BRACED FOR IMPACT

The continent’s previous experience of epidemics is thought to have helped protect it from the worst of COVID-19. Nevertheless there’s a long way to go in conquering this disease – and others

Among the grim reports and despair that the coronavirus is causing across the globe, there is some tentative good news, and it’s coming from Africa. The continent has defied early predictions and proven to be more resilient to COVID-19 than many high-income economies. At the onset of the pandemic, international experts forecast catastrophic scenarios in which overburdened, underfunded African health systems were predicted to collapse under the anticipated masses of COVID-19 infections, where a shortage of hospital beds, ventilators and qualified medical staff would lead to people dying in the streets.

Fortunately, the health emergency has unfolded differently. As the world marked 1 million reported COVID-related deaths at the end of September 2020, Africa’s share in this devastating toll was a proportionally low 35 954, according to the WHO. Even taking reporting inaccuracies into account, there’s one common trend across the AU’s 55 member states: the severity and mortality from COVID-19 is far lower than in Europe or the US.

The WHO has described the pandemic in Africa as a ‘slow burn’ – which is something the early national lockdowns and border closures set out to achieve: to prevent dramatic spikes in infections that would overwhelm weak health systems. WHO Director-General, Dr Tedros Ghebreyesus, said in mid-October in his opening remarks at the virtual Financial Times (FT) Africa Summit that ‘one of the few encouraging trends is in Africa, which has been less affected than other regions and is now the only region where cases are not increasing. The current downward trend is cause for optimism’.

Exactly why this is the case is still being investigated. One reason is likely to be the continent’s young average age, seeing that the coronavirus affects older people more severely. A UN University working paper on COVID-19 mortality compared the youthful age structure of Kenya’s population (where half are aged under 20 and just 4% are 60 or older) with that of the affluent but ageing Italy, a country with one of the world’s highest COVID death rates (where nearly one-third of the population is aged 60 or older and only 18% younger than 20).

Another key reason points to Africa’s disease preparedness, which has been honed during decades of dealing with infectious diseases such as Ebola, TB, HIV/Aids, Lassa fever, polio and measles, to mention but a few. South Africa has, for example, the world’s highest HIV prevalence (7.7 million people living with HIV), which has led to the development of the world’s largest antiretroviral programme. The country also has experience in tackling widespread TB and is currently part of an international trial to confirm whether a common TB vaccine routinely given at birth in much of Africa (but not in high-income countries elsewhere) might boost the immune response against COVID-19. The BCG (Bacille Calmette-Guerin) vaccine could be used to protect health workers and others at high risk until a COVID-19 vaccine becomes available.

West and Central African countries, meanwhile, have gained valuable know-how from dealing with Ebola, the deadly virus that has again flared up in the DRC. In early October, the WHO’s weekly bulletin on outbreaks and other emergencies lists several African countries that are currently burdened with multiple other diseases, in addition to COVID-19. There is a measles outbreak in Central African Republic, cholera in Cameroon, and the WHO is monitoring a total of 117 events across the continent, with the map also showing outbreaks of plague, yellow fever, hepatitis E and dengue fever, among others.

It’s wise to invest in emergency preparedness rather than react to a health crisis, which tends to be costly. According to the WHO, the response to the 2014 West African Ebola outbreak cost nearly US$3 billion and, tragically, 11 000 lives were lost. ‘Preparedness efforts which countries already have in place are paying off,’ said the WHO in February, in a statement pledging support to the AU on its joint coronavirus preparedness and response strategy.

‘For instance, investments in Ebola preparedness for the nine neighbouring countries to the DRC have yielded some dividends in relation to COVID-19. Most of these countries now have partner co-ordination structures in place, points-of-entry screening has been strengthened (particularly at major airports) and isolation units have been upgraded to manage suspected cases.’

Notably, even the existence of the Africa Centres for Disease Control and Prevention (Africa CDC) – which is leading the continent’s pandemic response – was inspired by the Ebola outbreak of 2014. The Africa CDC is owned and partly funded by the AU, and currently still based at the AU Commission headquarters in Addis Ababa, although China is ready to build the health agency its own US$80 million headquarters.

‘Africa’s long experience responding to infectious diseases means that a number of countries already have the expertise, laboratory infrastructure and networks of community health workers that are critical for containing COVID-19,’ Ghebreyesus told the FT Africa Summit.

Community health workers who encouraged increased hygiene and physical distancing during the Ebola epidemic can be just as effective in educating communities about the necessary hand-washing hygiene and distancing protocols to prevent COVID-19 infections. They can build trust and deliver crucial public-health messages in an age of uncertainty, fake news and social media.

In South Africa, NGOs that used to focus on HIV/Aids and TB education have shifted their attention to COVID-19 community work. One example is the Johannesburg-based Centre for HIV-Aids Prevention Studies, which specialises in HIV testing and voluntary medical male circumcision, but is now conducting community COVID-19 screening, testing and education.

In the race against the spread of the pandemic, and faced with financial and many other constraints, it’s all hands on deck and, where possible, repurposing existing solutions. This works for networks of community workers and NGOs as well as for laboratory infrastructure and materials.
In Dakar, Senegal, researchers at the Institute Pasteur are trialling a COVID-19 home-testing kit that was originally developed to test for dengue fever. According to Al Jazeera news, the rapid antibody test costs just US$1 and produces results in less than 10 minutes. If successful, this local solution could be easily scaled up to provide sub-Saharan Africa with scarce testing equipment.

Meanwhile, Lancet medical journal said that the Nigeria Centre for Disease Control was repurposing high-throughput HIV molecular testing and TB GeneXpert instruments for COVID-19 testing. South Africa also has more than 300 of this particular US brand of diagnostic machine and intended to convert about 180 for COVID-19 testing, according to Spotlight. However, the online publication, which monitors South Africa’s TB and HIV response and its health system, reported in May that the slow delivery of test cartridges from the manufacturer was thwarting the scale-up of COVID testing.

As major international companies are unable to meet the supply of their proprietary COVID-19 test materials, Spotlight argues it may be necessary for governments and companies to enable the manufacturing of such proprietary test materials by laboratories and competitors – as recently seen in the Netherlands, where manufacturer Roche eventually agreed to share the recipe for its proprietary reagents with other laboratories.

The point is that Africa has to compete with wealthier nations to access scarce medical supplies and protective personal equipment that are urgently needed to contain the pandemic. In June, the Africa CDC established a single online African Medical Supplies Platform to alleviate the supply and logistical constraints by pooling resources.

While the continent’s fight against COVID-19 must continue, it’s paramount that African nations don’t forget about their programmes for HIV and TB treatment as well as maternal health, so as not to weaken their public-health systems further and reverse hard-fought gains. Although the continent has shown unexpected resilience to the coronavirus, it will require significant global support to mitigate the humanitarian and economic fallout of the ongoing crisis and move towards achieving the UN Sustainable Development Goals.

The pandemic has shown that the interconnected global community is only as strong as its weakest member, and the experts are right in saying that the world will not defeat COVID-19 without including Africa in the global response.

By Silke Colquhoun
Images Gallo/Getty Images