The index COVID-19 case in Nigeria was reported on 28 February 2020.¹³ As of 28 March 2021, Nigeria has reported over 160 000 cases of COVID-19 and about 2000 deaths because of the virus, making it the 77th most impacted nation in the world and the fifth in Africa. The attack rate was found to be 78.8 per 100 000 people, a death rate of 1.0 per 100 000 people and a 1.30 case fatality rate.¹⁴

In response to the COVID-19 pandemic, a stringent multifaceted approach involving the Presidential Task Force (PTF) was adopted. They were saddled with oversight functions, strategies and policy guidance. The Nigeria Center for Disease Control (NCDC) also worked with the PTF to ensure coordination, resource mobilisation, epidemiology and surveillance.¹⁵ The two bodies (PTF and NCDC) also worked with research institutes to ensure early response and non-pharmaceutical and clinical intervention. To ensure an early response, mobilisation and sanitisations, training of rapid response team (RRT), and emergency centres were set up. Non-pharmaceutical interventions include travel restrictions, curfew, contact tracing, self-isolation and quarantine. Furthermore, public health campaigns, hand hygiene, face masks and social distancing were ensured. On the other hand, clinical interventions include health training professionals, use of personal protective equipments (PPEs), isolation, case management and proper diagnostic testing.⁴

Lassa fever is one of the most common recurrent infectious acute viral haemorrhagic fevers. It was first identified in Borno State of Nigeria in 1969.¹⁶ From 2009 to 2020, there were about 28 000 suspected cases, with about 1844 deaths in Nigeria.¹²

The public health response was undertaken by the Nigeria Centre for Disease Control and Prevention (NCDC) along with health officials of the impacted states. An NCDC Emergency Operations Center (EOC) was activated during the outbreak by deploying RRTs to the various states affected. Their response activities included surveillance, case management, prevention and control measures.¹⁶ To enhance the response to LF outbreaks, the NCDC created a national action plan in collaboration with WHO and other partners aimed at preventing and controlling these outbreaks. This strategy emphasised the enhancement of surveillance, the expansion and improvement of national laboratory capabilities, the raising of public awareness and the betterment of available case management.¹⁶

The first index case of Ebola in Nigeria was found in 2014, imported by a traveller from Liberia.¹⁷ The disease quickly spread from this index case to a total of 19 laboratory-confirmed cases of Ebola virus disease (EVD), and one probable case was reported in two states. Out of the confirmed EVD cases in Nigeria, eight resulted in death, leading to a case fatality rate of 42.1%, while twelve individuals recovered fully.¹⁸

Three months after the first case was confirmed, WHO declared Nigeria to be Ebola-free by WHO, which was deemed a successful public health response. The swift management of the EVD was enabled by the quick identification of the initial case, thorough contact tracing efforts and the isolation and treatment of subsequent cases. Additionally, the success was attributed to the multi-sectorial approach, public–private partnerships and utilisation of faith-based organisations and the media. Furthermore, international community participation, handwashing facilities in public and private schools and social mobilisation using multimodal strategies also helped in the success.¹⁸

Between 01 October and 16 April 2023, 1686 potential cases have been reported, with 532 of those confirmed, leading to 124 fatalities case fatality rate (CFR: 7%). The NCDC has implemented response strategies at the national level with assistance from WHO. The response included case management, vaccination and surveillance activities.¹⁹ The mass vaccination campaigns and other response measures, such as better case management and case finding during the outbreak, helped control the epidemic.¹⁹ A significant turning point in managing the meningitis epidemics was the introduction of the meningococcal A conjugate vaccine against Neisseria meningitidis serogroup C (NmC).²⁰

Previous issues of diphtheria have been documented in Nigeria, with the worst case occurring in Borno State, in the northeast of the country, in 2011.¹⁹

In response to the outbreak, he NCDC collaborates with WHO and various partners to oversee public health initiatives, including vaccination responses, enhanced monitoring for prompt identification of cases, management of cases and communication of risks.¹⁹

Cholera remains a significant public health concern in Nigeria, having persisted for approximately five decades. Although the outbreaks of this highly infectious illness are intermittent, it has been endemic in the country because the first epidemic case was reported in 1970.²¹ According to NCDC, over 3000 cases and 77 deaths were recorded in 2023 and 2024 alone.²²

To control the cholera outbreak, the government, together with NCDC, implemented a community-based strategy that encompasses community engagement, coordination, immunisation, water, sanitation and Hygiene (WASH) programmes, disease surveillance and early detection, provision of oral rehydration salts, case management, laboratory services and risk communication which was proven to be effective.²³

Nigeria’s public health surveillance system was significantly improved, notably the state-of-the-art Incident Control Centre (ICC) at the NCDC, collaborating with the Event Based Surveillance Unit (EBSU), as they collect and analysed data on disease outbreaks throughout the country, utilising several sources, such as online platforms, call centres, and rumour management tools known as the Epidemic Intelligence from Open Sources (EIOS). More so is involved the Surveillance Outbreak Response Management and Analysis System (SORMAS) for quick outbreak tracking and response and Early Warning, Alert and Response System (EWARS).²⁵

Additionally, resources were allocated to establish disease surveillance systems, EOCs and mechanisms for coordinating response efforts. These combined measures have enhanced Nigeria’s capacity to promptly detect and respond to infectious disease outbreaks.²⁶

The establishment of a National Reference Laboratory (NRL) that houses advanced technologies such as the Mega polymerase chain reaction (PCR) laboratory, Multiplex Bead Assay (MBA) Lab, Sequencing Lab, microbiology, serology and open system PCR lab suite has markedly improved the country’s public health response. The NRL also houses the National Biorepository Centre (NBC), accredited by the National Health Research Ethical Committee (NHREC), housing over a million samples from various national surveys for research, quality assurance and training purposes.²⁶

The country’s entry points were strengthened to prevent, detect and respond to infectious disease outbreaks. Competent authorities are stationed at six airports, five seaports, several ground crossings and trans-border markets.²⁷ The WHO’s list of approved ports for ship inspections and health certificates now includes the eight Nigerian ports, which enhances Nigeria’s position in international maritime health security and facilitates thorough inspections of vessels for safety and biosecurity. Additionally, five international airports and several land border crossings implement inspection programmes to guarantee that the environment and facilities utilised by travellers are kept in clean and safe conditions.¹⁶

Nigeria employed community engagement strategies to foster the adoption of preventive public health practices. The country collaborated with indigenous leaders and non-governmental entities to disseminate knowledge within communities regarding communicable diseases and strategies for their prevention.²⁶

Over the review period, Nigeria has developed its workforce and maintained a well-trained public health workforce equipped with the necessary technical skills, scientific knowledge and subject-specific expertise. This contributed to strengthening the public health system.²⁷ The Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) trained several hundred professionals, including epidemiologists, laboratorians and veterinarians.¹⁶

There is still a need for sustained and increased domestic financing for epidemic preparedness-related activities and gender equity in epidemic preparedness and response.²⁷ The persistent lack of adequate funding for healthcare has resulted in deficiencies in essential equipment, supplies and personnel, particularly in rural regions. This phenomenon can impede the promptness of response efforts during disease outbreaks.²⁶

Significant advancements have been achieved in improving human health security in Nigeria. However, because of zoonotic infectious diseases, there is still a necessity to incorporate and advocate for the environmental and animal sectors within the wider health security framework to effectively enhance public health.²⁶ The integration of these sectors is vital for a comprehensive one-health strategy that tackles the interconnections between human, animal and environmental health. Bridging this integration gap will enhance Nigeria’s capacity to predict and effectively respond to new health threats that frequently emerge at the interface of humans, animals and the environment.²⁶

Despite notable strides made at the national level, extending these advancements to the subnational regions, especially the local government areas is imperative. Strengthening capacity at this level ensures a more robust and decentralised response mechanism, enabling prompt actions in remote areas. Subnational capacity building entails providing adequate training, resources and infrastructure to local health authorities, ensuring that Nigeria’s health security improvements are felt throughout the country.²⁷

During a public health crisis, law enforcement must promptly work together with public health and medical authorities to coordinate their response. Nigeria was ranked lower than other countries such as South Africa, Togo and Kenya during the latest JEE in the linkage between public health and security authorities because Nigeria needed to have existing signed regulations and MOUs between security authorities and public health.²⁶

Nigeria lacks proper, multi-sectorial biosecurity policies and programmes. Biosafety and biosecurity measures, along with plans for incident and emergency response, are essential for addressing any situations involving hazardous pathogens. In addition, Nigeria needs more Institutional Biosecurity programmes and national coordination of biosecurity activities. There are no consolidated institutions and locations with dangerous pathogens and toxin control. Lastly, laboratory audits are not utilised to assess the locations and present inventories of hazardous pathogens.²⁷

The logistical complexities of expeditiously conveying resources and personnel to distant regions can pose significant obstacles in orchestrating a cohesive and synchronised reaction. Furthermore, the presence of obsolete disease monitoring equipment and disparities in health data accessibility among different states can also impede the analysis process.²⁸

Moreover, a deficiency of confidence in the government may result in resistance to public health measures in specific communities. Additionally, the recurrent attrition of personnel and the progressive exit of skilled professionals responsible for managing outbreaks can ultimately diminish an organisation’s accumulated knowledge and proficiency. In certain situations, there may be a persistence of administrative inefficiencies and a need for coordination between local and central authorities.²⁸