By Admin
The Academy of Medical Sciences of Nigeria has warned that the medical evacuation of the country’s first imported Ebola patient to Switzerland has exposed gaps in outbreak preparedness, including delayed diagnosis, limited isolation capacity and concerns over the welfare of exposed contacts.
Disclosing this position on Monday, the Academy, while describing the evacuation as consistent in principle with international health regulations, stressed that the patient’s departure did not end Nigeria’s responsibility to contain the outbreak.
The 42-year-old Ugandan-born woman, who is married to a Swiss embassy staff member in Abuja, was evacuated by air ambulance on Monday alongside her asymptomatic husband, following approval by the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate.
In a public health statement and advisory signed by its President, Emeritus Professor Osato Giwa-Osagie; Foundation President, Professor Oladapo Ashiru; and Rapid Response Committee member, Professor Boaz Adegboro, the Academy said the evacuation was permissible under the International Health Regulations (IHR) 2005, provided appropriate safeguards were observed.
The statement reads: “The Academy of Medical Sciences of Nigeria (AMedS) has noted the confirmation by the
Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, that
Nigeria's index case of Bundibugyo virus disease (BVD) was medically evacuated from Abuja to Switzerland this morning, together with her asymptomatic spouse.
“The Academy's assessment is that a properly coordinated medical evacuation of a clinically stable patient to her own country of nationality, under strict biosafety
protocols and with the agreement of both governments, is permitted under the
International Health Regulations (IHR, 2005) and consistent with WHO practice. It also follows international precedent: in 2014 Switzerland, Germany, Spain, the UK and the US received evacuated Ebola patients for care in high-level isolation units.
“The evacuation does not, however, end Nigeria's outbreak response. The decisive work now lies with the 53 contacts under follow-up, the health workers who cared for the patient, and the gaps this case has exposed,” the statement warned.
On whether the evacuation is consistent with international regulations, the Academy said: “Yes, in principle. The IHR (2005) does not prohibit the medical evacuation of a patient with a dangerous infectious disease. They require that any such movement be notified, coordinated between States, carried out with measures that prevent onward spread, and done with respect for the patient's dignity and rights.
“WHO's long-standing Ebola guidance, including the 2014 temporary recommendations, advised that confirmed cases should not travel internationally except as part of an appropriate medical
evacuation. This was such an evacuation. It also follows international precedent: in 2014 Switzerland, Germany, Spain, the UK and the US received evacuated Ebola patients for care in high-level isolation units.
“To remove any doubt, the Academy asks the Federal Ministry and NCDC to publish a short account of the evacuation protocol, the WHO and Swiss coordination, and the
decontamination steps taken.”
“At departure, the Minister reported that she was stable, conscious and communicating, with laboratory parameters returning towards baseline. He cautioned that clinical improvement does not mean she is no longer infectious; NCDC reported her samples remained positive on 25 October. Her husband's samples were negative.
While accepting the legitimacy of the evacuation, the Academy warned: “The outbreak is not over, the source case leaving the country does not reduce
the risk among the 53 contacts, who include health workers and domestic staff.
Each must complete 21 days of follow-up, and WHO requires 42 days without a
a new case before an outbreak can be declared over.”
Beyond the evacuation, the Academy raised concerns about the time taken to identify the infection. It noted that about 13 days passed between symptom onset and testing, and the patient was seen at more than one private facility.
“This exposed health workers and shows a low index of suspicion for viral haemorrhagic fever in febrile travellers, despite a PHEIC declared in May.”
The timeline, the Academy said, highlighted the need for greater suspicion of viral haemorrhagic fevers among febrile patients with relevant travel histories, particularly during an international public health emergency.
Acknowledging the work of Nigerian doctors, nurses, laboratory scientists and public health officers who cared for the patient, the statement said the evacuation underscored disparities in access to specialised treatment.
“A foreign national could be flown to a high-level isolation unit abroad; a Nigerian patient could not,” it said, calling for a healthcare system capable of providing an appropriate standard of care to everyone, regardless of nationality.”
It recommended establishing at least one high-level isolation and treatment unit in each geopolitical zone, staffed by trained personnel and supported by access to investigational therapies through WHO-coordinated clinical trials.
Among recommendations to the Federal Ministry of Health and Social Welfare and NCDC, the Academy called for publication of a brief account of the evacuation: the IHR coordination with WHO and Switzerland, the transport and decontamination protocol, and the arrangements for sharing clinical and laboratory data.
“Government should ensure complete 21-day follow-up of all contacts, with daily monitoring, rapid testing of any who become ill, and fully funded welfare for those in quarantine, offer occupational health follow-up and psychosocial support to every exposed health worker.
“The government should also issue a national alert to all public and private facilities to take a travel history from every febrile patient, and to isolate and test promptly anyone linked to affected areas, and establish at least one high-level isolation and treatment unit in each geopolitical zone, with trained staff and access to investigational therapeutics through WHO-coordinated trials, secure Nigeria's share of specimens and sequence data, and support Nigerian scientists to lead the source investigation with WHO, Uganda and Kenya.
“Nigeria contained Ebola in 2014 through speed, discipline and the sacrifice of its health workers. The same qualities are needed now. The Academy stands ready to offer its Fellows' expertise in clinical care, infection control, laboratory science and public health to the national response,” the Academy stated.
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