FEATURE… LASSA FEVER: How mistrust in health care system may  shape acceptance of vaccine introduction in Nigeria  

Despite rising spread of Lassa fever in Nigeria, deep-seated distrust in the health system continues  to undermine timely care-seeking and confidence in public health interventions. These dynamics  raise important considerations for the future introduction of Lassa fever vaccines. Repeated  experiences of misdiagnosis, delayed treatment, and symptoms that closely resemble malaria or  typhoid have left families with lingering concerns.  

In many cases, patients arrive at health facilities only after critical delays, or not at all, reinforcing  fear and skepticism towards hospitals. These challenges are most visible in Edo and Ondo states,  which consistently bear the highest burden of the disease of Lassa fever, and where preparedness  for immunisation will depend as much on rebuilding trust and community engagement as on  scientific progress itself. 

Thirty‑year‑old Theresa Chinenye died of Lassa fever in 2024 after her illness was first treated at  home as malaria and typhoid. When her fever began, the young nurse living in Owo, Ondo State  responded the way most families in her community would – she assumed it was malaria or typhoid  and relied on home‑based remedies.

Lassa fever Isolation ward at Federal Medical Center in Owo, Ondo State Southwest Nigeria. Photo  Credit: Abdullahi Muritala

According to her sister‑in‑law, Rachel Udeh, Theresa’s condition began to shift in ways the family  didn’t expect. The fever was followed by persistent vomiting and diarrhea, symptoms that looked  like the malaria and typhoid they were used to managing at home. Even as a nurse, Theresa  initially treated herself the same way many people in Owo would.  

When her illness worsened, the family took her to Saint Louis Hospital in Owo. After several days  without improvement, doctors referred her to the Federal Medical Centre (FMC) Owo for Lassa  fever testing, a process they were told could take up to three days. Theresa could still walk when  she arrived at FMC, but she came in at a point when Lassa fever is much harder to treat. 

Within days, everything changed. Her condition deteriorated rapidly, and doctors reported kidney  complications. She was moved to the Lassa fever isolation ward, where family contact was reduced  to brief phone calls. Rachel said the speed of her decline was almost impossible to understand,  especially because Theresa had seemed stable when she first arrived.

Mrs Udeh Rachel, sister-in-law to Theresa recounts her ordeal with Lassa fever in Owo, Ondo State. Photo credit: Abdullahi Muritala

Outside the hospital, fear spread just as quickly. Neighbours kept their distance. Friends avoided  the house. For Rachel, the experience left a deep mark. Watching her sister‑in‑law walk into the  isolation unit and never walk out has shaken her trust in the health system. She believes her  community will likely accept a Lassa fever vaccine if one becomes available, but she herself  remains cautious. Her story highlights a difficult truth: trust in future vaccines depends on how  people are treated in the health system today. 

“When I see people who will take it and confirm. But for me, I will not try it,” she said. 

Theresa was among the 174 people who died from Lassa fever in 2024, out of 1,035 confirmed  cases recorded nationwide. In 2025, the Nigeria Centre for Disease Control (NCDC), reported a  cumulative 995 confirmed Lassa fever cases and 184 deaths, resulting in a case fatality rate (CFR)  of 18.5 per cent, higher than during the same period in 2024. These figures reflect the  consequences of delayed detection and response in a disease where outcomes can deteriorate  rapidly. 

Stigma and the Struggle for Early Diagnosis 

Following Rachel’s experience, Dr Rosemary Ikeakele notes that similar patterns are common in  communities where Lassa fever remains poorly understood, even years after the 2018 outbreak.  The 32-year-old clinician at the Research and Isolation Unit for Lassa fever at the Federal Medical  Centre in Owo, Ondo State, she says late presentation is a recurring challenge. Many patients  arrive only after managing symptoms as malaria, or delay seeking care because of fears about  what a Lassa fever diagnosis might mean for themselves and their families

Dr Rosemary Ikeakele,  clinician at the Research and Isolation Unit for Lassa fever at the Federal Medical Centre in Owo, Ondo State Photo  Credit: Abdullahi Muritala

Inside the isolation ward, fully clad in protective gear, she often encounters uncertainty shaped  by misinformation. “People ask me if Lassa fever is curable. Some ask if it is spiritual,” she  explains.  

These fears extend beyond care-seeking to research and surveillance. Patients may resist blood  sample collection, influenced by cultural beliefs about blood or concerns about how samples will  be used and whether results will be shared. “People ask what we will do with their blood and  whether they will ever see the results,” 

According to Dr Ikeakele, such mistrust contributes to delayed diagnosis, weakens research  efforts, and limits the timely treatment, reinforcing the broader challenge of preparedness for  future prevention tools. 

Overcoming Cultural and Structural Barriers to Lassa Vaccine Development 

The challenges described by clinicians in Ondo State reflect broader barriers facing Lassa fever  research and preparedness across affected communities. Fear, stigma, and misinformation  continue to shape how symptoms are interpreted and how communities engage with health  services and research, influencing both early diagnosis and participation in prevention efforts. 

Research center in Owo, Ondo State Southwest Nigeria. Photo Credit: Abdullahi Muritala

Nigeria’s struggle with Lassa fever and other infectious diseases plays out against a deeper  structural challenge. Despite carrying a significant burden of infectious diseases, Nigeria still has  limited clinical trials infrastructure to support vaccine research at scale. Over the past 25 years,  the country has registered approximately 1,185 clinical trials , a modest figure for a population of  more than 200 million people. While this is now improving although slowly, limited capacity  affects the entire research continuum from early-stage research to sustained community  engagement, and constrains the country’s ability to test and introduce new technologies in real world settings. 

According to Dr Ojeifo Stephenson, Director of Public Health at the Edo State Ministry of Health,  community engagement is the backbone of any Lassa-related research or control effort. Before  researchers collect samples or begin fieldwork, the process starts with intensive sensitisation.  

“Before we carry out any research, we do thorough sensitisation of the community,” he explains  “We first identify the community, engage them, and make them understand what we want to  do.” 

This approach is necessary because misinformation continues to influence both care-seeking  behaviour and responses to scientific interventions. As a result, some patients refuse referrals to  this specialist treatment centre in Irrua, opting instead for herbal homes. 

Dr Stephen stressed that community engagement also has to confront the fear that surrounds  sampling and diagnosis. Though communities do not openly reject researchers, hesitation often  appears indirectly in delayed reporting, reluctance to undergo confirmation testing, or resistance  to accepting positive results. 

Sensitivity: Official Use 

Doctor Stephenson Director of Public Health, Edo State Ministry of Health. Photo Credit: Abdullahi Muritala

To address this, Edo State combines door-to-door outreach, local radio jingles, and large town  hall meetings supported by partners including the World Health Organization (WHO). These  forums bring together local government chairmen, youth leaders, religious leaders, and market  associations to reinforce messages on hygiene, sanitation, early reporting, and trust in health  facilities.  

Despite the challenges, Dr Stephenson says communities are gradually becoming more receptive.  With a Lassa vaccine currently in Phase II trials, he believes, acceptance will increase if  engagement continues and trusted institutions lead future rollout efforts. “Our vision is complete  eradication of Lassa,” he says. “When the vaccine comes, people will welcome it.” 

Religious leaders at the frontline of trust-building 

Many residents of Oke Ogun, a community in Owo, Ondo State, first turn to traditional and  religious authorities when illness appears, often believing evil forces cause their symptoms. Chief  Olakigbe Gabriel, a 67-year-old community leader, says people frequently come to him with  symptoms, later identified as Lassa fever, believing they are experiencing a spiritual attack rather  than medical illness. 

During previous health emergencies, including polio and COVID-19 outbreaks, he joined health  teams, going door to door to promote safer practices and encourage cooperation. However, he  notes that past experiences of misdiagnosis and weak health systems have deepened this  scepticism.  

Chief Gabriel, a community leader in Oke Ogun Ondo State . Photo Credit: Abdullahi Muritala

“Many of our doctors are doing trial-and-error,” he says, pointing to Nigeria’s limited diagnostic  capacity and recalling how an incorrect prescription “almost killed” a friend. 

Sensitivity: Official Use 

For years, Mrs Obehi Asemota has been at the centre of health sensitisation in Usen Market, Edo  State, encouraging nursing mothers during immunisation drives, urging families to seek proper  care instead of self-medication, and helping traders understand basic disease risks. Her influence  became especially visible during COVID-19, when she persuaded hesitant women to get  vaccinated despite widespread fear.  

That history of guiding her community through health challenges has strengthened her  confidence in future prevention tools. Drawing on past acceptance of vaccines such as hepatitis B  and meningitis, Asemota believes a Lassa fever vaccine would also be accepted, especially if  trusted voices continue to lead education and engagement.  

Her experience highlights how sustained community leadership can help position market women  not just as vulnerable groups during outbreaks, but as influential drivers of vaccine acceptance in  the community, an essential consideration for future Lassa fever vaccine introduction efforts.

By: Abdullahi Muritala 

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