The challenges of delivering a Covid-19 vaccine in Africa requires a new approach

COMMENT

A revolution in healthcare is brewing in Africa. Although people aren’t marching in the streets in celebration, behind the scenes, thousands of healthcare workers are learning new skills to provide best-practice speciality care that is saving lives across the continent.

More than 140 000 people living with HIV in Namibia are now being treated with the most up-to-date knowledge in the most remote villages of the country. And people suffering from infectious diseases from Zambia to Uganda, from Côte d’Ivoire to Kenya, are receiving care that was unthinkable only a few years ago.

With a vaccine for Covid-19 on the horizon, national health leaders have an opportunity to do for Covid-19 what has been done for HIV and infectious diseases such as tuberculosis (TB) and malaria. 

We can and must step up our readiness to do two things: first, train more workers to be Covid-19 experts, and second, distribute the coming vaccine based on lessons learned through continent-wide collaboration rather than through knowledge residing in individual countries alone.

We know that any vaccine — whatever its efficacy — will meet some resistance. It might be cultural, religious, logistical or medical, such as planning for potential side-effects. Our leaders must anticipate this and ensure that our healthcare providers are equipped to educate people across Africa to understand the life-saving benefits of a safe and effective vaccine.


After all, we can’t move massive numbers of doctors, nurses and others to care for sick people, but we can move knowledge. 

We know that this is doable because we have had remarkable success taking on a similarly daunting challenge by training an expanded workforce to manage HIV in Namibia. 

Our work was based on a model called Project Echo (standing for Extension for Community Healthcare Outcomes) a telementoring network that started in the United States to manage hepatitis C in remote areas of New Mexico. Using videoconferencing technology, community health workers, nurses and doctors — generalists by training — learn speciality care from deep experts and each other’s community-informed knowledge.

The result: patients treated by these community providers for hepatitis C now had similarly successful outcomes compared with patients being treated in the most advanced medical centres.

In Namibia, the ministry of health and social services set out to learn if the Echo approach could strengthen and expand the country’s HIV workforce. Could large numbers of new workers be trained to improve clinical care? Could doctors and nurses and other health workers in the most isolated parts of the country report improved professional satisfaction and less isolation? 

In big numbers, the answer was a resounding “yes!” And, now the ministry’s programme has expanded to more than 40 sites around the country, serving more than 140 000 people with HIV.

We’ve seen that more than 15 countries in Africa are already supporting healthcare workers in this way, managing multidrug-resistant TB and safer surgery, improving laboratory quality, even managing Covid. 

We’re experiencing what can be accomplished in the absence of traditional education and training. We know that we can reach hundreds of thousands of African people whom we otherwise couldn’t educate — or vaccinate — simply by growing the volume of experts who have the right training. And this can be done at very little cost because the training is virtual.

With a vaccine months away, we need a pan-African workforce that’s prepared to protect our people from this horrible disease. 

We’ve made a start. In a Covid-19 world, where in-person communication and collaboration is limited, African medical experts and hospitals are stepping up, creating virtual communities of medical practice across our continent. Experts are training new experts every day.

Now, we need to prepare for vaccinating the African people even before the vaccine is approved. As a practical matter, this means that countries that have not adopted approaches such as the Echo model should — and quickly. Africa needs more trained health providers for the monumental task of vaccinating a continent.

We must think as one. The African Union, its member countries, the Africa Center for Disease Control and the World Health Organisation should develop a staffing plan for vaccine delivery so that we have enough skilled workers to get people vaccinated. The goal is not only about country-by-country readiness, though that’s important. It’s also about learning from each other’s best practices, accelerating these, and doing the best we can continent-wide.

An African proverb says, “Knowledge is like a garden. If you don’t cultivate it, you cannot harvest it.”

With Covid-19, we have no time to waste. We need to plant the seeds now. And we have a proven workforce strategy to get us there.

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Dr Leonard Bikinesi
Leonard Bikinesi is the chief HIV clinical mentor at the Namibian ministry of health.
Dr Sanjeev Arora
Sanjeev Arora is the director and founder of Project Echo, whose mission is to reduce health disparities in underserved and remote areas of the world.

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