The realities of politics, testing and mitigation in Africa

COMMENT

The ongoing global Covid-19 outbreak has revealed how strikingly unprepared the world is for a pandemic. A governance crisis is unfolding alongside the pandemic as health officials around the world compete for access to scarce medical supplies.

As the governments of African countries seek to avoid catastrophic outcomes, we point to the recent Lancet analysis by a prominent team of global health policy experts from the O’Neil Institute and Chatham House.

At the beginning of May, Africa had recorded over 52 000 Covid-19 cases and more than 2000 deaths. Although this appears to be a small number relative to the global burden, the sad truth is that it is the tip of the iceberg. This is because of the low testing capacity of most African countries. According to the Africa Centre for Disease Control (CDC), testing capacity ranged from 10 tests per 100 000 people in Ethiopia to 280 per 100 000 in South Africa at the end of April. These pale in comparison to the rate of testing in western countries such as the United States, New Zealand and even Lithuania.

With rising nationalism in the face of Covid-19, Africa is being relegated to the sidelines in acquiring much-needed diagnostics as countries with the technology have restricted exports and preferably sell to wealthier buyers. This is a recurrent malady. During the Aids pandemic, lifesaving diagnostics and drugs got to many African countries only long after they were available in Europe and North America.

The generous donation of test kits and personal protective equipment by the Jack Ma Foundation to all 54 African countries has given a boost to national efforts of Covid-19 control. But given the limited availability of PCR-based testing, the anticipated development of a $1 test kits by Senegalese researchers and their partners in the United Kingdom is quite commendable. This may just be what Africa needs in its race to scale up testing. Such tests, however, may have reliability concerns. Before they become widely accepted, validation by the World Health Organisation (WHO) or Africa CDC is necessary.


African countries may also need to adopt the use of drones for faster transport of Covid-19 samples as recently demonstrated in Ghana.

Beyond limited testing, the bigger problem is the fact that healthcare facilities currently have grossly inadequate capability to cater for the anticipated number of cases. The poor state of isolation facilities in several African countries discourages symptomatic patients from accessing care. Because of our communal lifestyle, home-based care reportedly effective in parts of Italy may be useful in rural African communities.

Much has been said about the need to increase the number of ventilators and intensive care beds as part of efforts to cope with the complications of Covid-19. There has always been a critical shortage of intensive care staff and facilities in sub-Saharan Africa. As efforts are made to expand capacity where possible, it should be realised that manpower availability is also essential as equipment does not self-operate.

Due to surging global demand for personal protective equipment, widespread shortages have been reported. African countries need to find innovative local technology to manufacture facemasks, shields, gloves, gowns, etc. South Africa, Kenya, Zimbabwe, and Morocco are leading the way in this regard.

While measures such as social distancing, frequent hand-washing and self-isolation are proven control measures worldwide, they work best for those in the upper and middle classes of African society. Those in the lower class frequently cannot maintain safe physical distancing in crowded households. Nor can they wash frequently without access to running water. Creative solutions like the “Veronica bucket” are now commonplace in front of shops and offices. Such innovations must be encouraged.

With ongoing trials of different drugs and candidate vaccines worldwide, there is a need to expand such programs on the African continent. The whole of Africa needs to rise and join global efforts in search of a cure. However, should effective therapies or vaccines become available, will African countries be able to afford them?

Governments should protect their citizens. But the ethical principles of fairness must be applied. No single community, country or continent should bear the full brunt of global shortages. Although difficult decisions in resource allocation are inevitable, it is unethical for African countries to have considerably less access and harder choices than others.

Thus, Africa needs to remain aware of the realities of Covid-19 because the usual western donors are now grappling with their own national challenges. The lessons learned from our response to malaria, tuberculosis, and HIV should now be put to good use.

International collaborative efforts such as the Covid-19 clinical research coalition and the Partnership to Accelerate COVID-19 Testing are commendable. The former brings together scientists, physicians, funders and policymakers to accelerate Covid-19 research in resource-poor settings. The latter has an ambitious aim to perform 10-million tests across Africa by the end of October.

Africa must take its destiny in its own hands while the pandemic rages on because, as rightly echoed by a Lancet analysis, “every life has an equal worth”.

Dr. Akpabio Akpabio is an Internal Medicine physician and rheumatologist at the University of Uyo Teaching Hospital, Nigeria.

Dr. Utibe Effiong is a physician, public health scientist, and clinical assistant professor of Medicine at Central Michigan University.

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Akpabio Akpabio
Dr Akpabio Akpabio is a rheumatologist and internal medicine physician at the University of Uyo teaching hospital in Nigeria. He is certified by the European League Against Rheumatism and volunteers with the Global Image Foundation
Utibe Effiong
Dr Utibe Effiong is an internal medicine physician with MidMichigan Health and a clinical assistant professor of medicine at Central Michigan University. He is also a senior fellow of global health and development at the Aspen Institute

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