Despite the growing prevalence of Lassa fever in Nigeria, Distrust in the medical system Confidence in timely care requests and public health interventions continues to be undermined. These developments raise important considerations regarding the introduction of future Lassa fever vaccines. Repeated misdiagnoses, delayed treatment, and symptoms similar to malaria and typhoid fever have left families with lingering concerns.

Patients often arrive at health facilities only after significant delays, or not at all, reinforcing fear and skepticism toward hospitals. These challenges are most evident in Edo and Ondo states, which consistently have the greatest burden of the disease Lassa fever, and where vaccination readiness depends as much on rebuilding trust and community engagement as on scientific progress itself.

30‑year‑Elder Teresa Chinenye died of Lassa fever in 2024, after initially being treated at home for malaria and typhoid fever. When the young nurse in Owo, Ondo State started developing a fever, she reacted like most families in her area. Thinking it was malaria or typhoid fever, he went home.‑treatment based on.

according to her sister‑in‑According to the law, Rachel Uhde, Teresa’s condition began to change in ways the family had not expected. The fever was followed by vomiting and diarrhea, similar to the malaria and typhoid fever he was used to at home. Even as a nurse, Teresa initially treated herself like many people in Owo.

When her illness worsened, her family took her to St. Louis Hospital in Owo. After several days of no improvement, doctors referred her to the Federal Medical Center (FMC) Owo for testing for Lassa fever, but were told that testing could take up to three days. Teresa was still able to walk when she arrived at FMC, but her Lassa fever was much more difficult to treat.

Everything changed within a few days. Her condition rapidly deteriorated and doctors reported kidney complications. She was transferred to the Lassa fever isolation ward, where her contact with her family was reduced to short phone calls. Rachel said it was almost impossible to understand the speed of her decline, especially since Teresa seemed stable when she first arrived.

Fear spread quickly outside the hospital as well. Neighbors kept their distance. Friends avoided the house. For Rachel, the experience left a deep scar. looking at her sister‑in‑The law that requires her to stay in an isolation ward and never leave has shaken her faith in the health system. She believes the community will likely accept a Lassa fever vaccine once it becomes available, but she herself remains cautious. Her story highlights the difficult truth that confidence in future vaccines will depend on how people are treated in today’s health care system.

“When you see people pick it up and try to check it out. But for me, I don’t want to try it,” she said.

Teresa was among 174 people to die from Lassa fever in 2024, out of 1,035 recorded cases nationwide. The Nigeria Center for Disease Control (NCDC) reported a cumulative total of 995 confirmed Lassa fever cases and 184 deaths in 2025, resulting in a case fatality rate (CFR) of 18.5%, higher than the same period in 2024. These numbers reflect the impact of delays in detection and response in this disease, where outcomes can deteriorate rapidly.

Stigma and the fight for early diagnosis

Echoing Rachel’s experience, Dr. Rosemary Ikeaker points out that, years after the 2018 outbreak, similar patterns are still common in areas where Lassa fever is poorly understood. The 32-year-old clinician at the Lassa Fever Research and Isolation Unit at the Federal Medical Center in Owo, Ondo State, says delayed onset is a recurring challenge. Many patients wait to manage their malaria symptoms before coming to the hospital or delay seeking treatment out of fear of what a Lassa fever diagnosis might mean for them and their families.

Inside the isolation ward, fully clothed in protective gear, she often encounters uncertainty created by misinformation. “Some people ask if Lassa fever is curable. Others ask if it is spiritual.” she explains.

These concerns extend beyond seeking care to research and surveillance. Patients may resist having a blood sample collected, influenced by cultural beliefs about blood and concerns about how the sample will be used and whether the results will be shared. “People ask what we do with their blood and whether they know the results. ”

According to Dr. Ikeakere, such mistrust leads to delays in diagnosis, weakens research efforts, limits timely treatment, and strengthens the broader challenge of preparing for future preventive measures.

Overcoming cultural and structural barriers to Lassa vaccine development

The challenges described by Ondo State clinicians reflect the 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, impacting both early diagnosis and participation in prevention efforts.

Nigeria’s fight against Lassa fever and other infectious diseases faces deeper structural challenges. Despite the huge burden of infectious diseases, Nigeria still has limited clinical trial infrastructure to Support large-scale vaccine research. Over the past 25 years, the country has registered approximately 1,185 clinical trials, a modest number for a population of over 200 million people. Although this situation is currently improving, albeit slowly, limited capacity impacts the entire research continuum, from early-stage research to sustained community engagement, and constrains the country’s ability to test and deploy 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 Lassa-related research and control efforts. Before researchers collect samples or begin fieldwork, the process begins with: intensive sensitization.

“Before we conduct a survey, we do a thorough community sensitization process. We first identify the community, get them involved, and understand what we want to do,” he explains.

This approach is necessary because misinformation continues to influence both care-seeking behavior and response to scientific interventions. As a result, some patients refuse referrals to this specialized treatment center in Irua and choose Herbal Home instead.

Dr Stephen stressed that community engagement also needs to confront fears surrounding sampling and diagnosis. Although communities do not overtly reject researchers, hesitancy often manifests indirectly in the form of delays in reporting, reluctance to undergo confirmatory testing, and reluctance to accept positive results.

Sensitivity: Official use

To address this, Edo State University is combining door-to-door outreach, community radio jingles, and large-scale town hall meetings with support from partners such as the World Health Organization (WHO). These forums bring together local government chairs, youth leaders, religious leaders, and market associations to reinforce messages on hygiene, hygiene, early reporting, and trust in health facilities.

Despite the challenges, Dr. Stevenson says the community is gradually becoming more accepting. The Lassa vaccine is currently in Phase 2 trials, and he believes acceptance will increase if work continues and trusted institutions lead future rollout efforts. ““Our vision is to completely eradicate Lassa. When a vaccine comes out, people will welcome it,” he says.

Religious leaders on the front lines of building trust

Many residents of Oke-Ogun, a community in Owo, Ondo State, first turn to traditional and religious authorities when illnesses appear, often believing that evil forces are the cause of their symptoms. Chief Olakigbe Gabriel, a 67-year-old community leader, said people often come to him complaining of what was later determined to be Lassa fever, believing they were under spiritual attack rather than a medical illness.

During past health emergencies, such as polio and the COVID-19 outbreak, they have joined health teams, going door-to-door to promote safer practices and encourage cooperation. But past experiences with misdiagnoses and weak health systems have deepened this skepticism, he said.

“Many of our doctors use trial and error. ” He noted Nigeria’s limited diagnostic capacity, recalling how wrong prescriptions were made.I almost got killed.” I’m a friend.

Sensitivity: Official use

For many years, Mrs. Obehi Asemota has been at the center of health awareness in Edo State’s Yousen Market, encouraging breastfeeding mothers during vaccinations, encouraging families to seek proper care rather than self-medicating, and helping traders understand the risks of basic diseases. Her influence has been especially evident during the coronavirus pandemic, when she persuaded hesitant women to get vaccinated despite widespread fear.

Her history of guiding communities around health challenges strengthens her confidence in future prevention tools. Acemota believes that past acceptance of vaccines for diseases such as hepatitis B and meningitis will lead to acceptance of a Lassa fever vaccine, especially if trusted voices continue to lead education and efforts.

Her experience highlights how sustained community leadership can help position market women not only as a vulnerable group during outbreaks, but also as influential drivers of vaccine acceptance in their communities, an essential consideration for future Lassa fever vaccine implementation efforts.

Author: Abdullahi Muritala