Location will likely prove a key factor in how quickly the virus is blocked, and how many people lose their lives first. People densely packed into megacities are like kindling for an outbreak of any disease, says influenza expert Amesh Adalja, MD, FIDSA. And poverty and conflict can compound the risks. But even for the world’s poorest, least-prepared cities, there are practical ways to head off the worst-case scenarios.
Lagos, Nigeria—Africa’s most populous city, with about 20 million people—certainly meets the “high spark-risk” description, but also illustrates keys to preparedness. “A highly communicable disease like influenza could spread like wildfire there,” and rapidly outstrip hospital resources, explains Daniel Duvall, Nigeria program director of the Division of Global Health Protection for the US CDC in Abuja. Although Lagos has some of Nigeria’s most developed public health infrastructure, most people have limited access to medical care, he says. And in a country with major gaps in primary care and low per capita spending on health, preventive vaccination is not immediately financially realistic. Therefore, outbreak preparedness centers on general strengthening of primary and secondary care and laboratories, aggressive education and hygiene campaigns, and build-up of prepositioned supplies—all muscles Lagos had the chance to flex during its brush with Ebola in July 2014.