Chikwe Ihekweazu tried to steel himself as he surveyed people writhing in pain beneath ramshackle tents in the deserts of northern Nigeria. A deadly epidemic of meningitis had swept through the region in 2017, debilitating so many people that clinics had run out of space.
The tragic scene laid bare the challenges ahead for Ihekweazu, who had just been appointed director of the nation’s first agency tasked with tracking and responding to outbreaks, the Nigeria Centre for Disease Control (NCDC). Local health workers either didn’t know to report cases, or reporting lagged behind because they lacked electricity to charge mobile phones and laptops. Samples of spinal fluid spoilt before they reached the NCDC’s microbiology laboratory in Abuja, which made it impossible to confirm diagnoses — a requirement for unlocking access to international stockpiles of vaccines. As the agency struggled to count cases, the outbreak wore on, eventually infecting more than 14,000 people and killing almost 1,200. “That’s when it became clear how quickly things can fail,” says Ihekweazu.
Nigeria is Africa’s most populous nation and its biggest economy, but it is also the world’s poorest, as measured by the number of people living in extreme poverty. It is routinely battered by infectious diseases: meningitis, measles, cholera and newly emerging threats that plague communities and raise alarms around the world.
Ever since the Ebola crisis of 2014–16 — from which Nigeria was largely spared — global-health leaders have been fretting about the possibility of an epidemic exploding in Lagos and spreading to London, New York, Mumbai or Beijing. Many argue that the best hope of mitigating such a catastrophe will come from the capacity of African nations to catch outbreaks early and stem their spread. Ihekweazu had written about this necessity long before it was in vogue — but he never imagined leading the effort himself.
Yet just two years after his appointment, he has more than doubled the size of the NCDC staff, set up a network of molecular-biology labs across the country and become the steward of multimillion-dollar grants intended to diffuse the threat that an epidemic in Nigeria poses for the rest of the world. On his watch, the nascent agency has battled about a dozen outbreaks, which have infected more than 70,000 people (see ‘Keeping tabs’). “We are building the ship while we are sailing,” Ihekweazu says. Now he has another two years to transform the NCDC into an organization that will operate successfully long after he’s gone.
Many have faith that he can do so, because he’s proved to be an agile leader in a fragile part of the world. Furthermore, they hope that his strategies in Nigeria might be repeated elsewhere on the African continent, such as in the Democratic Republic of the Congo.
“Chikwe is showing that Africa can do what is needed, when it’s needed,” says David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine. “He is leading the way in how things can be done.”