First Ebola case in 12 years tests Nigeria’s outbreak preparedness

Nigeria’s confirmation of an imported case of Ebola virus disease in Abuja is testing whether the country’s surveillance systems, hospitals and emergency response arrangements can prevent a dangerous infection from spreading beyond the initial patient.

This is even as experts raise concerns about delays in diagnosis, gaps in state-level capacity and weaknesses in critical care infrastructure.

The federal government confirmed the Bundibugyo strain of Ebola in a woman who travelled to Nigeria earlier in October. She developed symptoms several days after arriving, sought treatment at a private hospital on October 11 and tested positive on October 20.

The case has raised questions about the difference between Nigeria’s ability to confirm an infection through laboratory testing and its ability to contain the threat and prevent further exposure.

Muhammad Pate, coordinating minister of health and social welfare said Nigeria had the laboratory capacity to test for the Bundibugyo strain, with laboratory testing achieved within 24 hours.

However, Oyewale Tomori, a virologist said the time between the patient’s arrival in Nigeria, her presentation to a health facility and the eventual Ebola test was too long, warning that the delay could have allowed the infection to spread more widely.

Tomori argued that where a patient has a history of international travel and presents with symptoms that could indicate a serious infectious disease, clinicians should maintain a high level of suspicion and consider appropriate testing rather than treating the illness only as malaria.

He said Ebola testing should have been conducted immediately, given the patient’s travel history and the public health threat posed by the virus, warning that the delay could have allowed the infection to spread more widely.

“We need to improve the timeline it takes to confirm cases. We had this same problem in 2014, and our awareness should be more acute,” he said.

Tomori also questioned whether the country could accommodate additional patients if contact tracing identifies more infections.

“Supposing two or three of the contacts are positive, what do we do? Do we have the hospitals, do we have where to keep them?” he asked.

Nigeria was not unaware of the threat. Months before the Abuja case was confirmed, Nigerian health authorities said they had introduced measures, including heightened airport surveillance, to prevent the virus from entering the country amid reports of ongoing Ebola transmission in the Democratic Republic of Congo.

The Nigeria Centre for Disease Control and Prevention (NCDC) said it had continued to maintain surveillance systems for Ebola and other epidemic-prone diseases across the country.

It added that event-based surveillance and monitoring were intensified, supporting laboratory and diagnostic readiness, reinforcing infection prevention and control awareness in healthcare settings, and strengthening community engagement activities.

The agency also directed states to activate public health coordination structures, assess their readiness, identify functional isolation facilities, establish safe referral pathways and ensure that frontline health workers had appropriate protective equipment and training.

Nigeria has experience containing Ebola, having successfully managed an imported case in 2014. But public health experts warn that past success and preparedness plans cannot guarantee another successful response. The current case provides an opportunity to assess whether the systems established to manage such emergencies remain functional, adequately resourced and capable of responding to a different strain of the virus.

Nigeria’s immediate response has involved contact tracing, surveillance, laboratory confirmation and measures to strengthen border monitoring.

Pate said on October 21 that authorities had identified 44 contacts and obtained the patient’s travel manifest to support contact tracing. The government also said it had strengthened surveillance at points of entry through the NCDC and port health services, working with the aviation industry.

The minister said Nigeria had laboratory capacity to test for the Bundibugyo strain and that experienced public health personnel who participated in the 2014 Ebola response remained available.

The concern is that a response capable of managing one confirmed case may face greater pressure if more infections emerge, particularly where isolation facilities, trained personnel and referral arrangements are limited.

While government at the federal level have highlighted laboratory readiness and the availability of experienced public health personnel, Adaobi Onyechi, publuc health expert raised concerns about differences in diagnostic capacity, isolation infrastructure and treatment readiness across states.

She also expressed concern about shortages of health workers, arguing that gaps in state-level capacity could undermine efforts to contain the infection even where national coordination and laboratory systems are available.

According to data from the NCDC, 549 health facilities across 32 states and the Federal Capital Territory are included in relevant preparedness arrangements, while Nigeria has 17 designated isolation and treatment centres.

With 36 states and the FCT, the 17 centres amount to fewer than one designated treatment centre per state on average. This raises questions about geographical access, referral arrangements and whether existing facilities can accommodate multiple suspected or confirmed cases simultaneously.

The NCDC’s guidance requires every state and the FCT to identify at least one functional holding or isolation facility for suspected cases, with a safe referral pathway to further care.

Onyechi also warned of the economic implications if Ebola spreads further. She warned that beyond the immediate pressure on the health system, a wider spread could require additional emergency spending and place greater demands on healthcare workers and facilities.

Saiki Adinoyi Musa, epidemiology and surveillance manager at the International Research Center of Excellence (IRCE) at the Institute of Human Virology Nigeria, said Nigeria’s existing outbreak response capabilities were important but insufficient on their own.

He said resilient preparedness systems required continuous simulation exercises, coordinated planning and better use of existing research capacity, including that of the Institute of Human Virology Nigeria and its International Research Center of Excellence, the Nigerian Institute of Medical Research (NIMR) and other private facilities.

He also highlighted cross-border collaboration and sustained domestic investment in public health infrastructure before emergencies emerge.

Olufemi Babalola, president of the Guild of Medical Directors, said improvements in laboratory systems and genomic sequencing capacity were not sufficient to address emerging infectious disease threats.

“We still need to strengthen our genetic analysis capabilities, which are still rather too narrow at the moment,” he said.
He added that Nigeria remained vulnerable because critical care infrastructure was underdeveloped in many parts of the country, particularly outside major cities.

According to Babalola, shortages of intensive care unit beds, oxygen systems and trained critical care personnel became evident during the COVID-19 pandemic and have not been fully addressed.