After 50 years, Lassa fever still killing, maiming Nigerians as survivors narrate ordeal

“It is indeed a shame for Nigeria that 50 years after the disease was discovered in Nigeria, thousands of Nigerians still suffer from Lassa fever with hundreds dying every year. It is the mark of a nation that cares little for the health of her citizens and criminal neglect of the welfare her citizens.” These were the words of a foremost virologist and head of National Committee on Lassa fever, Prof. Oyewale Tomori.

Lassa fever, which is endemic in Nigeria and most common during the dry season (January-March), is a contagious haemorrhagic fever and can lead to death in more than 70 percent of hospitalized patients. It has the highest incidence of any viral haemorrhagic fever in the world.

The disease is initially contracted from contact with rats and then can spread to other people through bodily fluids, making health care workers especially susceptible. Latest figures from the Nigeria Centre for Disease Control (NCDC) showed that from January 1 to 13, 2019, a total of 172 suspected cases have been reported and of these, 60 were confirmed positive and 112 negative. It also noted that since the onset of the 2019 outbreak, there have been 16 deaths in confirmed cases and Case Fatality Rate (CFR) in confirmed cases is 26.7 per cent.

According to the Centre, eight states (Edo, Ondo, Bauchi, Nasarawa Ebonyi, Plateau, Taraba and FCT) have recorded at least one confirmed case across 17 Local Government Areas (LGAs).In 2018, Nigeria experienced the largest confirmed Lassa fever cases in a single year. Also, despite the fact the virus was discovered in Lassa town in Borno State fifty years ago, the country still continues to experience yearly outbreaks.

Despite affecting up to 300,000 people per year across West Africa, and leading to more than 5,000 deaths annually, Lassa fever is a poorly understood disease that is challenging to diagnose and treat. Only a few laboratories in affected areas can diagnose the virus—which can lead to delays in starting treatment. While initially spread through contact with infected rats, managing Lassa fever requires appropriate use of personal protective equipment and other infection prevention and control measures, to protect healthcare workers and relatives of patients.

“One of the major challenges of treating Lassa fever is the nature of the disease itself because at the onset, it mimics diseases like malaria. A lot of time is wasted before the patient actually presents for treatment, and the prognosis gets very bad if treatment is not commenced within six days from the onset of symptoms. What we can actually do to contend is to carry out routine tests on almost everybody that has fever to make sure we provide the appropriate treatment,” said Health Commissioner of Ebonyi State, Dr. Umezurike Daniel.

Tomori in his keynote address at the first Lassa Fever International Conference in Abuja, which was organized by the NCDC, said: “There was frustration in my voice as I sounded like a broken record, repeating the same recommendations for controlling Lassa fever, made on numerous occasions in times past, to deaf and uncaring government officials, and some of our colleagues who mis-appropriated or mis-applied the little fund teased out of the tight fingers of government (like blood out of a stone). Tight fingers when money is needed for good purposes, and loose fingers when resources are set aside for looting!

“I appealed to all responsible to stop embarrassing Nigeria, by calling on donors to do for us what we should and are able to do for ourselves. Will the call again be unheard by those with deaf ears and unseen by those blinded by greed? I hope we will not have to wait for another 50 years and thousands of Nigerians to die before we hear the call of sanity.”

Survivors narrate ordeal
*I feared not just for my life but for my fertility if I survived, Dr. David Eseile Eseigbe
*Surviving doctor wants life insurance, better hazard allowance for professionals working in infectious disease centres
Dr. David Eseile Eseigbe is a medical doctor/case management officer, working with the Infection Control Centre Federal Medical Centre (FMC) Owo, Ondo State, and the Alliance for International Medical Actions (ALIMA). He specialises in managing Lassa fever cases.

Prior to my admission into medical school in Ambrose Alli University, Ekpoma January 2006,the prevalence of Lassa fever and its attendant mortality was a huge health burden and public importance to the dwellers in Edo central/North and its environs.

Simply put; the fear of Lassa fever is the beginning of wisdom. The fear was confirmed when I lost a roommate of mine in 200 Level in 2007. It was a rude shock to all of us as we took very good care of him while we were thinking of malaria and typhoid before taking to Irrua specialist Teaching Hospital (ISTH) where he was diagnosed and eventually succumbed to the disease.

In 2008, a very dear and distinguished lecturer took ill of the disease and was admitted for months. All night prayers by students in College of Medicine and various religious bodies were offered. Thanks to God he survived and today he a distinguished Professor of Anatomy.

As if that was not enough we had several students dying from the ailment year in year out.The one that struck me most was a very intelligent lady preparing for her first MBBS exam (whose uncle is a medical doctor) bowed to the ailment after several efforts and medications. Her father that cared for her while on admission also came down with the disease.

Not quite long one of the student who took care of her during the ailment; a classmate of mine took ill and was diagnosed to be Lassa fever. Most of us who had contact with her were also screened and monitored though negative. My classmate was treated and got cared and today he in U.S. Thanks to early diagnosis and prompt treatment.

My curiosity grew as far as Lassa fever infection is concerned with the finding that mastomys natalensis rodent was the vector for the disease. This prompted me to do my undergraduate project with a couple of my colleagues (Drs. Iredia Evbaruese Bridget and Aihonwalan Luis Brain -Then students) and supervised by Drs. A.D Asogun, Chuks Abejegah, Ike Awunor and Chidozie Ike under the Headship of Prof S.O Abah on the prevalence of mastomys natalensis amongst rodent using ISTH a treatment facility as a case study. Most of these my teachers and colleagues are in this conference today. This was adjudged the best project during my set and it set the pace for the quest into the Lassa world.

Furthermore we often involved as medical students in ISTH in management of Lassa fever during health workers industrial actions. Having shown interest in the past in Lassa fever treatment, one of my supervisors Dr. Chuks Abejegah called me to take part in the treatment of patient. Though having a full time job with an Health Management Organisation (HMO) as a Zonal manager, I resigned and joined in rescue for the dying

Despite the news of the death of a house officer in FMC, Lokoja where I previously had my Housemanship a year and half earlier and other health worker’s death, I was moved with passion to fulfill the course I had always yearned for.I Joined as a Volunteered dedicated medical Doctor with the Alliance for International Medical Actions (ALIMA) in FMC Owo, Ondo State.

We worked as a team of four doctors, 16 nurses and 16 hygienists at the Infection Control Centre, Federal Medical Centre, Owo. We were trained on standard precautions on infection prevention and control (IPC). Standard operative procedure (SOP) for patient’s management was also given. We had a robust patient management with reduction in mortality rate. This was mainly due to adherent to standard protocol and robust team work.

While we were celebrating the successes achieved in our work in the Infection Control Centre, FMC, Owo. The unexpected happen. I developed fever, headache, malaise, joint weakness and cough. I was treated for malaria and upper respiratory tract infection. However, after complete treatment of the above, the headache, malaise and joint pains and generalized body weakness persisted.

I was given two days off duty in which I travelled to Benin to visit my sister and family. While there, my sister’s daughter of five years old developed fever and her mother had a miscarriage. My heart sank. The child was treated for malaria with both oral and parenteral anti-malaria but to no avail. The whole family was thrown into pandemonium and her sample was collected for Lassa fever testing.

I reported to my supervisor Dr. Abejegah Chuks who insisted my sample must be sent to ISTH. Our samples were sent to Irrua and after 48 hours the big masquerade was unveiled. I was confirmed Lassa positive while my niece negative on March 30, 2018 (Easter Saturday).

I was properly counseled and prayed for by Dr. Ayodeji and my other colleagues Drs. Etafo and Faith Ekwughe and the matron Mrs. Alabi with the whole team almost demoralized. Dr. Chuks Abejegah had to place the duty on himself to call members of my family to allay their fears and encourage them. It was a huge task. I was admitted into isolation at the confirmed specifically in room 10. Commenced on I.V ribavirin immediately. Perceived the metallic taste, body weakness and other side effects of the drugs.

Probable sources of infection
This could not be ascertained. Workers in Infection control centre FMC, Owo are strictly adherent to standard Protocol of infection preventing control-IPC. However, I only had blood splash on my apron while on full personal protective Equipment (PPE). Though earlier had catarrh and cough in which I had not been proven as route of contamination that is airborne.

The psychological trauma
Having been a caregiver, now a patient was one of the traumas one can ever witness. Moreso, dealing with an infectious disease with rapid onset and high mortality rate was more than enough. Having to be isolated with an attached stigma of Lassa patient was colossal

Thankfully my team of great minds at the ICC were up to the task, my family and trusted friends were all praying for me during the period of my admission. A bigger fear was the affectation of my reproductive life. Having a full knowledge of the possible side effect of the virus/drugs, my worries increased astronomically. It was a time of the usual saying in our society ‘Who send you.’

While in the ward on treatment, the sad news of a female resident doctor from Federal Medical Centre, Umuahia on April 2, 2018 who died at Irrua broke out and was reported in the Channels TV. This took me down further as I was afraid assuming the possibility of drug failure especially on the strain of the arena virus. So many thoughts (both negative and positive). It was a tough battlefield of the mind.

An encourager to other patients
While in the ward, there were circumstances where some patients who were admitted were in denial, depressed and discouraged. Just walking up to them and letting them know that I am a doctor now a patient made a lot of difference. Some patient even recognized me inside the ward and said ‘doctor you too dey sick of Lassa?’ Then who safe? Just like saying Physician heal thy self.

ALIMA/FMC provided me a safe haven during my stay as a patient in isolation ward. There were a lot of calls and visits from other organizations. Family /friends was much there for me. This actually reduced the burden of the disease from me.Having stayed on admission for eight days,and gotten the first course of ribavirin. Sample was sent back to Irrua for a Lassa reverse transcriptase polymerase chain reaction (RT-PCR) assay. Thankfully, it came out negative. It was widely celebrated by my family, friends and more even the team of superlative ICC staff. It was indeed a return from the land of my ancestors. And was chlorinated and discharged home with hematinic.

Had a follow up clinic visit. Blood, urine and semen samples were sent for investigation to ascertain viral clearance from my system. It turned out NegativeI was reunited with family and friends, though my contacts were placed on surveillance

The big battle of stigmatization
I want to quickly appreciate the contact team who went to Benin to trace my sister. They did a nice job. My elder brother Dr. Samuel Eseile did a great work in educating my family and allays their fears that the transmission is not automatic. My nieces (Mercy and victory) still ran out to hug me when I came home after discharge. My co-workers were too nice and understanding.

Continuing in the humanitarian services
I resumed back at work after a brief break. I was not stigmatized in any way. All my contacts placed on surveillance were fine. My approach to management of patient became more empathic than before. My counseling skills improved example one of my patient who wanted to jump through the window in isolation ward thinking that was the end of his.

Reflection
Yesterday Prof. Oyewale Tomori (with due respect sir) said that any health worker who comes down or dies of Lassa is an act of carelessness. There are many factors to consider. Availability of required PPEs at all time. Health workers fatigue in the face of so many patients. Appropriateness of the PPEs. Health workers motivation.

Imagine if I have died!!!! Loss to my parents, family, friends and dreams and aspiration. Today I stand as a health care survivor to recommend for a special package for health workers combating this deadly disease.We need A Life Insurance!!!! We need a special policy document on the protection and insurance for those working in these centres. Health workers who come down with the disease should be compensated.

We must be very careful and proactive before we start losing health worker force that is caring for Lassa fever patients. Some are already resigning and moving to other places for one reason or the other but we know why! No insurance. We all must be encouraged to continue the good work

Revenge and future prospect
As an individual who have had a blow from Lassa, I would want to fight back!!
I want to continue in infectious disease as a career. I want to continue in Public Health but l need guidance and sponsorship. I want to get involved in the forth-coming clinical trials and I would want to be trained and prepared for it. I want scholarship for MSc for infectious diseases. “All I have is a sense of duty towards all people and an attachment to those with whom I have become intimate,” Albert Einstein.

Governor of Nasarawa State shared how Lassa fever made him deaf for 20 yearsGovernor of Nasarawa State, Umaru Tanko Al-Makura, last week, told participants at the first international conference on Lassa fever in Abuja how he contracted the disease in 1990 that made him deaf for 20 years before he had a cochlear implant.

“Growing up with seven sisters. In my own case my mother had seven girls before alas I was born. So among these seven sisters I learnt to do virtually what all girls do from cooking to hawking of all kinds of articles like akara, magidi (what the Yorubas call agidi), groundnuts, cassava flour. That was my vocation when I was a child selling cassava flour in the market because that was what all my siblings who were only girls were doing. So it inculcated in me early in life feminine and domestic instincts of care, protection that I brought to bear in my biological children.

“That was why as a young man of 37 years way back in 1990 my two sons showed symptoms of strange sickness which was earlier diagnosed as typhoid fever. We were in hospital when on the fourth day one of them in a state of fit was clenching his teeth as the doctors were battling and trying to administer some medications. That feminine instinct in me as a father to avoid my child from cutting his lips, intuitively I just went with my finger into his mouth so that his teeth did not cut his tongue and in the course of that I got bitten on one of my fingers. It was a very slight cut but not much blood. I did not know that was the beginning of the story.

“Unfortunately that son of mine died that same day. The second son who was on admission with him was lucky to survive but he survive with a lot of burden because either by the affliction of the disease or the medication he developed profound sensory neural defects. I can recall that five days after the death of my first son I started feeling feverish and began to cough, had stomachache, palpitation, and headache. I also had difficulties breathing because by nose has been flogged and my chest was tight which made my breathing abnormal and erratic. I even had seizures a couple of times. This state of hopelessness and trial by error or hoping for a miracle to happen went on for almost two weeks when all medications could not give any relief to my condition.

“The doctors were in a frenzy and all forms of fever were diagnosed. Hay fever, yellow fever and so on. I was treated a such but there was no significant improvement in my situation in spite of the fact that I was in a teaching hospital to be precise the Jos University Teaching Hospital (JUTH) in Jos, Plateau State. In fact now as I reflect on the whole episode the idea to associate and finally link my symptoms to Lassa fever was my saving grace and no other individual than the very humble and amiable Prof. Oyewale Tomori brought this about. Yes like a say with every certainty that Prof Tomori it was who was at that time by divine intervention. I don’t know how he got to know I was in the hospital without any relief. When he came and saw me in the hospital he diagnosed my and insisted that I should by flown to a more sophisticated hospital where there will be special care for me as all medicines and medications failed. And the only designation at that time, 1990, was the EKO Hospital in Lagos and also asked that my blood samples should be sent for tests.

“My blood samples were taken to Atlanta Georgia the Centers for Disease Control. Alas when the results came it indicated I had Lassa fever. I was later to be informed by the doctors that my infection was as a result of the bite when my son was in fits. So you could see a very simple thing one might not take note of might be a source of infection. I must say if not for the professional intervention of Prof Tomori at that early stage the story would have been different.

“My dear friends I stand before you today as a product of the tragedy of Lassa fever. I was completely deaf. I still am. I have a cell profound defect of sensory neuron type and had to live with that for 20 years before help came near. I was using hearing aids that I could not benefit much. May be the benefit was just about 30 per cent. I was basically reading lips and hearing aids augments until I had a successful procedure that ensured that I had cochlear implant in 2010, which mechanically processes the sound I hear although with some amounts of distortion. I endure a certain measure of physical discomfort because everyday I have to wear a hearing aid for almost 18 hours before I go to sleep. It was the same case for my son who was lucky to survive. He is also living with this burden.

“But for me I honestly consider myself to be very lucky and very privileged person who in spite of the challenge of hearing impairment caused by Lassa fever I have survived to tell my story. This is why I am here to day before this distinguished gathering to encourage all of us to rise to the challenge may be because of my condition my senses have become naturally heightened to the pain of a million other people who have lost their limbs, eyes and their arms and other senses and have to manage how to face life with all these challenges on their own even in a more pedestrian ordinary way. I see such persons and I can easily feel all the endless psychological trauma and bodily pain they have to endure. That is why even if I have to stand before you as a product of the tragedy of Lassa fever I am also proud to say that I typify the adage ‘There is ability in disability.’

“I believe a conference and interphase such as this are things that are likely to make many abilities in disability and also protect a number of people who would have been disabled. So that is why my motive when I got into politics has been to take development to the full flung corners of our society. To those who are poor, excluded, voiceless, forgotten, detached from the titles of power simple because they are disabled, disadvantaged by virtues of certain preventable diseases.

So let us try as much as possible to prevent diseases particularly such as Lassa fever, we will be able to save lives and partake in the development of our societies.

“So that was what informed my desire and audacity to dare contesting the office of Governor in 2010, twenty years after my aborted attempt in 1990 then when I was physically sound and holding the position as the then Secretary of NRC in the then Plateau State. However that did not quench my desire and commitment to seek a platform where I will inspire and advocate and lift, encourage and take decisions that can give equal opportunity to all especially those that are disadvantaged. As God will have it, I won the election in 2011 and got reelected in 2015. But in six months I will be on my way out as the Governor of Nasarawa State for eight years. So with this in mind when I became Governor in 2011 I led the peaceful demonstration to National Assembly in 2012 to demand the enactment of disability law in Nigeria that will ensure full integration of persons with disabilities into the society and to establish a national commission for persons with disabilities and face it with the responsibility for their education, health care and protection of their social economic and civil rights.

“In addition my executive bill in Nasarawa state was sent to the state house of assembly for disability law enactment and I am happy to say it has passed by the assembly. As I speak to you today I have signed into law the Nasarawa State disability law. With that we have what we call the disability rights commission in Nasarawa state. I have also established a functional comprehensive special school in Lafia which caters for children with disabilities especially the blind, the deaf, the physically challenged and also the Down Syndrome where special learning skills are offered from Kindergarten level up to secondary school level for free. This I did because as far as I am concerned there is correlation between disability and poverty. You find a lot of times people who are disabled finding it more difficult to live a normal life not because of the disability but because of the cost implication of managing the disability hence such school becomes necessary.

“Today and in this very timely and all important conference that we are gathered here today to sound an important wake up call to the entire country and indeed the African continent and the world at large that Lassa fever has been with us now for about 50 years without any end in sight or any clear and decisive preventive mechanism, I feel Lassa fever has over stayed its welcome. I feel it has stayed too long and we must kick it out of this country. By the time I contacted Lassa about 30 years ago medical information about the disease was scanty. The treatment at that time was barely experimental or should I say was at elementary level and the healthcare facility we had in my hometown Lafia and in the entire country at that time was grossly inadequate. So given the circumstance experts in the diagnosis and treatment of Lassa was not only readily available especially there were no special disease labs here hence my specimen had to be taken to a more advanced laboratory in America for test.

“Above all this as my contribution to the eradication of Lassa and other dangerous communicable diseases we are building a comprehensive laboratory and diagnostic integrated centre in Lafia that is likely to be one of the centres for diagnosis of Lassa fever before the end of the year. My government is building this and the project is about 80 per cent completed and we intend to seek collaboration with NCDC and other similar organisations. All these are my modest responses to my affliction with Lassa fever and my way of saying thank you God for keeping me alive to be here today and share my story which I hope will inspire you to keep up the battle against Lassa fever.

“Distinguished ladies and gentlemen let us rise up to the challenge and defeat Lassa fever once and for all.” NCDC initiates response to rising Lassa fever cases in Nigeria.There has been an increase in the number of Lassa fever cases reported from several states across the country since the beginning of the year. Recent epidemiological data shows that this trend usually occurs during the dry season, between January and April.

Given this increase in reported cases of Lassa fever, the NCDC has declared this an outbreak and activated an Emergency Operations Centre (EOC) to coordinate the response. Chief Executive Officer (CEO)/Director General (DG) of NCDC, Dr. Chikwe Ihekweazu, said the national EOC includes representatives from the World Health Organization (WHO), Federal Ministry of Agriculture and Rural Development, Federal Ministry of Environment, US Centers for Disease Control, as well as other partners.

Ihekweazu said in preparation for this year’s emergency phase, NCDC has been providing support to states including the provision of emergency supplies and deployment of Rapid Response Teams (RRT). The RRTs will work with states in response coordination, contact tracing, case management, risk communication and strengthening infection prevention and control practices.

He explained: “Since the Lassa fever outbreak in 2018, NCDC has worked with states to ensure better preparedness and improved response. In the last one year, guidelines have been revised, new data management tools have been developed and the laboratory network has been strengthened. Additionally, risk communications has been strengthened through radio, posters, flyers and social media. A national research plan has been developed, to enable its full integration into the outbreak response to gain a better understanding of the disease.”

NCDC advised members of the public to focus on prevention by practicing good personal hygiene and proper environmental sanitation. “Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households, and other measures to discourage rodents from entering homes. Hand washing should be practiced frequently. The public is also advised to avoid bush burning.”

The epidemiologist added: “Health care workers are again reminded that Lassa fever presents initially like any other disease causing febrile illness such as malaria; and are advised to practice standard precautions at all times, and to maintain a high index of suspicion. Rapid Diagnostic Test (RDT) must be applied to all suspected cases of malaria. When the RDT is negative, other causes of febrile illness including Lassa fever should be considered. Accurate diagnosis and prompt treatment increases the chances of survival.

“The national guidelines for Infection Prevention and Control, as well as Lassa fever case management have been developed, disseminated to States and are available on the NCDC website for download (http://ncdc.gov.ng/diseases/guidelines).“The Nigeria Centre for Disease Control remains committed to supporting all States’ public health teams to prevent and respond to public health threats.”

Other survivors and what to do with them
Tomori said: “Governor AlMakura rose from the ordeal, the suffering and the trial of Lassa fever to become the number one citizen of Nasarawa State and one of the highly respected and acclaimed of the 36 governors in Nigeria. There are many survivors, some suffering- more, or as much or less than Governor AlMakura. The message to them is to emulate and take courage from the life of Governor AlMakura. Tanko AlMakura continues to translate his experience into positive action, bringing his personality and using the resources of government to address the neglected issues of people living with disability.

“During the conference we also listened to Dr. David Eseile, a doctor who spoke on ‘Battling Lassa fever Viral infection: a survivor’s story’. It was another story of fear turned to courage as the young doctor determined in his mind not to succumb to Lassa fever. He recovered and has now dedicated his life to creating awareness of the disease and efforts to prevent infection, especially of the highly exposed healthcare workers. We have not done well as a nation by Lassa fever survivors. We have neglected them, ostracize them and excluded them from benefitting from the resources of Nigeria and as Nigerians. We have often classed them as lower than the rest of us. We need to follow up on the survivors and care a little more for them.”

Take home from conference
Minister of Health, Prof. Isaac Folorunsho Adewole, said it is clear that the changing environment and population dynamics, along with the improved capability to detect these cases is also increasing. “Therefore, we have to continuously build resilient health systems that can prevent, prepare, tetect, respond to and control these infectious disease outbreaks,” he said.

The Health Minister added: “Most of the cases of Lassa fever in the world, occur in Nigeria, therefore we should be at the heart of the response. We, in Nigeria have developed a Lassa fever research plan, which is aligned with the global Lassa fever research agenda.

“I am pleased that there is a growing global focus on developing vaccines, improved diagnostics, better therapeutics and other interventions for responding to viral haemorrhagic fevers such as Lassa fever disease. Hopefully, a few years from now, we will have more tools in our arsenal for preventing, detecting and responding to cases of Lassa fever.”Tomori said the 50 years of Lassa fever conference was not and could never have been a celebration, it was a cerebration because there was nothing to celebrate. “It was fifty years of a conundrum- a problem that got much worse, hotter, longer and devastating. It was fifty years of neglect of a problem by a leadership of “Polu-ticians” who did not care a hoot about the health and welfare of the people, they were aided by academicians and scientists who had no characteristics befitting the titles of scientists and academicians,” he said.“The Abuja meeting on Lassa —-Rising to the challenge, was to be a thinking time where we use our brains to think out solutions to the Lassa problem. It was meant to be a cerebration, and not a celebration.”

Recommendations
*Lassa Fever has been with us for far too long for us to do something positive about controlling it.
*We need to improve on our environment so that the rodents (harbouring Lassa virus) can return to the natural peri-domestic forest zones and reduce the s=contact and spread of Lassa virus to humans.
*Work on Lassa fever control from the One Health concept- involving and embracing a multidisciplinary (physicians, veterinarians, scientists, social scientists, community groups) approach.
*Recognize and appreciate national scientists and technical experts’ commitment to Lassa fever control.
*Improve and enhance Nigerian National Commitment to Lassa fever control – provide adequate funds, improve infrastructures, protection for health workers
*Get involved in finding a suitable vaccine for Lassa fever by creating the environment for human Lassa fever vaccine trials, committing to the activities of the Coalition for Epidemic Preparedness Innovations (CEPI), supporting the new national vaccine production company -Biovaccines Nigeria Limited to actively participate in eventual production of Lassa fever vaccine locally, and providing the resources to upgrade the National Agency for Food Drug Administration and Control (NAFDAC) to become our National Regulatory Authority NRA to license the Lassa fever vaccine.

“Again some, if not all these recommendations were made at least on five occasions- in 2000, 2005, 2007, 2016 and now 2019…. but it appears that the government that will listen has not yet been elected,” Tomori said.