Lead Writers: Ibukun Oguntola, Dr Aishat Usman, and Dr Virgil Lokossou
Walking through the bustling streets of Owo, a small town in the southwestern region of Nigeria, one might encounter the vibrant energy that characterises this town. Yet, beneath this lively facade lies a significant public health challenge: Lassa fever. This persistent virus has sustained one of the most challenging infectious disease outbreaks in West Africa, revealing the delicate connection between humans, animals, and the environment.
However, while Lassa fever outbreaks are often met with a combination of country response and international partners in the affected West African countries, there is a deeper question — who truly owns the fight against this disease? Who takes the lead in advancing research, vaccine development, and increasing public awareness? We must take a closer look, as country leadership is needed in setting national health priorities.
Lassa fever causes an estimated 100,000 to 300,000 infections each year, causing around 5,000 deaths. These numbers are potentially the tip of the iceberg. In heavily affected areas, poor diagnostics and weak surveillance systems often mask that scale, leaving countries struggling to ascertain the real burden and making it harder to target interventions, allocate resources effectively, and guide research.
This is one gap that the ENABLE study is attempting to fill by assessing and characterising the incidence of Lassa fever virus (LASV) infection in multiple countries through a coordinated governance structure and a harmonised study protocol. Results of this effort will provide critical insights about Lassa fever and will inform future late-stage clinical trials for promising Lassa fever vaccine candidates.
West African countries continue to struggle with limited in-country clinical, laboratory, research, and regulatory capacity, especially since the 2014 to 2016 EVD epidemic. Funding for Lassa fever research has been insufficient, and a lack of economic incentives for investment limits progress, as the disease remains endemic in under-resourced areas of West Africa.
Challenges in disease surveillance, fragmented healthcare services, limited public awareness, and insufficient cross-border collaboration exacerbate the ongoing risks posed by Lassa fever. Studies have also shown that changes in environmental conditions, driven by land use and climate change, may increase the risks of LASV spillover from rodent reservoirs, leading to changes in LASV transmission patterns and causing more frequent Lassa fever outbreaks.
There is currently no licensed vaccine for Lassa fever, despite its significant public health burden. Limited medical countermeasures such as therapeutics exacerbates the challenges faced by healthcare systems in endemic regions. Research suggests that a safe,effective vaccine could save thousands of lives over the coming decade while reducing substantial economic burdens.
The West Africa Health Organisation’s role in Regional Coordination
Achieving Lassa fever preparedness in West Africa depends on a delicate balance between regional cooperation and national ownership. Countries must strengthen surveillance systems, invest in local capacity building, and ensure that Lassa fever preparedness is a national priority. At the same time, regional entities like the Economic Community of West African States (ECOWAS) and West Africa Health Organisation (WAHO) must lead cross-border coordination, to foster a united approach against a shared public health threat.
In recent years, ECOWAS and WAHO have made significant progress in promoting regional coordination for epidemic preparedness and response. Through WAHO, the Regional Centre for Surveillance and Disease Control (RCSDC) facilitates collaboration among countries to strengthen disease surveillance and early warning systems. These organisations work to align national Lassa fever preparedness plans with regional strategies and international frameworks.
WAHO is further strengthening regional coordination through the establishment of the Lassa Fever Vaccine Coalition, a collaborative initiative that aligns national and regional priorities for Lassa fever preparedness.
Through this coalition, WAHO is also facilitating the integration of vaccine initiatives into broader preparedness plans and is creating an ecosystem where resources, expertise, and efforts converge to advance Lassa fever preparedness and resilience across West Africa.
The need to enhance country ownership of preparedness efforts
While regional coordination is critical, countries must take ownership of their preparedness initiatives to ensure sustainability and resilience. Local leadership enables governments to allocate resources and prioritise Lassa fever on their national health agendas, paving the way for more sustainable, responsive, and effective disease control efforts across West Africa. Strengthening in-country leadership and engagement is key to developing effective, context-specific response strategies that foster trust and ensure community buy-in.
Ownership begins with strengthening national preparedness plans aligned with regional and global frameworks. Ministries of Health must conduct risk assessments, ensure adequate supplies of personal protective equipment (PPE), and develop tailored response protocols. They must also ensure that communities are aware of Lassa fever risks and are actively engaged in prevention efforts.
A recent study highlighting the importance of community-driven initiatives in managing infectious diseases, emphasised that effective community engagement and education campaigns that involve local leaders, health workers, and civil society organisations can significantly enhance early detection and reporting. By fostering local ownership and bottom-up involvement, this approach ensures that national strategies are well-informed and align with local realities, while empowering citizens to take preventive actions, such as improving sanitation and reducing rodent exposure, crucial for addressing Lassa fever risk factors.
In recognition of the need for stronger national involvement in Lassa fever vaccine research and development, efforts and to ensure that national interests and priorities are addressed in current international efforts to develop and advance vaccine candidates, Nigeria, Liberia, and Sierra Leon established Lassa Vaccine Taskforces. These task forces, led by national health authorities, oversee research and development efforts, review existing research and vaccine development efforts, identify knowledge gaps and research priorities, develop vaccine roadmaps, coordinate and facilitate collaborations among relevant stakeholders, secure funding, establish surveillance systems for monitoring Lassa fever outbreaks and collect epidemiological data. In addition, they ensure adherence to ethical standards and regulatory requirements in all vaccine development activities, as well as promote effective vaccine adoption strategies for Lassa vaccine candidates.
Building a resilient future for Lassa preparedness: The Lassa coalition use-case
This year saw the start of the first-ever Phase 2 Lassa vaccine trial, carried out in Nigeria, Liberia and Ghana. As progress continues, the need for coordinated action is becoming increasingly clear. Organisations like CEPI have been instrumental in driving vaccine research and development. However, successfully introducing and deploying the vaccine will require a comprehensive coalition that aligns country, regional, and global efforts, led by the most affected countries.
With CEPI’s support, WAHO is working to establish a Lassa fever vaccine coalition. This coalition is led by a governing entity that includes the Health Ministers from the most affected countries. The coalition will bring together stakeholders to address the complexity of vaccine development and ensure effective distribution.
WAHO recognises that developing and deploying a Lassa fever vaccine is a complex challenge. It requires not only scientific advances and clinical progress, but also resource mobilisation, regional coordination, and community engagement. The coalition seeks to address these gaps through an end-to-end approach that prioritises country ownership and effective communication with stakeholders at all levels.
The coalition’s work will include several critical areas, including:
.raising awareness and advocacy: supporting evidence generation to raise both global and local awareness of Lassa fever and advocating for policies and financing to sustain vaccine initiatives.
.guiding vaccine decisions: generating data on disease burden, cost-effectiveness, and the potential impact of vaccination to inform country-level decisions as part of broader Lassa fever control strategies, including improved surveillance systems.
.facilitating clinical development and planning: collaborating with vaccine developers to support clinical trials and demand forecasting to align supply with public health needs.
Four key areas for intensifying country ownership in Lassa preparedness initiatives
(1) Political commitment: high-level political buy-in is essential to ensure that Lassa fever preparedness remains a priority in national health agendas. This can be achieved by supporting the establishment of initiatives such as Lassa Taskforces, led by government stakeholders. For existing taskforces, efforts should focus on enhancing their effectiveness through increased financial prioritisation, the development and implementation of robust policies to advance their agenda, and strategic investments in public health infrastructure to strengthen preparedness and response capacities.
(2) Strengthened policy development and Implementation: developing and implementing robust national policies is vital for creating a comprehensive Lassa fever preparedness framework. Such policies should prioritise vaccine research and development, including funding for local clinical trials and fostering partnerships with international health organisations and research institutions.
(3) Capacity building: strengthening the capacity of public health institutions in endemic countries is essential for supporting vaccine trials and ensuring the success of vaccine development initiatives. Investments should focus on training healthcare professionals, especially in areas where trials will be conducted to improve their technical expertise in vaccine research, clinical trials, and outbreak response. Enhanced infrastructure for laboratories and healthcare delivery systems will also play an important role in facilitating vaccine-related activities.
(4) Public awareness and community engagement: community-level education is critical for raising awareness of Lassa fever prevention and control measures. Engaging communities in discussions about vaccine development and the importance of immunisation will build trust and increase vaccine acceptance, once a vaccine becomes available. Tailored communication strategies that address local beliefs and concerns are key to ensuring widespread public support and uptake of an eventual Lassa fever vaccine.
As we look towards a future where Lassa fever outbreaks are minimised and contained, the development of an effective Lassa fever vaccine is crucial, as demonstrated by other outbreaks. By boosting country coordination and ownership, West Africa can strengthen its resilience and protect its populations through widespread vaccination efforts.