It takes threat of Ebola to see lessons from low income countries

In his recent perspective in the New England Journal of Medicine, the head of the United States (US) Centers for Disease Control and Prevention (CDC), Thomas Frieden, and colleagues, were concerned that the arrival of the Ebola virus (EVD) in Lagos, Nigeria heralded a concerning escalation of the epidemic in West Africa [1]. By 24th September 2014, a total of 20 EVD cases (19 laboratory confirmed, one probable) had been reported in Nigeria. All 20 cases stemmed from a single index patient, a traveller returning from Liberia on 20th July 2014. Unless Nigeria responded quickly and effectively, the virus would spread rapidly in Africa’s largest city and into the country beyond [2]. The subsequent successful containment of the virus in Nigeria led to a flurry of declarations in the media that much could be learned from Nigeria’s approach [3-6]. What was done right? Almost immediately after the first case was diagnosed, the Nigerian government declared a Public Health Emergency and centralised the command structure through an Ebola Response Incident Management Center [7]. Furthermore, they developed a robust and coherent Social Mobilization strategy that included multiple response teams spanning across several cities [7]. These teams conducted over 26, 000 rapid house-to-house, in-person visits to assess Ebola symptom development and ensure that community members understood risks and preventive steps [7-9]. Suspected patients were triaged and the areas they inhabited decontaminated [7]. Finally, to control and counter the outbreak of anxiety and hysteria triggered by early, inaccurate information [3,7], strong public awareness campaigns were deployed, making use of accurate and timely messages that were relayed not only by the national media [4], but also social media [8], Short Message Service (SMS) platforms [8], and traditional, religious and community leaders [4,6,9]. To sum it up,