As Monkeypox Threat Grows, Africa Needs More Robust Health Surveillance
Surveillance for the Ebola virus disease at the border between the Democratic Republic of Congo and Uganda.

LEIDEN – Pandemic preparedness rests on having a robust surveillance system to identify health threats – something that is still “rudimentary” in many African countries, says Professor Salim Abdool Karim, a South African infectious diseases epidemiologist.

Describing monkeypox as a threat to health security in Africa, Karim said that it was important that health services were able to identify individuals with recent onset of skin lesions and test them for monkeypox to control the infection.

“Ensuring the public knows what the monkeypox lesions look like and having the laboratory infrastructure to do widespread testing is key,” Karim told Health Policy Watch on the sidelines of the EuroScience Open Forum in Leiden in the Netherlands. 

Last month, the World Bank approved a $100 million programme to strengthen the Africa Centres for Disease Control’s (Africa CDC) technical capacity and institutional framework so that it could “intensify support to African countries in preparing for, detecting, and responding to disease outbreaks and public health emergencies”, according to the Africa CDC.

Laboratory testing

Testing for monkeypox is doable in almost all countries in the world as it is based on PCR technology that has been vastly improved during the COVID-19 pandemic, according to Karim. 

“The elements of surveillance [for pandemic preparedness] are well-known and most countries in Africa have [them] but they are rudimentary and we’ve got to build it up. It involves ensuring that healthcare services are aware to look for clinical symptoms and signs and look for patients that might be unusual,” said Karim.

Pandemic preparedness also means having laboratory testing capacity to identify new organisms, and having the data analytic and epidemiological capacity to monitor trends to know when things are changing.

The capacity to do surveillance in animals is also critical to be one step ahead and “not wait for organisms in animals to jump to humans”, cautioned Karim.

Another component of preparedness involves “epidemic intelligence” – knowing what is going on globally as well as on the ground in African countries to produce intelligence reports that feed into policy and into planning. 

Countries also need to ensure that they have health systems capacity to address epidemics, – including enough hospital beds, ventilators, laboratories and adequate health service personnel – and the tools to fight a pandemic, including diagnostics, vaccines and treatments. 


Communicating public health decisions and the science behind them is a fundamental plank in building public confidence and understanding – particularly in the era of disinformation and conspiracy theories on social media. 

“What disinformation does is shift the narrative, and undermine the public’s confidence in the government, in science and transparency,” said Karim, who served on South Africa’s COVID-19 ministerial advisory committee.

At the height of the COVID-19 pandemic, African governments and scientists “were not communicating enough, which created the opportunity for disinformation peddlers to get an upper hand” said Karim. 

“There wasn’t a counter-narrative that provided clear explanations to meet people’s anxieties and concerns,” he added.

Monkeypox is endemic in 10 African countries, but it is spreading in the general population and not, as in Europe and the US, in the men who have sex with men. But the fight to keep the infection rate low could be dealt a blow if stigmatization is not addressed adequately among this group of people, said Karim.

 “We have to avoid stigmatising any group for monkeypox, as it is a disease that affects anyone. In countries where the virus is spreading in the gay community, the acknowledgement of these individuals is key to whether the virus can be controlled or not,” said Karim.

Members of the South African National Defense Force patrol Bree Street Taxi Rank in Central Johannesburg during the country’s COVID-19 lockdown.

COVID-19 lockdowns

The total lockdowns imposed in countries including Kenya, Nigeria and South Africa, might not have been appropriate, said Karim, but there were so many unknowns about COVID-19 at the time. 

“If you turn back the clock to February and March of 2020, we had very little information about the COVID-19 virus.  What we did see, and played out on our television screens every evening, was that developed countries such as Italy and New York City in the US were being overwhelmed, the hospitals were under pressure and people were dying just trying to get a bed, or trying to get a ventilator,” said Karim.  

“That is the image that Africa had to work with at that time. Those countries vastly more resourced than ours were being hugely impacted and no country, no responsible leader can look at that and ignore.”

African countries followed the example set by European cities and China, where lockdown measures helped reduce the number of infections and flow of seriously ill people to hospitals. 

“That is the evidence Africa was faced with at that time and they had to act in good faith,” he said. “If you look at those decisions now ─ with the benefit of hindsight ─ we have a different understanding of the [diverse ways] in which countries in Africa were impacted.

“For instance, South Africa, Uganda and Zambia were struck heavily, especially when the Delta variant came along, resulting in many going to hospitals, and countries experiencing huge clinical burden.

Some countries that imposed strict lockdowns could have avoided such measures, or made them less painful socially and economically if more had been known at the time about virus transmission and severity. 

“When we look at the impacts of the first wave of COVID-19 in many African countries, we could have taken a different route, but that route wasn’t clear at that time. Perhaps that would have meant doing partial lockdowns, identifying cases, implementing stay-at-home orders in sections of the community, restricting movements, getting as many people as possible to work from home, reducing the flow of people and reducing the use of public transport,” conceded Karim. 


Image Credits: WHO/Matt Taylor, Flickr: IMF Photo/James Oatway.

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