Rising Lassa fever fatalities in Nigeria: Time to change strategy

Outside, rain drummed heavily against the rusted zinc roof of a community health centre in Ondo State, but inside the ward, the sweltering heat only amplified the mounting panic.

On a wooden bench at the health centre, Mrs Funmi Ariyo, a 34-year-old cassava farmer and mother of two, clutched her eight-year-old son tightly.

His body burned with a fever that refused to break, in spite of two rounds of over-the-counter malaria medication from a nearby chemist.

“For the first five days, I thought it was malaria. In my village, every fever is malaria or typhoid.”

According to her, seeking care was not a simple choice.

She said that the nearest standard hospital was three hours away by motorcycle over broken roads, at a cost higher than her weekly earnings from selling garri.

“People kept telling me, ‘It is just stubborn malaria,’ but by the sixth day, he started vomiting blood.

“At that point, fear replaced doubt.”

When they finally arrived at the local clinic, she said that the community health worker’s expression changed instantly.

“There was no personal protective equipment, only a few worn latex gloves left from an old donor supply.

“There was no running water. Staff fetched water from a borehole 200 metres away just to wash their hands.

“The nurse suspected Lassa fever immediately, but there was no way to confirm it.”

It was January 2026, the peak of the dry season, when Mastomys rats—carriers of Lassa fever—fled the burning bushes and invaded human homes in the community.

She alleged that the clinic had no Polymerase Chain Reaction diagnostic machine. A blood sample was taken, placed in a makeshift cooler, and sent on a public bus to a distant laboratory.

“We waited 48 hours; by then, my son’s condition had worsened.

“The doctor gave me a list—fluids, syringes, Ribavirin—from a private pharmacy.

“The cost was N120, 000, an impossible sum for a family surviving on less than N30, 000 a month.

“I had to beg my cooperative; they sold my stored grain at a loss just to start treatment. My son survived.”

But survival came at a cost that would follow the family long after they left the clinic.

Back in the village, she said that stigma awaited them. Neighbours kept their distance, fearing what they called “the bleeding sickness.”

Yet nothing about her environment had changed.

“To feed my children, I still spread cassava by the roadside to dry. I know the rats are there, watching from the grass.

“But without money for those drying tents, what choice do I have?” she asked.

Public health experts say Nigeria’s outbreak response system has improved significantly on paper.

Surveillance is faster, coordination is stronger, and more treatment centres exist than in previous years; yet survival is not improving at the same pace as detection.

As of mid-May 2026, Nigeria recorded 190 deaths by late April, with a case fatality rate of 25.2 per cent, up from 18.5–19.1 per cent in 2025, according to the Nigeria Centre for Disease Control and Prevention (NCDC).

In spite of expanded response efforts across Bauchi, Ondo, Taraba, Edo, and Benue, the outbreak continues to worsen.

A community health worker, Mrs Mary Edet, said the gap lay not in detection but in the system meant to convert detection into survival.

“For most families, the first barrier is financial.

“With health insurance coverage still critically low, treatment is largely out-of-pocket—covering Ribavirin, supportive care, and hospitalisation.

“Primary healthcare centres remain underfunded, often without PPE, isolation units, or outbreak preparedness capacity,” Edet said.

She added that laboratory systems relied heavily on centralised funding, delaying mobile diagnostic deployment during outbreaks.

“In a disease where hours determine survival, delays become fatal,” she said.

Patients in rural communities often travel long distances to reach specialist centres in Edo, Ondo, or Bauchi, losing critical time in transit.

At the primary level, most Primary Health Care Centres lack rapid diagnostic tools, forcing reliance on distant laboratories.

Dr Solomon Chollom, a virologist and public health expert, said misdiagnosis remains a major driver of mortality.

“Early symptoms are often treated as malaria or typhoid. Patients self-medicate for days before seeking care.

“By the time they arrive at a facility, the disease is often advanced. Early treatment is everything, but most patients come in too late,” Chollom said.

Dr Olayinka Badmus, former Deputy Project Director of Risk Communication at Breakthrough ACTION, said stigma was also fueling the outbreak.

“Families sometimes hide sick relatives to avoid isolation or discrimination, increasing household transmission.”

Badmus added that survival practices such as drying cassava on open roadsides exposed food to contamination from infected rodents.

“These behaviours are not negligence, but survival strategies shaped by poverty,” she said.

Experts say Lassa fever thrives in poor sanitation, overcrowding, and rodent infestation.

Rodent control remains reactive rather than sustained.

The disease peaks during the dry season when rodents move indoors, while climate change is expanding rodent habitats and increasing human exposure.

Healthcare worker infections, with more than 38 cases by March 2026, also highlight weaknesses in infection prevention systems.

Dr Jide Idris, Director-General of the NCDC, said the agency’s 2025–2029 strategy focused on state-level accountability.

Idris said the plan included mandatory real-time data sharing across states, permanent activation of emergency operations centres, and dedicated state outbreak budgets.

“It also includes subsidised treatment in high-burden states, expansion of the community health workforce, and year-round environmental sanitation and rodent control,” he said.

However, he noted that implementation remained uneven across states.

In spite of reforms, critical gaps persist, including weak legal enforcement at the state level, delayed PCR diagnostics, underfunded local governments, poverty-driven behavioural constraints, and poor rural health infrastructure.

These gaps have kept the case fatality rate at 25.2 per cent.

A longer-term solution is emerging through the West African Lassa Fever End-to-End (E2E) Access Roadmap, led by the West African Health Organisation (WAHO) and Coalition for Epidemic Preparedness Innovations(CEPI).

The framework aims to accelerate access to a licensed vaccine through clinical trials, ECOWAS fast-track approval, and targeted rural deployment.

The strategy prioritises high-burden areas such as Edo, Ondo, and Bauchi, States using predictive modelling, unified regulatory pathways, and pooled financing to reduce out-of-pocket costs.

However, gaps remain, including weak cold-chain infrastructure, limited trial capacity, and inadequate financing for last-mile delivery.

Health remains on the concurrent legislative list, limiting federal enforcement power.

States can legally ignore NCDC directives, creating a structural enforcement gap.

Proposed reforms include expansion of the Basic Health Care Provision Fund (BHCPF) and conditional federal funding tied to outbreak reporting compliance.

However, both passage and enforcement remain uncertain.

At the community level, innovation is emerging.

Experts say traditional roadside drying of cassava exposes food to rodents and contamination.

Safer alternatives include elevated solar mesh dryers, rodent-proof enclosures, and metal base guards designed to prevent rodent access.

However, costs ranging from N45,000 to N75,000 limit adoption without government or microcredit support.

Nigeria has improved its ability to detect Lassa fever outbreaks.

But detection without survival is not success.

Prof. Oyewale Tomori, a renowned virologist, said the country must close the gap between policy and reality.

“Until farmers, clinics, and local governments are fully supported, the virus will continue to exploit systemic weaknesses,” Tomori warned.

For families like Ariyo’s and countless others across rural Nigeria, those gaps are not theoretical; they are fatal.