Angulo Containment Transcript


Angulo Containment Transcript


[T]he huge success was the spread of Ebola into Nigeria that had occurred a month earlier. In Nigeria, we were fortunate that we had several collaborations in place. The introduction into Nigeria was a single person ill on an airplane and introduced it into Lagos, and secondary and tertiary transmission occurred in Lagos and then it also spread to Port Harcourt, a second city. When I joined the International Task Force, besides leading the response in Senegal, my team picked up the Nigerian response although it was well in its--it was quite a mature response. I led the lingering activities that were in Nigeria, and I learned a lot from that Nigeria experience because what Nigeria showed us was how vitally important it is to rapidly identify all of the controls and to monitor them and prevent secondary transmission. But in order to do that, the success story in Nigeria was that there was a Field Epidemiology Training Program, an FETP, that was very robust, in particular because of the polio resources. Polio's resources that were provided to the FETP in Nigeria led to well-trained field epidemiologists that were used to being in the field and finding cases. In some of the polio trace-backs, they found cases, even in the most difficult settings, and knew how to do contact tracing in a very robust way and to monitor the contacts. That EIS-matured program, experienced EIS program, was just phenomenal. They immediately went to the field in the Ebola outbreak and broke the chains of transmission.

The second thing was because of the polio effort, there was an emergency operations center concept and program in Nigeria, so that when Ebola was introduced, they immediately set up an emergency operations center to coordinate and make all the decisions rapidly. These decisions, which sound simplistic, but the emergency operations center for example had the ability to immediately allocate resources, small resources. In some of our other countries' responses, paying for the taxis, which was a minimal expense, would take a week to get the necessary signatures to pay for. But here in the EOC in Nigeria, they were able to immediately allocate funds. Although they did get some of the funds from private partners, so in some instances, even going through the government was not quick enough, they got additional resources added. But nonetheless, they had a mechanism to make decisions rapidly to, how do we respond? So the FETP, the EOC, and then they had a robust laboratory program network because of the polio. All those pieces were in place mainly because of our--in large part because of CDC country office partnership with the Ministry of Health, and we had their trusted relationship with the Ministry of Health. All those programs together allowed CDC to contribute to quite a robust response in Nigeria and rapidly contain the introduction.

We learned a lot from that in our team as we were starting up this Unaffected Countries Team, we called it, in the third week of August. I remember that we were fortunate that on my first or second day, Frank Mahoney had returned from Nigeria and came to the EOC, and I sat down with him and debriefed him, and he shared all these stories about the success in Nigeria, and we learned from that, that those are the things we needed to focus on for our responses in the other countries. We began to focus our energy on controlling Senegal, but rapid concerns about well okay, if this could happen in Senegal and happened just a month earlier in Nigeria, what about Côte d'Ivoire or any immediately neighboring country? And also, any country. Like Nigeria demonstrated, it doesn't have to be an adjacent country. Any other country that has connections, flight connections, there could be transmission. What can we do to strengthen the neighboring countries so that it does not spread out of these heavily affected countries?


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