What would happen if yellow fever started spreading in Lagos today? From the 12th to 15th of March, various partners and stakeholders came together to find out during a simulation exercise.
What is simulation?
Simulation is an imitated or pretend situation. For this exercise, actors were used as patients who showed up at various health facilities and points of entry around Lagos state and presented symptoms that could indicate yellow fever. Only select people at those sites knew they were acting.
So the question was, would the healthworkers and officials at these various sites detect and contain them? Would the system respond in a way that would limit the spread of a possible infectious disease and protect the public?
The idea was to simulate – or pretend to have – an outbreak of yellow fever so the gaps and challenges at all levels could be identified BEFORE an actual emergency situation arises.
Why a simulation exercise?
Assessing how prepared we are for the next potential outbreak is important. The simulation exercise allowed Lagos state’s emergency preparedness and response system to be tested in a safe and controlled way without actually putting anyone at risk (because there was no real infection spreading, it was just a simulated outbreak).
The exercise was able to test everything from the effectiveness of emergency policies and procedures to ambulance response times to communication and information flow across agencies.
Simulation made it possible to see where the state’s health and emergency response systems are failing or performing at sub-optimal levels, and also see where they are successful so the failures can be addressed and successes can be identified and built on.
Why yellow fever?
A few reasons:
- Until last year, Nigeria had not seen a case of yellow fever in 17 years
- There is a global shortage of the yellow fever vaccine which means the ability to protect communities is limited
- There is an ongoing outbreak of yellow fever in Brazil and Brazil is a country that is similar to Nigeria in its diversity, complexity, and economy
- There was a major yellow fever outbreak in Angola that crippled their economy for more than 1 year (the outbreak lasted from late 2015 to early 2017)
Why Lagos state?
Lagos is a mega-city. The most populous city in the most populous country on the African continent.
And we know that infectious diseases don’t respect borders. They don’t requires visas or passports to travel so any public health emergency or outbreak in Lagos has implications for the region, the rest of the continent, and potentially the whole world.
Additionally, Lagos is the economic center of Nigeria and already tackled one major outbreak (Ebola) in 2014.
Who was involved in testing Lagos state’s response?
The easier question may be who WASN’T involved! The type and scale of this exercise has never been done before in Africa. The leading groups were the West African Health Organization (WAHO), Nigeria Centre for Disease Control (NCDC)/Federal Ministry of Health, Lagos State Ministry of Health (LSMOH), and Public Health England (PHE).
Local participants included:
- World Health Organization (WHO) Nigeria
- Nigerian Institute of Medical Research (NIMR)
- National Arbovirus and Vectors Research Centre (NAVRC)
- Nigerian Ports Authority
- Federal Airports Authority of Nigeria (FAAN)
- Federal Ministry of Aviation
- Federal Ministry of Defence
- Lagos State Government
- Lagos State Ministry of Environment
- Lagos State Ministry of Education
- Lagos State Police Command
- Lagos State Emergency Management Agency (LASEMA)
- Lagos State Ambulance Service (LASAMBUS)
- Ogun State Ministry of Health
- University of Lagos, College of Medicine
- Lagos University Teaching Hospital (LUTH) Virology Reference Lab
- EpiAfric
- EpidAlert
- ProHealth International
- Instrat Global Health Solutions
International participants included:
- University of Maryland Baltimore
- WHO Regional Office for Africa
- World Bank
- UNICEF
- Economic Community of West African States (ECOWAS) Regional Centre for Disease Surveillance and Control (CDC)
- African Field Epidemiology Network (AFENET)
- Ministry of Defence Benin
- Ministry of Health Burkina Faso
- Ministry of Health Niger
- Government of Ivory Coast
- Government of Guinea-Bissau
- Ministry of Health Gambia
- Ministry of Health Senegal
- Ministry of Health and Sanitation Liberia
- Ghana Health Services
- Gesellschaft fur Internationale Zusammenarbeit (GIZ) Nigeria
- International Red Cross
As you can imagine from this long list, the diversity of the participants’ professional experiences and the varied contexts in which they all work made it a very exciting exercise.
During the simulation, DRASA observed at the Public Health Emergency Operations Center (EOC) which was the centralized site for the coordination of information and resources for the “outbreak.” The EOC was staffed by Lagos State Ministry of Health along with key partners, and the various departments included:
- Incidence Management
- Logistics
- Finance and Administration
- Planning
- Operations
- Epidemiology and Data
- Case Management and Infection Prevention and Control
- Laboratory
- Social Mobilization and Risk Management
What now?
The main findings and lessons learnt during the simulation exercise are being shared and disseminated across Nigeria, the ECOWAS region, and to other relevant stakeholders.
The goal is to:
- Develop a national and regional coordination framework for response to public health emergencies
- Strengthen partnership, teamwork, and multi-sector collaboration among stakeholders
- Address the gaps identified and develop specific action plans to strengthen the system
Needless to say, there’s a lot to do!
