How Nigeria’s TB Labs Became a Lifeline During COVID-19

By Tosin Clegg

When COVID-19 struck Nigeria in early 2020, the country faced an urgent question: how to rapidly expand testing capacity in the face of a global supply crunch and limited domestic infrastructure? The answer came from an unexpected place — the country’s tuberculosis (TB) laboratories.

These facilities, equipped with advanced GeneXpert diagnostic machines for TB detection, became a crucial part of Nigeria’s pandemic response. With careful coordination, the machines were reprogrammed to detect COVID-19, turning an existing health investment into a life-saving asset.

The coordination challenge

Repurposing TB labs for COVID-19 testing was not as simple as swapping cartridges. It required approvals from global health authorities, rapid procurement of new test kits, and the training of hundreds of laboratory staff.

One of the key coordinators of this process was ChidozieEzechukwu, then Executive Secretary of Nigeria’s Country Coordinating Mechanism (CCM) for the Global Fund. Under his leadership, the CCM worked with the Federal Ministry of Health, the National TB and Leprosy Control Programme, and donor agencies to integrate COVID-19 testing into the TB laboratory network without disrupting TB services.

“The goal was dual: protect the gains we’d made in TB control while using every available resource to fight COVID-19,” Ezechukwu recalls. “It was a test of flexibility for our health system.”

Making the most of donor investments

The repurposing effort was made possible by years of investment in TB diagnostics funded by the Global Fund and other partners. By 2020, Nigeria had a nationwide network of GeneXpert machines capable of delivering rapid, accurate results for TB. With the right cartridges, those same machines could be used to test for SARS-CoV-2, the virus that causes COVID-19.

This approach proved far quicker than setting up entirely new labs from scratch. It also maximised the value of donor-funded infrastructure, a point not lost on international health agencies. A 2021 report from the U.S. Centers for Disease Control and Prevention (CDC) highlighted Nigeria’s cross-utilisation of TB equipment as an example of pandemic adaptability in resource-limited settings.

Balancing two epidemics

The move was not without risk. Experts feared that diverting TB resources for COVID-19 could lead to a surge in undetected TB cases. But careful planning, including staggered machine usage, prioritised testing schedules, and emergency resupply of TB cartridges, ensured that TB services continued alongside the expanded COVID-19 response.

By the end of 2021, Nigeria had conducted hundreds of thousands of COVID-19 tests using the TB lab network, while also maintaining progress in TB case detection. According to National TB Programme data, the country actually recorded an increase in TB notifications compared to pre-pandemic years.

Lessons for the future

Ezechukwu believes the key takeaway is that investments in disease-specific programmes should be designed with adaptability in mind. “Infrastructure shouldn’t live in silos,” he says. “The more we design for cross-use, the more prepared we’ll be for whatever comes next, whether that’s another pandemic, an outbreak of Lassa fever, or something we can’t yet predict.”

Beyond COVID-19

The success of the TB lab repurposing has sparked discussions about how to integrate diagnostic services for multiple diseases. The Federal Ministry of Health is now exploring ways to expand the model to include testing for HIV, hepatitis, and other infectious diseases at the same facilities, maximising efficiency and accessibility.

For many in the health sector, the episode stands as proof that Nigeria’s health system, often criticised for its fragility can demonstrate remarkable agility under the right leadership and coordination. And for Ezechukwu, it’s a reminder that resilience isn’t just about having more resources, but about using the ones you have in smarter, more flexible ways.