In COVID-19 Battle, Africa Needs To “Own” Its Public Health Space – Senior Africa CDC Official Analysis 10/09/2020 • Paul Adepoju Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Locally fabricated plastic water containers with taps are making it easier for establishments and public spaces to set up handwashing stations. Ibadan, Nigeria – The pandemic has brought to the fore Africa’s reliance on international support for its health sector – and it is also challenging the continent’s ability to build up its resilience when donors fall through. “There is a new public health order that is coming because of COVID-19. COVID-19 has opened our eyes to resetting lots of activities, relationships, strategies and actions,” Dr. Ahmed Ogwell Ouma, Africa Centres for Disease Control (CDC) Deputy Director, told Health Policy Watch, in an exclusive interview. “What we are doing with COVID-19 is exactly what we need to do for all the other disease conditions and across the whole of healthcare. “We will own our space – Africans thinking for Africa and delivering for fellow Africans. This is the new public health order that is coming and COVID-19 is a way of delivering that public health order.” WHO said the pandemic is not ending anytime soon. In Africa, the messaging has changed from describing the virus as one that needs to be eradicated quickly to one that the people can safely live with by following specific guidelines – including ones guiding the resumption of air travel. On 1 September 2020, the number of confirmed cases of COVID-19 in Africa exceeded 1.2 million, just two months after the WHO African Region announced that COVID-19 pandemic in sub-Saharan Africa had reached the major milestone of over 500,000 cases confirmed. While South Africa remains the epicenter of the pandemic in Africa with about 630,000 confirmed cases, there are also indications that cases are climbing elsewhere but obscured by limited testing capabilities. Africa’s COVID-19 Numbers Are Lower Than Expected – But Will Continue To Climb At the outset of COVID-19, Microsoft founder, Bill Gates of the Bill & Melinda Gates Foundation, projected that the pandemic could claim as many as 10 million lives in Africa. But Africa has yet to become the pandemic’s epicentre, and governments across the continent have already reopened their countries extensively. While the global case fatality ratio is about 4.4%, it hovers around 2% in Africa. Ahmed Ogwell Ouma, Africa CDC’s Deputy Director “The predictions were based on very wrong assumptions that Africa has no capacity or ability to look after itself. We’ve proven this assumption wrong as Africa has the commitment and capacity to be able to look after itself,” Ouma said. Ouma noted that African countries are “doing really great work keeping the virus under control”. While the numbers are rising, Ouma said the disease outlook would have been worse if the interventions did not come early. “The rising numbers are not an indication of failure. In fact, it is an indication that in Africa, we are seeking out those who have the virus and containing it. Africa is doing okay and much better than earlier predicted,” he said. Ouma said he is not worried that Africa’s COVID-19 numbers may continue to rise further, noting that the continent is not yet at the peak of the pandemic. “As long as we keep the number at a manageable level as we seek therapeutics and vaccines, then we are alright. I’m not worried that the numbers are going up. Indeed it’s our expectation,” he told Health Policy Watch. “But I will be worried if the graph is steep. We want the graph to stay gentle which means the numbers are not overwhelming.” Absence of Global Leadership & The US’ Staunch Nationalism Have Pushed Africa To Be Proactive With the entire world combatting COVID-19 at the same time, countries that had historically been supporting Africa understandably decided to prioritise their national interests. Moreover, the existence of a gap in global health leadership is forcing a moment of reckoning that experts believe could compel African governments to begin taking more proactive roles. Africa countries historically been known for their weak health systems, but efforts to control COVID-19 have also been impacted by external factors. In Nigeria, for instance, the US.-based Abbott Laboratories, a major supplier of COVID-19 test kits, was accused of improper delays in filling orders from African governments, even when they were filed in a timely manner. The retreat from multilateralism by the United States, historically one of the continent’s biggest health donors, has signaled to African governments that they cannot afford to wait for traditional donors to step up in the COVID-19 pandemic response. The Trump administration’s decision to withdraw the US from the World Health Organization has also distanced the continent, especially at a time when an African was leading the WHO for the first time. “We are all very empathetic about the way Tedros (WHO Director Genera Tedros Adhanom Ghebreyesus) has been treated. We know Americans are being bullies. We don’t want that to happen anymore. What they are doing to him, they will do to Chikwe (Nigeria CDC’s Director General), and they will do to anybody,” Professor Moses John Bockarie, EDCTP’s Head of Africa Office told Health Policy Watch. The United States, along with other rich countries and regions such as the European Union, the United Kingdom, and Japan, have also been engaging in “vaccine nationalism” – preordering investigational COVID-19 vaccines, potentially buying up the world’s supply ahead of lower income countries. Along a similar vein, most of the world’s remdesivir, a drug that has been shown to speed up the recovery of some patients with severe COVID-19, had been bought up by the United States, leaving less than 15,000 treatment courses for countries that cannot buy generic remdesivir. Ouma thus described COVID-19 as a rallying moment where Africa needs to come first, African solutions should lead, and be propagated across the continent. He said Africa CDC is engaging programme officers across Africa, urging them to prioritise supply chain and capacity building on the continent. He added that COVID-19 has demonstrated why African countries should be sharing resources, particularly facilities for testing. By doing this, he said the continent will start achieving the integration and growth that is the aspiration of Agenda 2063 -The Africa We Want. Eswatini Builds On HIV/AIDS Capacity for Coronavirus Response Ambrose Dlamini, prime minister of Eswatini African countries are building on the extensive networks created for other diseases for the COVID-19 response. Ambrose Dlamini, prime minister of the Kingdom of Eswatini, told Health Policy Watch that while Eswatini is not currently fully ready nor fully-equipped to deal with pandemics, it has leveraged its HIV/AIDS response to expand capacity. “We’ve developed some capacity that we think we are going to leverage going forward. We are going to use the national response framework which has really done well, providing us with capacity over the years, we want to develop it to equip the country to deal with future pandemics,” said Dlamini. “That is the strategy going forward. “Right now, it is responsible for HIV, malaria, and TB. Those are the diseases that are being managed by the framework. It is really doing quite well in all of these diseases and we hope future pandemics will be managed through that structure.” Building on Local Capacities for Contact Tracing & Producing Equipment for Africa’s COVID-19 Response Technology is also being deployed, to aid contact tracing in some countries – although this remains a controversial solution. Even though digital innovations have also been developed and deployed for the COVID-19 response in several African countries, Ouma said the core of Africa CDC’s strategy for contact tracing is not mobile apps. “In developed countries they are using apps and technologies for contact tracing. In our own case, our technology is community health workers who will also educate the people on what they need to do to protect themselves,” he told Health Policy Watch. Handmade fabric facemasks One very low-tech solution is the wearing face masks in public, as now recommended by the World Health Organization. When the scarcity of PPEs hit the global market, local face masks and shield production systems soon emerged as African cities began to introduce and enforce mask policies, creating job opportunities for local tailors and entrepreneurs such as Abass Akinyemi. “Before COVID-19, I was selling bread along the Lagos-Ibadan expressway (one of Nigeria’s busiest highways) but when COVID-19 hit Nigeria and the government introduced lockdown, I had to think of something else to do,” Akinyemi told Health Policy Watch. He read about the state government’s plan to engage local tailors to produce one million face masks. Although he did not apply for the government project, he learnt how to make face masks, and began to sell them. “The cost of production is very low, the profit margin is very wide and the demand for the face masks is high. Business has been good,” Akinyemi told Health Policy Watch in Ibadan, southwest Nigeria. Different Contexts Require Different Solutions – Some That Still Need To Be Found Winnie Byanyima But in many settings in Africa, some of the basic measures such as handwashing and lockdowns are difficult to successfully implement without backlash. Winnie Byanyima, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), told Health Policy Watch that the measures considered most basic, globally, are difficult to implement in many settings in Africa. “Every day in Africa, a woman walks an average of 6 kilometer to fetch water. Now you’re saying wash hands every five/ten minutes. Who is going to fetch that water? It’s women and girls. Social protection came in so little and too late,” she said. She noted that COVID-19 containment measures also increased vulnerability to other infectious diseases such as HIV, since people couldn’t get as easy access to prevention and treatment. But beyond the immediate impacts of COVID-19 measures on vulnerable Africans, Byanyima added that long-term impacts on relevant African programmes, which heavily rely on international donor funding. “For the low income countries in Africa, we have reasons to worry very much. They are funded, almost 90%, by aid money. This is disturbing because those aid countries (donors) have been hit very hard [and] they have to recover their economy and the revenue they will raise will not be what they expected. So even if we say we are going to keep the level of official development assistance (ODA) where it is – say 0.3 or 0.7%, or whatever the country has been giving, in terms of real volume of money, it will be less money,” Byanyima said. Next Priority Is Scaling Up Testing, Tracing & Treatment With the pandemic not ending anytime soon, Dr. Nkengasong, Director of the Africa CDC said the priority for the response in Africa is to accelerate testing, tracing and treatment. On the continent, this is being driven through the PACT initiative (Partnership to Accelerate Covid-19 Testing). He described the initiative as the roadmap to safely unlock Africa’s economy. “Africa is scaling up testing very rapidly. As a continent of 12 billion people we should have tested 1% of our people which is about 12 million tests. So, we have tested 2.7 million people, clearly there is a gap of 10 million that we should have tested to be ahead of the pandemic,” Nkengassong said at a recent press conference. A signature aim of the initiative is to conduct 10 million COVID-19 tests by October 2020. But beyond testing, tracing and treatment, Ouma underlined that the COVID-19 response in Africa would still clearly benefit from the availability of new vaccines and more therapeutics. Early in July 2020, the Consortium for COVID-19 Vaccine Clinical Trial (CONCVACT) was launched to support the contributions of African scientists and healthcare professionals to the development and provision of safe vaccines. Ouma added that COVID-19 has also seen African countries working together to collaboratively overcome the challenges posed by the pandemic. Regarding treatment, he said African governments are being encouraged to ensure COVID-19 does not interrupt with the provision of other health services including maternal health, HIV/AIDS and malaria. “Our intention is to ensure that Africa has local R&D, local field testing, clinical trials and production – not only vaccines but also therapies and any other supplies we may need, including equipment. It’s time for Africa to take its rightful position. A continent of 1.3 billion people must look after itself. This is our intention,” Ouma told Health Policy Watch. Image Credits: Paul Adepoju/Health Policy Watch. 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