Ahmed Victor Idowu was a young medical doctor with a passion to reform health care in Nigeria. A recent graduate of the University of Nigeria, in January 2018 he was at the start of his in-hospital clinical training when he examined a seven-month old baby with an abnormally high fever. He was the only doctor on duty. It was his last duty. The baby had Lassa fever. Less than a month later, Dr. Idowu died of the Ebola-like virus that in its most severe form causes multi-organ failure and uncontrolled bleeding from the nose, mouth, and gut.
His death was one of the first in Nigeria’s latest outbreak of Lassa fever, which now stands at 423 confirmed cases and 106 deaths. It was the worst Lassa Fever outbreak ever reported in Nigeria, with more cases in just two months than the entire previous year, and an exceptionally high fatality rate of 25 percent. Although the Nigerian minister of health recently declared the Lassa fever outbreak over, the virus remains an ever-present danger, as the conditions that breed it have not changed.
The vast majority of transmission is through rats, millions of which proliferate in parts of West Africa where clean water, toilets and sanitary sewage systems are lacking. These conditions must change if we are to stop annual outbreaks of this potentially fatal disease.
Lassa Fever is endemic across West Africa. It currently causes up to 500,000 cases and 5,000 deaths yearly across West Africa, yet it has been a neglected disease since it was identified in 1969. Similarly, although the Ebola virus was identified in 1976, not until the widespread 2014 outbreak, when cases began appearing overseas, did the scientific and medical communities mobilize the muscle needed to rapidly develop tools for prevention, diagnosis and treatment—work that is still underway.
We cannot afford to continue the same mistake with Lassa fever. With the worst of this outbreak behind us, the danger of complacency is high.
We know the animal host of Lassa fever, how it is transmitted, and how to stop it. It is time for African leaders and their global partners to treat the improvement of Water, Sanitation and Hygiene (WASH) as a priority, and to launch a massive behavior communications campaign to ensure that every West African knows the steps they must take to prevent this disease.
In Nigeria alone, 37 percent of the population has no access to safe drinking water; 59 percent lack access to good waste disposal systems; and 28 percent still defecate in the open. In densely populated areas close to open sewage drainage, rats run amuck in households, eating stored grain and defecating on families’ food supplies and eating utensils. Using those utensils and eating the contaminated foods is believed to be a primary cause of infection.
Therefore, risk communication is strategic to halting Lassa fever. Even with the paucity of health workers across West Africa, community health volunteers who are trained to provide health education and refer cases to higher levels of care have been shown to be very effective. This was demonstrated in Ethiopia, where 38,000 community health workers greatly increased child survival rates, and a core service was providing advice on water and sanitation.
African governments must also develop extensive waste management systems that prioritize solid waste sorting into recyclable and non-recyclable garbage. The non-recyclable is brought out for collection close to the time of waste collection to discourage rodents. Sewage should be hygienically managed and public toilets provided. Provision of clean water should be a priority. It is not possible to maintain good hygiene without access to clean water.
Risk communication, improved access to clean water and to safe sewage treatment are the key, but not the only measures needed. In addition, an international Dialogue hosted by the Nigeria Centre for Disease Control (NCDC) in March identified the development of rapid diagnostic tests (RDTs), real-time gene sequencing and the protection of health workers as crucial measures for preventing or controlling outbreaks.
Lassa fever cannot be eliminated without funding. To date, the World Health Organization’s Contingency Fund for Emergencies to Support Lassa Fever Preparedness and Response Capacities has released US$900,000 to address the outbreak. But little of this goes to WASH.
The African Union recently established the Africa Centres for Disease Control and Prevention (Africa CDC) to monitor and respond to public health threats across the continent. The Africa CDC should now support the NCDC and other national public health institutes in their efforts to eliminate Lassa fever.
African leaders passively accept an annual outbreak of Lassa fever, with its preventable deaths of infants and adults alike. This must change. When the 360 million people in West Africa know how to prevent this disease in their homes, and have access to clean water and to sanitary waste disposal, Lassa fever can finally be eliminated.
Dr. Ifeanyi Nsofor is Director of Policy & Advocacy for Nigeria Health Watch, CEO of EpiAFRIC and a 2018 Aspen Institute New Voices Fellow.