CDC and Other U.S. Government Teams Support Nigeria’s Efforts to Stop Spread of COVID-19

When Nigeria confirmed its first case of COVID-19 on February 27, 2020, Dr. Mahesh Swaminathan – the director of U.S. CDC’s office in Nigeria at the time – recognized it would take extraordinary efforts to support Nigeria’s response to the pandemic.

“The country is large, diverse, and has a highly mobile population,” he explained. “I also realized very early that our capacity to support Nigeria’s COVID-19 response is spread across various U.S. government programs, divisions, and agencies working in this country.”

Nigeria has a population of more than 211 million people, the largest population in Africa. For a country that is only a little larger than the state of Texas but has two-thirds the population of the United States, preventing the spread of COVID-19 is not only a priority for Nigeria, it is a global priority. A mission-wide approach of providing U.S. government resources and financial investments was needed to make sure Nigeria’s COVID-19 response was effective, according to Swaminathan.

Members of the Mission Nigeria Incident Command System during a virtual public health response planning meeting.
Photo by Halilu Usman/U.S. CDC

Developing a COVID-19 Emergency Response Structure in Nigeria

As early as March 2, 2020, U.S. CDC’s Nigeria team organized an Incident Command System (ICS), which is the foundation of emergency response management. The ICS is a whole-government approach that activates agencies and personnel with different skill sets to work together to manage a public health emergency. U.S. CDC Nigeria had already used this approach from 2018 to 2020 to coordinate HIV/AIDS response efforts. An ICS also proved to be an effective structure to help eradicate polio in Nigeria in August 2020.

What began as a team of seven people from U.S. CDC Nigeria grew to more than 60 U.S. government employees, including 25 U.S. CDC staff members and experts from U.S. State Department, the U.S. Agency for International Development (USAID), and the Walter Reed Army Institute of Research. Everyone worked together as one U.S. government team. The ICS was the primary vehicle for responding to the pandemic within the U.S. Embassy community and supporting Nigeria’s COVID-19 response.

Expansion and Leadership Evolve into Action

The U.S. government’s support for Nigeria’s COVID-19 response became more strategic and effective as the country’s COVID-19 incident command system grew. U.S. Ambassador to Nigeria Mary Beth Leonard provided mission-wide leadership and Deputy Chief of Mission Kathleen FitzGibbon served as the overall incident commander. FitzGibbon worked with the highest level of Nigeria’s government, including the president’s office, to galvanize support for the COVID-19 response in the country.

Making a Difference Through Coordination and Implementation

The incident command system supported the country’s efforts to increase COVID-19 testing. This support allowed Nigeria to expand the number of DNA testing labs from 2 to about 100 public and private labs across the country in just over 11 months. These labs test DNA samples to confirm COVID-19 infection status.

The ICS also supported field contact-tracing operations that identified 172 people who were directly connected to the first confirmed COVID-19 case in the country. The team also assisted Nigeria’s government in developing various policies and guidelines, including when to enhance or ease lockdowns.

The ICS included staff from all divisions of the U.S. CDC’s Center for Global Health. One team focused on getting Nigerians tested for SARS CoV-2, the virus that causes COVID-19. It contributed to the design and implementation of the first walk-in COVID-19 sample collection center in Nigeria’s Federal Capital Territory, which includes the capital Abuja. People come to the center and have mucus samples taken from their nose or throat. The samples are then sent to a laboratory for testing. This model was expanded and adopted in all 36 states.

The team also worked with partners to start a weekly state response coordination process at the NCDC, which enabled weekly virtual meetings among the 52 national public health rapid response teams. This process contributed to the timely transfer of COVID-19 data from the states to Nigeria’s national Emergency Operations Center.

The incident command system also contributed to streamlining treatment approaches by helping 108 treatment facilities and isolation centers share their best practices for COVID-19 case treatments on a weekly basis. Additionally, USAID provided 200 ventilators, oxygen, and staff training for hospitals treating the sickest patients battling COVID-19.

U.S. CDC Nigeria trained volunteers to share accurate information about COVID-19 in their communities. Here, a volunteer is handing out handbills as part of campaign to raise awareness about COVID-19 and explain what people need to do to limit the spread of the disease.
Photo by Nigeria Centre for Disease Control

Informing the Public About COVID-19 Risks

The risk of getting COVID-19 goes up dramatically in areas where many people live in close proximity to others. Such living conditions are common in many parts of Nigeria. Therefore, informing the population about the risks they face and how they can protect themselves is essential during any public health crisis.

Creating compelling messages to educate the public about the importance of wearing masks, washing hands, avoiding crowds, and staying home if feeling sick was just the beginning.

“Early on, I would say, one of the other significant contributions of CDC Nigeria was our work with the government of Nigeria at the national and local levels, where we developed a COVID-19 risk communication strategy,” says Halilu Usman, Health Communications Specialist for U.S. CDC Nigeria.

200,000 Volunteers Help Spread the Word About Stopping COVID-19

Getting the word out effectively was a big challenge. Usman says U.S. CDC Nigeria helped train media organizations who could help share appropriate messages. But in a country as large as Nigeria, more was needed because a lot of disinformation, misinformation, and conspiracy theories were quickly spreading on social media.

Usman and his counterparts at the government level trained over 200,000 volunteers to share vital information to raise awareness about COVID-19 and counter misinformation. “We have a huge number of people across Nigeria trained to go out to the communities, to engage with individuals at the community level, and tell them how they can protect themselves from this virus,” Usman says. “We did this using the ZOOM and ECHO videoconferencing platforms.”

The virtual training sessions began at the national level and then cascaded to the state and local government levels. The training on the national level took about four months, between March and July 2020. The training of community volunteers continues in 2021.

The West Africa Regional ECHO mentoring project:
• Expands public health learning networks
• Connects experts across countries and continents
• Pools resources and experiences from other countries
• Includes 9 participating countries: Cameroon, Nigeria, Ghana, Côte d’Ivoire, Liberia, Sierra Leone, Guinea, Mali, and Senegal

Expanding COVID-19-Related Training in West Africa

Project ECHO (Extension for Community Healthcare Outcomes) is a virtual training platform that was  developed at the University of New Mexico in 2003. It provides doctors, nurses, and health care workers in underserved areas with the knowledge and support they need to manage patients with complex medical conditions. In 2017, CDC expanded this model to dramatically increase the ability for long-distance training and mentoring of medical professionals around the globe.

The success of the U.S. CDC Nigeria’s remote COVID-19 training in Nigeria led to another expansion of the ECHO concept. In February 2021, the University of New Mexico, U.S. CDC Nigeria, and the Nigerian government launched the West Africa Regional ECHO knowledge sharing platform for the COVID-19 Response.

By mid-July 2021, thousands of health care workers in the West African region received up-to-date COVID-19 case management and COVID-19 vaccination roll out training.

“The platform allows us to share experiences on COVID-19, stay up to date with latest developments, and update clinical practices when needed,” says Dr. Mary Boyd, U.S. CDC’s new Nigeria country director.

The West Africa Regional ECHO  also provides a critical platform to educate health care workers about how to address misinformation.

U.S. CDC Nigeria Health Communications Specialist Halilu Usman conducts a training session with religious leaders in Lagos State, Nigeria, on March 3, 2021. They are learning how to protect their communities by sharing accurate information about preventing the spread of COVID-19. Photo by Cecilia Owan/CCFN

Recruiting More Public Health Communicators

U.S. CDC Nigeria and other partners, including colleagues from the Nigerian CDC, trained religious leaders, traditional rulers, and celebrities to help spread the word about how people can protect themselves from COVID-19 infections.

Getting people vaccinated is now a big part of the overall battle against COVID-19. U.S. CDC Nigeria and the entire incident command team assisted the government with developing a plan for distributing the vaccines as they become available. By mid-July, about two million Nigerians received COVID-19 vaccines.

The next step for the team is to encourage more people to get the COVID-19 vaccine. “There are many reasons why some people are reluctant to get vaccinated,” says Usman. “Religious leaders were critical advocates for vaccine acceptance in the community in the past, which is why we continue to reach out to them to help us get the word out about the importance and benefits of COVID-19 vaccines.”