Strengthening outbreak response in West Africa: Insights from a Nigerian simulation exercise

Abstract

Introduction Recurrent outbreaks of emerging diseases highlight the need for efficient epidemic preparedness and response mechanisms in Nigeria. Simulation exercises are essential for evaluating response capabilities and strengthening public health emergency preparedness. In February 2025, Irrua Specialist Teaching Hospital (ISTH), Nigeria, conducted a field simulation exercise on the Sudan Virus Disease (SVD) outbreak in a rural community. The objectives were to assess the reproducibility of the World Health Organization (WHO) simulation exercise cycle in rural settings, evaluate existing response procedures, test coordination during emergencies, and identify areas for improvement. Methods The simulation adhered to the WHO simulation exercise cycle, comprising pre-exercise, exercise conduct, and post-exercise phases. Pre-exercise activities included establishing an exercise management team, developing an action plan, engaging stakeholders, conducting participant briefings, and developing the master scenario and evaluation tools. The two-day exercise simulated multiple SVD cases, prompting activation of emergency response structures. Participants, organized under emergency response pillars, undertook tasks such as community engagement and risk communication, case management, mobile laboratory diagnostics, contact tracing, safe burial practices, and coordination of the Emergency Operations Centre (EOC). Performance was evaluated by independent observers using a standardised checklist, immediate debriefs and a formal post-exercise review. Results The exercise confirmed that all WHO simulation phases are reproducible in the Nigerian rural setting. Effective pre-exercise planning and stakeholder engagement, particularly through the Community Advisory Board, addressed community resistance. ISTH demonstrated a high level of preparedness, with average performance scores of 80% across all tasks. Identified gaps included poor communication and instruction dissemination, inadequate access control at the isolation area, a lack of centralised waste management system, and vehicular breakdown. Conclusion The exercise provided insights into institutional preparedness for emerging infectious disease outbreaks. Replicating such simulations across other Nigerian States and the West African sub-region is recommended to strengthen epidemic preparedness.