From Silent Sentinel to Rapid Responder: Transforming Pathology Laboratories for Nigeria’s Outbreak Battles

Abstract

Background: Clinical pathology laboratories are indispensable to the timely detection, verification, and containment of infectious disease outbreaks. In Nigeria, however, their role has historically been reactive, serving mainly as confirmatory diagnostic points after clinical suspicion is raised. The escalating frequency, scale, and complexity of outbreaks ranging from cholera and Lassa fever to COVID-19 and mpox in Nigeria underscore the urgent need to reposition these laboratories as proactive drivers of epidemic intelligence. Objective: This review synthesises published literature, national outbreak response reports, surveillance reports, and first-hand outbreak experiences to examine the evolving role of pathology laboratories, their integration with surveillance systems, current challenges, and potential transformation of Nigeria’s pathology laboratories. Methods: A narrative review of peer-reviewed literature, national surveillance documents, and outbreak investigation reports was conducted. Author's field experiences from five outbreak investigations in Nigeria were used as illustrative case examples. Results: Historically, Nigerian pathology laboratories have functioned as confirmatory diagnostic hubs with minimal integration into real-time outbreak response. Case examples from cholera, Lassa fever, measles, dengue/West Nile virus, and multidrug-resistant Acinetobacter baumannii illustrate diagnostic delays, underutilisation of molecular tools, and missed opportunities for targeted interventions. Persistent challenges include outdated infrastructure, workforce shortages, fragmented data systems, and the absence of a national laboratory preparedness framework. The proposed Rapid Responder Laboratories (RRL) model emphasises decentralised real-time diagnostics, genomic surveillance, biosafety compliance, and integration with national and global surveillance platforms. Conclusion: Nigeria’s health security requires laboratories that operate as proactive outbreak responders. The RRL model is hereby proposed for adoption. The RRL encompasses infrastructure investment, workforce development, biosafety strengthening, and policy reform to transform clinical pathology laboratories from passive confirmation points to active epidemic intelligence and containment units for the country.