, using our Surveillance Outbreak Response Management Analysis System (SORMAS) tool. We are committed to working in partnership with other agencies and organisations to ensure that the response to Lassa fever is informed by the best available research evidence and data.

Another area which we have focused on strengthening in the last one year is Lassa fever research. Following the conference, we announced the development of the National Lassa Fever Research Plan. Since then, we have begun the implementation of aspects of the plan. On the sideline of the conference, the National Lassa fever Research Consortium was inaugurated. This consortium which includes the three main treatment centres – Irrua Specialist Teaching Hospital, Federal Medical Centre, Owo and Alex Ekwueme Federal Teaching Hospital, Abakaliki – and partners, is coordinated by NCDC. This has allowed us to provide a unified and well organised structure for Lassa fever research in Nigeria. One year after the Lassa fever conference, we are about to begin one of the largest epidemiological studies for the disease ever carried out. This is sponsored by the Coalition for Epidemic Preparedness Innovations (CEPI).

While we are yet to begin clinical trials for Lassa fever vaccines in Nigeria, we are much closer than we were a year ago. We are also better involved in discussions with vaccine developers on how to accelerate development of their vaccine candidates. Many of the vaccine developers attended the conference in 2019. This is one area of progress that we are very proud of.

Over the last one year, we have added one laboratory to the national Lassa fever/Viral Haemorrhagic Fevers laboratory network. NCDC, in partnership with the Foundation for Innovative New Diagnostics (FIND) and with support from the World Health Organization (WHO) and Alliance for International Medical Action (ALIMA), supported the Federal Medical Centre, Owo, Ondo State, to establish a laboratory in the hospital. This new laboratory will be critical to reducing the turnaround time and improving response activities for the state. In addition, we utilised peer to peer support for this activity, by embedding staff from the Irrua Specialist Teaching Hospital, Edo State, to train and mentor laboratory staff of FMC Owo.

One of our key priorities has been to support the development of sub-national capacity to prevent, prepare for, detect and respond to infectious disease outbreaks. In 2019, following NCDC’s support in establishing State Public Health Emergency Operations Centres (EOCs), we saw an improved level of coordination of response activities across states.

We have also strengthened our One Health approach to Lassa fever preparedness and response, as colleagues from the Federal Ministry of Agriculture and Rural Development and Federal Ministry of Environment are now part of national Rapid Response Teams (RRTs) when we deploy to support states. This presents a better opportunity to understand underlying causes of the disease from zoonotic and environmental perspectives which are critical to Lassa fever control.

Perhaps one of our biggest achievements since the Lassa Fever International Conference is our improved support to and engagement with other countries in West Africa. Like Nigeria, Lassa fever is endemic in Liberia. In 2019, we deployed three personnel to support Liberia’s Lassa fever outbreak response. This was sponsored by the West African Health Organisation (WAHO). Since then, we continue to support other countries by sharing lessons learned, guidelines developed and other resources to support Lassa fever control.

In addition to all these, we continue to intensify our risk communications and community engagement activities. Following the conference, we worked with several partners to develop Lassa fever resources – a platform to improve the sharing of social science insights for Lassa fever control.

Since the conference in 2019, we have continued to receive remarkable support from the leadership of the Federal Ministry of Health. We also continue to strengthen our partnerships and remain grateful for the support of national and international partners, who work closely with us in the fight against Lassa fever.

Behind the scenes of these success stories is a formidable team of health workers that work tirelessly across the country in response to the call of duty. We recognise that we are not where we want to be yet but remain committed to rising to the challenge of Lassa fever.

• Dr Ihekweazu is an infectious disease epidemiologist and Director-General, Nigeria Centre for Disease Control (NCDC).