Deadly Outbreak Tests Nigerian Health Agency Reforms Made After the Ebola Epidemic Have Boosted Nigeria’S Capacity to Track Diseases

NEWS IN FOCUS COSMOLOGY Stephen Hawking’s ARCHAEOLOGY Excavations in POLITICS China merges its PHARMACOLOGY When is an death prompts outpouring of Kenya reveal surprising start science agencies into one antibiotic too dangerous tributes from scientists p.423 to human culture p.424 massive ministry p.425 to prescribe? p.431 PIUS UTOMI EKPEI/AFP/GETTY PIUS UTOMI

Researchers in Nigeria are racing to identify cases of Lassa fever — and to understand why the ongoing outbreak is the worst on record.

PUBLIC HEALTH Deadly outbreak tests Nigerian health agency Reforms made after the Ebola epidemic have boosted Nigeria’s capacity to track diseases.

BY AMY MAXMEN 365 people and killed 81, making it the coun- building diagnostic labs to monitor the current try’s largest recorded outbreak of the virus. But outbreak and prepare for the future. n unprecedented outbreak of a deadly public-health experts say that the toll would be Later this year, the Nigerian government viral disease in Nigeria is showcasing much greater had Nigeria not strengthened its is expected to approve legislation that would the newfound might of the country’s Centre for Disease Control (NCDC) over the make the NCDC an independent agency with Apublic-health agency. Reforms put in place past few years. The agency, Nigeria’s first line of its own budget and decision-making powers. since a devastating Ebola epidemic struck West defence against disease outbreaks, has grown “The Nigeria CDC has become stronger and Africa in 2014 have transformed how Nigeria from roughly 30 physicians in 2011 to more faster,” says Kingsley Ukwaja, a physician at the responds to infectious diseases — including than 130 epidemiologists, microbiologists Federal Teaching Hospital, Abakaliki in Ebonyi the current Lassa-virus outbreak. and other specialists today. And it is deploy- state — a hotspot for the current Lassa outbreak. Since 1 January, Lassa fever has sickened ing sophisticated data-management tools and “They came quickly with protective gear,

NEWS IN FOCUS

and have sent epidemiologists to detect the escalating Ebola crisis in Liberia, Sierra Leone outbreak and those to come. The agency is source of the outbreak, and to locate the con- and Guinea. coordinating its response at an emergency- tacts of patients who may have the disease.” “We were very lucky,” says Ihekweazu, operations centre that is modelled on “war Outbreaks of Lassa fever occur regularly in who took the NCDC’s helm in 2016 and has rooms” deployed during polio outbreaks and West Africa, where the virus is carried by rats. changed how it operates. He convinced politi- the Ebola epidemic. Staff members are moni- A person infected with the virus can spread it cians to grant the agency more autonomy to toring suspected and potential cases using to others through their blood, urine and other provide top government officials with infor- software called SORMAS, which runs on tablet bodily fluids. Symptoms of the disease include mation on outbreaks, without concern for the computers and smartphones. It was developed fever — and, sometimes, internal bleeding that political ramifica- in response to the plodding pen-and-paper can lead to death. tions. Ihekweazu has “Sometimes method used to track Ebola. The 2014–16 epidemic of Ebola, a virus that also improved how things need to Yet the NCDC still faces some significant can cause similar deadly symptoms, acceler- the NCDC interacts get worse before challenges. Many Nigerian states lack facilities ated the transformation of the NCDC. The with the public. The they get better.” to quickly diagnose diseases such as Lassa and agency launched in 2011 with medical staff agency uses televi- Ebola, Ukwaja says, making it harder for the that lacked epidemiological training or the sion, radio and social media to educate people public-health agency to fight outbreaks from authority to act fast to curb outbreaks, says about public health; that includes combatting the start. In January, three of his colleagues at NCDC chief executive Chikwe Ihekweazu, false information about how diseases such as the hospital in Abakaliki died of Lassa fever. who works in Abuja. Lassa spread. They were exposed to the virus during a four- Nigeria became part of the Ebola epidemic in “We are not where we want to be, but we are day wait for test results from samples that had July 2014, when a man infected with the virus miles ahead of where we were,” Ihekweazu says. to be shipped out of the state for processing. entered the country in Lagos, Nigeria’s largest Now, that wait has been cut to 24 hours, city. Although only 19 people in the country DISEASE DETECTIVES because the NCDC has built a laboratory in ultimately became infected, many Nigerians Now, the agency’s public-health researchers Ebonyi state that has the equipment needed to felt their country had narrowly skirted disaster. are trying to understand why the current Lassa identify Lassa fever. The facility, which began The man in Lagos visited a renowned private outbreak is so extensive. The scientists are col- operating last week, is the fourth such lab in clinic where he was diagnosed immediately. lecting samples of the virus to see whether it Nigeria. That might not have happened had he entered has become easier to transmit; they are also “Sometimes things need to get worse before one of the general hospitals that serve much of exploring other hypotheses, such as whether they get better,” says Richard Garfield, an epi- Nigeria’s population, and often lack equipment, people are living in closer contact to the com- demiologist who advises the US Centers for doctors and nurses. mon African rats (Mastomys natalensis) that Disease Control and Prevention. “Pretty much In addition, international health organiza- can carry the virus. everything big we have done in epidemiology tions were poised to assist Nigerian authorities NCDC workers are also building long- was in response to a problem we didn’t know because they had already been alerted to the term infrastructure and systems to battle this how to handle.” ■

PUBLISHING they began receiving e-mails from academics asking about the quality of certain journals. The manager now spends four to six hours each weekend replying to these messages, and says Sites warn against that most questions come from academics con- cerned about publishing in a particular journal. If the journal titles aren’t already listed, the ‘predatory’ journals manager says, they carry out an “in-depth analysis” of the publishers’ policies, checking them against a set of criteria originally laid Blacklists emerge after closure of popular Beall’s list. out by Beall, and researching whether they are indexed on journal ‘whitelists’, such as the BY DALMEET SINGH CHAWLA to provide any further details of their identity, Directory of Open Access Journals or Journal citing fear of harassment. Citation Reports. Journals or publishers deemed hen librarian Jeffrey Beall shut Beginning in 2010, Beall, an academic untrustworthy by the manager are included in down his controversial blog listing librarian at the University of Colorado Denver, an ‘update’ addendum on the blog. By March potentially ‘predatory’ scholarly maintained a site listing thousands of open- 2018, the new site had added 85 stand-alone Wpublishers and journals last year, copies swiftly access journals and publishers that he said journals and 27 publishers to Beall’s original appeared elsewhere online. More than a year deceived authors by charging fees to publish lists of more than 1,000 titles. later, at least one of these copycat blacklists is papers without providing expected services, still growing — maintained by an anonymous such as peer review and editing. He closed the LISTS OF LISTS website manager who says that they spend site in January 2017, and later said that this was Another site, Stop Predatory Journals, also came hours each weekend working on the list. because of “intense pressure” from his employer online in January last year. It is run by a group Growing interest in the site suggests that — although his supervisor and institution have that, according to the website, consists of schol- there is still an academic appetite for a public denied this, calling it Beall’s personal decision. ars and information professionals who decided blacklist of predatory journals, says the site Sites preserving Beall’s list quickly surfaced. to “rebuild and resurrect” Beall’s list, hoping to manager, who identified themselves as a sen- The anonymous site manager says that their create a community-based approach to cura- ior research assistant in the hard sciences at own page, titled ‘Beall’s list of predatory jour- tion. But the site is not updated regularly. a European institution. The site’s keeper cor- nals and publishers’, was initially intended only “I understand their desire to be anonymous,” responded with Nature by e-mail and declined for personal use. But soon after the site went live, says Beall, who says that publishers listed

422 | NATURE | VOL 555 | 22 MARCH©2 0201818 Mac millan Publishers Li mited, part of Spri nger Nature. All ri ghts reserved. ©2018 Mac millan Publishers Li mited, part of Spri nger Nature. All ri ghts reserved.