Containing Epidemics Like Ebola: Lessons From Nigeria’s Success | Commentary
For the sake of public health preparedness here in the United States, as well as humanitarian assistance in West Africa, Congress should approve President Barack Obama’s request for $6.18 billion in emergency funding to combat Ebola.
In addition to helping West African countries contain the epidemic, the funding will build capacity in the U.S. to respond to Ebola and future epidemics. Moreover, combating contagions abroad offers lessons that can be applied here at home.
My own experience is instructive:
In July, when the first Ebola case was confirmed in Nigeria — Africa’s most populous nation — the news alarmed the country’s health care officials and sparked fear among the population that the deadly virus could infect thousands of Nigerians.
Recognizing the threat, Nigeria mobilized its entire government, the health care system, major industry and every segment of society around a unified message of preparedness. As part of that public-private approach, I led a six-person team from the Baylor College of Medicine in Houston — home to the National School of Tropical Medicine — to Nigeria to train community leaders, medical professionals and public health practitioners in how to contain the deadly disease.
Our mission was urgent and unprecedented. Together with the U.S. Centers for Disease Control and Prevention and its Nigerian counterpart, our team — sponsored by ExxonMobil, which has operations in Nigeria — trained nearly 1,500 health care providers and nonmedical personnel in preventing and treating Ebola.
Today, in an all-too-rare success story, Nigeria’s quick, unified approach stopped the disease in its tracks. Instead of thousands dead, the World Health Organization reports fewer than a dozen Ebola-related deaths in Nigeria and no new cases of the disease.
With people in many countries, including America, still anxious about a containable and curable disease and seemingly mystified about what to do, our work and the efforts of our colleagues in Nigeria demonstrate a teachable moment: When confronting a public health emergency, a nation needs a unified, uniform and standardized response. When variability is introduced into such basic policies as quarantines, hospital admissions, treatment policies, training methods and, above all, messaging to the general public, confusion results. And confusion kills.
Much can be learned from the African nation’s response to the disease, and applied to future epidemics at home and abroad. Four lessons stand out:
First, national public health leadership is needed. When a deadly disease emerges, the nation’s leaders should treat it like a national security crisis. Don’t mute calls to action for fear that the people will be needlessly alarmed. What frightens ordinary citizens the most is when their leaders sound conflicted, not concerned. Acutely aware of epidemics of Ebola elsewhere in Africa, Nigerian leaders sounded the alarm — early, loudly and clearly.
Second, it takes a team effort. The response should include government at every level, the business community, medical professionals, academia, and every segment of society, from community organizations to religious leaders. Working with the University of Lagos, we trained physicians, nurses and other health care workers, as well as nonmedical personnel, and helped to mobilize local council leaders, faith communities and other organized groups.
Third, a consistent, unified message is essential. We helped Nigeria offer three training programs. For the nonmedical public, we presented basic facts about the disease itself and how best to protect against it. For health care providers, we provided more sophisticated information about the best methods to prevent transmission, care for patients and protection against acquiring the infection during care. For those in contact with patients, from cleaning crews to caregivers, we explained how best to use personal protective equipment. For every audience, it was essential to explain that persons are only contagious if they have symptoms of the Ebola virus, such as fever and vomiting.
For training the health care providers and educating the public, a consistent and authoritative message is indispensable. Only by sharing accurate information can public health officials prevent panic and dispel myths and misunderstandings.
In Nigeria, public education countered commonly-held misunderstandings, such as the belief that salt water baths would protect people against Ebola.
Here in the United States, without a confident, coherent public education campaign, Americans lost confidence in public health authorities. With its continuous news cycle and its fixation on fright, the media did more to alarm than to inform, making it essential for health care authorities to convey accurate information.
Fourth, follow standardized procedures. The best practices for diagnosing, treating and containing Ebola must be the same in all 50 states. Communities need uniform protocols and designated health care facilities for treating Ebola so patients with other ailments will not be afraid to go to the hospital, and hospitals will not be afraid to admit new patients — a scenario that has sadly played out across the U.S.
Ebola’s three-week window of danger has now passed; the U.S. has defeated this disease. But other epidemics will emerge, some even more menacing. As Winston Churchill, and, more recently, Rahm Emanuel, said, “Never let a good crisis go to waste.” Now is the time for America to implement a plan for public health security that will standardize care, prevent confusion and, ultimately, keep citizens safe. Passing the President’s funding to combat Ebola is one step in the right direction.
Dr. Bobby Kapur, M.D., M.P.H., was the lead for the six-member team from Baylor College of Medicine in Houston, Texas that trained 1,500 health care providers and non-medical personnel in Nigeria about how to care for Ebola patients and contain the disease. He is the associate chief of emergency medicine at Baylor College of Medicine.