Limitations in COVID-19 testing capacity and surveillance—as well as uneven demand for testing—are likely masking the true severity of COVID-19 on the African continent, fueling the dangerous myth that much of Africa has been unscathed by COVID-19.

Test positivity rates were above 10% across many African Union (AU) member states during the second wave—substantially higher than the 5% maximum warning level suggested by the WHO and suggesting that many cases have gone undetected – says new research from the Partnership for Evidence-Based Response to COVID-19 (PERC).

A survey of 24,000 people across 19 AU member states also found that 81% of survey respondents reported challenges in accessing food, 77% reported experiencing income loss and 42% reported missing medical visits since the start of the pandemic.

The report calls for targeted public health measures for high-risk populations, increased surveillance in light of new variants, and scaled-up vaccine supply from the global community to control the pandemic in Africa.

“As case counts surge across the world, new variants emerge and vaccine rollout remains slow, it will be crucial for African Union Member States to use evidence-based strategies to manage COVID-19,” said Dr John Nkengasong, Director of the Africa Centres for Disease Control and Prevention. “The PERC report provides valuable insights to countries to strategically tailor their ongoing responses.”

High Vaccine Acceptance, But Global Community Needs to Deliver Them to Africa

Though vaccine acceptance was high among survey respondents, with 67% of people saying they would get the vaccine when it’s available, there are several important caveats to consider.

At the time of the survey, access to vaccines and information about them was still being rolled out across the African Union, with lack of information the driving factor to vaccine hesitancy. Recent news about vaccine side-effects also is likely to have diminished vaccine confidence. 

“Vaccine hesitancy is driven by high levels of disinformation, misinformation, and lack of information, which erodes trust in the safety and efficacy of vaccines,” said Dr Richard Mihigo, Program Coordinator, Immunization and Vaccine Development,  WHO’s Regional Office for Africa. 

“Going forward, we must prioritize sustained and targeted campaigns which address the growing infodemic around vaccines while providing evidence-based information to dispel myths and build confidence in vaccines. Communication and engagement is key to building trust and creating a positive discourse around vaccines from the ground up.” 

The delayed rollout of vaccines and the rapidly growing threat posed by new variants does present the opportunity for African Union Member States to ramp up vaccine acceptance campaigns and logistics for efficient vaccine rollout – and continually monitor and address vaccine confidence – before vaccines arrive in the region. 

In addition, the report calls on the global community to deliver vaccines to member states as soon as possible. 

The Africa CDC recently called the United States’ reversal on the World Trade Organization Trade-Related Aspects of Intellectual Property (TRIPS) waiver a ‘positive development’, though also cautioned that the announcement did not guarantee global patent rules for COVID-19 vaccines would be lifted immediately. 

Scale-Up in Public Health Strategies to Prevent Potential COVID-19 Surge

The African Union must also scale up effective testing strategies for detecting potential surges and sustaining the use of public health measures to prevent subsequent waves. 

Nearly nine in 10 respondents reported using masks near others in February 2021, but in some populous and hard hit countries, such as South Africa and Ethiopia, self-reported mask wearing trended downward, suggesting the need to redouble efforts to promote this low-cost and effective intervention in some countries. 

Overall, self-reported adherence to social distancing measures declined between August 2020 and February 2021. 

“Countries are most effective controlling the pandemic when they consider what measures people will actually follow at this stage in the pandemic and take steps to inform, partner with, and support communities,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies.

“Analysis of PERC data can help governments predict adherence to preventive measures, craft effective communications and mount a stronger response to COVID-19.”

Image Credits: EAC, WHO AFRICA, Partnership for Evidence-Based Response to COVID-19.